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Home My WebLink About0129 TANBARK ROAD - Health ,1.29:Tanbark Road I Marstons Mills F/R A = ,100 -,027001 l P I D�O �p��a01 Commonwealth of Massachusetts o�'' `^ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 129 Tanbark Rd Property Address Jonathan Stone Owner Owner's Name information is required for every Marstons Mills MA 02648 6-9-15 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. A. General Information 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State d Wd!TPj1 0 jV 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system:' ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation b e Local Approving Authority 6-9-15 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 "� Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 129 Tanbark Rd Property Address Jonathan Stone Owner Owner's Name information is required for every Marstons Mills MA 02648 6-9-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form !� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 129 Tanbark Rd Property Address Jonathan Stone Owner Owner's Name information is required for every Marstons Mills MA 02648 6-9-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired; B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in.the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N " ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): c C) Further.Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. ' 1: System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: { ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 129 Tanbark Rd Property Address Jonathan Stone Owner Owner's Name information is required for every Marstons Mills MA 02648 6-9-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and 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. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent'to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 129 Tanbark Rd Property Address Jonathan Stone Owner Owner's Name information is required for every Marstons Mills MA 02648 6-9-15 page. CityfTown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Z 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 2000gpd- ' 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"-to each of the following, in addition to the questions in Section D. Yes No El ❑ 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 El _ ❑ 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 A lf.you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 129 Tanbark Rd . Property Address Jonathan Stone Owner Owner's Name information is required for every Marstons Mills MA 02648 6-9-15 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ . Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system 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: ® ❑ 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)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms actual 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ° 129 Tanbark Rd Property Address Jonathan Stone Owner Owner's Name information is required for every Marstons Mills MA 02648 6-9-15 page. Cfty/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No 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: Sump pump? ❑ Yes ® No Last date of occupancy: 6-2015Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) r, Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 129 Tanbark Rd Property Address Jonathan Stone Owner Owner's Name information is required for every Marstons Mills MA 02648 6-9-15 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts f Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments _ �M 129 Tanbark Rd Property Address Jonathan Stone Owner Owner's Name information is required for every Marstons Mills MA 02648 6-9-15 . page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2004 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 24"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.): Good condition. Septic Tank(locate on site plan): 18" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank.is metal, list age: years Is age'confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 12° t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 129 Tanbark Rd Property Address Jonathan Stone Owner Owner's Name information is required for every Marstons Mills MA 02648 6-9-15 ` page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 129 Tanbark Rd Property Address Jonathan Stone Owner Owner's Name information is required for every Marstons Mills MA 02648 6-9-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 129 Tanbark Rd Property Address Jonathan Stone Owner Owner's Name information is required for every Marstons Mills MA 02648 6-9-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): Good condition with water at working level and no sign of back-up from field. 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. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form ki Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 129 Tanbark Rd Property Address Jonathan Stone Owner Owner's Name information is required for every Marstons Mills MA 02648 6-9-15 page. City(rown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2-500's ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach chambers in good condition and empty at inspection with no visible stain lines. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 129 Tanbark Rd Property Address Jonathan Stone Owner Owner's Name information is required for every Marstons Mills MA 02648 6-9-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 129 Tanbark Rd Property Address Jonathan Stone Owner Owner's Name information is required for every Marstons Mills MA 02648 6-9-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately in d G 04 r off t t3� - r � 3 7f , b—F— Y]� t5ins•3/13 Trtle 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M „ ' 129 Tanbark Rd Property Address Jonathan Stone Owner Owner's Name information is required for every Marstons Mills MA 02648 6-9-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+ 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: Original design plans show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts m W Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 129 Tanbark Rd Property Address Jonathan Stone Owner Owner's Name information is Marstons Mills MA 02648 6-9-15 required for every , page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 129 Tanbark Road Property Address Sylvester Owner Owner's Name information is Marstons Mills MA 02648 September 15 2010 required for p every page. Cityrrown 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 A. General Information W forms on the computer,use 1. Inspector: only the tab key C� to move your Patrick M. O'Connell cursor-do not use the return Name of Inspector key. Septic Inspection Services Co. Company Name � 189 Cammett Road Company Address Marstons Mills MA 02648 City/Town State Zip Code 508.428.1779 S1 12855 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenanc of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 140,ef Title 5(310 CMR 15.000). The system: �` g ® Passes ❑ Conditionally Passes ❑ Fails ---� -n -rt co Needs Further Evaluation by the Local Approving Authority s Cn t kA( September 15, 2010 Job# 10V18 Ins ector's ignatu Date W r— tv M The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the. report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. '****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. l5ins•09/08 Title 5 Official Inspection Form Subsurface Sewage Di sal System•Pa�e t of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 129 Tanbark Road Property Address Sylvester Owner Owner's Name information is p required for Marstons Mills MA 02648 September 15, 2010 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: Tank is not in need of pumping at this time, leaching system had no signs of surcharge or saturation. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or 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): 15ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 129 Tanbark Road Property Address Sylvester Owner Owner's Name information is P required for Marstons Mills MA 02648 September 15 2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within•50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments . ' 129 Tanbark Road Property Address Sylvester Owner Owner's Name information is Marstons Mills MA 02648 15, 2010 required for -September every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and 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 coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or a 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 El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 129 Tanbark Road Property Address Sylvester Owner Owner's Name information is Marstons Mills MA 02648 September 15, 2010 required for _ P every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, 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 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 129 Tanbark Road Property Address Sylvester Owner Owner's Name information is Marstons Mills MA 02648 September 15, 2010 required for P every page. CitylTown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system 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: ® ❑ 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)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 15ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 129 Tanbark Road Property Address Sylvester Owner Owner's Name information is Marstons Mills MA 02648 September 15, 2010 required for P every page. Citylfown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Currently Occupied Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: 15ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 129 Tanbark Road Property Address Sylvester Owner Owner's Name information is Marstons Mills MA 02648 September 15, 2010 required for p every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: date Other(describe below): General Information Pumping Records: Source of information: Tank pumped three years ago. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 129 Tanbark Road Property Address Sylvester Owner Owner's Name information is Marstons Mills MA 02648 September 15, 2010 required for p every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Leaching system installed: 2/9/04 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2'feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 16"feet Material of construction: ®concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) c e If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8.5' long x 5.2'wide- 1000 gal. Sludge depth: 4" t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form "s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 129 Tanbark Road Property Address Sylvester Owner Owner's Name information is Marstons Mills MA 02648 September 15, 2010 required for p every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 26" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Liquid level was found at botom of outlet invert, tees were intact and clear. Tank is not in need of pumping at this time. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 129 Tanbark Road Property Address Sylvester Owner Owner's Name information is Marstons Mills MA 02648 September 15, 2010 required for p every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No 15ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w y 129 Tanbark Road Property Address Sylvester Owner Owner's Name information is Marstons Mills MA 02648 September 15 2010 required for p every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): No solids or high stains present, liquid level was at bottom of both outlet pipes. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: l5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 129 Tanbark Road Property Address Sylvester Owner Owner's Name information is Marstons Mills MA 02648 September 15, 2010 required for p every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: Two 500 gal drywells. ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): SAS was probed with no signs of saturation chambers showed no signs of backup into d-box. 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 l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 129 Tanbark Road Property Address Sylvester Owner Owner's Name information is Marstons Mills MA 02648 September 15 2010 required for p , every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t 15ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 129 Tanbark Road Property Address Sylvester Owner Owner's Name information is p required for Marstons Mills MA_ 02648 September 15, 2010 _ _ ___....__. every page. City/town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ / / / / / / / / / / / / \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ I. \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ 12 3 48 3 • •J11, ii�. u {,"7�. .•.•.•.•.•.•.•............... Tanbark Road Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 129 Tanbark Road Property Address Sylvester Owner Owner's Name information is Marstons Mills MA 02648 September 15 2010 required for p , every page. City/Town State Zip Code Date of Inspection D. System'Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 30+ 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: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town groundwater contour map shows water at el. 35 and topo map shows property above el. 70. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .•'' 129 Tanbark Road Property Address Sylvester Owner Owner's Name information is required for Marstons Mills MA 02648 September 15, 2010 every page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 FAILED INSPECTION . NM A _ COMMONWEALTH of MAssAcxvsETT9- a EXECUTIVE OFFICE OF ENVIRONMENTAL,AFFAIRS _._ - _ _ _ _ DEPARTMENT. OF.ENVIRONMENTALECTION I e. a 0 D,-. ),0701 PARCEL EAT ►Z TITLE 5 OFFICIAL INSPECTION FORM_-NOT FOR VOLUNTARY AS 1�TTg _ SUBSURFACE SEWAGE DISPOSAL SYSTEM F PJRIFC � �� D CERTIFICATION ---. FEB 2 ? Property Address: /d 9 h� ��/ To 2004 v4-- odd 6� wyE°�BARNS-rABLE Owner's Name: H DE?-r Owner's Address: Tom; Date of Iaspecdon: / H a _`D Name of Inspector. (please rtnt) Company Nano: MaWn Address: p x �s—Th Telephone Number CERTIFICATION STATEMENT I oe *that I have personalty inspected the sewage disposal system at this ad*=and that the information reported bMiningelow is hue,expeluft in and co mplete as of the time of the' _ paOrmed based o my p f melon and mnce ofon on.The inspection was approved system inspector pursuant to Section 15 �(310 CMR 15.000). ems.I am a DEP The system: Passes Conditionally passes �eed4�rtla Evaluation by the Local Approving Audwifty 'ails n Inspector's Signature: �! Date: 2 2- O Theme';._ ,,,,,_..�...,_ ----- � ...;�. system:nspactor shall submit a copy of this" DEP)within 30 days of completing this inspectiono 1s a Authority(Board of Health or Spd or greater,the inspector and the system owner shall submit the report d t M or has a design flow of I0,00o DER The original should be sent to the system owner and m�O1�° Ice of the _authoity copies sent to the buyer,if applicable,and the approving Notes and Comments / C4 &,1 k, ""This report only describes conditions at the time of' usPecdou and under the ns of use at that tine.This inspection does not address how the system will perform in the future �� same or different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM-INSP_ECT-ION-FORM _ - _ PART A --- 11 CERTIFICATION(continued) Property Address: Date 0(hVeCd&-----j:--77 Inepcctton Summons Check AAC,D or E/ALWAYS complete all of Swan D A. 7"1ZL any inkffmation which indicates that any of the ftflm cxiteria descrbed m 310 Q1Rt 15.303 or in 310 CMR 15.304 east.Any failare criteria not evah m ted are indLcated below. Commeaft H. Sydim Conftkwaliy Passe Orre or more system components as described in the"Conditional Pass"section need to be replaced or reP"M&The system,upon completion of the replaced or zqw,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,rID)in the far the following statements,If"not deter p The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is guy u0sound,e�bits substantial infiltration or exfiltration or tank fail=is imminent,System will existing'ng tank is replaced with a complying septic tank as approved by the Board�Heaith. Pm won if the 'indicating that the tank is l*A metal septic tank win ess hen t inspection if it structurally sound,not leaking apt if a Certificate of years old is avat7able, ND explaim Observation of sewage backup or break out Of high static water level m the distrbWfon box due to broken or _ Obstrticted pk*s)or due to a broken,seuW of 'en approval of Board of Health): tbt�ion box System will pass inspection if(with broken pipe(s)am replaced obstruction is removed distab Won box is leveled or replaced ND explain: Pas d puVng more than 4 times a year due to broken or obstructed p Ws).ne system will inspection if(with approval of the Board of Health): broken pipe(s)are reply obstruction is removed ND explain: 3of11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION > CERTMCATION(continued) Property Address: ��`Q/ / Q h �i /<I J owner: �i o. 1 '� oa Date of —a G r Evainadon is Required by the Board of Health:_ Conditions midst which require further evaluation by the Board of Health in order to is biling to pyod lac health,safety or the environment. i. 3��is ill pan unless Board of Hlth ea determine&in accordance with 310 C31 j)(b)that the sing in a manner which wr7i prct public hcahth,safety and the endrosmest: _ Cesspool or privy is within 50 fed of a surface water _ 48Spool or Privy is within 50 feet of a bordering vegetated wetland or a salt marsh Z System wig fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is fmwdosing 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 swr&w water or t ftWy to a sudaoe water supply, _ The system has a Septic tank and SAS and the SAS is within a Zone i 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 w jL _ The System has a septic tank and SAS and the SAS is less than 100 feet but 50*a or more from a pm+aLe wager supply well".Method used to determine distance This system passes if the well water analysis,performed at a DEP bacteria and volatile organic cow indicates that the well is ceth8ed lam'for at iform riA , the prese=of ammonia introgen and nitrate and faihne criteria are triggeredq &ro is equal to or less thou 5 ppm from �pr��g�no� copy of the analysis must be attached to this form, Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS -SUBSURFACE_SEWAGE-DISPOSAL-SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner. Mloov Date of n: i ....... ...... ... ..... ... . _ _. . .... .. .. A System Failure Criteria applicable to all systems: You must indicate`yes"or"no"to each of the following for al!inspections: ro� - — — off into faNity or system component doe to overloaded or Clogged Dischaige or Iorcesspod clod SAS g of to the surface of the ground or surface due to an overloaded or — S lurid level in the distribution box above outlex'overt due to an overloaded or clogged SAS or — �@d depth m cesspool is less than 6"below imjeit or available volume is less da yflow more than 4 times in the last year NOT due to clogged t1�a pipe(s).Number Orumes pumped egged or obstructed 'on of the SAS .cesspool Or_. �Portion of cesspool or privy is within •� 00 is ow��i�d water elevation y feet of a surface water supply or� ,to a surface -J an of a Mspool or privy is within a Zone 1 of a public well. -- Any pa of a spool or privy is within 50 feet of a private water supply well. supply well with or PmY is less than 100 feet but greater than 50 feet from a pate water performed at a D ble water snu paw if the wen wailer analysis, indicates that the well is in*from Laboratory, for colitorm bacteria and volatile oManfr impounds poflatiion from nitrogen and nitrate that facility and the ammonia art A Ineu is equal to or leas than S puny provided that no other failure criteria copy of the analysis must be attached to this forml �es/No)The system farb I have determined that one or more of the above failure alteria described in310 CMR 15.303,therefore the system fails 'I'l exist as Health to determine what will be necessary to conre<,;t the fa �m owner should contact the Hoard of ihme:o E. Large Systems: To be considered a lame system the system must serve a f gpd. acility with a design now of 10,000 gpd to is000 You must indicate either"yes"or"no"to each of the following (T fo g ap*to large systems in addition to the Criteria above) yes no stem is within 400 feet of a surface dmokMg water s4Vy — the system is within 200 feet of a tn'butary to a surface drinking water suP1y — — the system is located in a nitro sensitive Zone H of a public water supply well area(Iirterim Wellhead Protection Area—IWpA)or a mapped or answered If answered" es"to - Y any gtjestion in Section E the system is considered a significant threat, "yesyou"in Shaveection D above the large system has faded The owner ar operator of significant threat under Section E or failed under Section D shall upgrade the any UW cOmdered a 15.304.The system owner should contest the appropriate regional office of the �r�0e with 310 CMR >�•,:�..�... Page 5 of I l _ �°, .� .�,,�. .. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE-DISPOSAL_SYSTEM..INSPEC'I`ION FORM PARTS CHECKLIST Property Address: d 9 Owner: IQ, Date d d Check if the foltowmg Dave been done.You mast fimacdc W or"no"as to each of the foftvinc ._ Y No was p w,&d by the owner,0av401%of Board of Health W Vi�er�e any of the system COMponeft pmped out is the pwkm two weeks :.-- system received noZmal fbws is the p�evioos two wee# ' wd :",HZ=*lkaqpvcdw=of water bees introduced to the system recently Or as part of this inspection Were as butt phus of tbesystmobtEnedandexamineffl(If they were not available nee as MA) the bcddy or dweiting mWec led for signs of sewav backup was the site inspected for signs of break out were all system coa>ponemik exchrding the&AS�bated an site wat of the�ffi tth �� and the i of the tank fm the co>dn / On, o nk of&pds depth of dodge and depth of scam mains toe of the baft owoec(and occupana if from Owner)provided with intOrmafimt aII the pry ge disposalsystem The*e and bcadm of the Sal Absorpdw System(SAS)On the site has been&wnMW based on: Y rm if Eabting iufwn iaa.For amapk a plan the Board�Heatth. Determinod in the freld (� anY af the faihue criteria related to Pact C is at issue M=dnwfi=of distmw is unacceptable)P 10 C R 15.302(3)(b)j 4�.n...-. Page 6 of 11 - - OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM-INSPECTION-FORA_._. PART C SYSTEM INFORMATION Property Address: ti Owner. Date at Inspect FLAW CONDITIONS _. RUEDENT AL._ Number atbedrooms(dedgp)c 2 Number of bedrooms(actual): DESIGN flow based on 310 C dR�15 Number of curra t residents: .203(for example: 110 gpd a#at bedrooms): _ Does residence have a scbage grinder(yes of no) Islwn&y on asqwMsewage system(Yes or no)•�['dyes�ft requi eM Lawxby inspectod(ya or no):ivo Seasond use:(yes or wk�V water meter team,if available(last 2 yem age(t4): Swmppump(yea or no)d&o Last dsieataocupanW. L, ilea . COMA USTW" Type of establishment; Design Now(based on 310 CUR 15.203): t'•od Basis of design flow(seatslpersonslscAetc.): Gffease trap present(yes Of no):— Industrial waste bolding tank present(yam or no): Non sanitarq waste discharged to the Title 5 system(yes or no):Water readium _ Last dale of if available. oY OTHER(describe): GENERAL INFORMATION PmnPing Records Source of information: was system pumped as paint of the v2 p-L If yes,vol �'�'J ©L✓v�,��/ ume inspection�m no): Reason ol A rallws—How was quaffidy p � - F SYSTEM Septic tank,distribution boa,soil absorption system _Single cesspool ___.overflow cesspool _PrhT Shared system(yes or no)(i fym attach previous inspection records,if any) h Imnwauve/Alternadive technology.Attach a copy of the cvrront operation and woe contract(to be obtained frma system owner) Tigbt tank _Attach a copy of the DEP approval _Other(descnbe): Approximate age of alt Components,datie m r )and soarne q tea/)` Were sewage odors detected when arriving at the site(yes or no):/� «.. •--%*Ws .. Pala 7 of I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DL4POSAL SYSTEM INSPE�"-ITON FOR11 _ PART C i l SYSTEM INFORMATION(conti nco 22 Property Address: /a� owner. Date of a 9— 'D -BUILDING SEWER ft to on ' Depth below va&— d_J Materials of coasuoctim. cast im n 1140_P other ce x Distance f m priests water sop*wcl or sacfic a 1iue: Cow(m ofF joimft venft evidence of leakage etc.): SEPTIC TAN>6G —(locaten onsite Pin) Depth mow gads: // Material won: _MOW ___volyeftiene mac ) If tank is metal list ague:— Is age confirmed by a cate of comp�aoe Eyes ce tfic ate) or ao):_(attach a copy of Drone:Dfistmoc ikW top of to bottom ai ontl�tee or bade: 4 ec:/ Scum tbic ::.. �� (/f'i✓'s Distan ft=top of==to top of onttet tee or baffle: Dtstanoe from bottom of scum to bottom How wens diau�s ft or Commemb(amP�8 to outlet invert,evidence of leabm dam• antlet tee or condWa%sti ucQ Wcgity,liquid keels 10 3 �� fees G GREASE TRAP.- locate on site plan) Depth below Material of grab:_ won.conarete—metal —PoiyetWene other Dimensions: Scum tbic�ss. Distance from tap of scum to top of outlet tee or bate: D _bottom of outlet tee or bak: Conmma (as MAW too�ut1 E cmdmwe a f �c�outlet tee ar bridle condition,SftmctmW iteegity,liquid levels Pa®e 8 of 1 Z OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION-FORIVF PART C SYSTEM INFORMATION(Continued) ) p Property Address: ()Wnw s s dt6�f Daft of — —o TIGHT or HOLDING TAM __tank must be pumped at time of inspoction)locate an site Plan) Depth below grade: Matenal of C `oWucttion. Concrete metal fibergtass � { k Dima�o®s: Design Flow: Alarm lnt iw or no): Ahem lava: Alarm in working order(yes or no): Dace of Iasi p� Comments(condition of sham and AM switches,eta): DISTBI UMN BOIL• (if present must be opened)(lacate on site Plan) 71 Dcp*offiqWdladAow`oWmvcft Comments(note ifbox is Tavel and diskAfton to ade:s equal,any ands=of suss of leakM�e into of out of bar,ettx PUMP CRAM M Al on site PumP in working older(yes or no): A1a®s in wo Tug order(yes ar no): Comments(note Condition of pomp chamber,conMon of pumps and appnrteoancM eta): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS • SUBSURFACE SEWAGE DISPOSAL STEM INSPECTION-FORM - -. PART C SYSTEM I WORMATION(oonbimred) Property Address: Id. 9 rO N 4,11 14 Q Owner: Date of Ins n: SOLI.ABSOIliPnm SYSTEM(SAS): (locate on site plan,excavaton80.cequire(j) If SAS not located explain why: g096mM*a: l v IWcWg changers,nun*w10chin ftsche4 kng&- , sans: : imcovative/alterna&e system Type(==of technology: Commma(fie '•an of soil,signs ponding;damp soil,condition of etc.): of hY c ,Level vegetatioA co CESSPOOLS: cesspool mast be 88 �- Put Of inspectionxtocnbe an site plan) Number and conagandon: Depth—top of liquid to hM invert: Depth of solids lava: Depth of scam layer: Dimensions of cesspool: Materials of congrucdon: Indfication:ofwoundwater inflow(yes or no): Comments(note conMOR of soil,signs of hydraulic failuee,level of pWWh X condition of v egewdo%etc.): PF"Y: (locate on site plan) Materials of construction: - Dimensions: Depth of solids, Comments(note condition of soil,signs of hydraulic failmr,level of ponding,condition of vegetation,etc.): Page 10 Of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS _SUBSURFACE_SEWAGE DISP03AI�SXSTEM_INSPECI'IONhORM-- --- ------ -.--- - n PART C SYSTEM E FORMATION(coramm ) PrWriyAddmm owwr. f4l c, Ea�r Date or �—of✓-o SKETCH OF SEWAGE DIUSSAL SYSTEM Proovub a sketch of the sewage ftosai system uwhx ing ties to a#bast two permanent reference lam of beaches Locate an wens withffi too feet Locate when pobhc water m *enters the bmlftg F/-0 ✓, � lY' J Id, 6 a� 4-3 - 3F E Pag 11 of l i d OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(condmmed) Property G� bo✓ Owner. 5 c, L.. a Date of hopediiin 0!�t SJCW srra� Suaface water Chi ceuar Shaw wells FstJimatod depth to pvmdwatec d-D.f Pleas ink(cbmk)all methoft used to&*nn ne the NO gourd wow etevation: CbMmd f m system design ikm on record-I€chewed,date of design Ptah reviewed: site(aboft Ply/ovation hole within 150 feet of ThadmdwithlocalBowdefHam-amiaia. /u S' Chwbd with local excavators,m tauas-(attach 'aocu untabc n) Accessed USES database-expiaia; Yon must descnbe establshed the h v� s�go r LdV i, a0e r TOWN OF BARNSTABLE BAR-AC 3828 Ordinance or Regulation WARN NG. NOTICE Name of Offender/Manager f , Address of Offender JN jAA � rtf"r { MV/MB Reg.# .*� /� Village/State/Zip (n A, i / Business Name Eam P/ on V/42Q' F y Business Address S'i natureo f Enforcin Off -`g g rcer Village/State/Zip ,, f Location of OffenseMEA4 Enforcing 'Dept/,•sDVvision. Offense 1 ``° `� `��*-�✓f /` ! / AA Facts ( f {• f }� ( :i ll f'', i 1 Sr ^� 111 T l I P, Ar ' t This�`will serve only as a warning 1At this time no legal "actions ha's been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. �, c.,T.-; r-t..,.s mom.;-Tm"+°r ^F#}mom-.".:r .....Y: ^l ; :x�• _ _ _ . ... � .r TOWN OF BARNSTABLE BAR_wze Ordinance or Regulation C WARNING NOTICE Name of Offender/Manager !,.° ct, � �,. � �. i^� �.� Address of Offender/ +; tt��'+ . + +"#+ l MV/MB Reg.# ~" Village/State/Zip 91 Business,..Name m on 20_ Business Address Signature/'of Enforcing Officer-) Village/State/Zip Location of Offense Enforcing Dept Pb,Vi'sion Offense Facts17 i # ,!, i # yi' "° ,� d Al r f This-'will serve only as a warningilAt this time no legal action' has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. � x m. TtJ WE �71E'BARNSTABLE. ;. �,oc��xortL 1 log? T/n a��C viLZA ASSEs. .. S MA3'Bc;lLt7T .,` Il'�STA,I,I,RR S N &P SPttC TA1eC CAFACL'i"t 1r> Atm�r� AMT : t2a) WID f Ott OW'i`E PEIMITDA:TN.... ::.r CGYil�bC`IA1�lt�: S6parataon I wtn arc'I�eletee�a �•. 1Vl�ixlmui ,/c�jwst cl GR�auiRiSwat6tUle to 66 MOM of Uachmg Xfluiility —� „= -» •--.— ' Iii Wit«V#04:60ply Well Wid I qc hirag racalary Of 101Y tv�;lis uxEs Cr�a►i on Soto os ev3th4n: 410 feet u lerohsa►�faGal►t��) ._.� :..�. I ci is aye iiUet� u9 suici 1<aeacdun I~acallty t ayy wetdand5 exist ZY. iitlt�ti:tQQ Ic ez...f eac:Iin��'a�:ilitya, Sw" ,, Fut•h(Aetl Q) 1 Fra�f - 1 o � � Q { � t A-c /a, 6 c 33' .A D- /f'6 aD- 399•- �}-E- 38' b-F- Y:?' 6-F-5 ' TOWN OF BARNSTABLE L CATION bey^IL S # ✓iS� Vl LAGE ASSESSOR'S MAP&PARCEL 'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY.(type) ��/Kw w%4 S (size) �CXj NO.OF BEDROOMS OWNER c� (lath'-er PERMIT DATE: C ATE:T 3n 51' 9 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 i f f f f { f f F ! F f J f f f J f J J J f f f J f f f J J f f 12 3 °t 48 3 TOWN OF BARNSTABLE ATION ZZ! ;f AfA0,14C SEWAGE # .ado Y-oat-/ -AGE wa,5roy.5 ASSESSOR'S MAP & LOT Ot D/o 1,74nl INSTALLER'S NAME&PHONE NO. �Josi=g Qe Pdrins SEPTIC TANK CAPACITY Moo " LEACHING FACILITY: (type) �-.5©� � 1�1>.l�/%'�"S (size) /-T X °f:' _6.NO. OF BEDROOMS ff BUILDER OR OWNER VI d ,)'PERMTT DATE: -9_o y COMPLIANCE DATE: 2—lei-U 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 faci 'ty) Feet Furnished by ��_`pie� cr tit,�e� �ro� �?�- �� 4 � i, .� �� 3�` \ � .. - �a � `{4 � �� I` ��6�� Fee �0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH. DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIPPYication for Mioogal *potem ttCongtruction Permit Application for a Permit to Construct( air( )Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. ! Q 11-4,V 6ork- Owner's Natne,Address and Tel.No. Assessor's Map/Parcel 6 o® �0 7-.aot' j2,/ 4Y, H4,// Installer's Name,Address,and Tel.No.&S — -�420—Q73S Designer's Name,Address, ddress d Tel.No. 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S. S. Description of Soil Nature of Repairs or Alterations(Ans er when appli able) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. ,IV /9/y S' ned Date Application Approved b Date cq Application Disapproved for the following reasons Permit No. Poo Y —D Date Issued No(cpgo e —�,,.4es_ Fee t Entered in com uteri 1 THE COMMONWEALTH OF MASSACHUSETTS p r. Yes t PUBLIC HEALTH;DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS 11pplication for Migpogar *pgtem Con! truction Permit Application for a Permit to Construct i pp ( (`Repair( )Upgrade( )Abandon( ) El Complete System O Individual Components Location Address or Lot No. 1;9 Owner's Name,Address and Tel.No. Assessor's Map/Parcel /o O --0 7-0 01' /2-,;/ nr, 11f.. Installer's Name,Address,and Tel.No. sp$ - e120-Q7•j? Designer's Name,Address Pd Tel.No. • �z� �,�� /�.,�' lei, �,l/ sad � �'��r� 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1 n Type of S.A.S. Description of Soil: n Nature of Repairs or Alterations(AnsZ r when applic�I ble) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board o�ealth�, Signed Date 6� Application Approved bye _ Date Application Disapproved for the following reasons Permit No. r O Y ,0 5_1 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that-the On�sit Se��w�rage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by at I has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. n c,U '�_l dated aI ql 16 q Installer Designer The issuance f this permit shall not be construed as a guarantee that the syste ill f ction asl�l\esne\d.(} Date I Q Inspector K4 / l 1 _._......------------------------------- — No. v `-t J l Fee J 0 �- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Miq gar *proem ttCon5truction Permit Permission is hereby granted to.Construct(_)Repai D�,Up ade( )Abandon System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conC,t:e ons. Provided:Construction ust be completed within three years of the of s er Date:_ /G Approved by TOWN OF BARNSTABLE �L LOCATION /2 f ? ✓' SEWAGE # "IDca S -05-1 VII.LAGE_//yig4STonS ASSESSOR'S MAP & LOST 1,90AI INSTALLER'S NAME&PHONE NO. sS`J�`9,9.0 733, SEPTIC TANK CAPACITY 194V J LEACHING FACILITY: (type) 5 (size) _ /9 X 2 NO. OF BEDROOMS BUILDER OR OWNER _ PTy17 7./.S D r PERMIT DATE:__2 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 faci 'ty) Feet Furnished bye A " {{ �rah�' i i own of Darnstaate �ptHE T �. Regulatory Services �P C y _..... �; Thomas F. Geiler,Director * BARNSTABLE. MASS. Public Health Division t639. �0 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form Date: 't Designer: ( ,Af s/r,-r ri �.�Installer: � j�- Address: . � ,j�,�. Address: .� rt s4rm �VA o�GG� On 2 f 6 ur- rt14Ct, was issued a permit to install a (date) (installer) septic system at A-f-r- /�� based on a design drawn by (address) 6J. YA11 —a dated (designer) certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. OF t er's Signature) oa WINSLOW yam M. �+ $ SPOFFORD H #26363 C /ST�FG ��O FS, SAG esignef s Si e (Affix Desi tip Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form r TOWN OF BARNSTABLE 1.0>4'I710N SEVNAGE ` I c VILLAGE wl a�S JW S _ ASSESSOR'S MAP & LOT (q —"//-� INSTALLER'S NAME & PRONE NO. Q( ,SCd it SEPTIC TANK CAPACITY. do0 7 «OL-s 1 LEACHING FACILITY:{type) L�'r^t�^ �' ' _(size:) ( �6)0C) off 1-d Lg- 10. OF BEDROOMS PRIVATE WELL PUIlL1C WATER BUILDER OR OWNER Z`e-e , 1p� �/L'Ve.' C! DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED; VARIANCE GRANTED: Yes No t� � Lod � 1Z � ^� Y. � "' � �� !�� , ,. L� t 0 � � � � l � �� a ., ti i � .' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................OF........................................-----------....................................... App ira#iou for Uhipmal or (noustrurtiou rrmff Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: A` G r /CA 6 ��.IV C.-I it k, /'O P:) /..(��L 5?O a S AA.f c c S ................•-----.._...----........._........____._....•-------._.......---•--r....._....... ..^_.____--•--__.__._.___._._...-----^--____.___..__._..__...__.____.............- Location- dd ,sG' or Lot N . n..gK1 0c�! .......-_.._... WSJ.. StU �' � ................ Owner Q S d� Address ?j.C1 TC0{.L Installer Address UType of Building Size Lot... ----------Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic (Y ) Garbage Grinder (�) A4 Other—Type of Building No. of persons............................ Showers Cafeteria a' Other fixtures .................................. W Design Flow...........S`..........................gallons per person per day. Total daily flow..__...._3.�4....._.._.........__......gallons. R,' Septic Tank—Liquid capacityl_60----gallons Length................ Width---------------- Diameter---------------- Depth................ 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.__!- 'YYI F_c Date----g./�® ......._ Test Pit No. 1----_______-----minutes per inch Depth of Test Pit...--..........__._. Depth to ground water---________.__.......... GT., Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.-----.................. --- 0 Description of Soil...'tt ev e------........q-----� �R-C,` - - - - - -- - - x 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!m y g g p y of the State Sanitary Code— The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has b issued y t board of health. Signeg --- ' ----------_---------- d `1''--- ..... /Dat Application Approved B ✓.... ........... -• -� f Date Application Disapproved for the following reasons:----------•-•--------------------••----••----•--•••••••--------.......---•----•---........................... ------------------••---------•••...•------•-.._....••---•-----------------...-••------.......•------------•-•-...........----------------------------------------------..........-------•-••-------•---- Date ^ Permit No.......X,"'./�...................... Issued....................................................... Date No. 1...":/1.0 t" FE$...Z. ': .Oa THE COMMONWEALTH OF MASSACHUSETTS _ BOAR® OF HEALTH - ............... ...._. .----_OF............................................ Applira aan flir Dispnaaal Works Tonstrurtiun Frrmit Application is hereby made for a Permit to Construct ( ') or Repair ( ) an Individual Sewage Disposal System at I3 T` I. o airs rV j 11 Z tt .'v.. . r� ...... ..1 Location-Addres or Lot Ng, f d C'e ov i,:z i d7.. C' .......---- ........ - .................................................. Owner Address Installer Address UType of Building Size Lot.... 0 0______._._Sq. feet HI Dwelling—No. of Bedrooms............................................Expansion Attic (` ) Garbage Grinder (Al) aOther —Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures -----------•--. _----•-•--•---•---••--•-------•--•---•--•-=-•-•--------------•••-------------------•-•---------------------• -•---------------- W Design Flow...........2-5__________________________gallons per person per day. Total daily flow......... Via_ .....gallons. WSeptic Tank—Liquid capacity./P±A.__gallons Length................ Width................ Diameter._.____.________ Depth................ x Disposal Trench—Nlo_ ____________________ 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 b _ eve/ E� �`P"° �"`t. ___. Date____ '__�� Y e ; Test Pit No. 1_.__�_-9_____minutes per inch Depth of Test Pit...`��'.. _...... Depth to ground water___�`�4i.';_____._ fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ---•---•--•.........................................••••-•------•-•---------•--•....----••--•-••----......................................................... D Description of Soil__I_`:_'_"_f_______S �? "'� 'I t c U --••---•------•----•----------------•----------••---•------ ------------------------....----•--•----••----------------•••--..------------------- W ------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--•-------•-- U Nature of Repairs or Alterations—Answer when applicable._______________________________________________________________________________________________ -•-•---•----•---------------•--•------••---•-------•---•-•-••--•--•---•••---------..._..------_._..._....._..-•---------•---------•--••---•----------•----•-----------•--••---•--------••--------•---•-• Agreement: The undersigned agrees to install the afor edescribed Individual Sewage Disposal System in accordance with the provisions of A I� .>a. p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beef issued.ky the board of health. a St ned,, ------------------------------------------- ,a $ . .... A lication Approved B Date Application Disapproved for the following reasons:----•--------------------------------------------------•--------------------------------------------------•---•- ..............................................................-..............---------....----•------•••--------•-----------•--------•-----••----••----••-------------•-----•--•------•--•------._.--- tr f'— / 4"- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................................................................. . w-Entifiratr of TaantliliFanrae THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (/) or Repaired ( } t„< 5 U^e1 ' ' - r � r, Installer ,,. ........................................... 6 T' ._ t 1a� A.4 Il r'�V 5' 'L4 at----------------------------------------------•--•--•---•--- --••--•_....#----- has been installed in accordance with the provisions of ii�4 gf e State Sanitary Vo ed in the application for Disposal Works Construction Permit No......................................... dated----.__//__._- ------------------ ____.._._________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE....................... ................ �...'...(1 I-----•--•-----•---. Inspector............. jr. -............................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No.................. FEE... . �i��raa�al aark� �nna�#rnr#uan rrntit Permission i hereby granted....... ' c.'. 5'"'f to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No....... -0>.........I ;Id 1 "/W'S 4 A M A?4%"a i; ;fdt'1 AA —0'j S a t<. ................................ -••------------ Street as shown on the application for Disposal Works Construction Permit No________ __________ D ed........................................... . I B DATE.......... -----�=`-7-• ----�-��------------- - -•- oard of Health FORM 1255 HOBBS & WARREN, INC., PUBLISHERS w - OwLs SHEET 7 OF 7 tMARSTONS I LOT 130 Mm u LOT 129 / .. taAp s LOCATION MAP so � I _ 7►5 v w'� LOT 12t .9 j\ ` Y3 4� 3 G % .7 O' LOT 31 a LOT 137 N•o W-AI +� �I t ` \6A '4i •9 r m7M ss Yb+i �\ 4� `� 124 d' LOT 106 �• r P j�, �� a r faaT .. ypad s► • 1�I \��\ LOT 126 -�L01V25'. ^� ��yao LOT 123` 77 7a s 1k.b --1mw r J \ � LOT 149 I11,te•: : 7/*' wY p LOT 138 �� 1 rf i \\ �, • _ LOT 134 „sai 1 I y \ ��'' I ►S LOT 122 ia7 . L 135 ,, IE} , �s 1� / •��i'�LOT 121 LOT 107 1? / •sue `j. M ` .. s , \� ,••S '� LOT 146 � .-'" 5 , a � � 1�1 y V 1640 1.1 '� '•y 141te�► � ?tOT 147 -11 X :. ' LOT 119 �t Ya!� \\\ e: LOT 141 \\ fi �,A`wMillteloo as tOT \`I r` 1 1 •s� 1 1'Itl ��/ ��Mt � � 1ar1 1i 1a•o P moo► . i j' LOST 1220 `L. \ A %'\ LOT 117 a x a•sr b 4j S '1� �,aA �'1F• LOT�43\\ �, \ x h�tame ` 'MA `�I �) 1 yi p a •► \ !� >oub ��/ Y 1�1 ` j1'o V, LI �5 I-' IL i. I.'-b" 601EET 7A or-1 1•oIC sou.. vas Aµp ,' -' 6 v •• 4 = / t,LOT 115 so•°' , �� -NIRao .+4 wsr. RtsWc. +°mod f 1 , ,x` g7oaoo _ _ �, e►7 I�it •uwsr4o' LOT 146 s e.so4 *r.ar �n� ,7oa7a ar ��' a r 1••e LOT 108 "• ? 11447 /'� 1S.f 1 toot `e i •' \\ '\ `' � '/ `\ M LOT 116 �' LOT 113 µ SL toa•o s fol ` 1�1 w r_ e� I 'Lbd a Y' LO 114 LOT 11i i0.am i s �. K Y 10a0° 4• 4i! 11 a •6 o.f..+.w o.1 leero E s�Mnwdb 11 29 BB FINAL BLDG. AND SEPTIC LOCATIONS PAL -2.-Wal" — BUILDING LOCATION PLAN DM 1 10 2 BB INITIAL 11 ELK NO. DATE DESCRIP110 BY �\ .,M,� ••�- ,,, J BUILDING LOCATION PLAN - `,I � LOT 110 MARSTONS MILLS WOODLANDS � e1 LOT 109 SUM w 1 BARNSTABLE, MASS CHUSETTS WOODLANDS ASSOCIATES \ ` SCALE: 1• 50' JOB NO. 1338/uao-te :I 18VY, EIMME do TAM AMOMn INC. calms um-n amn name uw xmm BBB wm Mt STRW CZffERVI= MA 0111111132 SHEET 7A OF 7 tM:AR;ST0:NS PwerP SUNNI[e>•rAa 7a�yo1 ® Me1 DE5�1 CALCULATIONS: �IMAIIAM[K�w�N f 1014E 61W10 PLOe LOCA110e YAP 1/f um �� r►Ana 1�/i rt new/lr PER n. MOMwlw i�4Nrt;G cn f /•Ar NAM u �� r 1A1w O7 AOe1AL on or own TAM am �- Ii4wD1e AeG KDAIOlM1S 1DL -7 •" afro AKA DA . r AMA r-f 1f�OM40Ir(0011�OIKr ocomw n00 eu Y - �1LEADON(� DSO nu O ti wri loft 4 NOT ® I. ALL�r AND MAINS t>MALL o0leMle"0t3L 011f S AM*9 WIN Or_AM M• MAN;AHD e00uwsE FOR Mf■OKWAQ DEPOSAL 01 KeAML 1000 GALLpI SEPTIC TAW L r ( r 1 r I s AL w•e00 a'1r a nAlm w1OE wu K @MMW m TIC SYSTrm pg fflt F I w O 1 • a my L ulna u®ID NEWSoD1af w aAKOWLLL K 09 m IIOeTMaI M PLAQ ♦ 4LL ODIDo1OR0 0r Mf 0Aw mr Srn01 Ev"K coma Aw IssAra l01TOY Or IEST HOLE or worms rw N-1•LGA0018 UNLESS 0R1•AIR YIOO1 a w•r 10 R.0r ewlo a►ADDlR AAKA& N-S0 MASON! LEACHING PIT SMILE"mMINE ME MINE!to or D•Ua an PANO A MIMINWAL AHD M511CAL O7PMDL.>Q LM.6�OS j •wlwla FWA 11DI000K - PLAe 1770-1e I LOT OT ELEVATIONS LEGEND: ELEV. 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 136 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 ar�iwwn o fa o LOCATI P1DIAer 1fADew Pff O A 73•s 7f.s 71•0 -ko 7b.e 110 s.e 74o 740 70-S NONMEMIR 1f4oewPrt RCMAIM MT -. O.FOUND 71.A 17.• 7r.4 lo,r, a& bs bLe 0W #1•o 00- - 01.0 91.0 70.0 11.0 74.5 1f.6 7f a 74.e 1r4wele Pff �•1 7�.s 7t4,s 71ti•o 7x• 7y.o •)S,o 76.3 yf.f 71s,o 1•ko 71.0 1p.0 71.5 74• ?JJf A AID Kv aa11111M111 POt B 110•9 41.s NA i4J iid 60.0 its 1i0 19.0 75.9 73,0 74.f 76•0 ois r Si I7tS 7f f ?#-1 Try 711.E - 7y.0 7M 77 c f 71.i. 7t� 71.i 1Rs !a i '04 7 7>f.f 5.4 70.6 741 7401 >7 4 ?l.4 714 H.4 ii.5 .0 ►10 71,o B C 7b•1 s f6.7 if i!~S fR1 I,It 7!t IL1 71.E 7t.1 74.E 7f.1 fi.$, �71. �91.7 7S. 77.e 11.b 1i.•• - 77.7 77:7 7f.t �� -/t3 1t(P 71•• 10,7 71Pd 1►.1 i 7>! 73 i 7f t 4 JA(v 1l.y 7t.1 71. HH 1 k. eft N.1 �.7 C D 70.0 i4+ (,s.s 6114 if.i 61.0 d,%@ 7Lf r•s W 1 79,5 74A 79.9 140 ± •° g-M.o 70.0 1tb 77 7to - 77.6 n1F 7f.r o 11.1 0•4+ 1.11 70.0 1e.0 7bS 71,o 7f•4 74.0 74.4 7" n.4 7t•1 *.1 4,9.1 Hryo 0.0 mf 71eS D E 6" Gf•0 1,15 if,4 69 4 ass (A-lb by 71.3 7s7 7t.3 76.• 7f.3 7f.f �n.• I e Ts1 77:9 1163 W-5 77.3 t 7b.9 AA T&I' 181 N•a SA.f 794 Pt.• 11. f4A 74s 7H:3 1Y.1 11•b • w.b if.b 64.6 64•3 1k3 E F 614 e16 60.1 rfs 115.7 pt 64.6 70•1, 71•1 7f.1 7S.1 7e•4 7f.1 7f.6. 177 77.1 77-1 7s.6 - 77.E TLI a 7i.r 7e.1 7o.'I os•i H•i 71.L 71.i 1•1.1 74.E 74.E 7i.1 Ijb 7e.y 6&6 66.y 6," 49.1 7b1 F G e4.f if.f if.0 Mo if.0 i7.e i!•s N.S -no 7t.e 1P•O 7f•8 7f.0 7s.4 70-5 �7e.s 7t5 77.0 77.e 77.9 Is.• - 11,E 74.9 75.f •n.s 7s.o 10.1 0.5 0.S 71.o •7t.s •o 745 740 1A9 1s.o 11•f 1e•0 Iks d5.r, i4.4 61.o lino G H osf itS f1•e 57.0 f1.0 &I.@ ►e•9 649 is•0 "m 1Lo 67.5 Ne e4•s fm•5 �70. 71.7 1.0 64•5 710 71.0 o1.s fr7•f i+.f Ii.• 1,4.9 (r3.6 y3,s 1rs,e (,.yo ib.s N.o 1.e w.o is.i r4.5 y:.s 645 Jib �l.o r4o H APPROVED: BOARD OF HEALTH J fts sf•s fs•o ffe �o sao pf M! (,W bt•0 Me t•'A5 090 If.5 �s.0 �y4s i7,5 1.1A 1,7• i44 _ sZs W.y ihf /3.5 (10.f as.e MS 5?•! f4s ypo is.i i#o 14f 14.0 4Tl.e yt.o "S 60-9 -f" 444E 1•0 .o 60.9 1 K 78•e 7x6 7r.0 eao µ• 70.0 11.0 77.3 73• 7/1• 7l.f 14•0 77.f 74.0 �71s 17xs of., •o ie.• 74•5 540 vae S 7t.3 75i74•b 74.e 7i•0 ••! K •A AAen JI 1>tb 7s.e 7i 7►i 770 7yl.b 711 7+3 73 1. 41•0 7y..f 7t.e 7A.0 L 71•6 71•S We 60.0 $0.3 64.0 1D.1 7i.e 7#e 1,401 1t.o 711.s Ito >♦.sI NM° ;1,•9 146 74.0 74.4 ".0 - 79•5 Tf.& 77.e -x,• 7t.1 Uf Ifs 7t4 73.0 1s.! 741.E 0 7fo )LO 7f.s 7if 74° 7j.e 11,e 7e.0 7LS 7tS L M 72.o l,o i7s if,s if.0 MS Two 72•9 71.0 *.3 'As 7l.O 7s.b 71a` Ice �700 77.r 71•i Inq 110 _ 7i,f 77•0 •1ao 7a.o 7oa 0 7•S 1t.f 7t.f 750 7w•s ±- 6 1f,4 71.4 7• 7S4o 7Y. a 64•S 7Lo 1s.Sm 0 (7e st.e if.e 7°,9 7t0 71..% 75 0 7b3 sM 7f.e 1fb 5) T fp 17b o M4 14.4 11, TO - 7f.f 77.0 74 0- 75.0 7M.0 7f.S 7;.f 75.o fs•f '/4.f 7f.o 7s.9 1,3 75.e 7i.0 >Mb 44A 61.0 7bS 71,,s 7N � 1 12 INITIAL ISSUE UCT NO. DATE DESCRIPTION By PERC TEST 1 PERC TEST 2 PERC TEST 3 PERC TEST 4 PERC HEST 3 SEPTIC SYSTEM DESIGN LOT,t6 LOT 125 LOT 131 LOT+4f LOT++� MARSTONS MILLS WOODLANDS - Y\.�. Sln.�-u ee.-7aAA Aw DO,�iK u SI a 01.4m•/Aee Y7) we Woodman, ao as ee= ` A�i•_re n AAA BARNSTABLE, MASSACHUSETTS ••A R�e1A1[ M WORSE! Saw WINE! w Ar' WOODLANDS ASSOCIATES REALTY TRUST Are eAwew e"A am w wwSr weAa w W Mee :-:L qw ere`""wt et w wwe� ifelAss, Aa`A•r eww AwA�a w SCALE: 1- 40' JOB N0. 133E/a4fe '.A v w w A rw1 r MOM WE MAN Ae w4w AS Me= e♦�P A Y DAw W E.IQ1`e� DAw R Of L iQ11163311)BY � WR W SM 10r9" WR v WIL IW OAR W ML 10T 520 w D r r ` 'e' PleODIAMM PATE 1L1/bMDN Pow"IMe PAR AL_feLA1S1 wMIfSlO 0r ieA,�e w111S0�•r A.nn�� weosm 0r ate. '" r,♦,�,{ PFa=*eAR sJLeeLA N PgCDAMfe OAR-j�IDL/MD1 VOW"Ua MR ID,4104 PERCOLATION SOIL TESTS Igpi, MME k TAGIM 00Cjs INC. IIIImI »s=; nay+ u1.> Sao HEST lum STF= CIQITalty= YA ON= TOP OF FOUNDATION EL Of ao ►S r TANDARD NOTE'" i GROUND SURFACE El, GROUND SURFACE Ems_ " MIN 1) THIS PLAN IS FOR THE LVSTALLATION OF A SEPTIC SYSTEM. OUTLET PIPE LEVEL 2) ALL INSTALLATION PROCEDURES AND MATERIALS•SHALL CONFORM TO 310 CMR 15.D00, Trf� STATE FNVII�ONMENTAL CODE, FIRST TWO FEET '>� t,lu VENT REQUIRED 2 `� TITLE 5,.. AND THE TOWN OF f>A�r�S7 G CT__ SUBSURFACE DISPOSAL REGULATIOII'S. TOP EL LIQUID LEVELL riiN e LAVER DOUBLE WASHED 3) NO DETE'RMIIVATION HAS BEEN MADE AS TO COMPLIANCE OF.A VAllABLF PROPERTY INFORMATION WITH RECORDED DEEDS D-BOX 1/B'= 2' STONE � • / �i OR ZONLrNG .REGUL_9 TIONS. i 10" INVERT EL 14~ t ..� j � -- "'�""` ' :t``,- � EFFECTIVE 4) TOWN WATER SrE'RVICES THIS PROPERTY. -- '- R•` SIDEWALL 5 THERE ARE NO KNOWN PRIVATE WEI:LS ON THIS PROPERTY OR WITHIN 100' OF THE PROPOSED SOIL ABSORPTION SYSTEM. GAS BAFFLE AT OUTLET INVERT EL _. ---� - -- B" S7t�NE BAS ' INVERT EL 6) ALL COVERS OF SYSTEM COMPONENTS SHALL BE BROUGHT TO WITHIN 12" OF FINISHED GRADE, WITH O-VE COVER OF THE INVERT EL s . Z ro vroo ; C ar,r5 NK� � SEPTICTA BROUGHT WIThtIN fi" OF GRADE D Box 5 „p 3/4'_ 1 1/2' DOUBLE ' 5��`� �/�� WASHED ST❑NE. 7 ALL SEYIEAf COMPONENTS .SHALL REMAIN ACCESSIBLE FOR INSPECTION. NO STRUCTURES SHALL BE LOCATED DIRECTLY INVERT EL ( ni�Br) Zy x �{ $ S -� o,r 6 STONE BASE INVERT EL C ( S )) �5 COMPONENT ES LOCATIONS, WHICH WOULD INTERFERE WITH THE PERFORMANCE, ACCESS, INSPECTION _ l �{ •i o orb A,Qnc,►.!C) UPON 01R ABOVE THE COMP EN ACCESS L TI v Gal Septic Tank BOT717M EL PUMPING OR REPAIR. (7�pica]) 8) NO DRIVEWAY, PARKING OR TURNING' AREA, OR OTHER. IMPERVIOUS AREA SHALL BE LOCATED ABOVE A SOIL ABSORPTION E L BOTTOM OF TEST HOLE SYSTEM, EXCEPT WHEN VENTING HAS BEEN PROVIDED. V � 3 9 SEPTIC 7TANKS; GREASE TRAPS, DOSING CHAMBERS AND D1STRIBUTION BOXES SHALL BE PLACED ON A 6" STONE BASE Z TO ENSURE STABILITY AND PREVENT SETTLING. 10) OUTLET DISTRIBUTION LINES SHALL REMAIN LEVEL FOR A MINIMUM OF THE FIRST TWO FEET OF THEIR LENG7TI 11) ALL SYS.'TEM COMPONENTS SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10' OF DRIVIE'WA IS OR PARKING OR :TURNING AREAS, IN WHICH CASE H-20 COMPONENTS SHALL BE USED. 12) ALL BUILDING SEWER LINES SHALL HA VE AN INNER'DIAME'TER OF 4" AND SHALL BE CAST-IRON OR SCHEDULE 40 PVC. - 13) THE DEPTH OF THE TOP OF ALL SYSTEM COMPONENTS SHALL NOT EXCEED 36" UNLESS VENTING HAS BEEN PROVIDED. 14) IN THE AREAS OF.EXCA VATION, EXISTING GRADES SHALL BE REESTABLISHED UNLESS NOTED AS PROPOSED CONTO ORS. 15) IF SOILS' ARE ENCOUNTERED DURING THE EXCAVATION OF TTIE SOIL ABSORPTION SYSTEM, THAT DIFFER NOTABLY FROM THE DEEP OBSERVATION HOLE LOG, CONTACT THE ENGINEER BEFORE PROCEEDING. 16) CONTRACTOR..TO VERIFY LOCATION OF, ALL UNDERGROUND UTILITIES. DESIGN DATA EjSj Pit DEEP OBSERVATION to be filled or removed Nurnber of Bedrooms: 3 HOLE LOG lured Lest Hole#1 PROPOSED LEACHING FACILITY as Garbage Grinder: N0 - f (E - y g. �9. 7) � Concrete 500 Gal Chambers .. - Design Flow: 3 � O p� th Kiev soli son son / ! , (24 � 4-8 r 8—g) or s-milar (�) (ft) Horizon Texture Color `p wi tb 4' stone around (110 Gal/BR/Dap g Number of BR) (usna) (Muneeu) Y�z313)oomX Septic Tank: (Minimurn Design Flow x 200%) /g $ �Z • � N d It)YR 5A,,� Leaching Area: . �' .�o, Existing ,1,000. Gal S-Tank g Sidewall. wU� C / ' ::' (g7. y i lls x Z / `F Z ) + Deep Obe Hole Date: l'�J D`O — — -- . _ 2 B (Z S'dewa t g Ft � / 99 8) (g 8) ¢�• ap son Evaluator. ( �+ /� \ Endwalls x ( Z (o F`t x �' _Ft witnessed By. (2 ) � TBSIt :.:'. l� � �' ` �,� Pero Rate:-_ t Z M �.//7/1 0 - " \ ..':.•.. S •1 �� - BS._, t� -�--- �, 50ll survey Desoription: CARVER S6 Pity Is'�_.G Hcattom: --- �, \ L) S Geologic Material: OUTWASH ...... { \ 96t 5 Line StA !/ ding Water. NA J —n x /�^�L) Depth to Weeping water. NA j Depth to Mott Color: NA Depth - ry �/ P �( )\ lr &7.3 �, g. p arice Rate �(LTAR): Est Seasonal High Gw: NA Lon Term Acce t / \ PrOlU o v U5G3 Observation Well: NA \ E 0 00 Leaching Area Design Capacity: Date of Last Measurement NA / N. D—Bbx .'�� Z' 98.5 Comments: (Sidewall Area + Bottom Area) x LTAR (98.DIN ) ''' Imo• �r �Q� S oa ?l�4 (971) �, 0 �0 , oF «� o�� w SA R ~ 1 Z3 � a (6,s.9)) IAA - - ,r, -j PROJECT. LOCATION !2 9. TA,�siq�rc_ J2 �oN � 25r0w /3 M ASSESSORS MAP /0 O LOT oZ7 00 ( F a� APPLICANT r�, l - _ y of ,�p�� Q•,i �.., �� _� /5 10Tow 5 /�� , • 4 PREPARED BY & M Land Services ' Sunset Drive South Yarmouth, MA 02664 l�P,tj (508) 394 2723 �L 2g (1 SCALE.• � � Zv DATE Z REV. LOCUS MAP 2 /Anf 2 D WG, NO. SHEET 1. OF / e4A,�Z-:5T o A/3 "W//h