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Home My WebLink About0085 TREE TOP CIRCLE - Health 85 `T1tEE 46P,CIRCLEa� To�nS C7 - - ---- - -- -- - j \ j CO MO.N-%VE.-'kI,TH OF MASSACHL;SETTS _ EhECL TArE OFFICE OF E.w,-mo.N- E\TAL AFFAIRS _ DEPARTMENT OF ENVIRONMENTAL PROTECTION O\7 WL\-MR STREE^.BOSTON Xk 0210i t61 1 292-550v TRi.DY C01-1 Secre:a_-y ARGEO PALL CELLLCCI DA�'ID B STP.-HS Governor Cotn.Russ:one- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIICATION PropertyAddress:85 Tree Top 'Circle K=,ofOw wMcDOnough M5 Me -lc Address of Owner: Date of Inspection: Name of Inspector:(Please Print)Wan. E. Robinson S r. I am a DEP approved systerrl inspector to Section 15-340 of ride 5 1310 CMR 15.000) compfnyName: Wm• E . Robinson Septic Service Marling Address: PQ BOX 0 9. Centervill M}1 Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site;sew a disposal systems. The system: Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: / a Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty (30)days of completing this inspection. If the system is a shared system or has a design flow of 10.000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS I 10l vEO S EP 8 2000 " . rowk®Feae� , T �IHD EPr, Q� e rev.se6 9/2/9E page iorii ar. C! ..^red o^Rec,-c:rd Pane, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Nop"Address: 5 Tree Top Circle , Marstons Mills Jwner: McDonough Date of IrLveetion: INSPECTION SUMMARY: Check 8, C, of D: A. SY PASSES: 1 have not found any information which indicates thafany of the failure conditions described in 310 CWIR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. STEM CONDITIONALLY PASSES: ne or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system. upon c mpletion of the replacement or repair,as approved by the Board of Health,will pass. Indicate yes no, or not determined(Y. N, or NO). Describe basis of determination in all instances. If"not determined'.explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection: or the septic tank,whether or not metal,is cracked,structurally unsound, shows substantial infiltration or exfiltration. or tank failure is imminent. The system will pass inspection If the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if Iwith approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced _ The system required pumping more than four times a year due to broken or obstructed pipels). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed revised 9/2/58 Paget of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Prop"Address$5 Tree Top Circle , Marstons Mills Owner: McDonough Date of Inspection: 2`...�6-0 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 the I ublic health, safety and the environment. I SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES W ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) YSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS NCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.. _ The system has a septic tank and soil absorption system and the SAS is less then 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for eoliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER PaQc3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 85 Tree Top Circler Marstons Mills owner: McDonough Date of Inspection: D. SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: 11 ave determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this de rmination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded orelogged 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 112 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for ,coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LAR E SYSTEM FAILS: You mus indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes o 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of t e Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART B CHECKLIST ri�roperty Address:85. Tree Top Circle , Marstons Mills Owner: McDonough Date of Inspection:1Z_ ;L' r-o—<) Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with NIA. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles �T or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _ Existing information. For example, Plan at B.O.H. _ Determined in the field(if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) 115.302(3)(b)1 _ The facility owner (and occupants,if different from owner) were provided with information on the proper maintenaar.8-of SubSurface Disposal Systems. re.-_sec 9/2/96 Page 5 of I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION prop"Address:85 Tree Zop Circle , Marstons Mills °1M1ef* McDonough Date of Inspecbon: FLOW CONDITIONS RESIDENTIAL: Design flow: ® g.p.d./bedroom. Number of bedrooms( esign): Number of bedrooms lactuab) Total DESIGN flow Number of current residents.&A Garbage grinder(yes or no): At Laundry(separate system) (yes or no) If yes,separate inspection required Laundry system inspected (yes or no) Seasonal use (yes or no):A-O Water meter readings,if available (last two year's usage(gpd): Sump Pump (yes or no):AO 2 Last date of occupancy: 1998 7, 000 gal. COM ERCIALANDUSTRIAL: Type o establishment: Design low: apd ( Based on 15.203) Basis o design flow Grease rap present: (yes or no)_ Industri il Waste Holding Tank present: (yes or no)_ Non-sa itary waste discharged to the Title 5 system: (yes or no)_ Water eter readings,if available: Last to of occupancy: OTH : (Describe) Last to of occupancy: GENERAL INFORMATION PUMPING RECORDS and ourc of information: System pumped s part of inspection: (yes or no) If yes, volume pumped: gallons Reason for pumping: TYP�XSYSTEM 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) IIA Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed(if known) and source of information: a- Sewage odors detected when arriving at the site: (yes or no)A 0 «ViseC �L; Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) *roperty Address:85 Tree Top Circle , Marstons Mills owner: MoDonou�h Date of Inspection: `L �'—� BUI ING SEWER: (Loc eon site plan) Depth elow grade:_ Materi I of construction:_cast iron_40 PVC_other(explain) Distan a from private water supply well or suction line Diam er Co ents: (condition of joints, venting, evidence of leakage,-etc.) SEPTIC TANK:_ (locate on site plan) Depth below grade:' Material of construction: ncrete_metal_Fiberglass _Polyethylene_otherlexplain) If tank is metal,list age_ Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions: y Sludge depth: Distance from top of slud a to bottom of outlet tee or baffler Scum thickness: rl Distance from top of scum to top of outlet tee or baffle:_ y Distance from bottom of scum to bottom�of outlet tee or baffle r How dimensions were determined: (�)S-"" )< 'omments: (recommendation for pumping, condition of inlet and out et tees or baffl s, depth of liquid level in,relation to ou gt invert structural integrity, evidence of akage. etc.) �JC) QN-0 ��✓ 'Zj If� p' GREAS RAP: (locate on 'te plan) Depth below grade:_ Material of c nstruction:_concrete_metal_Fiberglass _Polyethylene_otherlexplain) Dimensions: Scum thickn ss: Distance fro top of scum to top of outlet tee or baffle: Distance fr bottom of scum to bottom of outlet tee or baffle: Date of las pumping: Commen (recomm dation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence leakage, etc.) "et"_Sed 9 2 98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION fcontinued) '►op"Address: 85 Tree Top 'Circle , Marstons Mills Owrw: Mcponough Date&Inspection: TIGHT,,OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) (locate o site plan) Depth bel w grade:_ Material o construction:_concrete_metal_Fiberglass_Polyethylene_other(explain) Dimension Capacity: gallons Design flo gallons!day Alarm pr ent Alarm le el: Alarm in working order: Yes_ No Date of revious pumping: Comm is: (condit n of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: ',/ (locate on site plan) Depth of liquid level above outlet invert: Comments: Inote if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP HAMBER:_ (locate on site plan) Pumps in working order: (Yes or No) Alarm in working order (Yes or No) Com nts: (note ondition of pump chamber, condition of pumps and appurtenances, etc.) revise-. 5/2 /98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART C SYSTEM INFORMATION(continued) 'rop"Address: 85 Tree Top Circle , Marstons Mills Owner: McDonough Date of Inspection: .. SOIL ABSORPTION SYSTEM(SAS): (locate on site plan, if possible;excavation not required,location may be approximated by non-intrusive methods! If not located, explain: Type: leaching pits, number:_ leaching chambers,number:3 leaching galleries, number:_ leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number:_ Alternative system: Name of Technology: Comments: (note condition of soil, sigr�s of by ulic fai ure, lervel of pon ing, damp s1oi�l, condition of vegetation, a c.) h� A .b lr 4 C/✓� CES OOLS:_ Ilocate on site plan) Number nd configuration: Depth-to of liquid to inlet invert: Depth of olids layer: )epth of cum layer: Dimensio s of cesspool: Materials of construction: Indicatio of groundwater: inflow (cesspool must be pumped as part of inspection) Commen s: (note co ition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate on site plan) Materials f construction: Dimensions: Depth of olids: Comme s: (note c dition of soil. signs of hydraulic failure, level of ponding, condition of vegetation, etc.) e G �` ` L ' '` pig( 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(corrdnued) ''roperty Address: 85 Tree Top Circle , Marstons Mills )wner: McDonough Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) 1 �s Yes:_se PaRc 10 of 11 . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(COn6wed) mp"Address:85 Tree Top Circle , Marstons Mills Owner:McDonough Date of inspection: O2,- NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Moderate Deep Groundwater depth: Shallow SITE EXAM Slope Surface water Check Cellar Shallow wells ,i Estimated Depth to Groundwater Le Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site (Abutting property, observation hole. basement sump etc.) ✓Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers �sed USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) 6 7-6 C, r=visec 9/2/9E Page 11oru TOWN OF BARNSTABLE T1fil \�LOCA SEWAGE VILLAGE � S +�S Mv115 ASSESSOR'S MAP & LOT l 6®- Of� INSTALLER'S NAME & PHONE NO.(� /� 6��I SEPTIC TANK CAPACITY wosmTww , LEACHING FACILITY:(type)._2-,) '\A.gat¢QwkoQ(' (size) NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER �(`5U �r DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 13 VARIANCE GRANTED: Yes No L.— 5 �Jl 017 Q ` e No.. 3=11Q ` Ficis....'35.c)........... THE COMMONWEALTH OF MASSACHUSETTS ea►r�tabla APPROVE® BOARD OF HEALTH �+uart � TOWN OF BARNSTABLE -ram A lirtt#i ,t for lip; m l larlt C > gt #rUr rruti# Application is hereby made for a Permit to Construct ( ) or Repair (l.1"an Individual Sewage Disposal System at GcY Locitioi -Addres- or Lot No. ............... . ----- --------------------------- ---------................................................ AZd Owner --•...... ss & . r Installer Address Type of Building Size Lot............................Sq. feet U Dwelling— No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) 114 Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures ............................... . . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity....�....gallons Length................ Width................ Diameter................. Depth................ x Disposal Trench--No3_T!`-.�. .n Width....�'J... ......... Total Length.-./_'5 ._... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 1:+ •-----•----------------•------------•-----•-------••....------•----.......--•-•------------------------ -.... ...................... ........ .-...._._.... ..... . 0 Description of Soil........................................................................................................................................................................ x . U -----------------•-----•------•--------•-....._...--•--•----•------------------•---------....---------•-••--•-------------------------•----.......-----•-••••----------------------.........----........ W --------•----------------------------------------- ...................... ................................................. . .............................................................. c x Nature of Repairs or Alterations—Answer when applicable._.... n„�... ..--------0_-- b.,Y.-------------------------------•-------------•--........---..... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of CoI... has bee iss the b rd of health. Sign . .... ... ........ .. .... .. .......... ........... ................. .................D.re...........:...... DaceApplication Approved By ... .. .. .... .....r.... .......... ...................... Dare - Application Disapproved for the following reasons: ......................................... .......................................................................................... .................. . ........... ................................ ...................................................................................................................... .............. ............I.......... Dare PermitNo. .................................................................... Issued .................................................................:.. Dare FFR_3.ca........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diripwial Works Tonfitrurfintl ramit Application is hereby made for a Permit to C01IStI'LICt or Repair (L,<an Individual Sewage Disposal System at: 4 ................ ... .................................................I............................. .................................................................................................. Location-Address \ ................. . , , \ ,(�...\.....o.r...Lot..No. Kn U .(,k C& .......................... .... (..&. ......*N & n.... ...... ............. ...." ............... .................................................................6wrer . Address Lhn ..... . .............. . . k .. .............. ...... ...... Installer f Address Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms------------------------------ -- .Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons---------------------------- Showers Cafeteria P4 Otherfixtures ......................... -_--------------------------------------------------------------------------------------------------------------------- Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity------------gallons Length................ Width__--_-.-.---_--. Diameter.........._..._. Depth................ Disposal Trench-- N63�3�-,i_�. n Width..._............ Total Length...P� ....... Total leaching area....................sq. f t. Seepage Pit No..................... Diameter.........._......... Depth below inlet..............._._.. Total leaching area..................sq. ft. Z Other Distribution box Dosing tank Percolation Test Results Performed by.......................................................................... Date......4................................. Test Pit No. I................minutes per inch Depth of Test Pit_._._......_........ Depth to ground water..__.................... Test Pit No. 2................minutes per inch Depth of Test Pit..............._.... Depth to ground water........................ ......................................................................................."..."...............*----------------------------*"-*,*----*--------- 0 Description of Soil.............................................................................................I.......................................................................... x ........................................................................................................................................................................................................ .............................................................................................................................................................................................. ....... U Nature of Repairs or Alterations—Answer when applicable._.__ P_,- ........................ ............ ...............1*------ ....................... .................. .........�*........... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system.in operation until a Certificate ofCompliance has beeti,issued by the board Of health. % Signed,. .................... .................................... Due Application Approved By ... .......... ........................................................................... ........ 7 .......-..... Da,e Application Disapproved for the following reasons.. ........................................................................................................................................ ................................................................................................................................................................................................................ ........................................ Date PermitNo. .................................................................... Issued .................................................................... D.,e THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of C.ompliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired (N-1 by............................C...... ...... ...... ......................................................................................................................................... % Instalivr at ............................?7->---------- r7.�..y-._<:__L_e.......................... � ,................................................................ has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .....7�... .............. dated .................................... ------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------ ................. Inspector ..... --- ---------------------- ---------------- ------------- --------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ya= TOWN OF BARNSTABLE No... FEE..... Permission is hereby granted-------------- /--4 03/1� ( A '-Ad .................................................................. V--------------------- to Construct or Repair (L_)-afi Individual Sewage Disposal System atNo......................... ...... -------------- ........................................ Street as shown on the application for Disposal Works Construction Permit No.15--XX Dated........................................... ...... . ------- Board of Health DATE................. ------------------------------------- FORM 38308 HOBBS&WARREN.INC..PUBLISHERS