Loading...
HomeMy WebLinkAbout0028 WATERS EDGE - Health 28 WatersTEd'i-e . . itiarstc;ns Mills A— 062 039 I TOWN OF BARN STABLE Pr--a"t i T LOCATION a � W4761tA F�+JCr3 SEWAGE# VIL.LA6E M,IUASSI�'S M 1,u.,5 ASSESSOR'S MAP&PARCEL QW —OS9 INSTALLER'S NAME&PHONE NO. 3LUEW�IrE-A- (!iOe)`l"1 S - 2-e)00 SEPTIC TANK CAPACITY I,Sd d GILLLpcJ S LEACHING FACILITY:(type) 2 LEAe�-ui-J6- Puf-T (size) C 4 h NO.OF BEDROOMS OWNER t P 'PIS-X0CJ1� v PERMIT DATE:1�/ Q COMPLIANCE DATE: V I g o 0 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 M1. S O_Oa<r AF- Z 3' v w � A 1 E$SESSOR-S MAP NO. PARCEL L-0 C-A T 10N ) 'fb SEWAGE PERMIT NO. Cow 3 _. VILLAGE i Its UNSTA LLER'S NAME a ADDRESS B U I L DE R OR OWNER DATE PERMIT ISSUED _ � � DAT E COMPLIANCE ISSUED I - �l 1 28 No. `,e.�U — Zt/o /Q a Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIPPrf cation for 30i.5poe al *pgteut Couotructtou Vertu Application for a Permit to Construct( ) Repair(✓) Upgrade( ) Abandon( ) ❑Complete System U Individual Components Location Address or Lot No.?-8 W M-F(i5 ED6f vy\vv\ Owner's Name,Address,and Tel.No. (S08)c/26 '3?9 Assessor's Map/Parcel �p� ��'� Tl4tL-rp 10,,A 10 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ';5LVR` AA 6'Q- 9ay.0.+'. dam'''C' %SO avk t ij '61-a-CL`-T W %4 1 AIL4 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building Rr510C4 Cc No.of Persons 2 Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) (Zrp a CK r 57 N G D(S1-R) U-170 n( 0 Q> yO 0 ®_cs,L-r5 20" R 1L'te tA &&AJ)e W STWLL 101sOk 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 Certificate of Compliance has been issued by this Bo H th. SignFa 1� �� Date 1() I N O g Application Approved by Date rr Application Disapproved by: Date for the following reasons Permit No. p'�(XX� "y� Date Issued ----------------------- . - �+-J1 4{ weroM101h•fw.� • y ^ "fit • .� - � No. c `�J -- `(lU �60 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: (�- PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes i Zpplication for �Dizpooar 6p5tem Z on5truction Permit Application for Permit to Construct O Repair/Upgrade O Abandon O ❑ Complete System /Individual Components 1' s Location Address or Lot No._�j W M1FIZ 5 iW br— Vy.\y.ft Owner's Name,Address,and Tel.No. Assessor's Map/Parcel �i�- 2p:WQsras �DEF n/y..4.SiUNS N.1LLS Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �LveWA" 4 E' 9PVl0 J. 0a[3M•C, '3So nnarN 5-r2CL-T (50%)775-V600 W t s5 '-t A4_iO u n+' MA Type of Building: Dwelling No.of Bedrooms q Lot Size sq.ft. Garbage Grinder ( ) Other Type of Buildingp-r 510os cc No.of Persons 2 Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil \q� Nature of Repairs or Alterations(Answer when applicable) OGQ(ACF 0X ►5-I N G D(s1-R)A-r/ )r4 8 Q } vacs Ov-nXrS 20" gitow &fie iNsT-act- QrsoQ 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 Certificate of Compliance has been issued by this B and alth.`'fj/, Sig ed /7U� CJ' � ��/�/ Date 10,{(N 0 Application Approved by 1 Date / U$ Application Disapproved by: Date for the following reasons Permit No. .CC ~4-1 Date Issued I U0 W� 6 -------------- ----------- - ------------------- - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (V ) Upgraded ( ) Abandoned( )by D4VO S. bQQ-01 tr (BU)�LA)4TZ-,0") at 2� OAT%_- S A A_(L%3 ►S MILLS has been constryurcted in accordance J f r with the provisions of Title 5 and the for Disposal System Construction Permit No. �(]o J(d dated Installer 3Q�VIL-i Designer V r #bedrooms Approved design flowA U ).A gpd / [ The issuance of this )I p rmit shall not be construed as a guarantee that the system will fun tion as design d. �� Date f U� ��I(J� Inspector f tI -------------------------------------------- No. A ule�l —If �Q Fee/U G THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Mioonl 6raem Coon5truction Permit Permission is hereby granted to Construct ( ) Repair (v ) Upgrade ( ) Abandon ( ) System located at 2 96 W 4'i-- $ C0L I M4ZJ IONS and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date©f th si permit: Date 10 f!y I f1$ Approved by } Commonwealth of Massachusetts W Title 5 Official Inspection Form d Subsurface Sewage Disposal System Form o Not for Voluntary Assessments M 28 Waters Edge Property Address Phillip Pisano Owner Owner's Name information is Marstons Mills MA 02648 10/6/2008 required for State Zip Code Date of Inspection every page. Cityrrown Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information Gip When filling out forms on the computer,use 1. Inspector: only the tab key to move your Brad J. White cursor-do not Name of Inspector use the return key. gluewater Company Name 350 Main Street Company Address West Yarmouth MA 02673 City/Town State Zip Code. (508)775-2800 Telephone Number License Number . B. Certification I certify that I have personally inspected the sewage disposal system at this address and the it the,.._ information reported below is true, accurate and complete as of the time of the inspection. T;he inspection was performed based on my training and experience in the proper function and malntenan e,of on�site sewage disposal systems. I am a DEP approved system inspector pursuant�d°Sectior�15.340of Title 5(310 CMR 15.000).The system: vs c CD( a ❑ Passes ✓❑ Conditionally Passes ❑ Faai s ziry Fz ❑ Needs Further Evaluation by the Local Approving Authorityr'- cn rn 10/6/2008 Inspector's I to Date The Sy i pector shall submit a copy of this inspection report to the Approving Authority (Board of Health o EP)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. ^ Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 t5insp.doc 03108 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 28 Waters Edge Property Address Phillip Pisano Owner Owner's Name information is Marstons Mills MA 02648 10/06/2008 required for State Zip Code Date of Inspection every page. City/Town Be 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: B) System Conditionally Passes: - ❑✓ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over20 years old' or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: �— 0 Observation of sewage backup or break out or high static.water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 t5insp.doc•03/08 / Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ^M '5 28 Waters Edge Property Address Phillip Pisano Owner Owner's Name information is Marstons Mills MA 02648 10/6/2008 required for State Zip Code Date of Inspection every page. City/Town B. Certification (cont.) B) 7distribution m Conditionally Passes (cont.): box is leveled or replaced ND Explain: Distribution box is corroded and needs to be replaced ❑ 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 ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface.water,supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 t5insp.doc•03108 / l/� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 28 Waters Edge Property Address Phillip Pisano Owner Owner's Name information is Marstons Mills MA 02648 10/6/08 required for City/Town State Zip Code Date of Inspection every page. B. Certification (cont.) C) Further Evaluation is Required by the Board of Health(cont.): ❑ 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 r--,/ Backup of sewage into facility or system component due to overloaded or l�� 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 Ell than '/2 day flow El Required pumping more than 4 times in the last year NOT due to clogged.or, L� 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. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 t5insp.doc•03/08 0 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System-Form-Not for Voluntary Assessments ;M 28 Waters Edge Property Address Phillip Pisano Owner Owners Name 02648 10/6/2008 information is Marstons Mills MA required for State Zip Code Date of Inspection every page. Cityrrown B. Certification (cont.) D) System Failure Criteria Applicable to All Systems(cont.): Yes No ❑ 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- 10,0000pd. El criteria 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 0 [� the system is within 200 feet of a tributary to a surface drinking water supply : El El Area 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 gtaestion 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 nificant threat under Section E or failed under Section D shall upgrade the system considered a Sig system in accordance with 31.0 CMR 15.304. The system owner should contact the appropriate regional office of the.Department. Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 t5insp.doc•03/08 �/t✓/ I Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 28 Waters Edge Property Address Phillip Pisano Owner Owner's Name information is Marstons Mills MA 02648 10/6/2008 required for State Zip Code Date of Inspection every page. Cityrrown 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 El 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, in 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? El information 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 El approximation of distance is unacceptable) [310 CMR 15.302(5)] Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 t5insp.doc•03108 � 7 f Commonwealth of Massachusetts .Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ,M 28 Waters Edge Property Address Phillip Pisano Owner Owners Name information is Martsons Mills MA 02648 10/6/2008 required for City/Town !Town State Zip Code Date of Inspection every page. y Do System Information Residential Flow Conditions. Number of bedrooms (design)- 4 Number of bedrooms (actual): �4 � —a-1048 gpd DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): � 2 Number of current residents: Does residence have a garbage grinder? ® Yes 1§ No Is laundry on a separate sewage system? [if yes separate inspection required] ® Yes No Yes ® No Laundry system inspected? � ® Seasonal use? Yes No Water meter readings, if available(last 2 years usage(gpd)): ® Yes No Sump pump. Current Last date of occupancy: Date CommercialAndustrial 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.): ® Yes ® No Grease trap present? Industrial waste holding tank present? ® Yes ® No Non-sanitary waste discharged to the Title 5 system. Yes ® No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 t5insp.doc=03108 �� Commonwealth of Massachusetts W Title 5 Official inspection Form -- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 28 Waters Edge Property Address Phillip Pisano Owner Owner's Name information is MA 02648 10/6/2008 required for Marstons Mills a State eve Zip Code Date of Inspection every City/Town g D. System Information (cont.) General Information Pumping Records: Pumped after inspection Source of information: Was system pumped as part of the inspection? Yes ® No 1,500 gallons 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 0 � ;� Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: ---� System was installed in 1988 per plan dated 4-1-88 Were sewage odors detected when arriving at the site. ® Yes No Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 t5insp.doc•03/08 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Form Not for Voluntary Assessments Subsurface Sewage Disposal System �M 28 Waters Edge Property Address Phillip Pisano Owner Owner's Name information is Marstons Mills MA 02648 10/6/2008 required for State Zip Code Date of Inspection every page. Cityrrown D. System Information (cont.) Building Sewer(locate on site plan): op,. 25" Depth below grade: feet Material of construction: ❑cast iron ✓�40 PVC [] other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Building sewer is in good condition. No evidence of leakage. Used camera to check piping. Septic Tank(locate on site plan): _.._� 16" Depth below grade: feet Material of construction: 0 concrete ❑ metal ❑ fiberglass 0 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 ------------- 1,500 gallon septic tank Dimensions: 2" Sludge depth: 3111 � Distance from top of sludge to bottom of outlet tee or baffle 3" Scum thickness 8" Distance from top of scum to top of outlet tee or baffle 17❑ Distance from bottom of scum to bottom of outlet tee or baffle Measured How were dimensions determined? Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 t5insp.doc•03/08 �/�� Commonwealth of Massachusetts.. W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 28 Waters Edge Property Address Phillip Pisano Owner Owner's Name information is Marstons Mills MA 02648 10/6/2008 required for State Zip Code Date of Inspection every page. City/Town 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.): ® Inlet and outlet tees are in good condition. No evidence of leakage in or out. Liquid level is normal. Inlet cover is 18" below grade. Outlet cover is 15" below grade. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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): Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 t5insp.doc•03108 �/'`� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Waters Edge Property Address Phillip Pisano Owner Owner's Name information is Marstons Mills MA 02648 10/6/2008 required for State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) Tight or Holding Tank(cont.) 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 Distribution Box (if present must be opened) (locate on site plan): --N► 0 Depth of liquid level above outlet invert 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.): Distribution box is corroded and needs to be replaced. Box.is 20" below grade and has two outlets leaving it. Pump Chamber(locate on site plan): . Pumps in working order: ® Yes No. Alarms in working order: ® Yes ® No Title 5 Official Inspection Forth:Subsurface Sewage Disposal system-Page 11 of 15 t5insp.doc-03/08 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 28 Waters Edge Property Address Phillip Pisano Owner Owner's Name information is Martsons Mills MA 02648 10/6/2008 required for State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) 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: Type: leaching pits number: leaching chambers number: [] 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.): Soil is dry. No signs of hydraulic failure. Vegetation is normal. Pit 1 12"of water in it. Pit 2- 24" of water in it. Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 t5insp.doc•03108. r Commonwealth of Massachusetts W Title 5 Official - Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments - M 28 Waters Edge Property Address Phillip Pisano Owner Owner's Name information is Marstons Mills MA 02648 10/6/2008 required for State Zip Code Date of Inspection every page. CitylTown D. System Information (cont.) Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ® Yes No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 13 of 15 t5insp.doc 03/08• �/i`f�"� Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form Not for Voluntary Assessments ;M 28 Waters,Edge e Property Address Phillip Pisano Owner Owner's Name information is Marstons Mills MA 02648 10/6/2008 required for Cit /Town State Zip Code Date of Inspection every page. Y D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. I� if P.oT 04" 5SI ,q -F '73 tv � o Q Q - L (6 E 5-7i �- � �•r2 P yr l Kv . t Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 15 5insp.doc•03108 `/�� Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 28 Waters Edge Property Address Phillip Pisano Owner Owners Name information is Marstons Mills MA 02648 10/6/2008 required for State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) Site Exam: ✓❑ Check Slope ✓❑ Surface water ❑✓ Check cellar ❑✓ Shallow wells .--- 25'+ Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans on record 4-1-88 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: Previous Title V Inspection dated 10-16-06 ❑ Checked with local excavators, installers- (attach documentation) [� Accessed USGS database-explain: SDW 253/Zone B/Level 49.7/Adjustment 46.8" You must describe how you established the high ground water elevation: Taken from previous Title V Inspection report dated 10-16-2008. No indication of groundwater at 25' per original plan dated 4-1-08. Bottom of the deepest leaching pit is 11' below grade. See attached page for groundwater details. Title 5 Official Inspection Form:Subsurface Sewage Disposal System-,Page 15 of 15 t5insp.doc•03108 ------ ------ i. ............ ----------- JL ---------- I --J I&T.F- A AA OL --------------------- -two Pet- pacuw.---ss ............. ........... ....... ...... -------- ------- ............ No....F0-,_Y.2 1 f F:z$..... ... ....�.... h i • THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 4,0a..............OF....... Appliration for llhipoii al Workii Tomitrnrtiun prrmit Application is hereby made for a Permit to Construct ()C) or Repair ( ) an Individual Sewage Disposal System at: - .................................. .........•--•----------.. n�.�._.s . ...........---------------..........---........ - Location-AAdress or Lot No. ................... win:'......� O 11e.............................................. ...................� h:. .... C.....--------..............---.............. Owner A dress a ---------------------------------------------------•--------........_..----....................... ......------------.xwa I....Mwk.... Installer Address Type of Building Size Lot.. 1G,!. J.lo_.=__..Sq. feet U Dwelling—No. of Bedrooms.....nuts.........................Expansion Attic (4) Garbage Grinder We) 'k Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures -------------------------------• .... W Design Flow................................4;��.__gallons per person per day. Total daily flow..........4.14-0..........._:.........gallons. W Septic Tank—Liquid capacity./500gallonst Lengt Total Le.. Width.,T..�-"To al meter. Depth.S`........... x Disposal Trench—No..................... Width.__. ng area.................... ft. 3 Seepage Pit No._."I wck....... Diameter.......1.0........ Deptl below inlet..S 6.7_1... Total Total leaching area...5-l_4......sq. ft. Z Other Distribution box (-,<) Dosing tank ~' Percolation Test Results Performed by.A5.kpten...A...0-i'lwal. DIIXTWAIYK Date./irch._X_1c/.a...... ,tea Test Pit No. 1.....:?.......minutes per inch Depth of Test Pit..... Depth to ground wat ........... Li, Test Pit No. 2...x: ....minutes per inch Depth of Test Pit...l4.0 f........ Depth to ground M -•--••...............................................•--------.....--•-•-------•--•----.---- •-•-•----.. .� a gF•-•----•................. ;� S� �► �� ti` Seib S ' I ° - ............------------ •� ------------..-:-... AU.Yf I V U d11ac4P!.am Szi th� ...��. svzl._�a.._..1 '# �. v =�.�."....Ta oil......................... t� ...._ -e� �'.`_1.!$ -a.................................................... �c� ,p tC3 V Nature of Repairs or Alterations—Answer when applicable...........................................................� ��' ...--------••---•-•-------------------•-------•-••---•-------------•-----•-•--............................ -----------........------.............................. 6 };� Agreement: -. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System i accordanc with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Cgrnpliance has b n i pued1bby t board of health. Signe ----=• /3 =g-r Date Application Approved By..... `--- --------------------•- Date Application Disapproved for the following reasons:.......................................----•-----------------•------------------•---...........--•-•........._ .........-•---------•--------------------•--•-----••-----•-•---------•--------•-----------•-•-------...--------------------------------............--•------------------•----•-------•---•-------------- Date PermitNo.. - -------------------------- Issued....................................................... Date 9 � 4 L. FEz i �.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ------....UCUN..............OF........ I� iU;,�Tal;iL ,gyp irFa#ilan for Disposal Worka Tonstrnrtiun hermit Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal System at: ...-------V Lr_tL.r----•-. ----------------------------------- ---------- -------------�c�.T.... 3. .-----.....---------.........------•----------- Location--A dress or Lot No. ...... .............................................. ..........7-------- C z..... ........................................... Owner A dress a ....................................•------------------....---------------------------------••••• ir... 1. %1_l. M y Installer Address UU Type of Building Size Lot...`-�. ��?.�.(P=___..Sq. feet Dwelling—No. of Bedrooms_.....EC .U-r.........................Expansion Attic (//0 Garbage Grinder (A)6) Other—T e of Building No. of persons............................ Showers a Other—Type g ---------------------------- P ( ) — Cafeteria ( ) Otherfixtures -----•-------------------------------------------------------•---•-•-•----------••--••-------••---------••••-•-•••......•........................... Design Flow................................ .__gallons per person per day. Total daily flow----------- .....................gallons. R: Septic Tank—Liquid capacity..!-.=.gallons Length e�?.L./-_."�. Diameter................ Depth..s`l.�. Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit ------- Diameter........lQ------- Dept) below inlet....,k71... Total leaching area.... :&.....sq. ft. Z Other Distribution box ( ')Q Dosing tank (AI,-,) aPercolation Test Results Performed by_._�5k Q.hrn___A...0!.)ao.A. r3rj X7t A/y Date..-Oi�r g:_& Test Pit No. 1----- ._.minutes per inch Depth of Test Pit------ ;�Z......_.. Depth to ground wa � A9A 44 Test Pit No. 2.........:.:....minutes per inch Depth of Test Pit.::./.. f�f.:::::: Depth to ground w 'Sl EPHEN q�sG n r c o Z-------AM1?1<t-••---- O Description of Soil--- T ? �- f Q. a4�.....Lc� ��.I-•L Oyu�o t I �� 1 a� ® —a_ -------- -- U .............i . ..........�£ F,n . bra 4A !.� ✓�a.�� .�f� SC?� 1 r ��9..3Q2IS y V n �.. ?ruK 41- ••-•--... Z Nature of Repairs or Alterations—Answer when applicable...................................................................... ----------------------------------------•--•-----------•--•-----•-----------••--•-•••----••••-•--••--•--•-------- .................................................... Grcii L Agreement: 4,,e_ 8,8- The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1Z- 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificatee of Cpliance has b n is ed by th board of health. -�'"-- Signed..... . ................ . Date Application Approved By----- �J U as. ... :-........-•----------------------------- -------••fie Date Application Disapproved for the following reasons-------------------------------------•---------------•---------••----------------•----------------•-•---•••------ --•........................•-•--....-----•---•----------------•--•--------------.....-----••-------------..--------------------------------•------------------------------------•-------------------••--- Date PermitNo.....� ......................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............7C-Y,.k2........OF...........�j- �:.. :,:E,: 1.: ` Cwertifirate of TnmpliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by--------------------------------------------------•--.----• •-----..------•-•--------•--------------------•----------------------.-----.-•--------------------.---.---------•-----•--•------------ pstaller at.............. odl 1 has been installed in accordance with the provisions of TY�TIZ 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No------- ._----L?V:.7...... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......................J _.^... . ._r_..g. ...........-------•-------. Inspector.................. ................................................... THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HEALTH ............. . `?l .rt< .......OF............ :J: C.. No... ��... �:' �, :.4. 3- FEE....J 1 ...... Disposal Worb TPAantrudilan. - :ermit Permissionis hereby granted............................................................................................................................................. to Construct ( or Repair ( ) an Individual Sewage Disposal( ystem at No.------•4-cz---Z-----2)-a-----•--gym .......771.;!�.......-- UStreet as shown on the application for Disposal Works Construction Permit No.__►`j. ......\ ..__ Dated.......................................... _�..-1 --------------•-------•--------•-•-•-•---- DATE. v ............... Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS r Commonwealth of Massachusetts `~ Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M Inspection results must be submitted on this form.Inspection forms may not be altered in any way. A. General Information Important: When filling out 1. Property Information: forms on the computer,use 28 WATERS EDGE only the tab key Property Address o q to move your WILLIAM PISANO A/ �7/ cursor-do not Owner's Name use the return key. SAME _ Owner's Address MARSTONS MILLS MA 02648 Cityrrown State Zip Code Date of Inspection: 10-16-06 Date 2. Inspector. MICHAEL A. BURNIE Name of Inspector DAVID J_ BURNIE&SONS Company Name 307 A COMMERCE PARK N Company Address SO. CHATHAM MA 02659 cityrrown state Zip Code 508-432-7420 Telephone 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 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Eval do by the Local Approving Authority 10-16-06 Inspectors Signature Da{e Co The system inspector shall submit a copy of this inspection report to the Approv g Authority(Bp rd of Health or DEP)within 30 days of completing this inspection. If the system is- hared p �tem,or has a design flow of 10,000 gpd or greater,the inspector and the system own hall submit the, report to the appropriate regional office of the DEP.The original should be sere the system Owner L and copies sent to the buyer, if applicable,and the approving authority. ""This report only describes conditions at the time of inspection and under a conons�f use at that time.This inspection does not address hover the system will perlo in the future under the same or different conditions of use. BILL PISANO.doc doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 16 19 Commonwealth of Massachusetts Title 3 Official Inspection Form Not for Voluntary Assessments y` Subsurface Sewage Disposal System Form N B. Certification (cont.) 28 WATERS EDGE Property Address MARSTONS MILLS MA 02648 Cityrrown State Zip Code BILL PISANO_ 10-16-06 _ Owner's Name Date of Inspection 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. i Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined(Y, N, ND)in the❑for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the hank is less than 20 years old is available. ND Explain: BILL PISANO.doc.doc•0312006 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System �/� Page 2 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M B. Certification (font.) 28 WATERS EDGE Property Address MARSTONS MILLS MA 02648 City/rown State Zip Code BILL PISANO 10-16-06 _ Owner's Name Date of Inspection B) System Conditionally Passes(coat.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed III ❑ distribution box is leveled or replaced ND Explain: ❑ 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): U broken pipe(s)are replaced ❑ obstruction is removed ND Explain: 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 BILL PISANO.doc.doc•03i2006 Title 5 Official inspection Form:Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M B. Certif cation (cant.) 28 WATERS EDGE Property Address MARSTONS MILLS MA 02648 City(rown State Zip Code BILL PISANO 10-16-06 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health(coot.): 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#fiat no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other BILL PISANO.doc.doc•03=6 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 Commonwealth of Massachusetts Tine 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (coat.) i 28 WATERS EDGE Property Address MARSTONS MILLS MA 02648 CityfTown State ZipCode BILL PISANO _ 10-16-06 Owner's Name Date of Inspection 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 %day flow ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public 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 of 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. Yes No ❑ ® 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. BILL PISANO.doc.doc•0312006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 ,� r Commonwealth of Massachusetts Tine 5 Official Inspection Form Not for Voluntary Assessments �M Subsurface Sewage Disposal System Form B. Certification (cons.) 28 WATERS EDGE Property Address MARSTONS MILLS MA 02648 Cityrrown State Zip Code BILL PISANO _ 02648 Owners Name Date of Inspection 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"non 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 11 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. BILL PISANO.doc_doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 I Commonwealth of Massachusetts . Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. Checklist 28 WATERS EDGE Property Address MARSTONS MILLS MA _ 02648 City[rown State Zip Code BILL PISANO 10-16-06 Owner's Name Date of Inspection Check if the following have been done.You must indicate°yee 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 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)] BILL PISANO.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 F 6 - ° i Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System information 28 WATERS EDGE Property Address MARSTONS MILLS MA 02648 Cityrrown State Zip Code BILL PISANO_ 10-16-06 Ownersm Nae Date of Inspection Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15203(for example: 110 gpd x#of bedrooms): 1048 GPD Number of current residents: 2 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? 9 Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available(fast 2 years usage(gpd)): 05-274 GPD 06- 38.35 GPD Sump pump? ❑ Yes ® No Last date of occupancy: CURRENT Date Commercialfindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203). Gallons per day(gpd) Basis of design flow(seats/personslsq.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: Last date of occupancy/use: Date Other(describe): BILL Pt A S NO.doc.doc•03/2006 Trite 5 Official Inspection Form.Subsurface Sewage Disposal System �� Page 8 of 16 Commonwealth of Massachusetts _ Title 5 Official inspection Form Not for Voluntary Assessments N Subsurface Sewage Disposal System Form D. System Information (cunt.) 28 WATERS EDGE _ Property Address MARSTONS MILLS _ MA 02648 City/Town State Zip Code BILL PISANO _ 10-16-06 Owner's Name Date of Inspection General Information Pumping Records: Source of information: 1,500 GALLONS ON 9-27-06 BY D.J. BURNIE & SONS 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) ❑ Tight tank_Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed(if known)and source of information: 18 YEARS PER ORIGINAL PLAN DATED 4-01-88 Were sewage odors detected when arriving at the site? ❑ Yes ® No BILL PISANO.doc.doc-03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cunt-) 28 WATERS EDGE Property Address MARSTONS MILLS MA 02648 Citylrown State Zip Code BILL PISANO 10-16-06 Owner's Name Date of Inspection Building Sewer(locate on site plan): Depth below grade: t Material of construction: El cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: f AW eet Comments(on condition of joints, venting, evidence of leakage,etc.): Septic Tank(locate on site plan): Depth below grade: 18 feet Material of construction: ® concrete ❑metal ❑fiberglass C]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: 1500 GALLONS Sludge depth: 0.1 Distance from top of sludge to bottom of outlet tee or baffle 0" 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 How were dimensions determined? ESTIMATED BILL PISANO.doc.doc•03/2006 Title 5 Official inspection Form:Subsurface Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M D. System information (cont.) 28 WATERS EDGE Property Address MARSTONS MILLS MA 02648 Cityfrown State Zip Code BILL PISANO 10-16-05 Owner's Name Date of Inspection Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): i Grease Trap(locate on site plan): I Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): 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): BILL PISANO.doc.doc•O 2006 We 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form a D. System Information (cunt.) 28 WATERS EDGE _ Property Address MARSTONS MILLS MA 02648 Citylrown State Zip Code BILL PISANO 10-16-06 Owner's Name Date of Inspection Tight or Holding Tank(cont.) 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 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.): THE D-BOX WAS LEVEL AND SHOWED NO SIGNS OF SOLIDS CARRYOVER. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order. ❑ Yes ❑ No I BILL PISANO.doc.doc•03/2006 True 5 official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (font.) 28 WATERS EDGE Property Address MARSTONS MILLS MA 02648 Cityrrown State Zip Code BILL PISANO 10-16-06 Owner's Name Date of Inspection 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: I ype: ® leaching pits number 2 ❑ leaching chambers number: ❑ 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.): BOTH OF THE LEACHING PITS HAD ON A FEW INCHES OF WATER IN THEM AND SHOWED NO SIGNS OF HYDRAULIC FAILURE OR PONDING. BILL PISANO.doc_doc.03/2006 Tittle 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 28 WATERS EDGE Property Address MARSTONS MILLS MA 02648 Citylrown State Zip Code BILL PISANO 10-16-08_ Owner's Name Date of Inspection Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): BILL PISANO.doc.doc.0312006 Title 5 Offudal Inspec Uon Form:Subsurface Sewage Disposal System Page 14 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Farm Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cone.) 28 WATERS EDGE Property Address MARSTONS MILLS MA 02648 City/Town State Zip Code BILL PISANO 10-16-06 _. Owners Name Date of Inspection Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. � C O 7 0 c3 A V rram�,, �" S t � BILL PISANO.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 16 r Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M D. System Information (cont.) 28 WATERS EDGE Property Address MARSTONS MILLS MA 02648 _ Cityrrown State Zip Code BILL PISANO 10-16-06 Owners Name Date of Inspection J Site Exam: Slope Ye-- Surface water/10 Check cellar Shallow wells Estimated depth to ground water. 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: 4-01-88 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: SDW-253 ZONE B 2-3 LEVEL-47.8=2.0-ADJ You must describe how you established the high ground water elevation: WE REFERENCED THE ORIGINAL PLAN DATED 4-01-88 a'eJ A"'-d;ey BILL PISANO.doc.doc-0312006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 16 of 16 fH'� 1 (ps. ci F i _ e _tea Y i -!S` Sep, 25, 2008 9 ; 45AM No. 1227 P. 1 r rs, tt. A c¢tic. k 1 een H�FFE C+5 S . CanoolDavid J.SuenlelCape Rooter . ; 350 Maln Street m Route 28 West YaTmouth,MA 02573 )' TEL i-so0-593.6449 FAX (508).778-9828 -One Call Solves It All" i{F t€ ForAll Your Drain,Sewed Grease&Sepfic N®e s 'g s tx,• .4 FAX ' � •act' E�® .. I �'�'�D®III f�® • . —u f{I 1 ,G16S INCLUDING. THIS ONE: pp��sR,I�FrF�� µin'g�sn 1 rd' .00r uF 10" YK NJ. I 't 2e;R! vnvra — Nk t Iv I A/ NO/_LC-- NGGdre5 A/cY'/ao r,, 1 Gram<rry L UN/A/G d D d ✓4� ce t' 740 /!/C !7 Qrr71 # s/ 'Y r" LOCUS % C:E CI /J 'I M14iZ K t /� Tyr t 7-�-/ Z /�— Intoot_e TOP OF ._TONC `EOUQ0 12. 1 �� I Tr i y , dp yrt>GE POND yJ 'p .Su✓l soi/ [Jb 0i/ i J`� 1 Nary -Inu / /!// Cv<rsl/T vr><J a!/ /f�clO�S Girl %/ <✓�✓ ii r//C Y!✓r+y i /Me,'Ar /a/S .5ha// C��fcfr-.a'� fO J�rl ' `i8/to4 L Oc u /L/A P - tiocn/ ,L3Oarc/ �f /•,/«r/417 .P�<.,�/4f'ior!•s" fins �•i/tc / a, /-1 !/9i r9im N!r/ c f 72 //ours / >�- -f lce. .5�/f aT Cari r>zi^t✓c./7 on ,�-rk e / � � CGrrfT'ac�`tir /fl•U.r;J'' C:w// r.D�� 5a�'c H p (�- Ss00-922-4�SA4) 14nV "'i r/ ^ Gc.,tc v i 11 c. - O:.-}z r 0 i 1 l c (t� s+c r` ✓.3 Z (No Gi l.�r~�r } _v'9, / /• I / Jw.el din<rJ t 428 9 7 7 frr I! I I + f�0M EF '12 cJc \•JIVO i1:clr, i cH/NG S k"S 7—'iT/ .62 \ X v✓f)4 L / <; 5 G/o/D ��. \ Q� \ 57 /3c,rr-o�n %`/,SfP/> 64 xz I /048 Tfl r \ 7t ra ------------------- 6 a e \ AI - 6 - : 4o c u I !NV / ! 8 ` .Ob \ ° �/�J'L ` ``\ \- 1\ �'f4 (✓Z. ' /N�r Cv 0 ' \ � ,.. / � ,� r �:; :.hc� �Fone ,i �, \ /N✓ 63,q� ^ fhaTl.�T I ` I S 57,30 JAI stR Cd �\69 S� i I la (rwo� t TN.vK� �� \ � ,. I 4 a 6-7 fj itj 1111N : ./.FiJ '�� \' n8 /S 1T.F3 �4Y T 7_.,'E:_ r/ )Z-A IV �/v ' " eS,4 f S \ < Sg IVIL L S n. ..f f.;... ••''� I �L w 'r'k"i�d�'' pMy I j' xL S� \ / \A/ } C.R Rim m cc. 5Z 7 �J L } , . / /V �44- T- J C A L E M �` 2 0 ,yDv�� �f ia�✓n/ r: ::..... '�rV �o✓�/r�� �i'S /' / W/ 77-1 T1 L- S/v4"L.':w -: d57.V© s r7.31 ,9C� /J 3 X T. / V Sri _LNC r / R tv1/.sir>ENTS �" rfA:!F :Z) IV Off" 7- LOC/97Z-D !1 EG/,r T J � ,l !�}NU J�IJ�'i lE s Fo zo o so IN/Tf/1rV 7HZZ O/r7TE r _ C�-.::,Try:.J >U/ Z_4 4: j j I