HomeMy WebLinkAbout0044 WATERS EDGE - Health 44 Waters Edge
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Marstons Mills
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
0
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
44 Waters Edge, Marstons Mills, MA
Property Address t:w
Matthew Gravina 44 Waters Edge -�
Owner Owner's Name =r;
information is required for every Marstons Mills ✓ MA 02648 8/22/2018
page. City/Town State Zip Code Date of Inspection'.
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When
A. Inspector Information S� 13,2 TO
filling out forms
on the computer,
use only the tab Joseph M Martins
key to move your Name of Inspector
cursor-do not Accu Specheck
use the return Company Name
key.
17 Northside Drive
rab Company Address
South Dennis MA 02660
City/Town State Zip Code
508-385-5891 SI 147
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined
that the system:
1. ® Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
8/31/2018
In ector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of
10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
4 ZIA
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regional office of the DEP. The original form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: This report only describes conditions at the time of inspection and under the
conditions of use at that time.This inspection does not address how the system will perform
in the future under the same or different conditions of use.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18
cam, Commonwealth of Massachusetts
Title 5 Official Inspection Form
I Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
44 Waters Edge, Marstons Mills, MA
Property Address
Matthew Gravina 44 Waters Edge
Owner Owner's Name
information is required for every Marstons Mills MA 02648 8/22/2018
page. CityfTown State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
AN OLD LEACH PIT AND DBOX WERE FOUND CONNECTED TO CURRENT SEPTIC TANK.
LEACH PIT HAD LIQUID TO PIT TOP IN IT AND 4' SAND. LINE WAS CAPPED AT SEPTIC
OUTLET AND LEACH PIT LIQUID LEVEL LEACHED OUT. 2' SAND WAS THEN ADDED TO
COMPLETE ABANDONMENT OF LEACH PIT.
2) System Conditionally Passes:
❑ One or more system components as described in the" itional Pass"section need to be
replaced or repaired. The system, upon completion a replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no"or"not dete m d" N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 year Id*or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltratio r exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is repl ed with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pa inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating th the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND(Explain below):
t5insp.dcc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
u
44 Waters Edge, Marstons Mills, MA
Property Address
Matthew Gravina 44 Waters Edge
Owner Owner's Name
information is required for every Marstons Mills MA 02648 8/22/2018
page. City/Town State Zip Code Date of Inspectio
C. Inspection Summary (cont.)
2) System Conditionally Passes (cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with oard of Health approval if
pumps/alarms are repaired.
❑ Observation of sewage backup or break out or high static ater level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settl 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 le I or -1 ced ❑ Y ❑ N ❑ ND(Explain below):
❑ The system required mping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass ins ection if(with approval of the Board of Health):
❑ broken p' e(s)are replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ obstr tion is removed ❑ Y ❑ N ❑ ND(Explain below):
3) Further Evaluation is Require/an
ard of Health-
Conditions exist which requaluation the Board of Health in order to determine if
ZZ
the system is failing to protelth, sa or the environment.
a. System will pass unlesHe h determines in accordance with 310 CMR
15.303(1)(b)that the systetioning in a manner which will protect public health,
safety and the environmet5insp.doc•rev.7/26/2018 itle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
c� Commonwealth of Massachusetts
�a Title 5 Official Inspection Form
11. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
44 Waters Edge, Marstons Mills, MA
Property Address
Matthew Gravina 44 Waters Edge
Owner Owner's Name
information is required for every Marstons Mills MA 02648 8/22/2018
page. City[Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a s marsh
b. System will fail unless the Board of Health (and Public Water Suppl' r, if any)
determines that the system is functioning in a manner that protects a public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SA and the SAS is within
100 feet of a surface water supply or tributary to a surface wate upply.
❑ The system has a septic tank and SAS and the SAS is w' in a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SA s within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the AS 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 anal is, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the resence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no er f ilure criteria are triggered. A copy of the analysis must
be attached to this form.
c. Other:
4) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
Discharge or ponding of effluent to the surface of the ground or surface waters
El ® due to an overloaded or clogged SAS or cesspool
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System-Page 4 of 18
t
cam, Commonwealth of Massachusetts
Title 5 Official Inspection Form
la Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
44 Waters Edge, Marstons Mills, MA
V
Property Address
Matthew Gravina 44 Waters Edge
Owner Owner's Name
information is required for every Marstons Mills MA 02648 8/22/2018
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/day flow
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd-
10,000 gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine hat will be
necessary to correct the failure.
5) Large Systems: To be considered a large system the system m 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 a the following, in addition to the
questions in Section CA.
Yes No
❑ ❑ the system is within 400 t a surface drinking water supply
❑ ❑ the system is withi 00 feet of a tributary to a surface drinking water supply
❑ ❑ the system is cated in a nitrogen sensitive area (Interim Wellhead Protection
Area—IW )or a mapped Zone II of a public water supply well
t5insp.doc.•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System"Form-Not for Voluntary Assessments
44 Waters Edge, Marstons Mills, MA
Property Address
Matthew Gravina 44 Waters Edge
Owner Owner's Name
information is required for every Marstons Mills MA 02648 8/22/2018
page. Citylrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
If you have answered"yes"to any question in Section C.5 the system is considered a significant
threat, or answered"yes"to any question in Section CA above the large system has failed.The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate"yes"or"no"for each of the following for all inspections:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined?(if they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of br k out?
tnGl
® ❑ Were all system components, p i the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
IL Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
44 Waters Edge, Marstons Mills, MA
Property Address
Matthew Gravina 44 Waters Edge
Owner Owner's Name
information is required for every Marstons Mills MA 02648 8/22/2018
page. City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
Number of bedrooms(design). 3 Number of bedrooms(actual): plane floor
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
Description:
1500 GALLON SEPTIC TANK, DISTRIBUTION BOX, 2 500 GALLON LEACH CHAMBERS IN S
25'X1 3'X2' STONE VOLUME.
Number of current residents: 2
Does residence have a garbage grinder? ❑ Yes ® No
Does residence have a water treatment unit? ❑ Yes ® No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ® Yes ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d 340
9 ( y 9 (gp ))�
Detail
2016: 26,000 G ; 2017: 254,000 G HAS LAWN IRRIGATION
Sump pump? ❑ Yes ® No
Last date of occupancy: PRESENT
Date
I
t5insp.doc•rev.7r2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
I Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 44 Waters Edge, Marstons Mills, MA
Property Address
Matthew Gravina , 44 Waters Edge
Owner Owner's Name
information is
required for every Marstons Mills MA 02648 8/22/2(YIB
page. Cityrrown State Zip Cqde Date ofy1spection
D. System Information (cont.)
2. Commercial/industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): aeons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to th Title 5 system? ❑ Yes ❑ No
Water meter readings, if availabl .
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records:
Source of information: PUMPED 1/10/2014 PER BARN WWTP
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
t5insp.doc•rev.7126r2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
y s� 44 Waters Edge, Marstons Mills, MA
Property Address
Matthew Gravina 44 Waters Edge
Owner Owner's Name
information is required for every Marstons Mills MA 02648 8/22/2018
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known)and source of information:
3 YEARS. INSTALLED IN 2015 PER BARNSTABLE HEALTH DEPT
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
Depth below grade: -2
feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
>10
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
FLUSH TESTED NO EVIDENCE OF LEAKS.
t5insp.doc•rev.7/260318 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18
c Commonwealth of Massachusetts
,p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
44 Waters Edge, Marstons Mills, MA
Property Address
Matthew Gravina 44 Waters Edge
Owner Owner's Name
information is required for every Marstons Mills MA 02648 8/22/2018
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
Depth below grade: 1
feet
Material of construction:
®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed b a Certificate of Compliance? attach a co of certificate ❑ Yes ❑ No
Y P ( PY )
Dimensions:
APP 8.5 X6X5 1000 G
Sludge depth: 9 INCHES
Distance from top of sludge to bottom of outlet tee or baffle 25 INCHES
Scum thickness 0-1" INCHES
Distance from top of scum to top of outlet tee or baffle 6 INCHES
Distance from bottom of scum to bottom of outlet tee or baffle 14 INCHES
How were dimensions determined? CORETAKER
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
HAS PVC INLET TEE AND PVC OUTLET TEE. LIQUID LEVEL IS 48". NO EVIDENCE OF
LEAKAGE. (THERE IS ALSO ANOTHER PIPE GOING TO AN OLD DBOX. FOUND W SEWER
CAMERA.) PUMPING OF SEPTIC TANK IS RECOMMENDED.
l5insp.doc•rev.7/2 612 0 1 8 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
r. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
44 Waters Edge, Marstons Mills, MA
Property Address
Matthew Gravina 44 Waters Edge
Owner Owner's Name
information is required for every Marstons Mills MA 02648 8/22/2018
page. City(rown State Zip Code Date of In ection
D. System Information (cont.)
7. Grease Trap(locate on site plan):
Depth below grade: N/A
feet
Material of construction: ,
❑ concrete ❑ metal ❑fiber ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scu/mmendations,
le tee or baffle
Distance from bottom ofm of outlet tee or baffle
Date of last pumping: Date
Comments (on pumping inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related tevidence of leakage, etc.):
8. Tight or H ding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth b ow grade: N/A
Mated I of construction:
❑ ncrete ❑ metal ❑fiberglasspolyethylene other(explain):
9 ❑ ❑
Dimensions:
Capacity:
gallons
Design Flow:
gallons per day
t5insp.doc•rev.7/26/7J16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
44 Waters Edge, Marstons Mills, MA
Property Address
Matthew Gravina 44 Waters Edge
Owner Owner's Name
information is required for every Marstons Mills MA 02648 8/22/2018
page. City/Town State Zip Cod Date of inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: El Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and oat itches, etc.):
Attach copy of current pumping contract(required). Is copy attached? El Yes ❑ No
9. Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert AT INVERTS
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.):
DBOX IS LEVEL. FLOW DISTRIBUTION IS EVEN . NO EVIDENCE OF SOLIDS CARRYOVER.
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18
I
Commonwealth of Massachusetts
. Ip Title 5 Official Inspection Form
rm
io Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
44 Waters Edge, Marstons Mills, MA
Property Address
Matthew Gravina 44 Waters Edge
Owner Owner's Name
information is Marstons Mills MA 02648 8 2/2018
required for every
page. Cityrrown State Zip Code ate of Inspection
D. System Information (cont.)
10. Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments(note condition of pum rT
mber, c dition f pumps and appurtenances, etc.):
4
* If pumps or alarms are n in working order, system is a conditional pass.
11. Soil Absorption Syst (SAS) (locate on site plan, excavation not required):
If SAS not located, plain why:
Type:
❑ leaching pits number:
® leaching chambers number: 2-500 GALLON
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
I
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 13 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
-1 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
F'
44 Waters Edge, Marstons Mills, MA
Property Address
Matthew Gravina 44 Waters Edge
Owner Owner's Name
information is required for every Marstons Mills MA 02648 8/22/2018
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System (SAS) (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
LEACHING CHAMBER IS DRY. SOIL ABOVE, SIDES AND STONE ARE CLEAN W NO STAINING.
EXCELLENT CONDITION. GRADE TO SAS BOTTOM IS 8.5'. SEE NOTE Pg 2 on ABANDONED
LEACH PIT.
12. Cesspools (cesspool must be pumped as part of inspection) cate 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 infl ❑ Yes ❑ No
Comments (note conditio f soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc•rev.7r26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18
Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
to Subsurtace Sewage Disposal System Form-Not for Voluntary Assessments
44 Waters Edge, Marstons Mills, MA
Property Address
Matthew Gravina 44 Waters Edge
Owner Owner's Name
information is Marstons Mills MA J 02648 8/22/2018
required for every
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
13. Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments(note condition of s , signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc-rev.RM2018 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 15 of 18
` Commonwealth of Massachusetts
Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
44 Waters Edge, Marstons Mills, MA
Property Address
Matthew Gravina 44 Waters Edge
Owner Owner's Name
information is required for every Marstons Mills MA 02648 8/22/2018
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system, including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters
the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
A L3 ' 0
p ILI
1 0
♦Ca�plow
3
tS7� rS
At- qo.5' a t- i5' `
A1` 414 S10-05
A1A=`i ` GMz a�'s
. 133=a3' C3=a'•5
AKA-s�' 5-
t5insp.doc-rev.MM2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System.Form-Not for Voluntary Assessments
44 Waters Edge, Marstons Mills, MA
Property Address
Matthew Gravina 44 Waters Edge
Owner Owner's Name
information is Marstons Mills MA 02648 8/22/2018
required for every
page. Citylrown State Zip Code Date of Inspection
E. Report Completeness Checklist .
Complete all applicable sections of this form inclusive of:
® A. Inspector Information: Complete all fields in this section.
® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked
® C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4(Failure Criteria)and 6(Checklist)completed
® D. System Information:
For 8:Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
2 iW-i r tL.
IVAO
t5insp.doc-rev.7126f2018 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
ivoll Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
44 Waters Edge, Marstons Mills, MA
Property Address -
Matthew Gravina 44 Waters Edge
Owner Owner's Name
information is required for every Marstons Mills MA 02648 8/22/2018
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water: >=20
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: NO DATE
Date
❑ Observed site(abutting property/observation hole within 150 feet of SAS)
® Checked with local Board of Health-explain:
FILE
❑ Checked with local excavators, installers-(attach documentation)
® Accessed USGS database-explain:
GOGGLE, FRIMPTER
You must describe how you established the high ground water elevation:
PER DESIGN BOTTOM OF SAS IS 7.76'ABOVE DESIGN TEST HOLE. DESIGN TEST HOLE OF
12/1/2014: NO GROUNDWATER FOUND AT 12'. SITE IS 82'ASL. GRADE TO SAS BOTTOM_ IS
8.5'
GROUNDWATER CONTOUR IS 54'ASL W A MAX RISE OF 8':
SEPA13ATION MATH: 82-54+8.5+8 =11.5 TOP OF GRADE=Q -
Top of S.A-S__
—► Bottom of S.A-S.
Separation
Amt.of Stone= Ad'usted Crroundwater= o3-D
Observed Groundwater=
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
15insp-doc•rev.7126M 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18
ACCU Invoice
SEPCHECK
Helping homeowners make infoimed Date:
e 3t hole
decisions about their septic systems!
Joe Martins INVOICE NO.
Inspection Date: 2Z 12olt
t C4V;AeLOCATION: TO: Name:
Address:
Phone:
Email: a Vf K 4 A f/ �&�• �OV`-'"
16em#` Quanfiiy� � Descnpbon
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Subtotal
Total
Please remit to:
ACCU SEPCHECK
17 N9rthside Drive,South Dennis,MA 02660
Phone(6ffice):508-385-5891,joemartins a@comcastnet
r
Town of Barnstable
°FIMETO'rti Regulatory Services
HP °�
Richard V. Scali, Interim Director
• &ARNSras[.e,
MA-Sa �0$ Public Health Division
ATF&639. Thomas McKean, Director
200 Main Street,Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form
Date: ` Sewage Permit#` 0J i'� 00 5' Assessor's Map\Parcel �O
Designer: rp ] � � Installer: v''�+GQ1�}
Address: 5 LO Address:
On was issued a permit to install a
( ate) (installer)
septic system at �Lx�, Y1�Aqbased on a design drawn by
,� J (address)
�UJ 1> /"1 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. Strip out (if required) was inspected and the soils
were found satisfactory.
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. Strip out (if required) was inspected and the soils
were found satisfactory.
I ce ify that the system referenced above was constructed ' nce with the terms
of t e IAA approval letters (if applicable) �� OF
0B.
DAVID 9
r anature I MASON
( tall ' o )
s-re"
0
(Designer's ignature) (Affix Desi p 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.
QASeptic\Designer Certification Form Rev 8-14-13.doc
AsBuilt Page 1 of 1
I: CT A ION �Q "�?S � SEWAGE PERMIT N0.
��to �
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VILLAGE
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INSTALLER'S NAME R ADDRESS
s�/t &a 6 r
BUILDER OR Q�JI___M
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
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http://issgl2/intranet/propdata/prebuilt.aspx?mappar=062040&seq=1 12/l/2014
Commonwealth of Massachusetts
�, AGO
F W Title 5 Official Inspection Form
p �
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M
44 Waters Edge
Property Address
John and Nancy Leone
Owner Owner's Name
information is
required for every Marstons Mills MA 02648 November 4, 2014
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 A. General Information (�
filling out forms
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not David B. Mason
use the return Name of Inspector
key.
David B. Mason _
r� Company Name f
4 Glacier Path
Company Address
East Sandwich MA 02537
City/Town State Zip Code
508-367-1617 S1287
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 by the Local Approving Authority
November
4 2014
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 Inspecr. Subsuffne Sewage Disposal System•Page 1 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
oI Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
,M 44 Waters Edge
Property Address
John and Nancy Leone
Owner Owner's Name
information is required for every Marstons Mills MA 02648 November 4, 2014
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:
❑ 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.
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):
I
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
p Y 44 Waters Edge
M
Property Address
John and Nancy Leone
Owner Owner's Name
information is required for every Marstons Mills MA 02648 November 4, 2014
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) 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
44 Waters Edge
Property Address
John and Nancy Leone
Owner Owner's Name
information is Marstons Mills MA 2 4
required for every 0 6 8 November 4, 2014
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
® El clogged
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 '/z day flow
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
I
Commonwealth of Massachusetts
L Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 44 Waters Edge
Property Address
John and Nancy Leone
Owner Owner's Name
information is required for every Marstons Mills MA 02648 November 4, 2014
page. City/Town 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M
44 Waters Edge
Property Address
John and Nancy Leone
Owner Owner's Name
information is required for every Marstons Mills MA 02648 November 4, 2014
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 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
° 44 Waters Edge
M
Property Address
John and Nancy Leone
Owner Owner's Name,
information is
required for every Marstons Mills MA 02648 November 4, 2014
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
2
Number of current residents:
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 ears usage d Yes
9 ( Y 9 (9p ))�
Detail:
2013; 72,000 gallons and 2012; 39,000 gallons. Note-, one meter for property
Sump pump? ❑ Yes ® No
Last date of occupancy: current
Date
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:
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
44 Waters Edge
M
Property Address
John and Nancy Leone
Owner Owner's Name
information is required for every Marstons Mills MA 02648 November 4, 2014
page. City/Town 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: Board of Health
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
L
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
44 Waters Edge
M
Property Address
John and Nancy Leone
Owner Owner's Name
information is required for every Marstons Mills MA 02648 November 4, 2014
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:
Compliance on system issued April 5, 1985
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 3
feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: 10+feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Septic Tank(locate on site plan):
Depth below grade: 2feet
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 Typical
Sludge depth:
6"
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
I_
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
^M 44 Waters Edge
Property Address
John and Nancy Leone
Owner Owner's Name
information is required for every Marstons Mills MA 02648 November 4, 2014
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
40"
Scum thickness
5"
Distance from top of scum to top of outlet tee or baffle
3"
Distance from bottom of scum to bottom of outlet tee or baffle
10"
How were dimensions determined? Scour Stick
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Effluent level with outlet invert.
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: r Date
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
Title 5 official Inspection Fora
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M
44 Waters Edge
Property Address
John and Nancy Leone
Owner Owner's Name
information is
required for every Marstons Mills MA 02648 November 4, 2014
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
l5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17
IL
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
;M 44 Waters Edge
Property Address
John and Nancy Leone
Owner Owner's Name
information is required for every Marstons Mills MA 02648 November 4, 2014
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
S
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert effluent 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.):
No evidence of solids carryover.
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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Fora
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 44 Waters Edge
9
Property Address
P Y
John and Nancy Leone
Owner Owner's Name
information is required for every Marstons Mills MA 02648 November 4, 2014
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
® leaching pits number:
1
❑ 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.):
Leaching pit is full above inlet invert.
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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
N w Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 44 Waters Edge
Property Address
John and Nancy Leone
Owner Owner's Name
information is required for every Marstons Mills MA 02648 November 4, 2014
page. CityTTown 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
-i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 44 Waters Edge
Property Address
John and Nancy Leone
Owner Owner's Name
information is required for every Marstons Mills MA 02648 November 4, 2014
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
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
f Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 44 Waters Edge
Property Address
John and Nancy Leone
Owner Owner's Name
information is required for every Marstons Mills MA 02648 November 4, 2014
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: 18
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:
Groundwater Contour Map
❑ Checked with local excavators, installers - (attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Groundwater Contour Map
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
Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
° 44 Waters Edge
M
Property Address
John and Nancy Leone
Owner Owner's Name
information is required for every Marstons Mills MA 02648 November 4, 2014
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
E Inspection Summary: A, B, C, D, or E checked
E Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
E 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
Assessing As-Built Cards Page 1 of 2
' X77YlOCATION l/d6e?S lwl e SEWAGE PER IT NO.
+ Im, F — oa
VILLAGE
INSTALLER'S NAME A ADDRESS
5R
BUILDER OR Q�IIE�
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
7 �
1 0
�4.
6 4 - g
http://town.bamstable.ma.us/Assessing/HMdisplay.asp?mappar=062040&seq=1 10/10/2014
TOWN OF BARNSTABLE
LOCATION Y-9 Wfre-fS. N�W SEWAGE#p10/�', 1904'
�Z
VILLAGE ASSESSOR ASSESSOR &PARCEL-*
INSTALLER'S NAME&PHONE N
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type�ZT!kv 9464,u G'4 6oize)Z 5 X /.3 X Z
NO.OF BE ROOMS
OWNEIZ&t -
PERMIT DATE: I bh 5,--
COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY �����
10 ��►'
oven of Barnstable P olfo
#
'. Department of Regulatory Services
is Public Health Division Date
MASSL
200 Main Street,Hyannis MA 02601
fG A9A't
t ! !
Date Scheduled— I A Time VFee Pd.
Soil Suitability A. sessment for S w>ac'
Performed By: I Witnessed By: (�
LOCATION& GENERAL,,INFORMATION
Location Address G wner's Name 6C'Q7-ce S 40e_
/SOT Address
Assessor's Map/Parcel: 0 00 Engineer's Name?4Y,;O /'��c�G✓�
NEW CONSTRUCTION REPAIR /f"' Telephone#
Land Use Slopes Surface Stones
Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft
Drainage Way ft Property Line ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
X- WE
1 C-0
t�4
Parent material(geologic) Depth to Bedrock
Depth to Groundwater. Standing Water in Hole:_ Weeping frotn Pit Face
Estimated Seasonal High Groundwater
DETERNUNATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: in, Depth to soil mottles:
Depth to weeping from side of obs.hole: In. Groundwater Adjustment
Index Well# Reading Date: Index Well level Adj.factor �m A4J,Groundwater Level
PERCOLATION TEST Data,..,,.;, Time
Observation
Hole# Time at 4" _
b
Depth of Pero VTime at 6"
Start Pre-soak Time @ Time(9"-6")
End Pre-soak 11 40v,
r
Rate Min./Inch
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100' of wetland,you must first notify the.
Barnstable Conservation Division at least one(1) week prior to beginning.
Q:\SBPTIC\PERCFORM.DOC
DEEP.OBS.ERVATION HOLE LOU Dole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in,) (USDA) (Munselq Mottling (Structure,Stones,Boulders.
onsistency.96 Oravel)
1l
I
1- 1p
ir-
DEEP OBSERVATION BOLE LOG Hole#
Depth from. Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) - (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
onsisten % ra
I�
DEEP OBSERVATION BOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Con i to c O
DEEP OBSERVATION DOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Sall Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.
Flood Insurance Rate Man:
Above 500 year flood boundary No Yes
Within 500 year boundary No'' Yes _
Within 100 year flood boundary No. Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring per i u aterial exist in all areas observed throughout the
area proposed for the soil absorption system?
If not,what is the depth of naturally occurring per ious material?
Certification y�
I certify that on l v (date)I have passed the soil evaluator examination approved by the
Department of Environ ental Protection and that the above analysis was1perfor d by me consistent withthe requir raining, rd nd erience described in 310 CMR 15Signatur Date 7P1
Q:\SEPTICTERCFORM.DOC
CC
No.0 THE COMMONWEALTH OF MASSACHUSETTS FEE
BOARD-OF HEALTH
OFYCt,C1A��� �
APPLICATION FOR DISPOSAL SYST M CONSTRUCTION PERMIT
Applicatio for a Permit t Construct ( ) Repair ( ) Upgrade ( Abandon ( ) - ❑Complete System ❑Individual Components
Lo do Owner's Name
ap/Par el# Address
Lot# �, �� I_ ,� �laghone
/lam JA Inn-sttaallers a lA"t/ if Designer's Name
/ d ss !� �Addr_ ess_ �-7,7
elepho # 100, pho�n
Type of Building: 2 Ft'v Lot Size a
Dwelling—No.of Bedrooms Garbage Grinder ( )
Other—Type of Building No.of persons Showers ( ), Cafeteria ( )
Other fixtures
Design Flow(min. equiLed) ` pd Calculated design flowcgpd Design provide gpd
Plan: Date Zo Number of sheets _ I Revision ate
Title
Description of Soil(s)
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation
DESC IPTION OF YEPAIRS OR ALTERATIONS G
The under=greesnot
he above described Individual Sewage Disposal System in accordance with he provisions of
TITLE 5 and fuhe system in ration7"11 a Certificate of Compliance has been i su by the oard of Health.
Signed Date J� Z .
Inspections
FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96
�o/5 N5
No.
THE COMMONII E?-6T,H OF MASSACHUSETTS FEE
BOAR` OF •HEALTH
/ O F
APPLICATION FOR DISPOSAL,SYI�ST M CONSTRUCTION PERMIT
Applicatio fo a Permit t Construct ( ) Repair ( ) Upgrad ( Abandon ( ) - ❑Complete System ❑Individual Components`
Lo do Ap,� Owner's Name
/ap/Pamfel# M r Address
�'� hone),,,
Installer' a( � Designer's Name
d ssAddr�ess�` Z'7
7
7
...'l-elephorif# phon
Type of Building: 7 �am A-k-- Lot Size it ,
Dwelling—No.of Bedrooms Garbage Grinder ( )
Other—Type of Building No.of persons Showers ( ), Cafeteria ( )
Other fixtures 22
Design Flow(min. equi ed) �pd Calculated design flow gpd Design provided gpd
' f Plan: Date Number of sheets Revision ate
Title '7
y Description'of Soil(s)
Soil Evaluator Form No. Name of Soil Evaluator Date of Evy luation
DESC IPTION OF VEPAIRS OR ALTERATIONS ►2
ZS f^c 5
The undersign agrees to install the above described Individual Sewage Disposal System in accordance with he provisions of
TITLE 5 and furthe grees not top a the s stem in eration I a Certificate of Compliance has been sue by the oard of Health.
Signed Date
Inspections
FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96
No.�—�O0_5 �m+ E COMMONWEALTH OF MASSACHUSETTS,-� FEE
tom.• BOARD OF HEALTH
C"TIFICATE OF COMPLIANCE
Description of Work: [Individual Component(s) ❑Complete System
The undersigned hereby certify that the Sewage Disposal System;Constructed( ),Repaired( ,Upgraded( ),Abandoned( )
by:,
j at
has be�alled in accordance with the provisions of 310 Rj5. (Title 5) and the approved design plans/as-built
plans relating°to application No `�� dated - // Approved Design Flow (gpd)
Installer 61J1��-
Designer: Inspector Date 15
The issuance of this certificate shall not be construed as a guarantee that the system will function as designed.
/ FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96
r
No.C;23l5 _( 6_5 THE COMMONWEALTH OF MASSACHUSETTS, FEE QQ
1
'/ '""" ✓�� BOARD OF HEALTH,
Mon
ISPO AL SYSTEM CONST CTION PERMIT
Jr-mis hereby4atfd tr ct ( ) Re air Upgrade ( ) Abandon ( ) an individual sewage
g
disposal system at as described
in the application for Disposal System Construction Permit No. j '7 dated
Provided: Construction shhall ei completed within three years of the date of th' permi . Lcalnditions must be met.
Date 1 t� Board of Health
FORM 2 - DSCP DEP APPROVED FORM 5/96
FORM 1255 (REV 5/96) (SW) HOBBSB WARREN rM PUBLISHERS- BOSTON
LOCATION 0-10'e/?S SEWAGE PERMIT NO.
't L + -VILLAGE
v
a g�//
INSTA LLER'S NAME i ADDRESS
-T ®R
BUILDER OR Q
DATE PERMIT ISSUED '] s
DATE COMPLIANCE ISSUED '41si <zs
N
1 0 30
.b
76-6,
r
0 THE COMMONWEALTH OF MASSACHUSETTS a
BOAR® OF HEALTH
"0 �%/_)D fmur
....................OF.
Appliratiou for Dispas al IV larks Tonotrnrtiun ramit
Application is hereby made for a Permit to Construct ) or Repair ( ) an In 'vid Sewage Disposal
System at:
$ - � Q
.......... �, _......... .... _ f.. -� - ----------...._..._.....-- ----.... .. ---------•-
�(y Location-,Address o t o.
• �}` — — r-•--•............................... •----••-•---•---.............---
r
Owner Address
...............•----............................ •---••------------....................... ... ........ ......,........................
Installer Address
UType of Build'' ize Lot...J._-tV-3.4 t
Dwelling�No. of Bedrooms..._.___..`. ...........................Expansion Attic (� Garbage Grinder (G
'4 Other—T e of Building No. of persons............................ Showers — Cafeteria
Q' Other fixtures ..................................
5_.......... allons er person d Total d 1 flow..............��.o_............ lons.
W Design Flow------------------•--:..J.......� g P P �Y• �Y
WSeptic Tank—Liquid'capacity..� gallons Length_ ...6.._. Width 4l®--- Diameter________________ Depth. ...
x Disposal Trench—Nf--------------------- Width__ ------- Total Length.................... Total leaching area.....................sq. ft.
Seepage Pit No.--___-_`........... Diameter....... Depth below inlet............... Total leaching area.. G ...sq. ft.
z Other Distribution box (LY. Dosing to ) �(
Percolation Test Resul Performed by------....nkr�1 .'r Date....*1_ __4_._..... /
aTest Pit No. 1_�Zminutes per inch Depth of Test Pi ----- ... Depth to ground water...O.(J' 6'
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
o
U
-t......--a------. ---------------- � ..._.....------.
x Description of Soil S _.� --.�----- -r---- lP•
U -----------------------
---..............
----..........
-----------------------------------------
•------.-------FJ----------------------------•----•--•----•-----------
._...... ----•------------------
W -----•-•--------------------•-----••-•----------•---------------------------------------------------------------------------------------......-•------................................................
Nature of Repairs or Alterations—Answer when applicable._..............................................................................................
----------------------------•---•--•-------------•-•-------•------------------------................----........-----------------•--•--•-----------------------------------------------•---•---••----•_.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITIS 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
era ' n t'1 a Certificate of Compliance has4beeeen issued by the board of h lth.
Ligned,.Y.-( - •• ------••........ .......�.� r�. 8---•-
PPlication Approved BY-•-••------.. --------- `:qY.V -•-- ............� `... mac.. ....-----
Date
Application Disapproved for the following seasons------------------•---------••--------------------------------•--•---------------------------------...........---
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-------
Date
Permit No.._.�..._-� .� .. - . Issued. �l �` ..
Da e
No..�1=40 05 •
THE COMMONWEALTH OF MASSACHUSETTS ,
BOARD OF HEALTH
............. - ------------------------••-----•••-••.•....
Appliratiou for Uhipaii al Works Tomitrurtivit Vamit
Application is hereby made for a Permit to Construct (�) or Repair ( ) an Individ al Sewage Disposal
System at:
Location;.Address o=
{.:..A a� ........................................... .__ ....... 4 .. •�--------------------
......................
JJ.
Owner - ------Address��
W ............... f
Installer Address +
Type of Building Size Lot... ... ,-� _�,~..Sq--feet
Dwelling No. of Bedrooms........... �,.............................Expansion Attic ( Garbage Grinder
Other—T e of Building ............. No. of persons...._............___.__.___. Showers — Cafeteria
aOther fixtures --------------------- ...................................... .............................................................
W Design Flow....................... ..... 0
.. .gallons per person pqr clay. Total dg,il flow......... ..P�l........... ns.
WSeptic Tank—Liquid capacity............gallons Length._...-..... Width-. -_-- Diameter________________ Depth_...._ ('....
x Disposal Trench—N . .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.......7......... Diameter.......k......... Depth below inlet............... Total leaching area.,_-.t(,M)....sq. ft.
Z Other Distribution box Dosing to ( )
r
Percolation Test Resins Performed b _------___�`r�'�'�-.E���- '���'�°---------------------- Date_..__d.... .._f.._.�.�_----_-.-_ �
1.4 -Test Pit No. 1.-_.... =.minutes per inch Depth of Test Pit.__ • .. .• Depth to ground water_.fl.(.)' ' "...A�js
fZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
--------------........... ...........................................f--.-------- 1
D Description of Soil.....4!!�L- •• s! <i � J .............. d�-r -•-- i e l` ' - - -
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 TIT12 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
pe a io J til a Certificate of Compliance has n issued by board of ealth.
r
Signed -----. ..:...._.. ' ------••--••......•--•-• 1. ,. . _..
,,..� K`�r`� fi CDat
ti+w•.�..... _, p
Application Approved B z.: ... � ' �- �'
._�
Date
Application Disapproved for the following reasons:-------•-----------------------------------------------------•-------------•-------••-•••---••-•-----........
........................•-----•--•--•---------------•-•---------•---•-•-----•--------------•-•--••-............•-------•---•---••-••••-----••-•.......................................................
Date
{ ¢ !�(
Permit No...-.�.-----==------ Issued.............11
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.....................................................................................
Tatifiratr of ToutpliFattrr
THIS IS TO CERTIFY, That the Individual Sewa Disp� S stem canstructed ( or Repaired ( )
t
by--------------------_---- ............:---.:... .................................................--•-•---•---.._.....
�/,` �"� T - I s
at`T.'T_...Xl<!AT Pj�e,._-dy�.L�'--._W... --...:!` �� . _.. J -.......---•---------------------------•-•---------
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code a described in the
application for Disposal Works Construction Permit No----- j._.. dated_.------E_.{. .__S ...............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUA ANTES THAT-THE
SYSTEM WILL FUNCTION SATISFA O Y.
x
� S nspetor....:... .DATE.....----
THE :.._
OMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.........................OF..................................................................................... ')A ---
- FEE.....-•----=
Diopos al 041 • r wit r t�
0'` ,
Permission is hereby granted.........-...-•-..
.=.� w :_.. c'.....
to Cons r c ( , r e air ( an Iny ivid eviTagg ,D' p,� stem
at No.. 1 -`,? :U 't...f'7 (lC--��% ---f�.=-�:�-.. ......... -'---••------•-•--:.;
Street
as shown on the application for Disposal Works Construction Permit No..`mil ?''�Dated.._.....11 .....................
-1
,...,� ---------- ----•--------------------
..--- -- - • - .-----
i��... Board of Health •
DATE-•----- "�� _vJ`
FORM 1255 A. M. SULKIN, INC., BOSTON
7A►.1 C:L� F A M t LY - 3 B r-O Q,?o AA
-Gaq.BAr;E G
t2.IhlDE2
VN%L%( FLOW :°IIU X 3 = y3pG.Pv F
5SPTIG -rAQK = 330)05o0/- = -49�6.Po.
y5E- I000 GAL.
o15po5AL Pt'r vsE I U po mat_. �L�I� oIJ �62,C-OF
S DG YJAIt_ AQGA. = t�d S.r L ( �/ (�(STLa P., 1z--�`1`/
150 . 5.F � z•5 = 3�5 G.p�
130TTOM AZS-A= .. l O 5•F,
^To-TA1— pF.SIGN : .425 C�.PD•
'TOTAL pA I L`C F%-C>W = 330 G,PO,
PE2GOLL�TtOu GZATEi I`'Icv 2MIN o�LESS
Z<<OF �PL(N .�F 41,,p
P4CFlARD Pl TERA.
BAXTER SULLIVAN
Na 240M 9 No. 29733
SIONAI
is
��(.•S'6' ,e" t.AL 1=0iL 1`L� tit AFL� _.
•'. Iryy. (�'�
J- 1000 INS.
a{• -� G&L.
I_EAt:u
PIT INV. ItvY.,
WIT14 IGVL
�2 ,0�•t�
WAsu>iD
GRnw� 6T�N
CEczTIFtso PI-oT PLA1J
PRUFILG LoC4TIotJ E
q3 14 W0 SCALE SGAI:E 'sl. ��j �AT� tv-Ic.� �u, .
=
C E tZT I Y N AT T N t= t.west.G.l'e 5110 ww
Pt-At.� REPE2EN c,E
NE.Izsow COMPL`(S WkTP THE S I pELlt�1 •-T- rj
AWD SE-ce.GK 9-6G?vt2EM�N�'� oF -C1-��
-ro W N �3c:us c.N ►s I,�ar
LOCH S0 MITNIW TN6 GLOOD PLAI ICI
DATEID-I -8� Ll -sC�A
SZEG I ST�QEr'D'I.AW D S u MY E`(oeS
-Tu15 PL&IQ 15 KIO'T E3t\Sc n o►d AQ 0:5'rE2VILLE • MASS.
IW51-eUtAr61.IT' SV9-Ve ( er -THE oti=�SET5 'Su0Ut,
P L I C A,►—t T
_ t _ , 4 .. . . �. . �, � be � . w� z.' . ( •
4-c)
U , 7
:/� —� �9 t P.2o I �o f •
a` .3
07
1 M tNT44
7-N
97.1 ; 1 &A10 1��T
/01
614
of
CHARD.� ��y £`�` PETER
SULLIVAN
;,,
BAXTER y No 2 ,733
N.a 24048
A •Q
�,IUG-C- FAMIt_`! -E ''S BEOcZooM f r �I
I.r `'CC,1.CBAGE �jIzINDE�Z.
FLOW CD
5EPTIG TAtiK = 330x15o% = -491G.P
u5c- IOoo GAS-' r
ol,W06AL PIT use 1000 GAL.
5 I DSWALL A2Ca (5T"L.EP5 I
150 5.r- x z•5 -
5OTrOM AREA= „
5c -4.I~ x I. 0 = 5o G.Pca
'TOTAL pF.51(w r 42-5 G.PD.
-T&TA- DA I L%(
PE2G0�ATIo�I RATE � I''IN 2MIn1 opt-ESS
Ztt 0i AP,t<�,s kP��H F 1,16,,
FGHARD N PETER �r
SAXTI=R w SllLL;VAiV
Na 240Q No. 29733
O
STg A�'o���cisTF•�!e �``�
SS�CNA L
DAt-14,
I► T O P F I`t V" l I v
51 P 355q 100v IN\J.
,hfl f/LF,' pIST. 11J�/. 56PTIC �•g
�- - Gay.
LE•acu
PIT INV.
i uJITu
IcQ� t04.•h
I WASUGD
G,z��Bl- 6Tv N E
caz-rI v*-IGD pLo—r PLAID
PRUFIL� Lo44710tJ 2C �y
193 NO SCALE - sGAL:1= �II_ DATE
PIzopa� � 3-�• ss I�
N.l RE F t~Z<rN GE
A G E QT t F Y T N AT 7 N E �awc�u.l'�� 51.10 V�1N i 1
NER.EOW CoMPU?!5 WITH THE S 1 p>V-- 1
A C> 56reAC, 26Qv121✓Mr--W of -tNs=
TowN C>r- AND IS
LOCATED -\NITNIN T146 FLOOD tPL&I tiJ
gAxTE2e P.I`(E INC. �
RLE6 15'T t=.26r�'I.Au D S u MY 1=Yoe5
"fNl�j PLC►.! 1� NdO'T anSFr-) Ord AN os-rE2VILLE - MA56•
)j,5TR.uMEN-r Sv2Vey � -r AS 0I=r,5E"f5 5uOULD
►I T0 �04"-Q f �'
a
-17
c
/v7 z
4-c)
,o
07
1 . G
1
/Qv _ /cam.`I , ` � >�_ •`\ �o�f ,
1
i 1 ►� s,T�e�� l r
97•! .1 � ' \ O-�PT1T
1ioi .r/
7
tev
VC6.
94 Z �:� io6
_ 1
wc
_ CHAi�D.;.�IY;. PETEf� £�� _
A.- SULLIVAN1
BAXTER
�!•. I Y�
Na 2404�8 � (�0.
SAS �. S/pNA1
ASSESSORS MAP :
TEST HOLE LOGS
,
PARCEL
�D -� 1) The installation shall carnpi with Title V and Town of 3oard of
FLOOD ZONE: SOIL EVALUATOR.c. f leaith Regulation I i
�y �� ��� WITNESS : ����.1Xf / � !�' � 2 The installer shall verit/� ,� ) y the location of utilities, sewer inverts and septic
REFERENCE: - �-Z 3i DATE:
components prior to antallat�on and setting base elevations.
PERCOLATION RATE: -< 3) All gravity septic, piping,to be 4 inch Sch 40 PVC at 1/8" per foot. The first
two v� V ��� 4) This planstnot to be ltilizedleraching shall be level.
j! for property line determination nor any other
TH- I TH 2 purpose other thatrik,proposed system installation.
Ft VV 5) All septic componegts,;musfineet`Citle V specifications.
�� P 6) Parking shall not he ctiristructed ove5 H 10 septic components.
7) The property is bounded by,propert c .corners and property lines.
Zy 8) The property owner shall,rev,lew design considerations to approve of total
I LOCATION MAP _ /� �Qy�$ `�p� � ,A9 g � design flow and number i f bedrooms to be' considered for design. Receipt
y� 7 of payment for jthe.plan and installation based on the plan shall be deemed
approval of the,Aesjgn flow by the o."er. - .
_ 9) The existing tea,6Q or cesspools shall be pumped and filled with material
L { 7 per Title V abaritnmet procedures"`I Those within the proposed SAS shall
be removed along Wttlr contaminated'Isoil and replaced with clean sand per
�' 0� Title V specs
14
1 l�� 10)System componenl:�io,be 10 t'eet frotr# water line. Sewer lines crossing the
kl /ya �rQNG� l� :
�0 water line shall,-6AIeer�e�with 4 inbh'SCII 40 PVC with ends grouted if
7/
applicable: The,�. posedSA� is'bding installed below the water service
line.` The line{iota.�e`sleevedas,aforementioned and maintained in place.
SEPTIC SYSTEM DESIGN 11) If a garbage grit, 1 exists rt is to b�!removed and is the responsibility of the
owner to ensure sucht
FLOW ESTIMATE 1 Z)The installer is to take cAutiob in excavation around the gas line if such
exists.`
8Z J� BEDROOMS AT II�GAL/DAY/BEDROOM -� �GAL/DAY 13)The installer shad veriCy"the location',quantity and elevation of the sewer
\ 4' lines exiting the dwelling prior to the:installation.
SEPTIC TANK 14)This plan is representative only that,.a system can fit on a property meeting
Title V requirernents ;:i '
\ I N 3339 x 2 DAYS - GAL i f
\ / USE I�GALLON SEPTIC TAN `�1, T
?4 NT- owl '
ABSORP'i`T0N SYSTE _ -`
1 � I 1,4%) t -� ( �. k c ._ '4 fit`UFAfgss
/ r r
\ /A / �l to' S I DE AREA: 25 -f' ���g3 1(,Z 017 - f 1.97 DgVID
BOTTOM AREA: �: a r x 0/7 MASON m'1,
� d .,p N0.1066 y
44I SEPTIC SYSTEM SECTION17
— 7 �i�j�fiqtf10��i.
1
O h f i n -
}� s
d �—D� 0
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