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HomeMy WebLinkAbout0082 CINDERELLA TERRACE - Health 82 Cinderella Terrace Marstons Mills fi A= 047-117 Commonwealth of Massachusetts Oq� ' Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 82 CINDERELLA TERRACE Property Address JOSEPH CENTRELLA r.a Owner Owner's Name / information is required for every MARSTONS MILLS V MA 02648 2/24/2020 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:WhenWhen fillip out f A. Inspector Information f on the computer, use only the tab Christopher Maki key to move your Name of Inspector cursor-do not Cape Cod Septic Services use the return key. Company Name 350 Main St. ,y Company Address W Yarmouth MA 02673 City/Town State Zip Code relmn 508-775-2825 SI-14423 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 3/4/2020 Inspector's Sigrrgture Date. The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within_30 days of completing this inspection.If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner.shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2010 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts ip Title 5 Official Inspection Form i� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 82 CINDERELLA TE RRACE Property Address JOSEPH CENTRELLA Owner Owner's Name information is required for every MARSTONS MILLS MA 02648 2/24/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM IS IN WORKING CONDITION 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N; ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain.below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form =Not for Voluntary Assessments 82 CINDERELLA TERRACE Property Address JOSEPH CENTRELLA Owner Owner's Name information is required,for every MARSTONS MILLS MA 02648 2/24/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑. Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) 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. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 82 CINDERELLA TERRACE Property Address JOSEPH CENTRELLA Owner Owner's Name information is required for every MARSTONS MILLS MA. 02648 2/24/2020 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 salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system.is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and.SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t51nsp.doC•rev.v26/2o18 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts 19- Title 5 Official Inspection Form Flo Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 82 CINDERELLA TERRACE Property Address JOSEPH CENTRELLA Owner Owner's Name information is required for every MARSTONS MILLS MA 02648 2/24/2020 page. CityrFown 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 Y2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Z. 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 conform 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 CM 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ 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 t5insp.doc rev.712612018 Title 5 Official Inspection Form:.Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts rF Title 5 Official Inspection Form iQ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 82 CINDERELLA TERRACE Property Address JOSEPH CENTRELLA Owner Owner's Name information is required for every MARSTONS MILLS MA 02648 2/24/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all Inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered,.opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ 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.dgc•rev.7/26/201 a Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form p Flo Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 82 CINDERELLA TERRACE Property Address JOSEPH CENTRELLA Owner Owner's Name information is MARSTONS MILLS MA 02648 2/24/2020 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage '19-120 GPD 9 ( y g (9pd)) '18-115 GPD Detail: Sump pump? El Yes Z No Last date of occupancy CURRENT Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 18 Commonwealth of Massachusetts FW Title 5 Official Inspection. Form of Subsurface Sewage Disposal System Form Not for Voluntary Assessments 82 CINDERELLA TERRACE Property Address JOSEPH CENTRELLA Owner Owner's Name information is required for every MARSTONS MILLS MA 02648 2/24/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date .Other(describe below): 3. Pumping Records: Source of information: NA 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form le Subsurface Sewage Disposal System Form.- Not for Voluntary Assessments 82 CINDERELLA TERRACE Property Address JOSEPH CENTRELLA Owner Owner's Name information is required for every MARSTONS MILLS MA 02648 2/24/2020 page. City/Town 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: 2011 PER BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 911feet 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.): LINE CHECKED WITH SEWER CAMERA AND WAS FOUND TO BE CLEAN, PROPERLY PITCHED WITH NO SIGN OF ROOT INTRUSION t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•page 9 of 18 Commonwealth of Massachusetts Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 82 CINDERELLA TERRACE Property Address JOSEPH CENTRELLA Owner Owner's Name information is required for every MARSTONS MILLS MA 02648 2/24/2020 page. . City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: feet Material of.construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 GALLONS Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1000 GALLON TANK IN GOOD CONDITION.TEES IN PLACE AND CLEAN. TANK AT NORMAL. OPERATING LEVEL. COVERS 4" BELOW GRADE t5insp.doc•rev.7/261201a Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 i Commonwealth &Massachusetts Title .5 Official Inspection Form F a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 82 CINDERELLA TERRACE Property Address JOSEPH CENTRELLA Owner Owner's Name information is required for every MARSTONS MILLS MA 02648 2/24/2020 page: City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene 0 other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 82 CINDERELLA TERRACE Property Address JOSEPH CENTRELLA Owner Owner's Name information is ry MARSTONS MILLS required for eve MA 02648 2/24/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level.' Alarm in working order: ❑ Yes ❑ No Date of last puriping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert EVEN 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.): H-10 DB-3 WITH 1 LINE IN AND 1 LINE OUT IN GOOD CONDITION. BOX IS CLEAN AND LEVEL WITH MINIMAL SOLIDS CARRYOVER. NO SIGNS OF OVERLOADING OR HYDRAULIC FAILURE t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form LVSubsurface Sewage Disposal System Form - Not for Voluntary Assessments —5 82 CINDERELLA TERRACE Property Address JOSEPH CENTRELLA Owner Owner's Name information is required for every MARSTONS MILLS MA 02648 2/24/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):. * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: g -116" SERS ❑ leaching galleries number: ❑ leaching trenches number, length: El Teaching fields. number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: — t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 82 CINDERELLA TERRACE Property Address JOSEPH CENTRELLA Owner Owner's Name information is required for every MARSTONS MILLS MA 02648 2/24/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.). Comments (note condition.of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 15- 16" HIGH CAPACITY 160OBD(H-20) BIODIFFUSERS. NO SIGNS OF OVERLOADING OR HYDRAULIC FAILURE. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool .Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts R Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 82 CINDERELLA TERRACE Property Address . JOSEPH CENTRELLA Owner Owner's Name information is MARSTONS MILL: required for every MA 02648 2/24/2020 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 soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 82 CINDERELLA TERRACE Property Address JOSEPH CENTRELLA Owner Owner's Name information is required..for every MARSTONS MILLS MA 02648 2/24/2020 page. City/Town 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 t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts iip Title 5 Official Inspection Form is Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 82 CINDERELLA TERRACE Property Address JOSEPH CENTRELLA Owner . Owner's Name information is required for every MARSTONS MILLS MA 02648 2/24/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 132" feet Please indicate-all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If ciecked, date of design plan reviewed: Date /10 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: Checked w' - ❑ e with local excavators, installers (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: PLAN DATED 10/13/10 SOIL LOG SHOWS NO GROUNDWATER OBSERVED DOWN 132" Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 I Commonwealth of Massachusetts 11? Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 82 CINDERELLA TERRACE Property Address JOSEPH CENTRELLA Owner Owner's Name information is required for every MARSTONS MILLS MA 02648 2/24/2020 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of:. ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 18 of 18 f ca 3/3/2020 ShowAsbuilt(17OOx28OO) CY LOCATION SEMACE PERMIT NO. VILLAGE 047-//7 /1?Arsforis /rJi��S INSTALL.ER'S NAME i ADDRESS *nlf�R /oS f2C �{A/nS>N1J�� I771J BUILDER OR OWNER DATE PERMIT ISSUED DATE COM►LIANCE ISSUED__ 0 https:Hitsq ldb.town.barnstable.ma.us:8431/Home/ShowAsbui It?mp=047117&sq=1 1/1 r 3/3/2020 ShowAsbui It(1700x 2800) i TOWN OF BARNSTABLE LOCATIO - SEWAGE«:W VILLAO - ASSESSGOR;S MAP AR IN47ALLER'S NAME&PHONE N0. All /'SOB �Y SEPTIC TANK CAPACITY LEACIUNG FACAATY: NO.OF BEDROOMS OWNER PERMIT DATE COMPLIANCE DATE: 9epesalim DutmceBawem ILe: Maximum Adjusted t3rouadwmerTable to the Bottom of I.ea:hiog Facility Fat Prlvam Water Supply Wel I end LarLing Fnciliry(If esy wells exin o0 .sim m wkhtn 200 faa of leaching f'liry) Pea Edge of Wetland and Laehing Fuiliry(If xny wctloWs must wltlun 300 fat of kachmg{f�/i�yy) _Feet FURNISHED BY��/YI��� DP7 HOL615 / F- '3 as B ,D3 el 3s ceq 04 �3 https:/fitsg Idb.town.barnstable.ma.us:8431/Home/ShowAsbuilt?mp=047117&sq=3 1/1 Ot THE Town of Barnstable Barns&61e``" ti Regulatory Services Department ;micaC'j M Y + BARNS'fABLE, + "'"IS Public Health Division i639. ���' ArfD MA't a 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.GeilerLeach pit is only3f )undwagter,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7006 1810 0000 3525 5224 May 2, 2011 David Holt Today Real Estate 1533 Falmouth Rd(Rte 28),. Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 r The septic system 82 Cinderella Terrace, Ali ,MA,was last inspected on 4/26/2011,by Shawn McElroy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to overloaded or clogged SAS • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER THE BO OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures\1-1 SAMPLE 60 Day Deadline.doc e� 1-0—Lj/N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 82 Cinderella Ter Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 4-26-11 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: I I Shawn Mcelroy Name of Inspector Upper Cape Septic Service Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 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 4-26-11 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. II t5ins•11/10 Title 5 Official Inspect on Form:Subsurface Sewage Disposal System�I•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 82 Cinderella Ter Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 4-26-11 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): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 82 Cinderella Ter Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is Marstons Mills MA 02648 4-26-11 required for every ' page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N' .❑' ND'(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a mannerwhich 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 6f a bordering vegetated wetland or a salt marsh t5ins•11/10 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 'GSM 82 Cinderella Ter - Property Address Bank Owned - - -(Contact David Holt @ Today Real Estate 1 800 966 2448 Owner Owner's Name information is required for every Marstons Mills MA 02648 4-26-11 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 serptic 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: a 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments „ 82 Cinderella Ter Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 4-26-11 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 If 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 Thes..ystem owner should contact the appropriate regional office of the Department. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 82 Cinderella Ter Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 4-26-11 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 CM 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-11/10 Title 5 Official Inspection Form:Subsurface -Sewage Disposal System Page 6 of 17 P Y 9 Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 82 Cinderella Ter Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 4-26-11 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Well Water Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 3-2011 ,. .. _ r , _ 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 82 Cinderella Ter Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 4-26-11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/user Date Other(describe below): General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No t If yes, volume pumped: . gallons How was quantity pumped determined? S 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary.Assessments 82 Cinderella Ter Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 4-26-11 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: 1983 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 12' feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints,venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 4 feet r' Material of construction: t ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 12" t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 82 Cinderella Ter Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 4-26-11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 0 Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-11/10 Titte 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 l Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary_Assessments ,M 82 Cinderella Ter Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 4-26-11 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: 1983 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 12" feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints,venting, evidence of leakage, etc.): Good condition. 4, Septic Tank(locate on site plan): Depth below grade: 4 feet t' Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 12" t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Y ry ;M 82 Cinderella Ter Property Address P Y Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is Marstons Mills MA 02648 4-26-11 required for every ' page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank p (cont.) Distance from top of sludge to bottom of outlet tee or baffle 20' Scum thickness 0 Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Lt5in.•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 82 Cinderella Ter Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 4-26-11 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 1. t5ins-11/10 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 82 Cinderella Ter Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 4-26-11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box in good condition with obvious signs of back-up with stain lines above inlet invert. 4 Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts e Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 82 Cinderella Ter Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 4-26-11 page_ City/Town . State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1-1000 gal ❑ =�` leaching chambers �" y,. h " ` 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.): Leach pit has clear signs of failure with stain lines 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 82 Cinderella Ter Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 4-26-11 � page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 82 Cinderella Ter Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 4-26-11 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 • r � �7 " t I t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official- Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 82 Cinderella Ter t Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 4-26-11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ti, r ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 50' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: Checked with local excavators, installers-(attach documentation) ® Accessed USGS database - explain: F You must describe how you established the high ground water elevation: USGS and town "maps show groundwater at greater than 50'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 82 Cinderella Ter Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 4-26-11 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ❑ Inspection Summary: A, B, C, D, or E checked ❑ Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ❑ System Information—Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION r SEWAGE VILLAG i ASSESSO 'S MAP&PARCE _ _ �z, . ! INSTALLER'S NAME&PHONE NO. / GB SEPTIC TANK CAPACITY 11�0 9 LEACHING FACILITY: size) NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance etween 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 G" Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facili Feet FURNISHED BY t f` 140L or _ s® �, TOWN OF BARNSTABLE p ,OCATION 0 y? 4c' C(el' 9 �c! /2✓ SEWAGE 'ILLIkGE / s /s ASSESSOR'S MAP& LOT_ - ---- NSTAL4EPVS NA X-&PHONE NO. EP71C TANK CAPACIT. Q EACY.III,TG PMCILM, (type) / ` (sizc) TO, Or-',BEDROOMS— ilTiX DER OR OWNER ERMITDAM COMPL A.NC.E DATE: eparation Disumce Between thc: Aaximurn Adjusts d Groundwater bble to the Bottom of Leaching ac;ility eec rivate Water Supply Won and Leaching Facility (If any wells exist an site or within 200 feet of leaching facility). Ago of Wetland and Leaching Facility(if any wetlands exact within 300 feet of le hing.facility) �/ usnishcd by Qc,ck A - 0P /� 7 , I � s ' No. Fee THE COMMONWEALTH OF MASSACHJJSETTS Entered in cYPUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTSs r , �pYicatiori for VsposaY *pstent Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address r Lot No. 61jQr Owner's Name,Address,and Tel.No.% /17ee__A� r� ` Assessor's Map/Parcel Installer's a Address and Tel. o.(�lJ� V !PW e' �Designer's Name,Address,and Tel.No./ O' �o�T� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) _ gpd Design flow provided � gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 7^t W S 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 b=4.11n!s� Board of Health. r_1 m Date Application Approved by Date Application Disapproved by Date A�e for the following reasons Permit No. Date Issued No. F' Fee THE lzVIMONWEALTH OF MASSACHI�IETS Entered in comp ter: PUBLIC HEALTH DI ON -TOWN OF BARNSTABLE, MASSACHUSETTS Yes .. •pplication for WpoBal 6pstetn Construction 3permit k Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete Sysfem ❑Individual Components Location Address or Lot No. '�/�a%` Owner's Name,Address,and Tel.No% 14— o Assessors Map/Parcel 0 Installer's Name,Address,and Tel. o. 0—,w ,�j/' (+�I Designer's Name,Address,and Tel.No./ 0, /J Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures I Design Flow(min.required) �j gpd Design flow provided � (p,Q gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank er—z� /��1� Type of S.A.S. '� w �-� I-Fl /154S < Description of Soil i Nature of Repairs or Alterations(Answer when applicable) �"� Z7 dX S, ' Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in h 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 Board of Health. ^ = e Date Application Approved by Date Application Disapproved by Date for the following reasons 6 Permit No. Ub Date Issued ---.------------------------- --------— -- .------.--_------------------------ ------------------------------ . THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site,>Se3Arage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by 1-z11111xxa,,v 's at has been constructed acc9r ance with the provisions of Title 5 and Vie-for}DisposaLSystem Construction Permit No. )/ ated Installer Designer �QV�A_✓'' #bedrooms Approved design �fl--oww, gpd The issuance of this permit shall not be construed as a guarantee that the system will func" tior� s e g ed. _ { Date. �� / 7 1 ' I Inspector --------------------------------------------- - --- . �- �� ----------------- ---------.------------------------._----.--- ---- � (/ ---- No Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Vsposal *pstem Construction permit Permission is herebyranted to Construct Repair'( Upgrade Aba do 6 g ( U( ) P P�' ( ) ( ) System located at d i and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction ►4t be compl ed within three years of the date of this permit. ; Date - Approved by 9 it n u Town of Barnstable , '"E' t. Regulatory Services Thomas F. Geiler,Director MA,% � Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 1-7 Sewage Permit# Assessor's Map\Parcel Designer: �-rid�l � ��✓ Installer: -- ' � Address: X �1 I Address: - - On //G !� was issued a permit to install a (date G (Installer) septic system at o �lw� �'r�C based on a design drawn by (address) M Ce" dated /0 G .0 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. OF % DA 1 (Installer's ignatur No. 1140 Rf6IS1 SO IT \P (Designer's Signatu e) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF CONIPL1ANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Health/Septic/Designer Certification Form 3-26-4doc i • . I Town of BArnstable. P# � 3c�V Department of Regulatory Services nxars13M Public ifealth Division Date�^ �U fAO 'UASM&��e$ 200 Main Street,Hyannis MA 02601 3 !Fp µ►:I 2" Date Scheduled v Time L� Fee Pd. • j Soil Suitability AssessM"ent.for ,fie age isposal Performed By: �.l^� � � ' Witnessed By: 4 "�` LOCATION & GENERAL INFORMATION Location Address'.(� C04 � 6E,�ff f n"r1 I Owner's Name S IEVE I ( -Y W LI l r!j,�-d�R-n.j/�- �,� Address G-CAA-tLbC&(1 t,-A Tr,-f`f, Assessor's Map/P4rcel: // I Engineer's Name NEW CONS1RUt'2ON REPAIR j Telephone# Land Use ��t � �� Slopes(%) / s Surface Stones / Z l ft Drinking Water Well �( ft Distances from: Open Water Body `` ft Possible Wec Area f g 7 l 0 Q� ft Pro Line /O ft Other ft Drainage Way perry SKETCH:(Street name,dimensiods of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) I LU E— aUo .m o - nW 1 Li. mow^N � / eta ti 1x1 1 ILl Q �-j-- 32.00 VU N 153.30 - `; / _- Parent material(ge(Ilogic) iJG� Depth to Bedrock Depth to Groundwater. Sta ding Water in Hole: N i Weeping from Pit FACe Estimated Seasonal4gh Groundwater DtTERMINATION FOR SEASONAL HIGH WATER T"LE In. Method Used: I. Depth Cibipserved standing in obs.hole: in. Depth,to Sall mottles: i in, proundwnter AdJu8tlaent tY. Depth to weeping from side of obs.hole: Adj.ActOr—,— Ad).Oroundwatt r l eVe1,,.,e. Index Well# — ReadiugDatelz Index Well levy.) i PERCOLATIiION TEST D$'p� �t'J�� Observation I Time at V Bole# Time at 6" Depth of Pere �Y ►► ..--- -- fo. 03 I Time(9"-691) r Start Pre-soak Time.@to i End Pre-soak ./'z 1. fiate MinJInch uitabiht Assessment: Site Passed — Site Failed; Additional Testing Needed(Y/N) — Site S y Original:.Public kie$Ith Division Observation Hole Data To Be Completed on Back— ***If percolafiibn test is to be condracted within 100' of wetland, :you must first notify the Barnstable C44servation Division at least one (1) week prior to beginning. DEEP OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture Soil Color Soil Other .Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel VR 41, DEEP OBSERVATION HOLE LOG Hole#_� Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) 31 � c DEEP OBSERVATION HOLE LOG Hole# N Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) USDA) (Munsell) Mottling (Structure,Stones,Boulders. Cons istency.%Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consisten ra I Flood Insurance Rate Map: 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 pervious material exist.in all areas observed throughout the area proposed for the soil absorption system? ____ o If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department Enviro mental Protection and that the above analysis was performed by me consistent with the requiraraii and experience described in 3,10 CMR 15.017. �- 1Signature Date Q:\.SEPTIC\PERCFORM.DOC l'b CAT ION SEWAGE PERMIT NO. VILLAGE 04 7-//7 INS TA LLtR'S NAME i ADDRESS o5v1-)s1.A4 le e U I L D E OWNER R OR WN R tb- _ DATE PERMIT ISSUED G DAT E COMPLIANCE ISSUED 4 � S o �J a3F�s...yo......... Na ..................... ~ THE COMMONWEALTH OF MASSACHUS19TTS BOAR® OF HEALTH 704U t ...........0F....... �� �zc�;.e9_-S_6............................................ Appliration for Uhipati al Works Tomitrurtiou amit Application is hereby made for a Permit to Construct (°- ) or Repair ( ) an Individual Sewage Disposal System at: ...:�d...--�-•----.. ...........72--- re ce--- ---------- .....................................J• ................................... Location-Address or Lot No. Owner Address a a .4.' ' gp- -_...............'! dm f.__..._... ' ... ..........�. �r• __ i...........__ . ......................_ Installer Address Type of Buildi7 Size Lot_i�? i.o v -----Sq. feet U Dwelling No. of Bedrooms.......�3................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons..... ... Showers — Cafeteria W Other fixtures ---------------------------••••• . Design Flow........................1f.G_..........gallons per person per day. Total daily flow.._...__.___._._______..- ©____._..gallons. W WSeptic Tankx-Liquid capacity A<�_gallons Length._%'_.". Width..!! '.eO`'Diameter................ Depth...+!...._.. x Disposal Trench—No. .................... Width.................... Total Length................. Total leaching area....................sq. ft. Seepage Pit No......f------------- Diameter.........e�_.` __.___. Depth below inlet. .._�; _____________ Total leaching area........ ?jG7sq. ft. Z Other Distribution box (X Dosing tank ( ) aPercolation Test Results Performed by._. a--- '^�........OCS.G..................... Date... Test Pit No. 1..... .......minutes per inch Depth of Test Pit...�.`......_.. Depth to ground water./lesa ____� Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x -----•----------------------------------------------------------------------------------------------........................................................ 0 Description of Soil-------Q-1-�-•--••• Cvcsa 15 � • ..... W ••-•••......•--tea �t. r�-e = 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 iI'X U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Co, liance has been issued by the board of health. hS;911 r`- ----------------------------- ........... Application Approved . . ___ ----------- Date Application Disap ved or he following reasons:-•••---•••..............••••------------••--•---••••-••-•••••••••--••--•••••.............-•-----•-•--............ ........................... ........ ...... •------•••-••-•----•••••--•...-••-..............---------•-•----•--------•--•._._.....••••-----------•--•-•-•-••--•--•-•-•......--•-• •............_ Date PermitNo.....................................••••---•- Date No�........�.....b.. FE$............................_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -- ........ OF.......................................................................................... Appliration for Diopooa1 Works Tonitrnrtion ramit Application is hereby made for a Permit to Construct (1) or Repair ( ) an Individual Sewage Disposal System at: Location-Address or Lot.No. ^- T Uzt' - ----- Owner----- ,ry9 +� �t<//� � ! - Z�ddress W „Cr �Q.............. t........ram, ryry c c � ....... ! Installer tY Ress UType of Building Size Lot............................Sq. feet a Dwelling—No. of Bedrdims..........................................71 p4Wp* Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons............................ Showers ( ) = Cafeteria ( ) Otherfixtures .----•------------------•----------------------•--•---"-------------------•--------------........_...-7 ........ 4 ........ Design Flow____._.-ff,n...........................gallons per,p4roon per dW.0 Yipfdl daily flow............................................gallons. WSe jc Tank—Liquid;Ca ity............gallons Tength................ Width................ Diameter---_- .G. Depth................ x Disposal Trench—No...................... Width.................... Total tehgth.................... Total leaching area....................sq. ft. IP ..__.. Diarf-Pter.................... Depth below i et_................_.. Total jvg*Tg tea.. q. t. Seepage rt No............... � L_9 ___s f z Other DistributiXn box ( ) J� gl, Alle"( ) �ie9 P o"'good. aPercolation Te Results Performed by-----------.............................................................. Date......................................... Test Pit o. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.......... . (Tq Test Pit No. 2................minutes per inch Depth of Test�it,...._..p.t__.....:Ue dc(<grot;�ifiW � ��j_.. M '... C3� .... .yBti.Z3...... la ..... ...................... .. Descripti2p.of,§6il lr �• . �.,.� Rx �.a �......-------• ..s.....................lX ----- ;, --- x V ....------••--•------•----•-------•-•-------------------------------------"-••....--------....-----------•••--••......------------'-----.............................................................. UW .............. ``'"-----it----------------------------------------- ------------------------------•----------------------------------------•--------•---------•-----------------------. 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 TIT1E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of �C}omp fiance has b�essued by the board of health. Signed..................................................................................... a ---------- te- Date Application Approved�!. - ------------•-----------------.... ------------------------------------------------- ----------------------------------------------........... ...............................•----. ..... �. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF...��'',..s r. .ss. ....................................---' Tatifirab of Tomplianrr THIS IS TO CERTIFY, Th) 7p Ipp v by......_.._.. ,ylt l Sewage Disposal System constructe. ...d ( ) or Repaired ( �-......'"Y ) -'----'-- ----••------- --- -------'-- .. ....... .................. 11 ...................-••--••-•---------'-------•-..... ----------------= ..---- ------- -•------...._-_..._ t has been installed in accordance with the provisions of TIT j d� TKe State Sanitary Co . as escr>bed in the application for Disposal Works Construction Permit No......................................... dated---------------------_.......................... THE ISSUANCE F THIS CERTIFICATE SHALL NOT BE CONSTRUED S A GUARANTEE THAT THE SYSTEM WILL iJN N SATISFACTORY. DATE.... .. Inspector.. ..... --'---------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....:.....................................OF..................................................................................... ,• No......................... FEE........................ Diopo l Workii QX11t n rrmit Permissionis hereby granted---------------•-------....................--..............................................................-•---------•••••-•--------...------. ........ .....-- to Construct ( "S or Repair an_,individual Sewag Aiisp� yste �, at No. `GT o� ,wC Street as shown on the a li on for Disposal Works Construction Permit No--- --_�_ ..__..... Dated......... .._.._...:...... ................. ........................... .....----•-••-•------•------•----------....----'---------.--..---- Board of Health DATE-.......... -• ---•-' ..................................................... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS �- ' � • ' } MARSTONS MILLS + !/ RACE LANE Z fly � S SIT v 7 h O v V -J V� LOCUS MAP LOCUS INFORMATION \ E REF: LCP #C121820 1 ARCEL ID: MAP 047 PAR. 017 /II OPERTY IS IN ZONE II O0 SEPTIC SYSTEM r 1 REPAIR PLAN v EX15T. I ,000G LOCATED AT: 1nr •r (0- SEPTIC TANK 82 CINDERELLA TERRACE p 0 82 . MARSTONS MILLS, MA. ���/ 84 PREPARED FOR MARTIN Map Port �`�� OCTOBER 13, 2010 8�j SCALE: 1" = 20 ft. 0 0k �A wee T —1 # 8 OF� ss9l' ii ® — t o D M. TH 2 EY 90 " No. 1140 ` / sl /S `�NITAR�a� �D.►3 ,1 15T. LEACH PIT DARREN M. MEYER, R.S. } (NOTE 10) P.O. BOX 981 9G 92 EAST SANDWICH, MA. 02537 TBM = (508)362-2922 E�. 95. 0 BULKHEAD FOUND, 94 SHEET 1 OF -2 1 NOTE: TO PREVENT BREAKOUT, THE PROPOSED DESIGN CRITERIA , NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:95.0 FOR A DISTANCE OF 15' AROUND THE NUMBER OF BEDROOMS: 3 BR DESIGN PROP IS IN ZONE II) PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. SOIL TEXTURAL CLASS: CLASS I DESIGN PERCOLATION RATE: <2 MIN/IN ' T.O.F. EL.=96.0 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER DAILY FLOW: 110 G.P.D/BR. DESIGN FLOW: 330 G.P.D. OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G. • F.G. EL.=95.0f F.G. EL.=94:0f F.G. EL: 94.Ot F.G. EL: 95.0-94.0(MAX.) GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) fVENT PROPOSED SEPTIC TANK: 200% X 330gpd =' 660GPD (USE EXISTING 1,000 GAL CAPACITY) L = 10't 9" MIN COVER/ LEACHING AREA REQUIRED: (330)/0.74 = 445.94 S.F. 36" MAX COVER L = 4 L = 10'(MAX) INSTALL TWO INSPECTION PORTS (MIN.) ® S=IX (MIN.) ® S=1X (MIN.) ® S=1% (MIN.) DISTRIBUTION BOX: 3 OUTLETS (MINIMUM) 4"SCH40 PVC. 4"SCH40 PVC 4"SCH40 PVC PRIM ARY S.A.S. 10" 14• s' 11.2" To USE 3 ROWS OF 5 - 16" ADS 1600BD BIODIFFUSER H-20 UNITS INVERT INV.= 92.15 aa"uoUID _ NO STONE AND EXTENDED 0.75' W CONTOURED WEDGES LEVEL INV.=91.90 E E / M _ BOTTOM AREA: GENERAL USE APPROVAL FOR 4.73 SF LF OF BIODUFUSER G BAFFLE INV.=91.20 _ ( / ) AS BA 3 ROWS OF 5 UNITS A7 6.25'/UNIT + 0.75' WEDGE - 32.0'/ROW INV:=91.00 (BIODIFFUSERS) 15 UNITS x 6.25 LF x 4.73 SF/LF = 443.43 SF INV.=91.40 SOIL ABSORPTION SYSTEM (PROFILE,) (CONTOURED WEDGE) 3 ROWS x 0.75' x 4.73 SF/LF = 10.64 SF T EXIS ING 1.000 GALLON SEPTIC TANK TOTAL AREA = 454.07 SF RESTORE VEGETATIVE COVER DESIGN FLOW PROVIDED: 0.74GPD/SF(454.07SF) = 336.01 GPD>330 GPD req'd EXISTING SEWER .OUTLET BACKFILL WITH CLEAN PERC SAND TO TOP OF CHAMBERS 75" NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INVERTS PRIOR TO CONSTRUCTION �•'''' !," ' .39 2) D-BOX SHALL BE SET LEVEL AND TRUE TO INV. ELEV.= 91.0AL GRADE ON A MECHANIC ALL COMPACTED S IX BOTTOM ELEV.= 90.06 ~ INCH CRUSHED STONE BASE AS SPECIFIED IN UIE .-EXISTING SUI TABLE 310 CMR 15.221 2 BREAKOUT=TOP ELEV.=91 2.83' MATERIAL 3) REPLACE EXISTING 1,000 GALLON SEPTIC 5 MIN. ABOVE BOTTOM OF T.P. EXCAVATION OR.G.W. EFFECTIVE WIDTH = 3 x 2.83' = 8.49' I _ TANK WITH 1500 GALLON SEPTIC TANK (7.56' PROVIDED) USE 3 ROWS OF 5-HIGH CAPACITY f 76" IF FAILED, DAMAGED, OR UNDERSIZED. BOTTOM OF TESTHOLE- EL.=83.0 ADS 160OBD BIODIFFUSER UNITS-NO STONE 4) INSTALL INLET & OUTLET TEES AS REQUIRED (H20) W/ CONTOURED WEDGE PROFILE SEPTIC SYSTEM PROFILE TYPICAL SECTION N.T.S. ".*a 16GENERAL " NOTES: � ���,�� of Mgss9� SOIL LOG 11.2" 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL yG P#: 13034 BOARD OF. HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS DA M DATE: AUGUST 19, 2010 34"----►I OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE No. 1140 SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE. #1614 LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: WITNESS:. DAVE STANTON, BARNS. BOH SECTION END CAP - 310 CMR 15.405 (1) (B): � 1) A 0.61 - r. VARIANCE FROM 310CMR15.221(7) TO ALLOW LEACHING TO BE C/51 Elev. TP- 1 Elev. TP-2 16" HIGH CAPACITY 160OBD H-20 BIODIFFUSER UNIT 3.61 FT OW GRADE VS RE 'D 3 FT. H2O ENT PROVIDED S a� Depth Depth ( ) BELOW Q ( /V ) ANITAR� 94.0 0" 94:25 0" SEWAGE SHALL NOT BE A 3 TOEI INSPECTION AND PPROVAL BY THE BOARD BACKIFILLED PRIOR AND THE DESIGN ENGINEER. LOAMY SAND A LOAMY SAND MODEL 16" HICAP ��-��- 93.58 tOYR 4 2 10YR 4 2 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOS SHOWN HEREON B 5" 93.75 B 6" LENGTH 76" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. LOAMY SAND LOAMY SAND EFFECTIVE LENGTH 75" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. - } 10YR 6/8 10YR 6/8 SIDE WALL HEIGHT 1 1.2" DIFFER SLIGHII_Y FROM ACTUAL PRODUCT APPEARANCE. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO 91.58 1 29" 91.75 C1 30" OVERALL HEIGHT 16" NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. OVERALL WIDTH 34" 4640 TRUEMAN BLVD MED. SAND MED. SAND HILLIARD, OHIO 43026 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED 2.5Y 6/2 2.5Y 6/2 13.6 CF • TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. CAPACITY (101.7 GAL) ADVANCED DRAINAGE SYSTEMS, INC. f 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. i PROPOSED SEPTIC SYSTEM/SITE P LA N 10. EXISTING LEACH PIT TO BE PUMPED, CRUSHED AND FILLED PER TITLE V. PERC 0 89.50 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 83 CINDERELLA TERRACE, MARSTONS MILLS, MA 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY 83.0 132 83.25 132" AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY PERC RATE <2 MIN/IN. ("C" HORIZON) Prepared for: Mike Dedecko 13. NO PRIVATE WELLS WITHIN 150 FT. OF PROPOSED LEACHING NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN 14. ALL PIPING TO BE 4" SCH 40 ® 1/8"/FT (UNLESS SPEC. OTHERWISE) DARRENM.MEYER,R.S. Eco-Tech Environmental NTS D.M.M. 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW • I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 PO BOX981 to conduct soil evaluations and that the above analysis has been performed by me consistent with the (508) 364-0894 DATE: CHECKED SHEET NO. FOR THE USE OF A GARBAGE GRINDER EAST SANOW/CH,MA 02537 requirements of 310 CMR 15.017. I further certify that I have passed the Soil Eval. Exam in October, 1999. N P 508-362-2922 1 O/1 3/1 O D.M.M. 2 of 2 16. NO WETLANDS WITHIN 100 FT. F PR LEACHING { u i ►#AS-*DNE +3+►r A s.... }z'a, '" . ',^�'0-:7" a, Z - .,. , , 1 4%.I. I i s x` I v r1r IOOO ^s t e, •�'} 1000 — GAL I s{{ GAL. . I _ _`_. _e;J ; a•� -.t. PR£CASI, O!t I i , SEPTIC 6 ' i®•�,# BLOCK 4 TANK ) SEEPAGE PIT 4 FOUNDATION � t �`•`' ¢ c I IA WAS"EO STONE ELEVATION SKETCH '— ` ' ' , SCALE , I1., 4, 3 ' 1 i. ......r.,w...+�rws•+.+s.•a�.,...ws-.-*..••�+r•M^+* �.rw:.- ue_c.r,...,.:'�M�W�'..,....,�,„.....,........,...r......-s.-..., ...�..:,.,.,. ...�....._. ,.�_...:.�,r'p-.��@ '. , • ):' I :'�, ,.a,,,,.i p..,.. ..*,... .tea"` • ,...w+.. ,,. ..�r� ,4 , R } a r , t / r M � TIN r t z - ;ham ✓' ,a, ,� ,��. y " tl , >Y op AL. ,,. ,.+ .< Al R > r 0. ,.a. ". - ':ter :a,` ,. `,. � .. .,,:+,.:. � ;' .^ ,. � :r,.•+-. .f::•L"`„a.--.:..:.:s ,.s lw._' ... .. ti .,,..e A �..., r"+` .. 1'"�.t. t -.W .. +. 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