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HomeMy WebLinkAbout0016 KNOLLWOOD LANE - Health 16 Knollwood Lane Marstons Mills P A = 101 069 i 1' TOWN OF BARNSTABLE LOCATION �IO )k;n 0OWM, IAA SEWAGE # VILLAGE M- M-I II ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY I o?Jb LEACHING FACILITY: (type) ��� �X� (size) a �Otit -.ENO. OF BEDROOMS 3 - BUILDER OR OWNER 1 �; 1A�e 1 OMAS PERMTTDATE: 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 f cility) Feet Furnished by 1 S w t�/ OnFG/ Y 4 C' t y . ► A � a a 3 aq 33 as 3 y3 19 C 3o aS ,r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 16 KNOLLWOOD LN Properly Address ZAPPALA Owner Owner's Name information is required for MARSTONS MILLS MA 6-10-11 every 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.he end of the form. Important:Whenfilling out A. General Information When forms to the computer;use 1. Inspector: f (l f/� VT only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. DOUGLAS A BROWN INC Company Name � P.O. BOX 145 Company Address CENTERVILLE MA 02632 City/Town State Zip Code 508-420-4534 S14297 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 -3 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: En >^� °- (I Passes e•_ ®, ❑ Conditionally Passes ❑ Fails r Ui Needs Further Evaluation by the Local Approving Authority _L 8/25/11 Inspector's Si re 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. Sins•W= Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 1 of 17 I Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form=Not for Voluntary Assessments M 16 KNOLLWOOD LN Property Address ZAPPALA Owner Owner's Name information is MARSTONS MILLS required for MA 6-10-11 every page. Cityff own 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: AT THIS TIME SYSTEM MEETS MINIMUM PASSING REQUIREMENTS, FUTURE PERFORMANCE CAN NOT BE PREDICTED UNDER THE SAME OR INCREASED USE(THE HOUSE HAS BENN VACANT FOR SOME TIME) 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 exfiitration 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): bins•09M8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form=Not for Voluntary Assessments E M 16 KNOLLWOOD LN Property Address ZAPPALA Owner Owner's Name information is MARSTONS MILLS required for MA every page. C¢y i own 6-10-11 State Zip Code Gate 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): ob struction is removed ❑ Y ❑ N ❑ ND(Explain below): b x leveled r replaced ❑ Y n N ❑ ND(Explain below): ❑ distribution o iso ❑ 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•09M Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 3 of 17 • a. Commonwealth of Massachusetts �9�p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 16 KNOLLWOOD LN Property Address ZAPPALA Owrer Owner's Name information is MARSTONS MILLS required for MA everrr page. �rtyl- 6-10-11 Stale 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: ❑ T he systern 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 AS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ Z, 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 dogged SAS or cesspool n Z 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 Y day flow t5ms-09P38 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form MYSubsurface Sewage Disposal System Form=Not for ,.ota^ Assessments 16 KNOLLWOOD LN Properly Address ZAPPALA Owner Owner's Name information is MARSTONS MILLS required for MA 6-10-11 every page. ultyfrown State Zip Code Date of inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Z Any portion of a cesspool or privy is within 50 feet of a private water supply "� well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis- and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine What will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ 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 I I 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. t:ms•09108 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 16 KNOLLWOOD LN Property Address ZAPPALA Owner Owner's Name information is MARSTONS MILLS required for MA every page. City/Town 1 State Zip Code Date ate 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 ❑ f�71 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) Z ❑ 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? 0 ❑ 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? ❑ 2 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): DESIGN flaw based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins-09,Da Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form=Not for Voluntary Assessments 16 KNOLLWOOD LN Property Address ZAPPALA Owner Owner's Name information is MARSTONS MILLS required for MA 6-10-11 every page. Crtyi I own State Zip Code Date of inspection D. System Information Description: ACCORDING TO AS-BUILT CARD SYSTEM CONSISTS OF A 1000 GALLON TANK D-BOX AND A 6X6 LEACH PTI WITH 2 FT OF STONE 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)): Detail: HOUSE VACANT Sump pump? ❑ Yes ❑ No Last date of occupancy: 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.): GreaCe trap present? El 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•09108 Title 5 Official Insp ection 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 16 KNOLLWOOD LN Property Address ZAPPALA Owner Owner's Name information is MARSTONS MALLS MA required for every page. CItyi I own Stale ZiCode Date p te of inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 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): t5 ns•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts WON Title 5 Official Inspection Form Subsurface Sewage Disposal System Form,-Not for Voluntary Assessments 16 KNOLLWOOD LN Property Address ZAPPALA Owner Owner's Name info-mation is required for MARSTONS MILLS MA every page. Crtyi I own 610-11 State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known) and source of information: APPEARS TO BE ORIGINAL FROM 1985 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑cast iron ❑40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 2 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: I U GALLON Sludge depth: 4" t5ins•09M 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 16 KNOLLWOOD LN Property Address ZAPPALA Owner Owner's Name information is MARSTONS MILLS required for MA every page. cdyill own 6-10-11 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 28 Scum thickness LIGHT 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? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): RECOMMEND PUMPING EVERY 2-3 YRS 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•09M Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 10 of 17 h Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form=Not for Voluntary Assessments 16 KNOLLWOOD LN Property Address ZAPPALA Owner Owner's Name information is MARSTONS MILLS required for MA 6-10-11 every page. City(fown 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 El 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 t5ms•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for r Voluntary,Assessments , 16 KNOLLWOOD LN Property Address ZAPPALA Owner Owner's Name information is required for MARSTONS MILLS MA 6-10-11 every page. city/I own State Zi Code P Date of inspection D. System Information (con t.) 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.): BOX COULD USE A RISER INSTALLED/SLIGHT CORROSION PROBABLY DUE TO AGE 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: It-ins•OM Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 12 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Fo:m=Not for Voluntary Assessments 16 KNOLLWOOD LN uv�� Property Address ZAPPALA Owner Owner's Name information is MARSTONS MILLS required for MA 6-10-11 every page. Cliyill own 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: ❑ !eaching 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.): PIT WAS DRY AT TIME OF INSPECTION INDICATING LEACHING/STAIN LINE WAS AROUND 10"FROM BOTTOM OF INLET PIPE , STAIN LINE WAS HARD TO DETERMINE DUE TO IT NOT BEING A VERY DARK LINE BUT TO THE BEST OF MY KNOWLEDGE IT WAS @10" 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•09N8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Se::-age Disposal System Form=Not for Voluntary Assessments 16 KNOLLWOOD LN Property Address ZAPPALA Owner Owner's Name information is required for MARSTONS MILLS MA 6-10-11 every 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(dote condition ii toil soil, Signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ns•09.08 Title 5 Official Insp ection 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 16 KNOLL WOOD LN Property Address ZAPPALA Owner Owner's Name information is MARSTONS Mi�LLS MA required for 6-10-11 every page. t dyi I own Smie 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: LJ hand-sketch in the area below ® drawing attached separately t5ins•09A8 Title 5 Official Inspection Form:Subsurface Sewage Disp osal posal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forme Not for Voluntary Assessments 16 KNOLLWOOD LN Property Address ZAPPALA Owner Owner's Name information is MARSTONS MILLS required for MA 6-10-11 every page. Cityrown 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: 20 FT+ feet Please indicate all methods used to determine the hig h ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 6-2011 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. 5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 IL Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal Sy stern Form=Net for Voluntany Assessmen ts 16 KNOLLWOOD LN Property Address ZAPPALA Owner Owner's Name information is MARSTONS MILLS required for MA 6-10-11 every page. Cltyi I own 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 i5ins•0N8 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Assessing As-Built Cards Page 1 of 1 TOWN OF BARINSTARLE LOCATION l to O/ W VO0 1�+'�t, SEWAGE # VILLAGE M. M 1 ASSESSOR'S MAP& LOT/0/ ' 5 INSTALLER'S NAME&PHONE NO. C smwnc T Ar:; cAPAcrI. LEACHING FACU rry: (type) >e td /tom (size) STo•�e NO,OF BEDROOMS 3 BUILDER OR OWNER--- 1-14e-,4 JI4e ?,q PERMUDATE: 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 Edg e of Wetland and Leaching Facility(If any wetlands east within 300 feet of leaching f ility) Feet Furnished by .� co �1 t e�k a A �B 33 a 3Y a8 3 y3 12 C http://town.bamstable.ma.us/Assessing/HMdisplay.asp?mappar=101069&seq=1 8/25/2011 `a Commonwealth of Massachusetts . Title 5 Official Inspection Form ~ Not for Voluntary Assessments— Subsurface Subsurface Sewage Disposal System Form Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated 611512000. Inspection forms may not be altered in any way. A. Certification Important: /7 t When filling out 1. Property Information: forms on the computer,use 16 Knollwood Lane only the tab key Property Address to move your Timothy&Sarah Alty cursor-do not Owners Name use the return key. 16 Knollwood Lane Owner's Address 4:1 Marstons Mills MA 02648 Cityrrown State Zip Code Date of Inspection: 05/03/06 Date 2. Inspector: Mike Hudson Name of Inspector ^-. Septic-wiz Environmental Services Company Name 31 Midway Drive rt Company Address --m; Centerville MA 0263877 Citylrown State Zip Code, 508-367-5669 r Telephone Number Certification Statement: I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of 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 16.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority +;;? 05/05/06 I pector's/Sionfiture 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. 16 Knollwood'Lane-T5 Inspection.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 16 f Commonwealth of Massachusetts . Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 16 Knollwood Lane Property Address Marstons Mills MA 02648 City/Town State Zip Code Alty 05/003/06 Owner's Name Date of Inspection Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: ,I B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: 16 Knollwood Lane-T5 Inspection.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cunt.) 16 Knollwood Lane Property Address Marstons Mills MA 02648 Cityrrown State Zip Code Alty 05/03/06 Owner's Name Date of inspection B) system Conditionally Passes(coat.): tj lip ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Bard 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 16 Knollwood Lane-T5 Inspection.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 f Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cunt.) 16 Knollwood Lane Property Address Marstons Mills MA 02648 Cityrrown State Zip Code Alty 05/03/06 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health(coat.): 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's*. Method used to determine distance: *"This system passes if the well water analysis, performed at a DEP certified laboratory,for c oliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 16 Knoltwood Lane-T5 Inspection.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 4 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 16 Knollwood Lane Property Address Marstons Mills MA 02648 CitylTown State ZipCode Alty 05/03/06 Owner's Name Date of Inspection D System Failure Criteria Applicable to All stems: Y PP 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 ❑ 0 Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.) Yes No ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 16 Knollwood'Lane-T5 Inspection.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form_ Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 16 Knollwood Lane Property Address Marstons Mills MA 02648 Cityrrown State Zip Code Alty 05/03/06 Owner's Name Date of Inspection E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes"or"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. 16 Knolhmood Lane-T5 Inspection.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 I,. a Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Checklist 16 Knollwood iLane Property Address Marstons Mills MA 02648 Cityrrown State Zip Code Alty 05/03/06 Owner's Name Date of Inspection 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(3)(b)) 16 Knoltivood Lane-T5 Inspection.doc-11/2004 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 7 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments � Subsurface Sewage Disposal System Form M C. System Information 16 Knollwood Lane Property Address Marstons Mills MA 02648 Cityrrown State Zip Code Alty 05/03/06 Owner's Name Date of Inspection 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 Number of current residents: 3 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 ears usage d 2004-490 GPD g ( y g (gpd)): 2005416 GPD Sump pump? ❑ Yes ® No Last date of occupancy: occupied 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: Last date of occupancy/use: Date Other(describe): 16 Knollwood lane-T5 Inspection.doc-11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cost.) 16 Knollwocd(Lane Property Address Marstons Mills MA 02648 Cityrrown State Zip Code Alty 05/03/06 Owner's Name Date of Inspection General Information Pumping Records: Source of information: Water Pollution Control, pumped 99, 02, 04 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: N/A gallons How was quantity pumped determined? N/A Reason for pumping: N/A Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 21 years, installed fall 1985 via as-built and engineering plan on file at Barnstable BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No 16 Knollwood Lane-T5 Inspection.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 16 f Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments 30 Subsurface Sewage Disposal System Form lug C. System Information (cont.) 16 Knollwood Lane Property Address Marstons Mills MA 02648 Cityrrown State Zip Code Alty 05/03/06 Owner's Name Date of Inspection Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting,evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 2'feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: N/A years Is age confirmed by a Certificate of Compliance?(attach a copy of ❑ Yes ❑ No certificate) Dimensions: 4'10"Wx8'6"Lx5'8"H, 1000 gallon Sludge depth: 4' 10"-2"thickness Distance from top of sludge to bottom of outlet tee or baffle 30" Scum thickness <111 Distance from top of scum to top of outlet tee or baffle 10" Distance from bottom of scum to bottom of outlet tee or baffle 8" How were dimensions determined? measured stick w/rag, tape, flashlight 16 Knollwood Lane-T5 Inspection.doc•11/2004 T-itie 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 I Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ,.` Subsurface Sewage Disposal System Form M C. System Information (cont.) 16 Knollwood Lane Property Address Marstons Mills MA 02648 City/Town State Zip Code Alty 05/03/06 Owner's Name Date of Inspection Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): System did not need pumping at time of inspection, tees were present in working condition, all levels normal, no evidence of leakage IGrease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade:, Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): 16 Knollwood Lane-T5 Inspection.doc•11/2004 Tale 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 16 Knollwood Lane Property Address Marstons Mills MA 02648 City/Town State Zip Code Alty 05/030/6 Owner's Name Date of Inspection I Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert even w/outlet 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 was level, cover cracked so cover was replaced with 2 concrete patio stones as covers are not being manufactured for that particular size d-box.There were no solids or evidence of leaking, levels were normal. D-box 27"below grade, recommend a riser Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 16 Knollwood Lane-T5 Inspection.doc-11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information (cunt-) 16 Knollwood Lane Property Address Marstons Mills MA 02648 City7fown State Zip Code Alty 05/03/06 Owner's Name Date of Inspection Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: (1)6'R w/2' stone ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): soil conditions normal, signs of hydraulic failure, no ponding damp soil or abnormally lush vegetation. Pit had 47'of water w/the stain line 8"below inlet pipe. If heavy water usage continues(over 330gpd)it is my,feeling the system will need replacing within 2-4 years. 16 Knollwood Lane-T5 Inspection.doc•11/2004 Tale 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cunt.) 16 Knollwood Lane Property Address Marstons Mills MA Cityrrown State Zip Code Alty 05/03/06 Owner's Name Date of Inspection J Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): r 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.): JA 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.): 16 Knol-Wood Lane-T5 Inspection.doc-11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 14 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 16 Knollwood Lane Property Address Marstons Mills MA 02648 cityrrown State Zip Code Alty 05/03/06 Owner's Name Date of Inspection Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet Locate where public water supply enters the building. C 16 Knoltwood Lane 6' Radius Leachpit Marstons Mills, MA 02648 w/ 2' stone 3 Bedroom 3 Op Rear oP House Deck A B 1 O O 2 D-Box A l-29' B 1-33' 1000 Gallon H-10 2-34' 2-28, Septic Tank 3-43' 3-18, 4-30, C 4-25' 16 Knoihvood lane-T5 Inspedion.doc•11/2004 Tile 5 Official inspection Form:Subsurface Sewage Disposal System Page 15 of 16 Commonwealth of Massachusetts Title 5 Offic-ial Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M sv>y` C. System Information (cont.) 16 Knollwood Lane Property Address MArstons Mills MA 02648 CitytTown State Zip Code Ally 05/03/06 Owner's Name Date of Inspection Site Exam: Slope r10 S%ci+-e- G Surface water N I rt J Check cellar 16 Shallow wells t J Estimated depth to ground water: Z,o 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: 05/05/06 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: reviewed engineer plan soil log, ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: reviewed USGS topo map and USGS groundwater resource map You must describe how you established the high ground water elevation: Reviewed soil log on engineer plan, no water encountered at a depth of 11.9', USGS maps indicate site at an elevation of 66' , nearest open water at an elevation of 40', estimate depth to ground water a minimum of 20'+ 16 Knollwood Lane-T5 Inspection.doc-11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 16 of 16 I� f Health Complaints 19-Sep-05 Time: 2:45:00 AM Date: 9/14/2005 Complaint Number: 18461 Referred To: DAVID STANTON Taken By: RITA Complaint Type: GENERAL Article X Detail: Business Name: SARAH ATLY Number: 16 Street: KNOLLWOOD LANE Village: MARSTONS MILLS Assessors Map_Parcel: Complaint Description: A VERY FOUL ODOR A COUPLE OF TIMES A MONTH. A FRIEND TOLD HER IT IS EVEN. STRONGER IN THE LAND FILL AREA. Actions Taken/Results: DS WENT TO SAID LOCATION AND SPOKE WITH OWNER. THERE WERE NO ODORS PRESENT DURING THE VISIT. SHE SAID WHEN IT SMELLS, IT'S PRETTY BAD. SHE IS NOT SURE WHAT TYPE OF ODOR IT IS, BUT MANY PEOPLE THAT HAVE SMELLED IT, SAY IT SMELLS LIKE CHICKENS. DS IS NOT AWARE OF ANY CHICKENS IN THAT AREA. DS ASKED ABOUT A HORSE MANURE ODOR, OR COMPOST TYPE ODOR, OR SEWAGE ODOR, AND SHE SAID NO. DS ASKED HER TO TAKE NOTE OF THE WEATHER NEXT TIME IT SMELLS, AND WHERE THE WIND IS COMING FROM. DS DROVE AROUND AREA AND DID NOT PICK UP ANY ODORS. THE TOWN WAS DOING SOME WORK UP THE STREET, ON REPAIRING OR INSTALLING A NEW ROAD. NO VIOLATIONS OBSERVED. NO FURTHER ACTION REQUIRED. 1 w4 Health Complaints 19-Sep-05 Investigation Date: ..c /15/2005 Investigation Time: 1:40:00 PM 2 4 Ti o COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION PARCEL 0� LOB` o TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 16 Knollwood Lane Marston Mills, MA 02648 Owner's Name: Harold Thomas Owner's Address: Date of Inspection: April 7, 2004 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O. Box 49 Osterville,MA 02655-0049 Telephone Number: (508) 862-9400 r- ;_ o CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the49�ormatio�eported below is true,accurate and complete as of the time of the inspection. The inspection was perform d basedtm 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 s ✓ Passes co Conditionally Passes ry r" Needs urther Evaluation by the Local Approving Au hority Fails Inspector's Signature: Date: April 9, 2004 The system inspector shall subm 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. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 f Page 2 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 16 Knollwood Lane Marstons Mills, MA Owner: Harold Thomas Date of Inspection: April 7, 2004 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, wiI I pass. Answer yes, no or not determined (Y,N,ND) in the for the following statements. if"not determined", please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 16 Knollwood Lane Marston Mills, MA Owner: Harold Thomas Date of Inspection: April 7, 2004 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier, if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 i : Page 4 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 16 Knollwood Lane Marstons Mills, MA Owner: Harold Thomas Date of Inspection: April 7, 2004 D. System Failure Criteria applicable to all systems: You must indicate either"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 '/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS, cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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. 4 , Page 5 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 16 Knollwood Lane Marston Mills, MA Owner: Harold Thomas Date of Inspection: April 7, 2004 ,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: Yes No ✓ 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(3)(b)]. 5 Page 6 of I I OFFICIAL, INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property tyAddress: 16 Kn llwood La ne Marstons Mills, MA Owner: Harold Thomas Date of Inspection: April 7, 2004 FLOW CONDITIONS RESIDENTIAL 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 Number of current residents: 2 Does residence have a garbage grinder(yes or no): No .Is laundry on a separate sewage system (yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): pd 3asis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped 3 '/_2 years ago-per owner Was system pumped as part of the inspection (yes or no): No If yes, volume pumped: _gallons-- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank, distribution box, soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes,attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components, date installed(if known)and source of information: Installed 10124185-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 16 Knollwood Lane Marston Mills, MA Owner: Harold Thomas Date of Inspection: April 7, 2004 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints, venting, evidence of leakage, etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 2' Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 2" 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: 12" How were dimensions determined: Measuring 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.): _Tees were present. The liquid level was even with the outlet invert. There did not appear to be anv signs of leakage GREASE TRAP: None (locate on site plan) Depth below grade: 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: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 7 • Page 8 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 16 Knollwood Lane l Marston Mills, MA Owner: Harold Thomas Date of Inspection: April 7, 2004 TIGHT or HOLDING TANK: None (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Gate of last pumping: Comments(condition of alarm and float switches, etc.): 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.): The D-box was level and clean. No solids were present PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes-or no): Alarms in working order(yes or no) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): 8 • Page 9 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 16 Knollwood Lane Marstons Mills, MA Owner: Harold Thomas Date of Inspection: 4pril 7, 2004 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits, number: 1 - 6'x 6'w/2'stone (per design plan) 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.): The pit had 4'of water on the bottom. The scum line was at the same level There did not appear to be any signs of failure The Eottom to grade was 9. The cover was 3'below grade CESSPOOLS: None (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 or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): PRIVY: None (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.): 9 • Page 10 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 16 Knollwood Lane _Marston Mills, MA Owner: Harold Thomas hate of Inspection: .4pri1 7, 2004 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. C� a 3 a9 33 y 3o aS 10 I Page I 1 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 16 Knollwood Lane Marston Mills, MA Owner: Harold Thomas Date of Inspection: April 7, 2004 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 30 +/- feet Please indicate (check) all methods used to determine the high ground water elevation: Obtained from system design plans on record - If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators, installers-(attach documentation), Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using the Barnstable topographic map and the Cape Cod Commission water contours map the maps were showing approximately '0'+/-to ground water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the.future. There have been no warranties or guarantees, either expressed, written or implied, relating 10 the system, the inspection and/or this report. It CAT ION SEWAGE PERMIT NO. Ij floc, VILLAGE INSTAqq L /LER'S NAME(' i AADDRESS '�I o h R U I L D E R OR OWNER z-g- i�y�tiGr,s DATE PERMIT ISSUED ' - Ia _ - DATE COMPLIANCE ISSUED Jv --- zs �e� � , ,� w L � �e h .sir D ..... .� THE COMMONWEALTH OF MASSACHUSETTS �j BOARD. OF HEALTH Town Barnstable ........................................0 F.........................................-----------.._..------------..._...............-- Appliration for Uiiipniittl Vorkg Tnnitrnrtion ramit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at: Lat ' 7 - Knollwood Lane , Niarstons Mills It MA ....................•---.....---....................._-----••- Capricorn Rea°S� °y"gust 765 Falmouth RoUrs, N�;yannis -••--••------_....---•--.......--•............................................ ......-••---.............-•----............... ........--••-••-•-••••....._......•-••--••-•••--- Steve L ebel owner Address •••--..._...... •-•-----•----•--.._.....••••••----••••-•• ....................•--...............--•.......................................--•............... Installer Address U Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms ............................................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of BuildingY'a11C�?................ No. of persons............................ Showers Cafeteria ( ) 914 Other fixtures ........----•----•-•............................•--•--..........------------------------ ---------.......................-----..............-•-_------ W Design Flow......55.................................gallons per person per day. Total daily flow....... �� i WSeptic: Tank—Liquid capacit�.000...gallons LengtO................ Widt ....10....... Diameter................ Dept> ............_... x Disposal Trench—No. .................... Wid h.................... Total Length..._b�__.._...... Total leaching area._.265_........sq. ft. Seepage Pit A----------------------- Diameter.................... Depth below inlet..._.__............. Total leaching area.___..__.__.......sq. ft. Other Distribution box ( ) Dosinggtank ( ) '-' Percolation Test Results Performed by.r'1 dredge Engineering 11-..5-81 ..................... Date `ja Test Pit No. 12..0....._..minutes per inch Depth of Test Pit 12_._..... Depth to ground wat&one encounter- A /A N.�A-..--- ea Test Pit No_ _____________minutes per inch Depth of Test Pfil1-.__._...____.__. Depth to ground water_. _.__..___. ' •---•---•--•----------------•-----..........----..............................•-•--••---•-........--........................................................ O Description of Soil.......0 ' - 2_!_.__._ loam- & topsoil ----------•-----------------------------•--------------------------•--------.----- x 2' - 10' Tviedium yellow sand .-•--------•--•-------------------- ---- -•-----•------ 10 ' - 12' med. white sand traces of grave no wa er a: 12' W ----•-------------------------------- --•----------------•----..... ----••-----•--------•---•----------•--------•---------------------•----•. -----------------•---•-..........--•---------........ UNature of Repairs or Alterations—Answer when applicable............................................................................................... •---------------------------•---•----•----...-•-•-•--------•---..................----............................-•--•----------------------•-••-------•---. ........................................... Agreement: The undXgnffinstal' the aforedescribed Individual Sewage Disposal System in accordance with the provisions State Sanitary Code—The undersigned further agrees not to place the system in operation ntimpliance has b��eeen issued by the��bo rd of Health. •% gned!!.!_-a". 7./��G' d P e s.rDt Applicarion Approve �.. ...... .................... -..._.. ._....... Date Application Disapproved for the following reasons:............................................................................................................... .....................•----.........-•-------------•----•-----------------••-----...._...........-•-•-•--------•--•---------------------•-------....-----------------------------------------._.......... Date PermitNo......................................................._ Issued....................................................... Date ---------- ------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable ............ ... ...............O F.............................................._.......... ,���lirtttion fux �i��o�ttl ork� C�on�trttrtion rrutit '. Application is hereby made for,,� Permit to Construct or Repair an Individual Sewage Disposal System at: Lot # 7 :_ _Knollwood Lane , Marstons Mills ;, IPA ......T................. ......................................... ..... ............._...................._......... .......................................... .... ..... ............ Capricorn Relgj*A��shSt 765 Falmouth Rdaif;Noiyannis ......................-.......................................................................... (� Steve Lebel Owner Address Installer Address d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.3........................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building ranch No. of persons............................ Showers 0.1 YP g c P ) — Cafeteria ( ) Other fixtures .._..----•--••----•---•---•----• - W Design Flow......55-............................... 000 gallons per person peg day. Tot l�daily�flow...._..33�___....._...I...............:g bons. WSeptic Tank—Liquid capacit,-.--___--:..gallons . Length_............... Widt -....1-•U--...... Diameter................ Deptlt..�..t........... x Disposal Trencl;—No. .................... Wid `................... Total Length...._._r__....... Total leaching area.... _ _. sq. ft. ,,> Seepage Pit N .............,._-___•- Diameter.... ......_..... Depth below inlet......._._._....._ Total leaching area.�Ss.......sq. ft. Z Other Distribution box ( ) Dosi tank 1­4by Engineering 11-25-81 minutes per mch Depth of Test Pit__T______________ Depth to ground wate ,._. .__.._.._ Percolation Test Results Performed b ........................................ Date................................ 2 0 12 one encounte - ,� Test Pit No. 1./.._... : .....-.. Test Pit No. Y..__A....._....minutes per inch Depth of Test Pif1...A............. Depth to ground water-'ry� ---••-.-._-___. e ---------------------------------------------------•-----------••--------•-•---....................•......................................................... O 0' - 2 ' loam & to soil Description of Soil -•-••--.-•--- ------.-----•--•--- --------------------------"---------•-- x � - -•f0 -•-•-•Ty'.e ium e �__ ow sand �, _ 1 Y mecl: whil............... saricl/traces off` graver/rio...wEter__aU...12' ----------------------------------------------------------•----------------------•---------------------------------------------------------•-------•---"--•--------•---------.._..--•----••--...-•---- V Nature of Repairs or Alterations—Answer when applicable............................................................................................... ... . ..................... Agreement: The underVaestall the aforedescribed Individual Sewage Disposal System in accordance with the provisions oState Sanitary Code— The undersigned further agrees not to place the system in operation u it pliance has been issued by the board of health. Signed ........................................•----........-••-.PreS. APPlicationP _ _srr-�. C�. �e.a.L% / ! >._... a c-�_... D sw...............•-•-•••-•••. /�jr :2, a`te r�. Application Disapproved for the following reasons---------------------------------------------------------------•-•------...................................... - .......................................................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH -OF MASSACHUSETTS BOARD OF HEALTH Town..................O F......Barnstable . ... ................................................... Trrtifiratr of Tont;litturr THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ) or Repaired ( ) Steve Lebel bY........................................... ..........................................................................................................................................-•---•-•......---•--•----•-•---------------•-•-•--...•--••-......----•-•-•---..............---•-- Install at...._.._Lot _� 7_ Knollwood Lane, Install Mills , f-'A . . • . • . -----------•----•----•-•-•............................•-•-.......-••------ has been installed in accordance will, the provisions of TITLE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated-............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM. WILL-FUNCTION SATISFACTORY. ' "'L`�` -� --- Inspector...---•- DATE... =.............................. - y THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �. Town Barnstable OF.......................... i ................. MoVosal Work114owitrudivit Firrutit Steve Lebel 1 Permission is hereby granted.............----•---••--•-•---•----• --....---------•-----------------.....-------•---•......-= �i_---...................---..---- to struct ,) or Repair ( � ) an•Indrvidual Seam Disposal System _.__ ---- ""' at No..`4-ot �t 7 - Knoll�v00d Lane, � �tarstons Mi11s , i',A - - --------------------•----- --------------........... Street �` as shown on'the-application for Disposal Works Construction Permit 'lt'sy........ Dat :.._ �`.�_ -t:w.l. ~ Z_ ••. Board of ealth _ DATE......................... FORM 1255 A. M. SULKIN, INC., BOSTON , F NOT£: ��� 7U P06/1APi-i161 L .. / ..-�54 A lJ + C�j NTOURS £ittSFD O ni Q L OT C ���iiitiNs" THE• _Av V Q I 1 VA / DArEz DEC g /97A, a .e. {� Q TOPOGRAp►f.c /LA.,. or LA,,.n BHRNSTAALE IMA�TOui r-au.�)Mnx� ,' � _ Fx Ly 2z. 0 Vi r50 M." Z to . ' 'N, 1 s .. 4 Rs&6MML•D Lor RtvTU71oq—1, Tow" B.YLAw,$ ) J0l OAle 5 44 RGCi IRT 31 °P v 01 e 366 r n i r dam` 112/ GENV.._ D s, ' EXISTING SPOT ELEVATION OxO �"-.N IEXISTINiG CONTOUR --- 0 -- - - L�r BI CERTIFIED. PLOT PLAN FINISHED SPOT ELEVATION (� FINISHED CONTOUR 0 NOTE: _The location of any existing underground sewers e_, mNs wells, or, other utilities shown on t; is plan is approx Ia;i0a imate onl as determined from records and/or verbal h � information. The contractor is responsible for the �� ^'��� ��� verification. of. the existing locations in the field. . SCALES / 30 DATE FE3 4� gS .DREDGE ENG/NEERIKG CO. /NG� CLIENT. �___ w__ I CERTIFY .THAT THE PROPOSED EGI3TERE REGISTER JOB NO. .Es�2- BUILDING SHOWN ON THIS PLAN CIVIL LAND CONFORMS TO THE ZONIN LAWS ENO NEER RV N DR.BY, OF BARNSTABL MASS 712 MAIN STREET CH. BY p.w � HYANN I S, MASS. ) 2 , SHEET— OF ATE REG. LAND SURVEYOR • /YO'TF /F E/TNR THESEPTIG TANK OR Z_-ACH//YG. P/r ARE ^10RE 7-NA/1! /2"BELC$PV /O P7. M/N. rrRAOE� c�4'.D/AM E7ER G'ONCR.tc TE. COi�ER' ' SNALL BF ®APOL/GHT TO Cs TA OE.6AV E�t'TRA bj M CONCRBTE i '4~PYC P/PE j�E,4VY CAST IRON CO!/EI? S/`/ALLr &E USED cor'ERS f /N- P%TCN !F/N L.7Ao1 VE y1/r4 Y /g"P1=,P s=7 i 2•� M/N. CO/VCRL7T.E ' dk.9oE COVER CL_-AV SANO. .: ' "• ' &A.CXF•/LL LQtI/O LEYEL - � IT'D►^ _ 2 LAYER SCHEvuL&40 y •' 1000 a v o P o QF /B" di /•9JN.PlTGN GAL. ' a • • . . • • • • • v .•ie yyASHFO 57rNE SjEPT/C .TANK • D/sT. • s 1 • • • • • • I • a e i • it:, • e o 1 •,eEfFECT/✓L`' ' ' . r 3�4 - � �2~ . r • • DEPT1/ • • • • • WASHED STONE Q i eg,o 0 a. , r.• • • • • • • I d e•�, PR'ECAS 7"SEEPAGE P/7 OR EQVIV. l/VV4-97 LPLEY�4T/GN.� %, `1;•[` ° " • • e • • a • I o _ • • • Ar /NX&RT AT Bl1/4D/NG 6-7 FT. Ga �; °+ /NLET` SEPTIC Ti4A/K. S� $ FT, - �''✓F; >D FT O/X1M• i C�SFE T�LULATION, OUTLET SEPTIC TANK FT. — /NLET GISTR/8!?/ON BOX 6Z--Y FT. GROvVD WATE/W 7AALE . SECT/0^1 -OF j O!!7"LETD/STIR/B[lT/ON BOX (o,Z f7 / 1 YLE.7 LEACHING. PJT .Fr.. SELVAGE 015RO-SA L SKS7',6M -rAS JLATlDN LE.4CHIIV #4=/T ' DRSlG/V CR/TER/R SCALE %s" D//+fHv51 N a G-o FT. s NUM®ER OF EEDRo4MS 3 D/MgNS/®N C t.^sAReAG,ED/SPO•SAL VAIer NIA SOIL LOG TOTAL EST/NlA7-EG Fj-oAv 330 G.44e..1DAY SOIL TEST #/ SO/1- 7EST#*2 SOIL 'TEST NUMBER AF L,E`ACJVlNLt PITS- 1 f^F[EY. S �fLEK pA7 OF'SOIL TEST JL�w l�t�f i SIDE LEACH/NG PER P/T 1 5!T SSQ. FT. p _�� ' RESULTS >�//TNESSED 9Y�R"sue S9c�'ra' t BOTTOM L04CH/NG PER P/7' —,7 ,gQ. FT. PERCOLATION MATE#l >2 _ MjAoIIINCH Loy.J- TOTAL LE4CN//1'Cr AREA .SQ. FT. l°lF1eCOLA7/0N RATE�2 MI�V.�INCN RESERJ/E LB4CNJN6 AREA 2 '�i S.P. FT.: s' RC^ART 4 � i s�JLL- a ! ;v _ LoT � �.yottcvr�o� LAn�F //,ARSrsan>5 _ 5 Plql ;o 'CDR " �4y . � 6 c FLORFDG� ENCr/I lAW)?7 lG CG,1NC. ss o/ ",;� J 7/2 MAIN ST., HYANN/9, MAS Li S. 4 4\�u� STERF' i<Q� �p su '•r_' -•���- ® NO GR0L1N0 YYi4TER ENCOIJNTEREO D•tTE FE3 I.,IL gS C_3 GRO LINO kv-47----oe AT AFLE'ti JOB /VO_ R22 S G 816fa�E'r�tJR Z—