Loading...
HomeMy WebLinkAbout0044 CRANBERRY LANE - Health 44 Cranberry Lane Barnstable A=234-030 I i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 44 Cranberry Lane Property Address Kathleen F.Thomas Owner Owner's Name information is required for eve �_ �� J MA 02632 November 15,2011 ry-� page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not David D. Coughanowr, R.S. { use the return Name of Inspector key. Eco-Tech Environmental ICI Company Name 43 Triangle Circle Company Address Sandwich MA 02563 City/Town _ State Zip Code 508 364-0894 1328 Telephone Number License Number B. Certification y. 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 theinSpection.The inspection was performed based on my training and experience in the proper function and=maintenance of o'site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.3401 of Title 5(310 CMR 15.000).The system: c ® Passes ;❑ Conditionally Passes '❑ Falls ❑ Needs Further Evaluation by the Local Approving Authority �. k November 15, 2011 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 of110,000 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. tsins-11110 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 1 of 17 i Commonwealth of Massachusetts Title 5 official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 44 Cranberry Lane Property Address Kathleen F. Thomas Owner Owner's Name information required fo Centerville MA 02632 November-15, 2011 r every page. Cityrrown 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: Inspector's Note==> The septic system described herein is deemed to pass this Real Estate Transfer Inspection if it does not meet any of the failure criteria enumerated in Section D on pages 4-5.The scope of this inspection is limited to health and environmental compliance and the septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. 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): tsins•11/10 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 Voolunta .ry Assessments 44 Cranberry Lane. Property Address Kathleen F. Thomas Owner Owner's Name information is required for every Centerville- MA 0263Z N_ovember15, 2011 , page. cityrrown 'State Zip Code Date ofInspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out`.or high static waterieve'l 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) r ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction:is removed ❑ Y ❑ N ❑ ND (Explain below): j ❑ distribution box is leveled-or°replaced ❑ Y ❑ 'N ❑ ND (Explainbelow) ❑ 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 pipes)-are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction.is removed ❑ Y' ❑ N ❑ NO (Explaln.below) C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist:which require further evaluation,by the Board.,of HealthrT,in order to determine if the system.is failing to,protect public.health, safety or the environment. C System will pass unless Board of Health determines ih accordance with 310:CMR 15.303(l)(b)''that°.the system is notfunctioning in a.mannerwhich will protectpublichealth, safety.and the zrivironment:- Cesspool or priV.y"is within',50 feet of a':surface water El Cesspool or privy is within 50 feet of.a bordering,vegetated wetland or a salt marsh' t5iiis•'11f10' Ti the:5`.OfficiatInspect ion Form::Subsurface Sewage:pisposalSyslem Page3pf.17 Commonwealth of-Massachusetts 0. T"t 5 Official Inspection Form Subsurface Sewage Disposal System Form -N.ot for Voluntary Assessments 44 Cranberry Lane Property Address Kathleen F. Thomas Owner Owner's Name information is Centerville MA 02632 November 15, required for every 2011 page, Cftyrrown State Zip Code. Date.of Inspection .B. GertiffcatiOn (cost.) 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: Thesystem 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 of a public water supply. E The system has a septic tankand SAS and the SAS is within 50,feet of a private water supply well. ❑ The system has aaeptic tank and�SAS and the SAS is less than 1'00 feet but 50`feet or more from a,private water supply well*". Method used to determine distance: This system passes if the well;wateranalysis; performed of a DEP certified laboratory, for fecal coliforrn 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 =❑ Backup of"sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ 0 Discharge or ponding of effluent to the;surface.of the'gro.und.or surface waters due to n-overloaded or clogged SAS;.or cesspool El 0 Static.liquid level in the distribution box?above outlet invert due to an overloaded or clogged SAS or cesspool I El 9 Liquid depth in cesspool is less,:than 6" below invert or available volume.is less than 1/2 day flow t5ins-11110 Title 5 Offcial Inspection Form:Subsurface Sewage Disposal System r Page A of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 44 Cranberry Lane Property Address Kathleen F.Thomas Owner Owner's Name information is Centerville MA 02632 November 15,2011 required for every ' page. Citylrown 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 systerivis 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. 15ins•I ill p Tdle 5 official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth oftMassachusetts Title 5 official Inspection form — s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 44.Cranberry Lane Property Address Kathleen F. Thomas Owner Owner's'Name information is required for every Centerville MA 02632 November 15 2011' page, Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been.done..You must indicate"yes" orno"as to each.of:the following: Yes .No. Pumping.informatiomwas provided by the owner, occupant, or Board of Health ❑ Were any of the system components pumped. out in the previous two weeks? 0 ❑ 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 ofthe system obtained and examined.? (If they were not.El 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 breakout? ❑ Were all system components, excluding the SAS, located on site? 0 ❑ Were`the. septic tank,man holes 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. 0 ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based.:on:310 CMR 15.203 (for example: 110 gpd x#'of bedrooms): 330 qpd t5ins•11f10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6.of 17 3 Commonwealth of Massachusetts.- ,ar _- -_ Title 5 Official inspection ,err s_ Subsurface Sewage Disposal System"Form Not for"Voluntary Assessments: t u 44.'Cranberry Lane.- Property Address Kathleen'F. Thomas Owner Owner's Name information is x required for every Centerville MA 0263Z November`15, 201:1' page. City/Town State Zip.,Cbde Date of In D, System Information Description: Number of current residents:; 3 Does fesidence have a ga tIagegnnde�? ❑ Yes ® No , Is.laundry on:.a separate sewage"system?. if yes separate"inspection required] ❑ Yes Q No Laundry system.inspected? El Yes, ❑ No Seasonal use,? y M ❑• Yes" ❑ No Water meter;readin s, if available last 2 ears usa e. d 118 gpd 9 � y.. . 9 (gp )) Detail: a 2010, 2011 Sump:pump? ❑ Yes No Last;date"of'occupancy: a, current Date Commercial/industrial Flow'Conditions: , Type.of Establ shment- Design flow,. b sed,'on 310 CMR'1.5.203) ` x F Gallons per 06Y(9pd) Basis.df design flow(seatslpersonslsq;ft, etc.") = Grease trap.present, ,�. ❑ Yes ❑_ No 1ndustrial,waste holding tank-pr.,esent? ` ❑ Yes ❑ No Non-sanita. waste dischar ed to.,the Title 5 s stem? ry 9 Y ❑ Yes,`❑; No Watermeter'readings,.If:available . t5ins:+`J t/10 Title 5(O}ficial Inspection Formi7SubsurtaceSeviage'Disposal System r.Page e Camrn;onweaith of.Massachusetts r le 5 Official Inspection Farm 'Subsurface Sewage Disposal System Form,-Not for Voluntary Assessments 44.Cranberry Lane Property Address Kathleen F. Thomas b Owner Owner's Name information is required for every Centeruille MA 02632 November 15, 2p11 page, cityrrowri State Zip Code pate of Inspection D. System 'Information (cont.) Last date of occupancy/use:. Date Other(describe below,): General Information` Pumping Records; Source of information: Was ysten :'pumped.as.part of the inspection?'' ❑ Yes ❑ No If;yes;volume pumped: gallons How~was quantity pgrnped determined? Reason for:pumping-, ---- Type of System: . Septic tank, distribution box,.$oil absorption system. 0 Single cesspool' El' Overflow cesspool Q. Privy 0 Shared system(yes or no) (if yes, attach previous inspection records, if ,any) Innovative/Alternativetechnology, Attach a copy of the,current operation and maintenance contract(to be obtained from system owner)and a copy of latest :inspection of the /A system bysystem operator under contract Tight tank. Attach a copy of the DEP approval. El Other(describe): t5 ns•11f1Q Title 5 Qfficial,lnspection Form-Subsurface Sewage Disposal System-Paget of 17 Commonwealth of Massachusetts Title 5 Official Inspection F®rm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 44 Cranberry Lane Property Address Kathleen F. Thomas Owner Owner's Name information is Centerville MA 02632 November 15,required for every 2011 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Age: 9+years. Certificate of Compliance issued 2-8-02. (permit#2002-51). Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 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.): Sewer line appears structurally sound with no evidence of leakage or backup into dwelling. Septic Tank(locate on site plan): Depth below grade: 1.5feet 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 11.5 x 5 x 6- 1500 gallon tank Dimensions:' Sludge depth: 4 in t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth o.f Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not-for Voluntary.Assessments 44 Cranberry Lane: Property Address Kathleen F. Thomas Owner Owners-Name information is required forevery Centerville MA 02632' November 15, 2011 page. Cityrrown State Zip Code ;Date.of Inspection D. System Information (cont.) Septic Tank.(cont.) Distance from top of sludge to bottom of outlet'tee or'baf,e 30 in "Scum thickness 2 In Distance from top of scum to top of outlet tee,or baffle 9,in Distance from bottom of scum to"bottom of.outlet:tee_or baffle 13 in How were dimensions determined? Desi" n,plan Comments (on pumping recommendations, inlet and outlettee or baffle condition,,structural integrity, liquid levels as related to outlet.invert, evidence of-leakage etc.): Liquid level at outlet invert. Pumping not;required at'tl`is time, but maintenance pumping is recommended"within and,every 2 Years.Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out"was:observed. Grease Trap (locate on site.plan) Depth below,grade: feet Material of construction: El concrete ❑ metal ❑fiberglass ❑polyethylene. ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to>top_of outlet tee or baffle Distance from bottom,bf scumto bottom of outlet tee or baffle .Date of last pumping: Date 't5ins 11110'. Title 5 Official Inspection Form`.'Subsurfbco,Sowage:Disposal System.Page 10 of 17 Commonwealth of Massachusetts . - - Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments 44 Cranberry Lane Property Address Kathleen F. Thomas Owner Owner's Name information is Centerville MA °02632 November 15,required for every 2011 page. Clty[Town State Zip Code Date of Inspection ` D. System Information (cont.) : Comments(on pumping recommendations, inlet and`outlet jtee 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:f � Date Comments(condition of alarm and float switches, etc.): *Aitach copy of current pumping contract(required). Is copy attached? ❑,Yes ❑ No t5ins•11110 Title 5 Official Inspedion Form:Subsurface Sewage Disposal System•Page t f of 17 Commonwealth of,MAssachusetts; x - Title 5 Official Inspection For Subsurface Sewage.Disposal System Form% Not for Voluntary Assessments y�— 44 Cranberry Lane Property.Address 'Kathleen F. Thomas. Owner „ Owners Name information is Centerville MA 02632 November 15, 2011 required foP every. ' page. cttyfrown State Zip Code Date of Inspection D. System. Information Distribution Box(if present must be opened;) (locate,on site.plan): Depth of liquid level above outlet invert at outlet invert Comments(note if box is.Level and distribution to outlets equal,,any evidence of solids carryover, any evidence of'leakage,:into or out of box; etc.): D=Box appears structurally sound andJunctioning as intended.No evidence of leakage in or out was observed. Few solids in sump. A bucket.of water was poured into the:distribution box and was observed to pass through in a rapid and:unobstructed manner, and could be heard splashing down into the leaching_gallery. 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.): i i Soil Absorption System (SAS) (locate on site plan, excavation not-required): If'SAS not located, explain why: 15ins-,,11ho Title,'Official Inspection Forme Subsurface Sewage Disposal System•Page.12 of 17 Commonwealth of Massachusetts _ Title 5 Official xInspection Fornn Subsurface Sewage Disposal System Form -Not for Voluntary.Assessments 44 Cranberry Lane Property Address Kathleen F. Thomas Owner Owner's Name information is required for every Centerville MA 02632 November 1.5, 2011 page. Citylrown . state Zip Code Date of Inspection D. System Information (cont-) Type: ❑ leaching,,pits number. ❑ leaching chambers number: leaching-galleries, number:, 1 ❑ leaching-trenches number, length ❑ leaching fields number,,d,imens'ions' El overflow cesspool number ` . ❑` innovaEive/alternative system Type/name of technology: Comments(note condition of soil;signs of hydraulic failure, level of pondi'ng,;damp soil, condition of vegetation, etc.), Soils above leaching gallery appear unsaturated. No evidence of.surface ponding,breakout, lush vegetation, or other evidence of hydraulic failure was observed-An observation hole was dug into leaching gallery stone and no effluent:contact staining was observed.in the stone or overlying soils. No standing effluent was observed.to a:depth of 1 feet below the top of th'e peastone layer. 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 bimensions.pf cesspool Materials &'construction Indication of'groun'dwater inflow- 0 Yes ❑ No 15ins-11110 Title.S,Uficial Inspection Form:?Subsurface;Sewage_Disposal System,•;P8ge;13 of 13 -Gomrnonwealth:ofMassachusetts Title 5 Official Insp cti n Form _ - 'Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 44 Cranberry Lane' Properfy Address Kathleen F. Thomas Owner Owners Name information is required for every Centerville MA 02632 November 15, 2011 page. C1tylrown. State Zip Code Date of Inspection D. System Information (punt) Comments;(note conditiorj 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 conditlon of soil, signs of hydraulic failure; level of ponding, condition of vegetation, etc.)€ t5ins 11/10' Tillo 5 6fricial Inspection Form:Subsurface.Sewage Disposal System•Page 14 of 17> f Commonwealth of Massachusetts - Ville 5 ® iclM inspection Form . Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 44 Cranberry Lane Property Address r Kathleen F.Thomas Own sr Owner's Name iequir dfo90n is Centerville MA 02632 November 15,2011 required for every page. cityrrown 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 stfpply enters the building. Check one of the boxes below: ® hand-sketch in the area below ° ❑ drawing attached separately r % rL 0 3� ! 444 W C2rfrWBFRJR' LwE 951r+s•1111110 Us 5 Of6dal Inspection Form:Subwfece Saw Cis ago pa:al System-Pap 15 ar 1T Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 44 Cranberry Lane Property Address Kathleen F.Thomas Owner Owner's Name information is required for every Centerville MA 02632 November 15, 2011 page. City/town State Zip Code . Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 25+ 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: 2-7-2002 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: Barnstable GIS Department records. You must describe how you established the high ground water elevation: Approved design plan on file with the Board of Health shows bottom of system to be 2.5 feet above the bottom of a test pit in which no groundwater or groundwater motting was observed.Town of Barnstable GIS Department records indicate that the property is over 25 feet above groundwater table. Before filing this Inspection Report,please see Report Completeness Checklist on next page. 15ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 44 Cranberry Lane Property Address Kathleen F. Thomas Owner Owner's Name information is required for every Centerville MA 02632 November 15,2011 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 15ins-11110 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 17 of 17 ~ Commonwealth of Massachusetts - . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 319 Marstons Lane Property Address Mary Ellen Bunnell Owner Owner's Name information is Cumma uid MA - -02637� 10/12/11 required for every 4 , page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form.-inspection forms_ may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General-Information • . on the computer, . use only the tab 1. Inspector: key to move your cursor-do not k i Mike Hudson • use the return key. Name of Inspector ~ Septic-wiz Environmental.Services Company Name 31 Midway Dr - Company Address s /' Centerville MA 02632 City/Town State Zip Code 505-367-5669 DEP SI#4254 Telephone Number -License Number B. Certification I certify that I have.personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection , was performed based on my training and experience in the proper function and,maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes F El Fails ❑ Needs Further Evaluation by the Local Approving Authority x c 'r tj Inspect lg gat ' Date t The system inspector shall submit a copy;of this inspection report to the Approving Authority @oard 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 shalllsubmit th€ 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. a Sewage Disposa t5ins•11/10 Title 5 Official Inspection Farm:Subsurface l System•Page 1 of 17 ' Commonwealth of Massachusetts , Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' ,M 319 Marstons Lane s Property Address Mary Ellen Bunnell ` Owner Owner's Name information is required for every Cummaguid MA 02637 10/12/11 page. Citylrown 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. ,A The septic tank is metal and over 20 years old*outhe 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 *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 isavailable. ❑ Y ❑ N El' ND(Explain below): • - .pro- .. ... t5ins•11/10 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 g i F Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments` 319 Marstons Lane Property Address Mary Ellen Bunnell Owner Owner's Name information is Cumma uid MA 02637, 10/12/11 i required for every q ' page. City/Town State Zip Code Date of Inspection B. Certification (cont.) - �I 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): t . ❑ 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)�f Further Evaluation is Required by the Board of Health:A✓ ; El 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 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 El Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh' t5ins•11/10 rr Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 3 of 17. Commonwealth of Massachusetts Title 5 Official Inspection ForM Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 319 Marstons Lane Property Address E Mary Ellen Bunnell Owner Owner's Name information is required for every Cummaquid - MA 02637 10/12/11'` 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 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 aseptic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No • El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool El ® 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 Y day flow Y t5ins•11/10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 .. r a� a 4. - , .-. y.•- .. '. Commonwealth of Massachusetts Title 5 Official Inspections, Form' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 319 Marstons Lane G M ! Property Address r Mary Ellen Bunnell ' r• �� Owner Owner's Name information is umma uid ,- MA 02637 - 10/12/11 required for every C 4 ' page. Cityrrown Y State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in ttie 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 orprivy is within a Zone 1 of a public well. • Y .-F a ❑- '® 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 systemjthe 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 [I E] .v Area'-IWPA)or a mapped-Zone II of a public water supply well - If you have answered', es"to an question in Section,E the system is considered a significant threat Y Y Y Y 9 ,. r " 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. t5ms•11/10 a Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 I , Commonwealth of Massachusetts n Title 5 Official lnspection Form t Subsurface Sewage Disposal System Form=Not for Voluntary Assessments M 319 Marstons Lane Property Address y» Mary Ellen Bunnell Owner Owner's Name - information is umma uid :MA 02637 - 10/12/11 required for every C q _ page. City/Town State Zip Code Date of Inspection C. Checklist a Check if the following have beenFdone.You must indicate"yes",or"no"alto each of the following: Yes No ® ❑ 'Pumping information was provided by.the owner, occupant, or Board of Health ❑ 0 Were any of the'system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows inthe previous,two week period? El ® 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 exam_ineV (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage backup?`, , ® ,❑• - , Was the site inspected for signs of break out? » ® ❑ Were all system components, excluding the SAS,located on site? E ❑ 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 pfoper 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. ® FY 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: f Number of bedrooms(design): 4 Number of bedrooms(actual): 4 - DESIGN flow based on 310 CMR'15 203'(for example: 110,gpd x#of bedrooms): 440�- - , t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 k h Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for,Voluntary Assessments M 319 Marstons Lane Property Address E Mary Ellen Bunnell Owner Owner's Name information is Cumma uid MA 02637 10112h 1 required for every q - page. Cityffown State' Zip Code Date of Inspection D. System Information Description: English Tutor " Number of current residents: 1 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. Y ❑.Yes ® No Seasonal use? - ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2009-268 GPD 9 ( Y 9 (gP )) 2010- 109 GPD Detail: 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? R t Y ❑ 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 319 Marstons Lane Property Address Mary Ellen Bunnell Owner Owner's Name ` information is Cumma uid MA 02637 10/12/11 s required for every q page. Cityrrown State Zip Code Date of Inspection D. System Information (cont) ;{ Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: ;. Homeowner: Source of information: . Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: N/A gallons` How was quantity.pumped determined? N/A F Reason for pumping: ' , WA 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) El 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 K ❑ Tight tank` Attach a copy of.the DEP approval. ❑ Other(describe): t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 17 Commonwealth of Massachusetts : Title 5 '®fficiasl Inspection Form W Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .a M 319 Marstons Lane Property Address , Mary Ellen Bunnell - Owner Owner's Name information is Cumma uid MA 02637 10/12/11 required for every 4 page. CityTrown State Zip Code Date of Inspection .. D. System Information (cont.) t Approximate age of all components,date installed (if known)and source of information:. 27 years for tank, d-box and old pit, installed 1984, new leach pit installed in 95 via as-built card provided by home owner s Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): Depth below grade: eet } i; - n 9• Material of construction: ❑ cast iron ®40 PVC ,❑ other(explain): Distance from private water supply well or suction line: N/A feet Comments(on condition of joints, venting;evident"ce of leakage etc.): ' joint appeared intact, vented thru roof, no signs of leaks ' Septic Tank(locate on site plan): 24" 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 4'10"Wx 8'6"Lx5'8"H 21000 gallon Dimensions 4'11" (1"thickness) Sludge depth:-, • - 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 M 319 Marstons Lane Property Address Mary Ellen Bunnell Owner Owner's Name information is Cumma uid "' a MA 02637 10/12/11 required for every q - ' page. City/Town State Zip Code. Date of Inspection D. System Information (cont.) Septic Tank(cont.) f. Distance from top of sludge to bottom of outlet tee or baffle 33" Scum thickness r 1/2"and less, minimal scum 12" Distance.from top of scum to top,of outlet tee or baffle r Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Sludge probe, mirror, floodlight, tape measure 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 1x every 36 months, inlet and outlet tees in good condition, tank appears to be structurally sound, liquid level normal to outlet invert, no signs of leaks at time of inspection. - 41 4- - 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 4 Date of last pumping 4 .+ Date t5ins•;11/10 " Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts , Title 5 official Ins ection IF'or p f . Subsurface Sewage Disposal.System Form-Not for Voluntary Assessments „ 319 Marstons Lane Property Address , Mary Ellen Bunnell Owner Owner's Name information is required for every 4 Cumma uid MA � 02637 10/12/11 page. Citylrown State Zip Code' Date of Inspection D. System Information (cont.)' Comments(on pumping recommendations, inlet andoutlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): jl t or Holding Tank(tank must be pumped at time of inspection) plan): Ih Tigh Depth below grade: Material of construction: ❑ concrete ❑ metal ❑.fiberglass ❑ polyethylene ❑ other(explain): Dimensions: - d . Capacity: gallons Design Flow: : gallons per day Alarm present: k ❑ Yes ❑ No, + Alarm level: ` ° ; '' Alarm in working'order:e 0 °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 t5ins•11/10 y Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 17 P Y • 9 i Commonwealth of Massachusetts Title 5 official Inspection Form' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 319 Marstons Lane [' Property Address Mary Ellen Bunnell ' Owner Owner's Name information is umma uid MA 02637 10/12/11 required for every C q ' page. Cityrrown State Zip Code . Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): t 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 level, liquid level even w/new outlet invert, no solids carryover or leaks in or out of d-box Pump Chamber(locate on site plan): k 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: r • .. ,; t5ins•11/10 ,y, Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments ' s M 319 Marstons Lane Property Address Mary Ellen Bunnell Owner Owner's Name ` information is q required for every Cumma uid MA , 02637 10/12/11 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) . Type: ® leaching pits* number: (2)6'x6'w/3' stone around ❑ leaching chambers number: ❑ leaching galleries number: F' ❑ leaching trenches number, length: 4- ❑ 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.): loamy to med sand, (2)6'x6' radius concrete leach pits w/3' stone, no signs of hydraulic failure, no ponding, damp soil or abnormally lush vegetation. Top of liquid.4' below invert in pipe. Clean sidewall from water up. Bottom of SAS 108" below grade. Cesspool's (cesspool must bepumped'as art of inspection) locate on site Ian p ( P P .. ( 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 Forth:Subsurface Sewage Disposal System°Page 13 of 17 f Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 319 Marstons Lane Property Address Mary Ellen Bunnell Owner Owner's Name s information is Cumma uid MA 02637 10/12/11 required for every Q page. Citylrown 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.): M 1� 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.): t t5ins•11/10 r Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Forte Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments 319 Marstons Lane Property Address ; Mary Ellen Bunnell Owner Owner's Name information is required for every Cummaguid MA 02637 ,-.' 10%12/11 page. Cityrrown State Zip Code. ' Date of Inspection D. System Information (cont.) Y 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: a ❑ hand-sketch in the area below ® drawing attached separately t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 15 of 17 • „ Commonwealth of Massachusetts _ Title 5 Official Inspection Form n N for Voluntary Assessme is Subsurface Sewage Disposal System Form of o 9 P Y 319 Marstons Lane Property Address Mary Ellen Bunnell Owner Owner's Name - information is Cumma uid MA _ 02637 10/12/11 required for every q page. City/Town State Zip Code Date of inspection D. System Information (cont.) Site Exam: i1' r ® Check Slope A ® Surface water I f ® Check cellar ® Shallow wells W a, Estimated depth to high ground water: 1 T 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: _ reviewed prior inspection by Bortolotti 1995 - ❑ , Checked with local excavators, installers-.(attach documentation) ® Accessed USGS database-explain.' r ` Reviewed USGS topo and water resource maps You must describe how you established the high ground water elevation: Reviewed USGS topographic and water resource maps and Google Earth Satelite map. Bottom of SAS at elevation 41' 108" below grade water table at elevation 18'which is a 23' seperation.Reviewed prior inspection by Bortolotti construction 1995. 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 ' Commonwealth of Massachusetts Title 5 Official Inspection Forums 9` Subsurface Sewage Disposal System Form-Not for Voluntary Assessments - M 319 Marstons Lane Property Address Mary Ellen Bunnell Owner Owner's Name information is Cumma uid MA 02637 10/12/11 required for every Q " 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 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 6'x6' Radius Leach pit w/ 3' stone around • (Hydraulically'Failed) 6'x6' Radius Leach,pit w/ 3' stone around e k + z„ D-BOX a, 1000 gallon y septic tank w... 1 r Al 3 0' B 1 - 2 3' A2 43' B2 - 34'.. ,. _ F t A3 - 64' H3 - 63' :• t A4 51' B4 - 69' ' p y - Marston 319 Lane * + Cummaquid, MA 02637 ,. y I Y Drivewayr_4 W Marstons Lane ' TOWN OF BARNSTABLE LOCATION SEWAGE # _gW2-0 97 ll i VILLAGE- new7 ext Mlle- ASSESSOR'S MAP & LOT Z 3 LI-0 3 p INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /360 LEACHING FACILITY: (type) (size) �.X - _ NO. OF BEDROOMS BUILDER OR OWNERS ®- PERMITDATE: _COMPLIANCE DATE: P- 9 U :2 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet-of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Pe 2 h o( a 4 6J9 i N' 'TOWN OF BARNSTABLE LOCATION SEWAGE# VILLAGE ASSESSOR'S MAP & LOTo!� - 03 b INSTALLER'S NAME&PHONE NO._ SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by TOWN OF BARNSTABLE LWA—nON C0�btr ' AL SEWAGE # VILLAGE �a�t.N-0 Ar-&z ASSESSOR'S MAP & LOT.Z3y 03a INSTALLER'S NAME&PHONE NO. SoT V SEPTIC TANK CAPACITY LEACHING FACILITY: (type) SSpUd�S (size) NO. OF BEDROOMS a 0 BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by '4 AI- AaL- yo jo a rU O OF BARNSTABLE / C SEWAGE # 2-0,5/ VILLAGE _ �. ``ASSESSOR'S MAP & LOT 23 LI-0 3b INSTALLER'S NAME&PHONE NO. (� ��/lam G/i�•S � SEPTIC TANK CAPACITY �5 LEACHING FACILITY; (type) �1,keC (size) A-2 x i NO.OF BEDROOMS BUILDER OR OWNER ' '" G PERMITDATE: COMPLIANCE DATE: U Separation Distance`Between the: 1 Maximum Adjusted Groundwater Table to the Bottomof Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) ' Feet. Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Ak 9 Re A'�l u U)�.g -i e �z 6 s NO. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYicaltion for Miopaal Opotem Construction j3ermit Application for a Permit to Construct( , )Repair( )Upgrade(x)Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 144 4CR.ANi3E11R`( LN, YLAt1fLLEN '1-1141 SAS Assessor'sMap/Parcel - / r<'► .4ss 1 44 CPAP BERRY L" 114 23 �I n 30 �Fl� C�%Y7FErl//LL6 I�i1sf Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. .SUL L P VAw E/VG IrYGtT tLIWe- I/VG 20 av ��a 7 P4A-I4EI'L st 9 A S� Type of Budding: Dwelling No.of Bedrooms Lot Size 1 S,U/!i sq.ft. Garbage Grinder QVGY Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 42 gallons per day. Calculated daily flow I gallons. Plan Date PC-13 • -7, 2 a o 2 Number of sheets I Revision Date _WM Title PPU Po5 c D se-P rP C. 4 P G-r°A O C Size of Septic Tank /SUo Cr LP L L Oo'V Type of S.A.S. t 2 X ZS' L L4 C I P��k CA9MAt/1- Description of Soil; 0- `I LOAM SI -' 7 QrA- Ca4rs f S,Oiv A , 7 Z Z 41 S traA-6 B/^fv Crogrscj 5AA4 2 G G 3 '' QrN'ISH 'YEL. coArsE spa» . G3"- i2o „ Yj_LLPeN 13rA, G�Ars� s•AIV) Nature of Repairs or Alterations(Answer when applicable) 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 Certifi- cate of Compliance has been iss by this oard eal �. Signed Date 0�l Z Application Approved by11_ Date a Application Disapproved for the following reasons Permit No. Date Issued ��� 7 �`«*Fee�V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ;. Yes PUBLIC HEALTWDIVISI.ON.-TOWN OF BARNSTABLES MASSACHUSETTS 2ppiication for ;migpo!5a[ 6potem Cori0truction Permit A Ip Application for a Permit to Construct( )Repair( )Upgrade OO Abandon( ) O Complete System 0 Individual Components +. I' 3 Location Address or Lot No. Owner's Name,Address and Tel.No. t44 CP_ANt3ERR`1 L.M• ICJ4t11LLEN e 4 1`ilal►��►S M qt z - , rt, ,ass U ak CrAn•>3tr �►� ` Assessor's Map/Parcel /11 23 LI P 30 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No ��� ( iyf sL/LL l t/�w ENGfH�GEIIIW(� l/�c�, 1; Qo m °��. • 7tt' 7 P10IL146 M S1 �,�� y�2& A,V1t-cE Type of Building: Dwelling No.of Bedrooms�_ Lot Size S U/G sq.ft. Garbage Grinder(A161 Other Type of Building No.of Persons Showers( )+Cafeteria( ) " Other Fixtures Design Flow 3 d gallons per day. Calculated daily flow 3 3 ( gallons. Plan Date PO Q. 7, 2 oe°L Number of sheets I Revision Date WfA ` Title PrvPastp SEPTtc L/P6/`AO6- cam Size of Septic Tank /SOO A CAL LOry Type of S.A.S. 1"1 X ZS LG-`Acti,rvy CANM©t^ 1. Description of Soil; O - 4 L,9,0 M Ll " 7 OrN Cu4rs F e OA, D , 7-+Z L 57/'O*6 r Qr/v Caa rsc: 5/,��v7J Z G� G 3 Qr N �s H YCG• coArS� Nature of Repairs or Alterations(Answer when applicable) 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 dthe Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issi-jed by this oard ealt,. Signed Date �^2- R O Z Application Approved by C,_ e 1 Date a' �- Application Disapproved for the following reasons . r Permit No. L_5s Date Issued �� + .k� ------------ -- ------------------- t THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO C TIFY,that the Ori-site Sewage Disposal System Constructed( )Repaired( �raded( S�) Abandoned( )by at 14 Y e tAIVQ E1'/'Y LA 4 'r 15-/Vj-jrr/i L L 6 4 ss, has been construct i °accordance �- a with the provisions of Title 5 and the for Disposal System Construction Permit No% CAS�dated Installer : Designer The issuanc of tl} permit shall not be construed as a guarantee:that the sys wilkfunction as desr d: Date a �(� Inspector �.�^ .1 -------- No. �V(�� 'V�J ' Fee THE COMMONWEALTH OF MASSACHUSETTS t PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS 4, Miq ozar ! tem Construction Permit � p Permission is hereby granted to Construct( )Repair( )Upgrade()<')Abandon( ) System located at 4414 C t A►'VQerfl Y L4t/, e61Vte,-V1 L-L t- IkN and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date: r� 7 /C ��- Approved byQ F .. r Commonwealth of Massachusetts } Executive Office of Environmental Affairs ' Department of Environmental Protection fE0 . One Winter Street, Boston MA 62108 (617).292l5500 ;vJAY .� .1 2D04 YOk'N0" IQHftF b �R[7DY CORE - Y Secretary ARGIA PAUL CEI I UCCI B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION - Property Address: 44 Cranberry Late, Centerville, MA Name of Owner: Angie Simpson Address of Owner: Sane Date of Inspection: May 8, 2000 Name of Inspector: (Please Print) Janes M.Ford I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: James M. Ford Mailing Address: P.O. Box 49, Osterville, MA 02655-0049 .Y`" Map: 234 Telephone Number: (508)862-9400 Parcel: 030 Lot. 6 r e CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: ✓ Passes M ,, Conditionally Passes Needs Further Eval ti By the Local Approving Authority Fails f : Inspector's Signature: Date: May 9, 20004. The System Inspector shall sub ' a copy of this i 'on report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector,and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND CONM ENTS K .. t}•. iS`.. to t"rt r. ;, ;,F ,j, .C%,.ikM.' h J�Z 1r �• revised 9/2/98• Page iofll 3 .. 41 'Primed on Recycled Paper `a a .. 1 .. - yY. ,f SUBSURFACE- SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 44 Cranberry Lane, Cewerville, MA i Owner: Angie Simpson, Date of Inspection: May 8, 2000 INSPECTION SUMMARY: Check A, B, C, or D. A. SYSTEM PASSES: ✓ I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 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. Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal, is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved'by the-Board of Health. wage Backup or'breakout or high!static water level observed in the distribution`box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health) broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four,times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): p broken pipe(s)are replaced obstruction is removed revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL" SYSTEM INSPECTION FORM , PART A ' CERTIFICATION,(continued) Property Address: 44 Cranberry Ivne, Centerville, MA °, ra"i S ! 3 Owner: Angie Simpson Date of Inspection: May 8, 2000 ,#'� ;► :acta,cl l ..' C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and 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 THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ r 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 AND SAFETY AND THE ENVIRONMENT: v"li ,: '— .,The system has a septic tank.and soil absorption system(SAS)and the SAS,is;within feet to a surface water supply or tributary to a surface,watersupply f The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis 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. Method used to determine distance (approximation not valid). 3) OTHER -" a revised- 9/2/98 Page3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION.(continued) Property Address: 44 Cranberry Lane, Centerville, MA , Owner: Angie Simpson .r Date of Inspection: May 8, 2000 D. SYSTEM FAILS: You must indicate either"Yes" or"No" as to each of the following: I have determined that one or more.of the following failure conditions exist as described in 310 CMR 15.303. The basis for,this . determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded 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 levee 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 'h day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a publicwell., --_ Any portion of a cesspool or privy is within 50 feet of a private.water supply well. r Any portion of a cesspool or privy is less_than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.*If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd of greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes 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 H of a public water supply well The owner or operator of any such system shall upgrade the system in accordance_ with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM i PART.B CHECKLIST Property Address: 44 Cranberry Irate, Centerville, MA � Owner: Angie Simpson Date of Inspection: May 8, 2000 'Aa , Check if the following have been done:.' You must indicate e N ' ither..",Yes". or"No" as to each of the following:,, y`=t •, ;.' x ` Yes No ✓ _ Pumping information was provided by the owner,occupant,or Board of Health. ✓ _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. n/a As built plans have been'obtained and examined. Note if they are not available with N/A. ✓ The facility or dwelling was inspected for signs of sewage back-up. .' ✓ _ The system does not receive non-sanitary or industrial waste flow. ✓ _ The site was inspected for signs of breakout. 4 • ✓ _ All system components,excluding the Soil Absorption System,have been located on the site..' - . r:w.� ✓ _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for conditions of baffles or tees,material of construction,dimensions,.depth of liquid,depth of sludge,depth,of^scum ,;q ;.,,. The size and location of the Soil Absorption System on the site has been determined based on: .ti'e ,- .. ,.: ;: - 'E s..r..di L .,� $ii• ,,t. . ; "!* iy ,�is.:�:6 is til.;t �',:j itt'`fL '�. _ ✓ Existing information. For example,Plan at B.O.H. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [15.302(3)(b)l• s ✓ _ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. - , i r rsi..'i . . if i 3 {. s:eR- -•.F. a) i:. t y :i-xf p Ne'. (aXC-y . .'i' { 4d,ar- :l.st:�t' „t,(` {�!'Sr .,,1 .75.;•;*w� r. i .{"_,par tlt.�I : . i ' !, 1! revised 9/2/98 PW5of11 4 • T SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 44 Cranberry Lane, Centerville, MA Owner: Angie Sisson t Date of Inspection: May 8, 2000 FLOW CONDITIONS RESIDENTIAL: Design flow: n/a g.p.d./bedroom. Number of bedrooms(design): n/a Number of bedrooms(actual): 2 Total DESIGN flow n/a Number of current residents: 1 Garbage grinder(yes or no): No Laundry(separate system)(yes or no):No; If yes,separate inspection required Laundry system inspected(yes or no): .No Seasonal use(yes or no): No Water meter readings, if available(last two year's usage(gpd): 1999-16,000 gals.;1998-17,000 gals. Sump Pump(yes or no): No Last date of occupancy: Currently occupied. COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: eud(Based on 15.203) Basis of design flow 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: =1 ,`.k xedt: 11i J,:..'t OTHER: (Describe) - Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Pmrmed on Aug. 2197-per treatment plant. System pumped as part of inspection(yes or no): No If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system r Single cesspool ✓ Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other - APPROXIMATE AGE of all components,date installed(if known)and source of-information:- Unknown Sewage odors detected when arriving at the site: (yes or no) No revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 44 Cranberry Late, Centerville, MA 'tr Owner: Angie Simpson Date of Inspection: May 8, 2000 t ;c� ..�,, +• , ,.> ;u>:' _ BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction: _cast iron _40 PVC _other(explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints,venting,evidence of leakage,etc.) SEPTIC TANK: None (locate on site plan) Depth below grade: Material of construction: concrete _metal Fiberglass ._Polyethylene _other(explain) If tank is metal, list age_ Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions: - r k .- Sludge depth: , Distance from top of sludge to bottom of outlet tee or baffle: +.H .•- •.:3 Scum thickness: - • W �# y Distance from top of scum to top of outlet tee or baffle: y Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: Comments: (recommendation for pumping,condition of inlet and outlettees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) GREASE TRAP: None (locate on site plan) r 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: J" Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) revised 9/2/98 Page7of11 ' r r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 44 Cranberry Lane, CerueMlle,MA - s Owner: Angie Simpson Date of Inspection: May 8, 2000 TIGHT OR HOLDING TANK:' None (Tank must be pumped prior to;or 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: ' Alarm level: Alarm in working order: Yes_ No_ Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: None (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) 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.) revised 9/2/98 Page 8of11 !+ ' ^ e • - . .. a fi • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM : PART C SYSTEM INFORMATION (continued) Property Address: 44 Cranberry Lane, Centerville, MA41 .. Owner: Angie.Simpson i Pew r.: +i+3a{ *� - C^s'i• ',' Date of Inspection: May 8, 2000 . ,t, 4' SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan, if possible; excavation not required, location may be approximated`'bynon-intrusive inethods) If not located,explain: , Type: leaching pits, number: leaching chambers, number: leaching galleries,number: leaching trenches,number, length: i... leaching fields,number,dimensions: overflow cesspool, number: 1 Alternative system: Name of Technology: Comments: (note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.) The overflow cesspool was S'W x 4'Tx 9'bottom to grade. The cesspool had 2'of water on the bottom. There were no signs of failure. CESSPOOLS: ✓ (locate on site plan) Number and configuration: I with overflow Depth-top of liquid to inlet invert: =.z l r� Depth of solids layer: S" Depth of scum layer: 2 Dimensions of cesspool:S'W x S'T Materials of construction: Block Indication of groundwater: None inflow(cesspool must be pumped as part of inspection). Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) g The hawd in the cesspool wws even with the outlet pipe.'No tees were present. The bottom to grade was 10'. -S PRIVY: None (locate on site plan) Materials of construction: Dim ens i.ons: Depth of solids: Continents: f' (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation;etc:) - revised 9/2/98 Page9of11 _ ` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 44 Cranberry Lane, Centerville, MA '. . Owner: Angie Simpson Date of Inspection: May 8, 2000 ti :+ °`• Map: 234 Parcel: 030 Lot. 6 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) _ (00 , a revised 9/2/98 Page 10ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM,INSPECTION FORM PART C SYSTEM INFORMATION (continued) ..., Property Address: 44 Cranberry Lane, Centerville,MA k a ,~ l tR f Owner: Angie Simpson ,- r Date of Inspection: May 8, 2000 NRCS Report name Soil Type Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep STTE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater 30+/- Feet Please indicate all the methods used to determine High Groundwater Elevation: + — Obtained from Design Plans on record — Observed Site(Abutting pioperty,observation hole,basement sump etc.) Determined from local conditions ✓ Checked with local Board of Health Checked FEMA Maps , Checked pumping records Check local excavators, installers ✓ Used USGS Data p y Describe how you established the High Groundwater Elevation. Must be completed) r The bottom of the cesspool to grade was 10'. Using the Barnstable topographic map and water contours map, the maps were showing approximately 30' +/-to groundwater at this site. Using the Cape Cod Commission Technical Bulletin, the high groundwater adjustment for this site(A]W 247, Zone C, 3100)was 6.5'. This report has been prepared and the system inspected and passed as of the date of inspection. 'Tins 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 to the system, the inspection and/or this report. revised 9/2/98 Page 11of11 : !t ry • 41, r , �l r C A FE t V NEya ELEc : cam. = d,7 ,o��i�.a r _ 1 , 1 r i -..» -• `. ,,,..- .,a,,.n` «�»-Tw F G 70.10.............,.,..E-•-.»„_-�• �: .- '•,� „ ,t 1� ( ,a:,�- ... ....:-.•.,- _ • -...ter`-. ` rw-.-' -�-><...•-ya•��`_.�.,._ - � .'` IN ERC'WNNFnEi�� y ' r \1 `1Gol('Co�rse 73.0 `� 67 5,f. 6 6.5 �; , al Il <t7.3. 1500Gallon: e " Top El.67 5: \ �:.., - >. L��w Septic Tank 67.1 Bot.El: 64 5' 66.7 n - 1 CT;nberr X' a. y.. (- �` ;�vp : `•' - ,. , . . Bedding as 1 O t Per Title 5DIV a L.I\ o _+ T S'T.'ZpnlZ`O u2S -_ t c'\ - :'" •,ter. � �z �.,-,o.t✓. r. DELVE.LOPED PROFILE-O ' �o,, w..x, TE.M •11' 6' Lewis _ r - F PROROSED.SEP.TIC y�,,, n a i �, Island, ; - / M •r _ r ' , - Not:to Stale- YS i 4 � .� � tl'Beamse. � �•G � ,. 1 — es % _ - - .:; >, 9 , + Y r � i! n To of .. stall Addttton Stone o � r" £tl Compacted:F _ creae 7oMaintam3 Max. �LOCU PL�A f pT - • . ,. s E _ ,.• - 4j z <; - �. DESIGN DATA I -`2000 .0 m .-.. '- '+' f Filter ... — ' w: Scale• " > . _ n > Single Family 3,Bedroorri ^ Assessors 234 , / ;� -.a.:o+ Fabric—� Compacted 2. f-1$ p. :. .. r o ! No Garbage _� ti . _0 - - c. l ' .� � >.,_ ,: , . ,' �.. , _ ` . - � Parcel 30)- 0 o a N - g' ` n� 1-. T,. Dail ;Flow I10 x 3 -.330 d t/e"v2" r o r` nd 1Ndter Overla W P Peh,Stone <. - ny G OU 4 Septic Tank 330 9Pd zL200 /0-660 p'd, Y >.m. . a se a`,• ., .... a _ _� � �..fi, 500' Gallon Septic.' ank.` . - ,, a. s ,< LEACHING AREA a:` y 3 t'2 .: '- - . _ :.❑ _. ':sl. .Leachln 'ta - i w .Chamber — R rg` Doable - ,r,� 330 d/0.74- 446 f.Required. -�.� a. 9P- � wa5nea � Sidew611t 2 12'+25' 25 148 s.f. a. I I Bottom Area 12' x 25, =.300 s.f. ; T 0, 448 s.f.Total Provided. z' . .. LEACHING CHAMBER DES b <: COSS SECTION OF CHAMBER IGN z Alipes to be Schedule 40 PVC.Use 2 . _ NO TO SCALE. - . _i500 Gallon kin o Leaching Chambers'in a m y „ - -. ,'.. - - w .: •.r r ':r. ,.:. .. . ...C:• - `:d: F'- `5 #,. +.x. .W asked Stone Field as Shown. 5 12, 2 : s� - 4 NOTES ' : - 4 ... �. �. s . . ,. ' � �' � •'.� : 'T­.Water Supply.For This Lot Is Municipal Water. - w OF ; ' ;. tr i 2.Location of Shown on This A p " m . Plan re A rox. an N 'At Least Hours L H10 Prior to Any Excavation For This Pre ect Th ntr ,.max 1 e,.o actor.ShalLMake Required T h e R eq t ,Notiftca.tron :o DIG SAFE_-:I-888 344-7 r R 3.The Contractor I RequiredAppropriate s equ to Secure ,F �. _ 4 r Permits Froln Town Agencies For Construction". �j _�a n> W �/� fy� .: .« ,_ Defined byTt:is Pion.: ;. . ." �� � �. 4.Install Riser R r._ OWL �. P-LAN. VIEW' ; x as equlred,toWtthin l2 ofFtnished. :. 4, Grade, h °�^ x a -: ,'- - a .. _�" 5.A11 Structures..:3uried Four Feet•(4�) or More or _ ,�'•,�� - - `�'_ �« "� � �` � '$ Subject to Vehicular to be H=20 Loading, - 44 Q " ~ 6.Septic System to be Installed in Accordance With - a ."1 1'<ST 4+oLs L. 7Z.0 CMR'15:00 Latest Revision And The Town of O Barnstable Board of Health Regulations. �oA►� Barnstabl }° . . Li aMN COARSE sANp 7.AIJ Ptptng;to lie Sch.40 PVC. 4" , STROwI L3RN t B SAntO to Yr2 s�� .. � 'R - : - de c , %;Zt4'15H YEL. COAra-SC J Proposed tic Upgra For: �en'Thomas x Pro ed Se coaGL�S lava r,�L _ � - , berry e Kathie -�� '/CL- la 8RN CoAtrsE - Cranb ry Lan " SAND SO Goc3f3L-ES ,OYR 1 2.0 L At: 44 ' NO G{30UnIDWArE2 - Centerville Mass t31/ SULL114AN ENGINr--eJZ1NC INC_ " i n ' nc. ti -1` SullivanSull n Engineering xa Ostervgle`Mass ` 508-428-3344 . "' February'7, 2002