The URL can be used to link to this page

Home My WebLink About0053 CRANBERRY LANE - Health (2) 7ff� Agi"'; , ev NO Ml to lit 4"" ')PW lv�lliq%*�W-M::' !,,�V'.M'7� R ri�'4u 11111;11V'11�"�.'"A N '10 !AW QRl' '_W�'�� OWN& 0 GRA NOW pA ig NIT '41 RPM" ............... WN 'APT IN 14l' MV" k OIN "M 44" �z7l_ "a So 17 iy'M XT im nw 'XI ;1., x "t"'a , 1" 1, ff.,re q, OW Nq A eivi Z.,2C ,fflma; Wii. A, B'4 24- Y -,Clllrl N gem IF," "N t , mj�yk Ns '4 & MI j-""44" 1 ARM KE —awn lw_ I t 77 4 Al, 32 Nis t "IM, MR"'ot -V F. _IA -Exam" M AS I d 14 M `115 -a--W 0 VM qAg-".W W _m Own ��nAvoisil DOM; 21 IF"T 'ic' "s" . L Commonwealth of Massachusetts - Title 5 Official Inspection Form. ,x Nt Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M Joan Day Property Address 53 Cranberry Lane Owner Owner's Name information is� required for Centerville Ma. 02632 9/16/2009� 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 the end of the form. . Important: A. General Information When filling out forms on the 'TII' Ill/nl/(/nl/1 P i computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not use the return Name of Inspector key.. Capewide Enterprises,LLC. Company Name r� P.O.Box 763 Company Address Centerville Ma. 02632 nun City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number y 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 15.3%of Title 5(310 CMR 15.000).The system: C7 - 4a ® Passes ❑ Conditionally Passes ❑ 1is ~t7 -rr t* ❑ Needs Furth valuation by the Local Approving Authority tom . 9/16/2009 Inspe is Signature Date The system inspector shall submit a,copy of this inspection report to the Approving Authority(Board t of Health or DEP)within 30 days of,completing this inspection. If the system is a shared system or f 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 DER 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. F t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form # . Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M Joan Day Property Address 53 Cranberry Lane Owner Owner's Name information is r equired for Centerville Ma. 02632 9/16/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present 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 exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•06/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 r Commonwealth of Massachusetts W Title 5 Official\Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Joan Day Property Address 53 Cranberry Lane Owner Owner's Name information is•,required for Centerville Ma. 02632 9/16/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,-safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M Joan Day Property Address 53 Cranberry Lane Owner, Owner's Name required fo is Centerville Ma. 02632 9/16/2009 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for 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: k 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 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 ❑ E Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Joan Day Property Address 53 Cranberry Lane Owner Owner's Name information is Centerville Ma. 02632 9/16/2009 required for every page. City/Town. State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 1 0,000g pd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above.the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance'with 31 O CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M Joan Day Property Address 53 Cranberry Lane Owner Owner's Name information is Centerville Ma. 02632 9/16/2009 required for { every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? A.- ® ❑ 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? M El Were the septic tank manholes uncovered opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information _ Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•09/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M Joan Day Property Address 53 Cranberry Lane Owner Owner's Name information is required for Centerville Ma. 02632 9/16/2009 - every page. City/Town State Zip Code Date of Inspection D. System Information Description: The septic system consists of two cesspools and one leaching pit. Number of current residents: 1 r grinder? Y N.Does residence have a garbage a de ❑ es ® o 9 9 9 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 2008:35,000 g ( y g (gpd)): 2008:35,000 Detail: 2007:145 gpd 2008:96 gpd t Sump pump? ❑ Yes ® No 9/16/2009 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.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 i r _ Commonwealth of Massachusetts ti W Title,5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M Joan Day Property Address 53 Cranberry Lane Owner Owner's Name information is required for Centerville Ma. 02632 9/16/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Capewide Enterprises,LLC. Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? measured Reason for pumping: Maintenance Type of System: ❑ Septic tank, distribution box, soil absorption system ® _ Single cesspool ® Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑, Other(describe): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M Joan Day Property Address 53 Cranberry Lane Owner Owner's Name information is Centerville Ma. 02632 9/16/2009 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes M No Building Sewer(locate on site plan): 18" Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of leakage.System vented through the house vents. Septic Tank(locate on site plan): Depth below grade: feet Material of construction: < ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 P 9 P Y 9 Cominonwealth of Massachusetts Title 5-Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M Joan Day Property Address 53 Cranberry Lane Owner . Owner's Name information is required for Centerville Ma. 02632 9/16/2009 . every p'age. . City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): ,a 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts u Title 5 Official inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Joan Day Property Address `e 53 Cranberry Lane Owner Owner's Name information is required for Centerville Ma. 02632 9/16/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): �9 Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 ILN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Joan Day Property Address 53 Cranberry Lane Owner Owner's Name information is required fog Centerville Ma. 02632 9/16/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): n. Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Joan Day Property Address 53 Cranberry Lane Owner Owner's Name information is required for Centerville Ma. 02632 9/16/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: r ® leaching pits number: 1 ❑ leaching chambers number: El leaching galleries number: ❑ leaching trenches number, length: ti ❑ 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.): Sandy dry soil.No signs of hydraulic failure.Water was 5' below invert.Stain line is 3' below invert. =4` s Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 2 Split system tied together. Depth—top of liquid to inlet invert 0 Depth of solids layer 0 Depth of scum layer 0 Dimensions of cesspool 6'x6' Materials of construction Concrete block Indication of groundwater inflow = ❑ Yes ® No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts F W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r' M Joan Day Property Address 53 Cranberry Lane Owner Owner's Name information is required for Centerville Ma. 02632 9/16/2009 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.): Both cesspools were full to outlet lateral to leaching pit. 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.): 15ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Map Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size zoom Out In 51 i T v d k y Y£ Q � Y 1 £ l W 2 fit: Set Scale 1" = 20 I Aerial Photos z MAP DISCLAIMER (` —rinhf,)nnr-,)n O Tnuln of P—cfohlo KAA All rinhfc racani. http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=234025&map... 9/17/2009 < , ' z Commonwealth of Massachusetts W - Ti IO-5 :Official Inspection Form °Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .- Joan Day ` s Property Address 53 Cranberry Lane Owner h- Owner's Name Information is Centerville Ma. 02632 9/16/2009 required for every page. City/Town State Zip Code Date of Inspection ` D. System Information (cont.) Site Exam: Z Check Slope ® Surface water ® Check cellar , ❑ Shallow wells Bottom of LP 45' f Estimated depth to high ground water: feet : Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record r x If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) s' ® Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: ;a #`•. You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 annual ranges of groundwater elevations. yM1. If Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M Joan Day Property Address 53 Cranberry Lane Owner Owner's Name information is'required for Centerville Ma. 02632 9/16/2009 every 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 a t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 l TROY WILLIAMS ' SEPTIC INSPECTIONS y Certified by MA Department of Environmental Protection (508) 5b5-1300 19 Hummel Drive South Dennis, MA 02660 `COMMONWEALTH OF MASSAC10SE111'S EXECUTIVE OFFICE OF ENVIRONMENTAL, AFFAIRS DEPARTMEN.T.OF ENVIRONMENTAL PROTECTION 'ITITE S OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE I)ISPOSAL SYSTEM FORM PART A CERTIFICATION �a Proper(N Address: 53 Cranberry Lane Centerville,MA Joan Da Owner's Address: 53 Cranberry Lane *- Centerville,MA r 0� Date oflnspection: September 20,2006 O Yr L - Na►ne of Inspector: Troy M. Williams - Company Name: Troy Williams Septic Inspections Mailing Address: 19 Hummel Drive � � s South Dennis, MA 02660 Telephone Number: (508)385-1300 CERTIFICATION STATEMEN 1 I certify that 1 have personally inspected the sewage disposal systeni'at this address and that the information reported t below is trite, accurate and complete as of the time of the inspection. "The inspection was.perfonned based on my t training and experience in,(he proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved si stern inspector Pursuant to Section 15.340 of Title 5(310 CMR 15.000). The svztcni (.f Passes Conditionally Passes Needs Furthert:valuation b) the Local Approving Author it) Fails . Inspector's Signature: Date: �av /off The system inspector shall submit a copy of this inspection reli6rt to the Approving Authority(t)oar(l of I leal(h or DEP)within 30 days of cornpleting 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 l DEP.The original should be sent to the system owner and collies Seri( to the buyer, if applicable, and the approving authority. t Notes an(] Coninten(s' Although system rneets the minimum requirements set forth by the Massachusetts Department of Environmental Protection,certification is not to be construed as a guarantee of future working condition of system,piping or components. This inspection represents the conditions of the system on the Date of Inspection noted above. *4A~This report only describes conditions at the time of inspection and under the conditions of use all that - time..I his inspection does not address how the system will perform in the future under the same or different condilions,of use. Title 5 Inspection Form 6/15/2000 Page I of ' I'ilgc 2 of I I 01-111C.`IAL INSPECTION li'012M — NOT let)it VOA UN'I'AlI2Y ASSESSMENTS t S1JBStJ121i'ACI: S1 'WAGW, 00"OSAI, SYSTEM INSPECTION ION 1+011M C1=1241 11CATION (continued) Properly Address: 53 Cranberry Lane Centerville,MA. t Owner: Joan Day l 1)a►te of Inspection:. September 20,2006 Inspectiuu Sulunl:u•y: Check A,I1,C,I)or C/ ALWAYS complele all of Seciiuil 1) A. System Passes: I i I have not loulid any information which itidicales that any of the lailulit efileria described in 310 CM It 1 15.303 of in 310 CMIZ 15.30'1 exist. Any falilllle clilelia not evallllilted are indicated below. t Coiun►culs 117 SyslcurCondililinally Passes: r One or fuow system C0111p)nculs as desc►ibed ill like "Conditional Pass"section need lc e replaced or repaired."Pike sysleul, up al curupletioll of the leplaceilleut of repair, as approved by the IA. t of I Icalth, will puss. Answer yes, no or not.ticteimilked(Y,N,NI)) in tile_ for the following slalcolul If"not determined"please ' cxphiiu. - - i —•I•he septic lank is niclal and ovef 20 years old* or the septic lank ( tether metal of nol) is slnlc(Milily F kinsound,.exhiblis sulislaruial inhllraliou of exllltralioll t)I tilllk taillike i- 11111ilioclll. System Will pass inspection it the existing tank is ieplacetl will is complying septic laok i. approved l !be fluard of I Icalth. "A metal septic lain well pass iuspcgiuu it" is stiliclilr111y soul , not ICAiug and if a Certificate of Compliwice , indicating that like lank is less than 20 years old is available. I. ND explain: 1 _ Observation of sewage backup of bfcak n of high slalic"wutcl level ill the disll'ibotion box doe to broken of obsti-ucted pipc(s)of due to`a broken, selllell t i111eveil dish iblllioll box. SystClll will pass inspec(lo11 1.t(wlill approval of Beard of ileaillh): ' — 1)1t cil pipe(s)are feplaccil )slfliclioll is I(loovetl . _ a dislribulion box is levelctl al 'leplaced . . i NI)explain: " 'file system f uircd pilluping inure thiru q limes it year title to blOken of ol)slflicled plpe(s).T Ile system will pass,inspection i Willi approval of the 13ilafd f,Ileallh): brokeik pipe(s)are replaced -- obslruclion is refit lved ND explain:' t: i 1 t. x Page 3 of I l I t Off I(IIAI., INS11KC'I'ION VORIVI - NOT VOR VOI.IJN'I'ARY ASSESSMEXIS SIIIISUIZI ACIs.SI�VyAGL 1)ISI'()SAj-, SVS'Y CM INSIT C"1'ION VORIVI PA RT A ('1?R'I'II�ICA'I'IQN (talnunnetl) ' . '. Properly Address: 53 Cranberry Lane 1 Centerville, MA (huller: Joan Day i Dale of Inspecliuu: September 20,2006 I ('. 1'u►lime► h.valualtoo is Required by ll►e Board al Health: i _ Cundilions exist which requirC timber evalmalio❑by file Board of health in order to dcteraniue if the system I is failing li.►protect public health,safely of.Ibe ertvirounlcnt. L System will pass unless Hoard of Ilcallb tl�lerirlines in accordance with 310 Guilt 15.303(I)(1k) Ihul Ile. sysieln is not I•mncliol►img in a Inal►ner WI►icll will l►1'olccl public bcalll,safely and like envi wnenl: i Cesspool or privy is wilhiu 50 leed of sal lace water �II _ Cesspool of privy is within 50 feel ofa bordering vegetated Welland or a sali near t . 1.. r l 1 2. .System will fail unless like lluarll of Ileallb(and I'ublic Water S pplicr,if ally) determines that like l systen►is Iwictialliug ill iyll►alu►el• Mal projects like public health 'afcty :aid cnvL-oluneot: l '!•Ike:sysleui bas a seplicuaik and soil absoiphon sysl 1(SAS) and the SAS is within 100 feel of.a I surface water supply or 11ibolary to a.surface Watcl.su Y. i `I'lie system.has a seplic.uolk and SAS and c SAS is wilhiu a Lone I ()fit public water supply. i I Pike sys)em has it septic lank and S atul Ibe SAS.is williiii 50 feet imf a priva►c wales Supply well. I i "!•be system bas.a septic tank tl'SAS and the SAS is less loan. 100 feel bill 50 feet or more Irnnm a q privale walcr supply well**. mud used to tlderritine distance **"Phis system passes if' .e well wales analysis,perfagnctl al it I)l'P cerlihed laboratory, for colitarm bacleria anti Olalile -genic Conlpotitlds illdicales dial like well is lice from pollution 1'161n lhal facility and the Ill. lce.of a u0111a nitrogen and 111llale 111(1'ogen is e4aal lit of less than 5 ppm;provided dial no oller failure criteri•, arc triggered:A copy of tide analysis must lie altacbcd it) Ibis form. F , •. 3 . } f Tube it of*1 1 0111,ICIAL INSPECTION FORM — NOT FO12 V01M '1'ARY ASSESSMENTS f SUBSURFACE SEWAGE DISPQSAII SYS` ELM INSPECTION FOIiNI l CIa12`1�I�I�=A�I14N tcunllnue(I) !i 53 Cranberry Lane Properly Address; Centerville,MA i Joan Day (huller: September 20,2006.. E Dale of Inspectiop: l i 1). Sysle'lo Failure Crileria applicable to all systems: i You uulst indicate"yes"or"no" it) each of,(liefollowing jot dill iuspcclions: Yes No Backup of sewage into lilcility of syslcu�cofnPolleiiI flue 10 overloaded nr clogged SAS or cesspool _____ ✓ Discharge or ponding of efllui;nl to Ille sill race of'(lie ground or surfilce waters due to an overloaded or. clogged SAS of cesspool - Static liquid level ill the disli ibuliun.box above onllet iuveiI (lilt to an overloaded or clogged SAS or— cesspool I_iiluid de)ill ill cesspool is less iban 6"below invci o - ! I 1 uvuilahle volume is less than /s day flow ktquiicd Punlpiilg more than 11 limes in lilt last year NOT due to clogged or obstiticted pipe(s). Number of Blues pungied __ ✓ Any portion ol'the SAS,cesspool of privy is below high ground water clevalion. _ _,/ Any pot lion of cesspool of privy is within 100 feel of it Suilace wales supply of It ibulary to it Surfaet w filet supply. �. Any porlioo of a cesspool or privy is wilbin it Lune 1 ufa public well. Auy lwitioo ufa cesspool or privy is witbiti 50 feet of-a private water supply well __ ✓ Ally poi liou of it cesspool or pi ivy is less tbau 100 feel hill giealer.thau 50 feel ti-oin a private water l Supply well willino acceptable water quality ana1 analysis. Lois s stela passes if the well waler noalysis, ` 1 " Y 1 Y 1 pel forn►ed ai it 1)10P cel!died labo►Ialpl-Y,fur colifol-n►bacleria and volatile organic conglouuds fndicales lbal (lie wc11 is tree Irojik polltlliol►Iralli that facility and Ibe presence of auunootil nilrogeu and nilrale nilrogen Is cy p 14) its-less than 5 ppn►, provided !flat fill other failure criteria } are Iriggered. A copy of file analysis luitsl tic allacbed (o (his forlri.l } NV_(YCS/No)The system ff►fls. 1 have dulcttnillul Ilial !)lit,or mile ol'the above I` holecriteria exist as t desciibell in 3 M emit 15.303, Ihcleforl; the SYS16if lilils. Pike sysleul tiwiier should i onlacl Ilic hoard of health to deleirnine Mull will be necessaq it,correct file failure. 1 . 1,14-ge Systems; To be collsillcl-ctl a Jill-be s.yslein the syslellt n1 ns1 sel-ve.1 cllily with it esibn Ilow of 10,000 gpd to 15,000 gill!• you must indicate cillitf"yes"'or"no"to eilcll of file 4u11owifig: (The following crile fia apply In iaige systems ill addition to lilt till is above) yes nu -- — tbt system is within qU0 lecCof a snrliice drinlCil wafer supply ttie system is within 200 1'ct of a liibutary . a sulfa!t drinking walei supply tbesysicul is loi;aled iu i1 11111'ogC11 se Itive at ea(hllefipi Wellhead 11foleclion Area—IWI'A)of it mapped l Zone 11 of it public wafer supply If you have answered"yes" 10 any flue roll ill Section 141 like systerrt is considered it significant 1111'eat,of answerer! yes".ln Section I)abgve' file large slein Ilan failed.I'lie owner of opeial If ol'.ally large systerii consi(lered a aibnilicafil Itife114 ryul f Section C ,r(ailed under Secliolt P shall Ileg1itde lilt syslent in accordance will!316 CMIt . 15.311q `I'lle.systtni owner Sit( , tl cot fact the ah(�I�pt-lilt C Iebiollitl 6111ct`of IIIe l epalIliteuf. Page 5 of I 1 01+11CIA1, jNSI't,CTIIOIV 1eORM — NOT FOIIt VOIIA-INTARY ASSESSIVI N'1'S SUBSURFACCIC S1 'WACY1�. DISPOSAL S'YSTLi'IYI !NSPI1eC`I'ION vO121YI ; Properly Address: 53 Cranberry 1Lane Centerville,MA Owner: Joan Day l I Dale of Inspeclioml; September 20,2006 l:heck if the likllowing leave been done: You nmusl iudicale"yes"or"no"as to each of the following: Yes No Nimruping i1doilllalion was provided by the owner, occupant, hoard ikf IItalllm t — -i/- Wart ally of the syslenk conkponiinlS pumped otml in Ills previous two weeks? — I las the systcnk received nonual (lows in the previous two,week period i have largo vulurnes of,water been iulroduccd to Ilene syslcln iccenlly or its pall cif This inspeclion? l Wcrc as buill plans ol'the systtirk obtained ilnd examined?(II Ibey welt not available mite as N/A) t __- Was like I'acilily or dwelling iospeeled for signs of sewage back up? -,� -- Was like site inspected for signs of break rent ? { --— Weic all sysicul cikngxkikenls, exclmkding like SAS, loclled lilt-site '? N_!-q_ Wetc like septic iiwk mauhu `les mkuly l -1 likened, and the interior of like took inspected for like condition � of Ilke bai'lles m Ices, mll ueiial ol�coustruction, dimensions, depth cif liquid, t1cplh of sludge and depllk of scmkrn? f 41 -✓ --_ Was lime facility ownul (and occupants if dilluelki (room(Iwuei)provided will) inliirumation oo tilt piopci , maintenance of subsurface sewage ilisposal sysleius Y `!'he size antll Iucalion of lilt!Sail Al)snrlklii►ll Syslclit(SAS)on tilt silk gas been llelermined based on: Yes uu Existing infonmialion. l"'or example, a pla►l at the 130itrd of I lealib. m Dete mined in [lie field(if any of the (ailmlre criteiia related In Bait C iS ul issue approximaliolk of distance is unacceptable)(310 CZAR l S.302(3)(b)) • l 5 Page 6 ill' I t 1 01 1-1(AAI- YNSI'CC`j'IUN FORM — N()`I' I'Oli VOLUNTARY ASSESSMENTS , SUIISUItliACt; SEWAC:h 0114.0SO, SYS`I'INVI INSI'I-e�CTION FORIVl SYS"ITIN INVORMAI-ION Property Address: 53 Cranberry Lane Centerville,MA (hvuel: Joan Day Bale of 111s ►cetio : SePtember 20,2006 I W l, ,O l:0 ) `CO t N l . lNS RESMEN'11Al. Number of ltcdioonls(design): Number of bedrooms(actual):J DESIGN flow based on 310 CMR 15.203 (lia tr xamplt: !10 glut x IE of btidroonls): 33 0_ Number ofcmicni res t cIl , Does residence have a garbage grinder(yes ill no): //a f Is laulldly ou it sepalale sewage system(yes or no):ti_tz lif yes separate inspection retluired] I-auullly systeoi ilIspcctt tl(yes ill-ob): _y..j.1q 1 Seasonal Ilse: (yes of lid): jvP f Willer nlctcl-readings, if available(last 2 years usage(811(l)).4> �(1-�poo_c/.•lla^S U`l (,3,00b Suulp pump(yes or lit)). N0 Last dale ol,Occo}tine Lc �J .-d { CUMIVII�R(�IA1..1IN1!)US`fltl��l. Type of cstabfislurlcill: l)esigo flow(based oil 310 CMR I5/—) — gpdBasis of design flow ___Grease lnlp piescol(yes or no): - —Industrial waste bolding lank presen —Noll-sanilaly wade discharged to thll yes ol-no):'Wales rnctel readings, ifavailable: ---L ilm dale of occupancy/osc: --OTJIEIt (describe): --- --- GENVAOIll. INFORMATION ► 1 l'uullling Records SouiceofiIli-it-mllion: V Was system pumped as pail of Olt; inspectioll(yes of no): dun If yes, volume punlIletl:_--gallons - llow was ttuanfity primped dewrinined?—_ Reason till-puulpi'Ig' -------=-----=------------=--- Septic lank,distribution box, soil absoiplio.it Sys!eirl _Single cesspool t Overflow cesspool -- Privy —Shored system(yes of 116)(if yes, attach previous lospeclioll records, if any) —Innovative/Alternative lecl►uology. Allach a copy of the cuiiew operation and maintenance contract(in be ob(allletl front systelll owilel) "light Tank Attach it copy of the M-T approval t • lI Other(describe):-- -- - --- — -- --- Approxiipme age of all components, dale installetl(if known)and source of infurnialion: n A :A_u.. I Z t/( 2 , Were sewage gdors detected whet►arrjving al the site(yes Of no): A1_0 6. . Page % of 1 t ()F ICIM, jNSITCTION r'ORM -NOT JeO t VQIAMI'ARY ASSE'SSIVIEN'I'S SUIISVIMACC SE'WAGJ 1!)ISPO$Aj, SYSTEM INSP CCI'ION FORM S YS`i'�AI 1N��[aI1MA`I'ION (cgnl�nneil) Properly Address; 53 Cranberry Lane Centerville,MA Owner. Joan Day ` Dale of 11►spectiot1; September 20,2006 1101L.DING St WCR(locale oil site plall) • i Depth below grade:—a I — - Malerl lls(ifconslnlcliun. cast troll 40 I'vC ,/olhcl(explain):(wf.-, Distance f onl plivate wider supply well u1 suction lioe: &14 — I Comments(oil condition of johns, venting,evidence of leakage, etc:.): ,1 1 ��s t�.�I.L��h c i C✓-v.rt �✓l� G r�f /mod ;<6 : UYw�. 6 i i ) C �sg ✓J I L ( wa S S h,"'f Ik .LJVvja c Yc+✓� �( t rl Is j 0 ✓ N+n- hec C t t�c �tir �t� r r SEPTIC TANK: _(lucialc ousile plaij). o ist v�is�, /qjs� ho t " 6 Depth below glade: - - (►1a1 7 h�y� �u /// < s .� o�Lwn� �l.,r'bl s.,s a f I. Material ufcousllucliou: ci,ilcrcle _nlelal libciglass _--polycll cu 7 6e • If tank is oici al list age: -- Is age confillned by it eellificale of lupliance(yes o1 no):__(altach a copy of ccl'llllcale) A � I)iinensions:_ f Sludge depol ----- - - - t Distance lion)lot)of sludge to bolloin'of oollel ice pl' afllc: Scuu1 thickness: _ I Dlslance 1,10111 lop Ofs(.11111 Ill 101)rol omlct tee( tattle: Distance lion buUuro of s(:uu►it) l)(Mool of ullel tee or bafllc: How were dinwnsio(Is deleruuned: { C:'uuunculs(()it punlpi 18 rea)nuucild ons, ilkict all(I uullcl lec or balli(;coudltiou, sliucllu.11 111leglity, liquid levels 1 as relalcd to outlet iuvelI, evideoc of leakage, etc.): I (:Rai ASE TItAI': _(locale oil silo plan) Deplll below glade:— tYlillCllilt of l;nI1Sl1-llc't1011.__-_CUZoi 1Clill_=llberglil9S - po 'lllylLlle OttlelScum lhickncss:Dislilucc lioiu lop of soon lit loee Ill battle __DisUice lY(in1 butluin ofsculu t uullcl I ur battle.Dale of last Iminping' -----Comnlenls(on puitlpillg recoluni .el liu(l outlet lee or baffle condiiioli, structural integrity, liquid levels as ►elated to outlet iuverl, evidcge,etc.): .. 7 ^. - 01" ICIAl- INSI'LWVIQN FORM - NUT J�Q12 W4,UN'1'ARY ASSE$SMEN`I'S 51113Si<Jlil��Cl? SEWAGI-' 1l)NSl<'()SAX, SYSTLIVI INSI'1?f_"I'IUN f,'U><iM I'AOT C. SYSTVIVl INFORMATION (couliuned) ` i Property Aililress. 53 Cranberry Lane. Centerville,MA Owner. Joan Day Dale of lmspcctimu September.20,2006_ I'l GA IT or I101.1)1N(. 'LANK. lank must )c 'gun►►et at lime o ► ( ( . Ilt 1 I cctu�n locale o►►site �l l Ian 1 t )( I ) beplli below grade: Material ofc011sliuchon:_ eonciele inelal_ fibergh _ polyethylene olhei(explain): r 4 Dilne►►s it) is: - . . Capacity: gallon S — ---------- - � Design blow — - _ gallons/flay Alai-in prescmt(yes o► n6) - Alarm level: _ _ Alarm in^working of ci(yes or no): . Dole of last puu►piug: -_--- l Comiucnls(Condition of alarin and I at switcbcs,cic.): iff i D1STi2llIU11ON BOX. (if present ii►►191 be opcnc�l)(lu le on site plan) 1 Depth of liquid Icvcl above millet.iovel I Cooumeols(Hole ifhi►x is level and distribution ill o ,cis cllual, allyevideocts ofsolids carry►iwer, any'evidence of leakage into ►r_oul of box, etc.): t ---- .. -— -----------------. ------- - _..—_. PUMP CIIAMIIII:It;--(locate oil site plan) t Pun►ps ill working order(yes,of oo): Alarn►s in woiking order(yes tx nu): —_ C un►inenls(note condilioo o(puimp cha►nbcf, conditit of puotps and appuitcnamrs, etc.): 1. . Page') i,l' 1 01, ICIAL 1NSI'I C1'ION PORM —NOT fe011 WIMNTA1ZY ASSI SSMIINTS SUBSr1M,ACE Sll WAGC SYS`l'I-1N! 1NSJIIi C'll'ION FORM 1'A 1i'I' C SYS` I-IM I11+ORMATION (co lfinueil) Properly-Address: 53 Cranberry Lane I Centerville,MA Owner: Joan Day . Date of lospectioll: September 20,2006 SOIL AUS(lltl''I'ION SYSh1NV1 (SAS): (locale 9t►site plan,exc;tyaljon kill !cyulr( l) l If SAS not locale(l explain wily: Ype Icaclliub pits, nur►llier:_I= 6'x 6 l�� 1.,, ��.► w:'�h 2�s h� ( H Lo S� _-- leaching chambers, number. leaching gallcrics, rnlniber:- _- leaching(tenches, minher, Ienglh: - _— leaching fields, nuiober, (1ilneusiuns: - ------overflow cesspool, nunibu: i — innovative/alternative sysle m `hype/came of Col III wills(nole condition of soil,signns ofhydi-aillic failure, Ievel of pondirll;, daiup SoII- , condition of Vegetation, t Etc.): ?4- ;h�,�jS-a� c,!�._s,..�i_.i_i.._b11.-��_1;_��---S��nl�J_Zc._—��_�•__-� °+-�-_mot .�!t)L.G_,o._��-i__�_r�Si.vj� I r=S.G•Y. )'.J Mo .�.✓_ ..t-w(.�<.tp/� cl-f/O`✓l;.c.. �'e�„i,J✓•�•- v✓ `.a/'v�j�•�sr� s L1 C'( SS�'OQt : ✓ (cesspool must be pumped as pall of inspeclioll)(locale Oil Site plan) a Nunlbcr andcoult uruUou 2 t�w'ti 4 Depth lop of liquid to inlet invcit ��_ ----- . Depth of solids layer: - Dep►li of scum layer: Dimensions ofcesspool: Materials of coilslrucllon: Indication of grouu(lwaWl inflow(yes of rlo): Aid (u,;� ;•p� , ;•,sP- u�sp ) Coninients(hole condition of soil, sighs of hydraulic lailuie; level of ponlling, condition of vegel(llion,etc.): ��r•�- vac_��J.�..,t_�_.ci��->-R��,�.,�,�__1�.�j m��.�+��-�-�• '��•_��>+-�% f hp n+�.•,� LOKJl2.71 y�,/o tg/ o s ./ Sy t'12IVY: (kli ate on silo plan) P j );' � ke-4, �f L/ L-4u �Ly Ivialerials of collsti oction: G ` S S 9 1 Depth of•solids: i--- - — Culmncnls(note cou(jiliuu of soil,signs of hydial c lailuie; level of poConditiong, condlln ut uii vegelan,etc.): . f Page 10 of 1 l r +{ OFFICIAL INSPECTION fl,O IVI - NOT I4It VOVUNTARY ASSESSMENTS SultstiltitACE SEWAGE I)ISI'()SAl, SYS'I'I�M INSI'E'C'I'1QN DORM I SYS'j'ckI INFf)RIVIATION (cowinued) . i 53 Cranberry Lane Properly Address: Centerville,MA + Joan Day Owner: September 20,2006 Dale of Inspecliou: f SKETCH OFSEWACE DISPOSAI,SYS'I'hIYI 1 Provide a sketch of the sewage disposal sysreln incllldiug lies to at least two pef111anclll felelence landmalks or 1 benchniarks. Locale all wells within 100 feel.locale wliere public waler supply untels the building. ------------- 1 - r 1 / z ys—0 31 ' 3 s f'3 . p ' � l Page I I of l I { t OFFICIAL INSPECTION jeORM — N()"1' I�()li Y()1-.UN"1'AIiY ASSI?SSMI�N`I'S ' SrIIiSUR ACl". SCWAGC 01SPOSAI, .SYS EM INSPECTION FORM SYS"Wm 1Nje01iMAT!ON (coulinued) Proper(y Address: 53 Cranberry Lane Centerville,MA Joan Da +` Owner: Joan r Ihrlc of luspecliurr: September 20,2006 I SI"I•IC P XANI 1 Slope { Surface wafer �- Check cellar Shallow wells lalinraled.dcplh to giouud wait i zy•S)reel Adµrslcd high grouurl wirier elcvalion .2'7-L'fcel . Please indicate (check)all mciltods used lu iJcicnuine dic liigh ground wilier elevaliou` I Obtained I'lom sysleru design plans oil record Ifclreckcd, date of design plan reviewed: Z Observed silo(abulling properly/obsu valion 1161c within 150 feel ol-SAS) _— — Checked wills local hoard of I leahb-cxplilul: Checked wilh local excavalols, ruslallers. (mlacl{rlucuutenlalurn). Accessetl I,JSGS dal.lbesc-explaiir: ygjv-_.r 2`j7 jvwye You u►usl describe lww You eslablished rile high gi( uud w;rlCi- cicvaliou: l _4�,�._5 .:.may:�-Q--.�t3:.Y �. ^� ._�.,��H..► .� ,�� yef.,�� 24 r , -t—_ A . ---------------- --�a_�rn� --d� _.�_4sa�s%�ik��.>. .ca-.�- 1�.:.c2.�._<r c�S ___1'L.t2 3-.._-._f♦sa G-c'�=-�.:s-�_ r�l=--�� Xq. � I t o Il.ot This report Iias beet)prepared and [Ile system Inspecled as of Ilia dale of inspection. This report is nor a warranty or guarantee that CI)e systerrr will (unction properly In the fulure..Tliere have beer{no warrarilies or ua a lees either x ere r n e r s d written o 9 er . n r Implied, sierra o 1 . . P.e<f, f. t e s ate►n he Ins ec, o 9 . .h 1 �Inar/o P., .y P and/or r this report. , . f w TOWN OF BARNSTABLE ?LOCATIO SEWAGE # C VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME &_PHONE SEPTIC TANK CAPACITY .; . LEACHING FACILITY:(type)'- (size) K - 3 NO.-OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT.ISSUEDi : DATE COMP-LIANCE,ISSUED: / 1 VARIANCE GRANTED: Yesy No ✓ f f No .APPROM ' e 8arnStebl9C0nS9W8tW06PftMe'VHE COMMONWEALTH-OF MASSACHUSETTS [ b _�sEu SOAR® OF HEALTH Signed pate . TOWN'OF BARNSTABLE 'r Appliratiou for Ui"b aal Works C �r r uan rr�ti# Application is hereby, made for a Permit to Construct. ( ) or, Repair= an Individual Sewage Disposal System at s 1 Cranberry Lane Centerville f ............................ ...Y... .._..................... ...... - ... ....... .. ........ ....._................ 4 .....:.......................... John Ryan Location,-Address F or Lot No: r ...................... --• :: ................................................................... -- W J P Ma e o mb e r J r ownerddress .:.._•------------------•••------------------ ------- I......................................... ............................................................_ .. ...... Installer Address R Type of Building Size Lot.... ................:.....Sq. feet V DwellingY-No:`of :Bedrooms.............. Ex ansion Attic Garbage Grinder 04 Other—T e'of Building ............. ___.... No. of'Persons 'Showersia a -------Cafeter d Other fixtures --------- -------------------- -----'-- -------- ------------. ------ ---- W Design Flow.............................................gallons per person.per,day. Total daily flow ._.. _:..:.:.. gallons. '0 Septic Tank—Liquid capacity..............gallons Length __. Width............. Diameter r_' _ Depth................ ----------- y Disposal Trench—No. .................... Width....................... Total Length.......-__............. Total leaching area.___ ..__..._.....sq. ft. Seepage Pit No..................... Diameter................... Depth below inlet.................... Total leacl-iing area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by --------------------•----....-•------------ Date- �] , Test Pit No. I________________minutes per inch' Depth of Test Pit Depth to ground water-__ f� Test Pit No. 2............:..minutes per inch Depth of.Test Pit _............_---- Depth to ground water........................ a Description of Soil.............................................................................................. 1 v Sand & Grave_1 = F W ...........................................------------------- - ;.......---• --=-- U` Nature of Repairs or Alterations—Answer when-applicable--------------_____ ---• ------- •--------- ...................................... 1-_1Q.0Q...gallan...le&ch. pit...P.achaa...ia..ataae------=-- --- - - Agreement: },y The undersigned agrees to install the aforedescribed'Individual Sewage Disposal System in accordance with } the provisions of TITLE 5 of the State Environmental Code—The undersigned further,agrees not to place the system in operation until a Certificate of Corn Ilan y" has b i the oar of,health. = i 1 1/6/92 Signe ' Da Application Approved B = -� /� � PP PP Y ' - ..--- ----------- Application Disapproved for the following reasons: :.... . ... :_ ----- ............................................................ --- Permit No. /.'. `: �-........ Issued :r; . .' �"' .. 2 Dare - - , ��= No. -..-- ...... ..... Fizs.. THE COMMONWEALTH OF MASSACHUSETTS ht a �v�°1a. BOARD OF ,HEALTH TOWN OF BARNSTABLE { Appliration"for Dhiposal,lVarks Toustrukttnn Vamit Application is hereby made for a Permit to Construct ( ) or Repair Y(XX) an Individual Sewage Disposal System at 61 .Cranberry Vane Centervilie ' - ............ ..__......_ .....................--•yl..--:...-------------------.-_:...... --------------•---•--------•------ •--•--- -----•---------•--•----•--------:--:------ Location-Address- or--Lot N--o. John Ryan --...................-.......................................................................... ................................................................................................. I Owner Address W J.P.Macomber Jr. a •---....-•-------------------------------- -•-------------•-----------•------•---•--------- .............................................•-- es.s......---....------........----.....----•-•. Installer Address Type of Building Size Lot............................Sq. feet U Dwellings;No. of Bedrooms........... J............................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ---.. No. .of persons............................ Showers — a Other—Type u g ----------------------- P ( ) Cafeteria ( ) Otherfixtures .----•------------------------------------------•. -----------------------------:------------------....---....---- ---------------- W Design Flow.............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...................:. Diameter.........--....._... Depth below inlet.................... Total-leaching area.......:..........sq. ft. Z Other Distribution box ( ) Dosing tank a Percolation Test Results . Performed by........................................................................... Date.............................--......... . Test Pit No. 1............. minutes per inch Depth-of Test'Pit.................... Depth to ground water........................ f=, Test Pit No. 2................minutes per inch Depth of.Test Pit......................Depth to ground water..--................---. O • • Descrlption of Soll ----••----•-=-------------------••-••----•-•-••--•-•-----••••••••--•--------••----•-........._....... v ........................... and_A..Grave 7 -------........................... . W - x -•------------------------------------------------------ ----------------------------•-------------------.........................................................-.................................. U Nature of Repairs or Alterations—Answer when applicable................................................................................................ .1=1 nnn Pa,cke-A...in--- a nne..------------- =-------------------------------------•- . --- Agreement: r The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the 'State Environmental-Code—The undersigned further agrees not to place the system in operation until a Certificate of Complian has b e iss ed/by the ,oar of health. �l Signed/ r. .. , /� - /� 1/6/92: ------ ------------------- -- Date A��lication Approved BY = �� ... == - / `� -------� . Dace Application Disapproved for the e following reasons: -------------------------------......................----- ---.------........------ ---------------- ------------------------- 4 - .............................................................................................°..................---- ............/......-----..--.- ..............................----------- it No. ---- Issued -------------- ......1...''--- Perm . . Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE } Ter#tfterate of OT mytiance XI THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed( ) or Repaired ( X b J.P.-Macomber Jr. ;: Y -----------------------..................................----------------- at .... .1 Cranberry Lane Centerville Installer --- --------------------------------- .............--............................................. has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as.described in the application for Disposal Works''Construction Permit No .. �` .. ?._" dated .. p"- -`� : THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-------:-----------------' 1- < � Inspector :. ; THE COMMONWEALTH OF MASSACHUSETTS BOARD, 'OF HEALTH. ' TOWN OF BARNSTABLE s� o,00 No / FEE... ...3--...----... Disposal o ii o rr tt rk �>Q� �r �ln ut J.P.Macomber Jr. Permission is=hereby granted-------------------- to Construct ( ) or Repair (XX) an Individual Sewage Disposal System at No...61---Cra-nblexrm T, nra ('antarvi l la Stre el 9 as shown on the application for Disposal Works Construction Permit d R._......� Dated................................ - q � J ' t Board of Health DATE........ ....... ---•--./....-------•----•--------------- FORM 3660E HOBBS&WARREN.INC.,PUBLISHERS