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Home My WebLink About0066 CRANBERRY LANE - Health 66 Cranberry Vane B4rnstab.le, A= 234-028 , F . s d No...— Flcs,o'6.. '............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . ..............OF..... ................................ Appliration for Uiipnsal Works Tomitrurtion rantit Application is hereby made for a Permit to Construct ( ) or Repair ( A-)-�an Individual Sewage Disposal --f GL � System at: --------------Location- dd Lot No.ress ...---.--.................................... O ner Address ....... �........ ............ . .................................................................................................. Installer Address Type of Building Size Lot.................... .....Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons..................•......... Showers — Cafeteria a' Other fixtures .................................. Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W.W Septic Tank—Liquid capacity............gallons Length................ Width..............._ Diameter................ Depth................ x Disposal Trench—No..................... Width................:... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching 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........................ L% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+' -• .... ......1 ---••--------------------------------------------------------------------------------------------------- 0 Description of Soil............ u .................... ----•-•-•------•------------------•----------------•------•--------------------------------------------------- x W -•--••-•---•---------•------•----•••......•-•••--••••--•••••-- ......--•--••--•••......-----•......----•------ ---------------••--- • ---••-•--•-----•••••....••---....... V Nature of Repairs or Alterations . when applicable..____J_'� ... U !QW:LISP......................... r Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the bo�yrd of health. Signed---• . •.-• . . / � . jt E -"".e�.Z �Da Application Approved BY jam_ ..�..... --•-C------ ` Date Application Disapproved for the following reasons-.................................................................. ........................................... - .......................................................................................................................................................................................................... Date PermitNo.---..... .............................................. Issued........................................................ Date •- - - �+ - - - ��.�_ ---------------------- --- . ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. ............... .................................. Appliration for Disposal Works Tonstrurtion ramit Application is hereby made for a Permit to Construct or Repair (man Individual Sewage Disposal System at: /Z �'Z. ......... e............................................................................... A Location-Address or Lot No. .............................................................................. . ................................................................................................. Owner Address IL7-- Installer Address Type of Buildin;,, Size Lot............................Sq. feet Dwellings No. of Bedrooms............................................Expansion Attic Garbage Grinder 04 Other—Type of Building ............................ No. of persons......._............_....... Showers Cafeteria 44 Other fixtures ..................................................................................................... ------------------ Design Flow............................................gallons per person per day. Total daily flow......... - ..........gallons. Septic Tank—Liquid'capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No..................... Width---.........._...... Total Length......._.._......... Total leaching area...................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. f t. 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......................... fil Test Pit No. 2................minutes per inch Depth of Test Pit................._.. Depth to ground water............_........... -M .............4...................................................................................................................................... i b, 0 Description of Soil.............. ......................................................................................................................................... W .......................................................................................................................................................................................................... U .........."I ------------------------------------ ........................*......... ---------------------------" ..........*------------------***------- -------- - - U Nature of Repairs or Alterations—Answer when applicable..... 6:1 ......................... ....................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the.provisions of TITLE 5 of the State Sanitary Code—,The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed..?.. .. ...................�"/ ...........m.... ... ............................... D Application Approved By............-_�i... .................:7�......... ..............71.1pZ-5;�..... Date Application Disapproved for the following reasons:........................................................................................................... ........................................................................................................................................................................................................ Date Permit No......... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............. .......OF..... ....................... Tntif irate of T-amplitturr THZ PT , TI� P ER �Y, That Individual Sewage Disposal System constructed or Repaired by.........✓.... ........................Installer...............................*.............................................. . . at........../............... ............ ..........................Z............................. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Cod t as described in the 7 ........................ ....... ..................... application for Disposal Works Construction Permit No...... dated.-..'411.... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WIL7U C ON SATISFACTORY. ................ . DATE.. .. . ............................................... Inspector.... .......................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF O& 2. ............ .`.......OF......... ................... N . ...........0 FEE Dispont Works Topstrurtiott Prrutit Permission is hereby granted... . fit............... ........................................................... to Cc;nstryq ( ),p- r R (1,17an Indio' Sewage),AsposW System- // Cif . .............. ....................................... at No....j�k...... Street 17 as shown on the application for Disposal Works Construction Permit ��ZDItSd---- 0*. ................. —Y " 01%421� ............... ..........................I............................ " TE.............I.. ................................... ................ Board of Health SFOR � 1253 A. M. SULKIN, INC., BOSTON Commonwealth of Massachusetts _ Title 5 Official Inspection Form ' ' '-' Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 4 'rM 66 Cranberry Lane .. Property Address a Everett and Karen Lilly Owner Owner's Name information is — — — required for �P MA 02632 December 15,'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:When filling out A. General Information ' , forms on the f ` computer, use 1. Inspector: .5 1 only the tab key .< ' to move your David D. Coughanowr "' f cursor-do not use the return Name of Inspector , key. Eco-Tech Environmental - Company Name ' r� 43 Triangle Circle 4 Company Address Sandwich w. ,. • .; w MA 02563 'e"07 City/Town State `, Zip Code 508 364 0894 1328 Telephone Number License Number ,j • b B. Certification 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 15.600).The system: ® Passes ❑-Conditionally Passes ❑ Fails ❑ Needs,Further Evaluation by the Local Approving Authority December 15, 2009 Inspector's Signature: Date . The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or . has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner +. and copies sent to the buyer, if applicable,.and the approving authority- F ****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. r - t5ins-09/08 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 66 Cranberry Lane M Property Address Everett and Karen Lilly Owner Owner's Name information is required for Centerville MA 02632 _ ,,, _Dec6m' U6r,15, 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: Inspector's Note==> A septic system is deemed to pass this Real Estate Transfer Inspection if the inspector cannot answer Yes to any of the failure criteria listed in Section D on pages 4-5 of this report. 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): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System.Form - Not for Voluntary Assessments 66 Cranberry Lane Property Address Everett and Karen Lilly Owner Owner's Name a information is Centerville MA 02632 December 15 2009 required for , every page. Cityrrown State Zip Code - Date of Inspection B. Certification (cont.) t ` 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(§)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, ry ❑ 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 4' the system is failing'to protect public health, safety or the environment. 1. System will passunless 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, . F safety and the environment: - ❑ Cesspool or privy is within 50 feet of a surface'water 0 'Cesspool or privy is within 50 feet of a bordering vegetated wetlandor a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 + Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 66 Cranberry Lane Property Address Everett and Karen Lilly Owner Owner's Name information is required for Centerville MA 02632 December 15, 2009 every page. CitylTown 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: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 a Commonwealth of Massachusetts ,. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -'Not for Voluntary Assessments, 66 Cranberry Lane Property Address Everett and Karen Lilly Owner Owner's Name Information Is required for Centerville MA . 02632 >a December 15. 2009 '_< '; • every page. City/Town r State - Zip Code Date of Inspection B. Certification (cont.) Yes NoEl 0 �. r Re quired aired pumping more than 4 time s es in the last ear NOT due to clo r q p p g ed o obstructed pipe(s). Number of times pumped: f ❑ ®t Any portion of the SAS, cesspool or privy is below high ground water elevation. Any portion of,cesspool or privy is within 100 feet of'a surface water supply or ® tributary to a surface water supply. .� . ❑ ® Any portion of a cesspool or privy is within.a Zone 1-of a public well. ❑ Z. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Ell ® 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 cesspop.l.serving-a facility with a design flow of2000gpd- r 10,000gpd.El ' 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. _4 - Yes `No ❑ ❑ ° ' the system is within 400 feef'of a surface drinking Watersupply El F1 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 SectionE the system,is considered a significant threat,:" or answered "yes" in Section D above the large system has failed: The owner`or operatorof any large system conside'red,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. w ' t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 - Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 66 Cranberry Lane Property Address Everett and Karen Lilly Owner Owner's Name information is required for Centerville MA 02632 December 15 2009 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? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ❑ ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based'on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue f approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): n/a Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n/a-no plan t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts V Title 5 Official Inspection Form Jf . Subsurface Sewage Disposal`System Form -Not for.Vol untary.Assessments, : .. 66 Cranberry Lane Property Address Everett and Karen Lilly Owner Owner's Name ' information is Centerville MA 02632 December 15 2009 required for , every page. City/Town State Zip Code Date of Inspection' D. System Information Description: i, P Number of current residents Does residence have a garbage'grinder? ❑ Yes ® No Is laundryon a separate sewage system? if es separate inspection required] ❑~Yes ® No p 9 Y I Y P P q l ' Laundry system inspected? .. ❑ Yes ❑ No Seasonal uses * ` ❑ Yes .® No i h`, Water meter readings, if available (last 2 years usage (gpd)): 122 gpd Detail: 2008-2009 Sump pump? 4 ❑ Yes R 'No current 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 desigrr.flow(seats/persons/sq.ft., etc.): Grease trap present?:• ❑ .Yes ❑ `No Industrial waste holding tank.present?, 4 El Yes ❑ No m 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 Commonwealth of Massachusetts F Title 5 Official Inspection Form a Subsurface Sewage Disposal.System Form - Not for Voluntary Assessments 4M 66 Cranberry Lane Property Address Everett and Karen Lilly Owner Owner's Name information is required for Centerville MA 02632 December 15 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: occupant Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ® Single cesspool ® Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a co of the current operation and 9Y copy p 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form.- Not for.Voluntary Assessments ,M 66 Cranberry Lane Property Address Everett and Karen Lilly ;' Owner Owner's Name N, information is required for Centerville MA 02632 - December 15,2009 every 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: 23+ years. Certificate of Compliance for overflow cesspool.issued 4/24/86 (Permit#86-302) Were sewage odors detected when arriving at the site? E` ❑ Yes ® No Building Sewer:(locate on site plan): Depth below grade` � :, a° 2„ feet' Material of construction: - r •_, ® cast iron ❑40 PVC ❑ other(explain):'4 Distance from private water supply well or suction line: '' feet Comments (on condition of joints,.venting, evidence of leakage,etc.): No evidence of leakage or backup into dwelling was observed. Septic Tank(locate on site plan): a ;Depth below grade: feet Material of construction: } ; ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age ' t J 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 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 66 Cranberry Lane Property Address Everett and Karen Lilly Owner Owner's Name information is required for Centerville MA 02632 December 15 2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 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.): 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 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts �.� Title 5 Official Inspection Form k Subsurface Sewage Disposal System Form.- Not for Voluntary Assessments t , 66 Cranberry Lane _Property Address Everett and Karen Lilly- . Owner Owner's Name _ information is required for Centerville MA 02632 December 15, 2009 every page. Citylrown ? State Zip Code Date of Inspection D. System Information (cont ) tT o Comments (on pumping recommendations, inlet and outlet tee or baffle condition;structural integrity, liquid levels as related to outlet invert, evidence of leakage,,etc.): Tight or Holding Tank(tank must be pumped at,time of inspection) (locate on site plan): : j Depth below grade:•_ Material of construction: ❑ concrete `❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)-. Dimensions: Capacity: gallons Design Flow: ;;; n ' gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order ❑ Yes '•❑ No Date of last pumping. Date i Comments (condition of alarm and float switches, etc.): • .. - . . ,.. °. - - .ate .,• .. • *Attach copy of'current pumping contract(required): Is top y attached?_., `❑ Yes r ❑ .No t t5ins•.09!08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 66 Cranberry Lane Property Address Everett and Karen Lilly Owner Owner's Name information is required for Centerville MA 02632 December 15, 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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 66 Cranberry Lane a t Property Address Everett and Karen Lilly f Owner Owner's Name information is required for Centerville `; MA 02632 December 15, 2009 � '-�' every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) . Type ❑ leaching pits =LL �number.' El leaching chambers number:, ❑ leaching galleries x" number: ❑ leaching trenches number, length:, ❑ leaching fields number, dimensions: �.j ..i . i - 2 ® 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.): Soils above all cesspools appeared unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. Third cesspool was uncovered and found to contain effluent 28 inches below inlet invert. No effluent contact staining was observed on cover or interface. ' Cesspools',(cesspoof must.be pumped as part of inspection) (locate on"site plan) Number and configuration 3 total in series Depth—top of liquid to inlet invert at outlet invert w 6 in Depth of solids layer . Depth of scum layer r , 4 in Dimensions.of 6 ft x 8 ft approx. cesspool ` Materials of construction concrete bolck Indication of groundwater inflow ❑}Yes ® No'' i } * t5ins•09/08 �x ` Title 5 Official Inspection on For mi Subsurface. ,Sewage x Disposal System•Page 13 of 17 s t: Commonwealth of Massachusetts ' W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM , 66 Cranberry Lane Property Address Everett and Karen Lilly Owner Owner's Name information is required for Centerville MA 02632 December 15, 2009 every page. Cityrrown 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.): Pumping not required at this time but maintenance pumping is recommended within and every two years.-Cesspool and outlet tee appear structurally sound and functioning as intended. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , M 66 Cranberry Lane Property Address Everett and Karen Lilly Owner Owner's Name information is Centerville MA 02632 December 15 2009 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 supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately ' 6 6 , t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 ,E J Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 66 Cranberry Lane Property Address Everett and Karen Lilly Owner Owner's Name information is required for Centerville MA 02632 December 15 2009 every 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: 1 feeett Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: Town of Barnstable GIS Department records indicate.that the property is over 15 feet above nearby wetland. 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 Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 66 Cranberry Lane Property Address _ Everett and Karen Lilly Owner Owner's Name information is required for Centerville *- MA 02632 December 15, 2009 every P City/Town/Town State Zip Code Date of Inspection page. Y P P E. Report Completeness Checklist ® Inspection Summary: A;B, C, D,For 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 171of 17 DATE 8/14/01 --- - Ma o Mansfield z PROPERTY AODRESS• �, y� _-,,,-__,,,�-. 66 Cranberry Lane ^- Centerville,Mass. w02632 On Iho above data,. I Inapooted th'e sep,tlo oys<tv at.the above address. This systom conslsls of (he. lollowing;.. 1 . 3-6 ' X8 ' Block Cesspools. Based on my Inspe;llon, I corilty tho foIIQwIn9 'oondltIona; 2 . This is not a title five septic system. This is a. sewage system that consists of three cesspools -in series. 3 . The sewage system is in proper working order at the present time. r $1aNATVRE ., . _ Son rnc ,ComP ny: Jo, .� P _N•comb.r b O A•ddre53 : Box .66 .. _Cent-erjjjtL Ne_ 02632-0066 Phone: 508- 775-3338 THIS CfATIFICATION OOCS NOT CONSTITUTE A OVARANTY OR WARRANTY JOSEPH P, MACOMBER & SON, INC, T+nki•oe i epoofi-1 9 achflild+' Pvmp�d 4 Init+ll1d r Town 3#wfr Cvnn#909n1 p;o: 8ox 66 CenlorYlllr, Mil 02632-0066 77S JJJB 775.6412 YRECEIVED AUG.3 1 2001 + TOWN OF BARNSTABLE w HEALTH DEPT. -\ COMMONWEALTH OF MASSACHUSETTS r EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT�OF ENVIRONMENTAL PROTECTION TITL OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A. CERTIFICATION Property Address: 66 Cranberry Lane ' 'en erville,Mass. Owner's Name: Maryjo Mansfield Owner's Address: Same Date of Inspection: 8 14 7 01 _ Name of Inspector: (please print) Joseph P.Marr)mhPr Jr. _ Company Name: J P Macomber & Son Inc. _ Mailing Address: Box 66 . 02632 . , Telephone Number: 508-775-3 38 CERTIFICATION STATEMENT I certify that 1 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: /asses `+ _ _ r Conditionally Passes Needs Further Evaluation by the Local Approving Authority k Fails. Inspector's Signature: /, Date: / The system inspector shalt submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or.has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments;, ****This report only describes conditions at the time of inspection and under the conditi6ns of use at that time.This inspection does not address how the system will perform in the future under the same or different, conditions of use.-- Title 5 Inspection Form 6/15%2000 page I ' Page 2 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE,SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ' 'CERTIFICATION (continued) ' Property Address: 66 Cranberry Lane t ` Centerville,Mass. Owner: Maryjo Mansfield Date of Inspection: 8 1 4 01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section l) V01 m Passes: ave not found an informatio hick indicates that any of the failure criteria described in'310 CMR in R 15.304 exist. Any failure criteria not evaluated are indicated below. Comments.- None f B. System Conditionally Passes: AZ& One or more system components as described in the"Conditional Pass"section need to be replaced-or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes, no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. • 'A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: /` bservation of sewage backup or break out or hi water level in th distribution bo ue to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box System will pass inspection if(with approval of Board of Health): ' broken pipe(s)are replaced obstruction is removed distribution box is•leveled or replaced ND explain: led 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): _ A broken pipe(s)are replaced obstruction,is removed t T " d ND explain: • ". - 2 T Page 3 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 66 Cranberry Lane . en ervi e, ass. Owoer.Marvio Mansfield ` Date of Inspection: 8/1 4/01 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 public health, safety or the environment, I. 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 wbich will protect public bealtb, safety and the environment: �lJD Cesspool or privy is within 50 feet of a surface water $D Cesspool or privy is'witbin 50 feet of a bordering vegetated wetland or a'salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any)determines that the.: system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet-of a surface water supply or rributary to a surface water-supply. The system has a septic tank and SAS and the SAS is within a Zone I of a public'-water suppl.\. The system has a septic tank and'SAS and the SAS is within 50 feet of.a private water supply well. 6VThe system has a septic tank and SAS andthe.SAS is less than 10 feet'but feet or more from a private water supply well,'. Method used to determine distance ' 'This system passes if the well water analysis, performed at a DEP certified laboratory,.for coliform . bacteria and volatile organic compounds'indicates that the well is free from pollution from that faci'liry and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than S ppm, provided that no other failure criteria are triggered: A copy of the analysis must be attached to this form. 3. Other: r__ << — f This is a sewage system, The- system consists of - Xblock cesspoo s in sertes.MC1.1 ,-, as a septic tank. I 3 Page 4 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:66 Cranberry Lane Centerville,Mass. Owner: Mary-io Mansfield ` Date of Inspection: 8/14/01 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No./ of sewage into facility or system component due to overloaded or clogged SAS or cesspool _AL Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool f 1&0&& Static liquid level in th distribution box bove outlet invert due to an overloaded or clogged SAS or cesspool �quid depth in cesspool is less than 6"below invert or available volume is less than '14 day flow equired 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. 1/ Any portion of a cesspool or privy is within a Zone 1 of a public well. _ y portion of a cesspool or privy is within 50 feet of a private water supply well. �y portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water . supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds ' indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] Z(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. , E. Large 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 You must indicate either"yes"or"no"to each of the following: , (The following criteria apply to large systems:in addition to the criteria above) yes Zhe system is within 400 feet of a surface drinking water supply _ system is within 200 feet of a tributary.to a surface drinking water supply V system is'located in a nitrogen sensitive'area(Iinterim Wellhead Protection Area—IWPA)or.a mapped Zone'II of a public water supply well v significant eat or answered If u have w t' 'n Section E the stem is considered a si ific n threat, you h answered yes to any question t Se system o gn , "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR; 15:304.The system owner should contact the appropriate regional office of the Department. 4 ; s Page 5 of I 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART B . CHECKLIST Property Address: 6 6 Cranberry Lane Centerville,Mass, b Owner: Maryjo Mansfield Date of Inspection: 8/14/01 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 4z Were any of the system components pumped out in the previous two weeks ? Has the system`received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? ,I/ Were as built plans of the 1.system obtained and examined?(If they were not avail able,notetiKN/A) 7 4Z _ 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,4*cluding the SAS, located on site Were the a tic'tank 'anholes uncovered,opened,and the interior of the tank inspected for the condition '. of the baffles or tees, materta] of construction,°dimensions, depth of liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: - Yes no _ _ !/ Existing information. For example;a plan at the Board of Health. Determined in the field(if any of& failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] 5 Page 6 of 1 I OFFICIAL INSPECTION FORM'—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM y PART C SYSTEM INFORMATION Property Address:66 Cranberry Lane" Centerville,Mass. Owner: Maryj o Mansfield Date of Inspection: 8 1 4 01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): ' DESIGN flow based on 310 CMK 15.203 (for example: 110 gpd x#of bedrooms, � ,� Number of current residents:_ Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system (yes-or no):4 [if yes separate inspection required] . Laundry system inspected (yes or no): Seasonal use: (yes or no): t10 nn !l Water meter readings, if available{last 2 years usage(gpd)): Sump PAP(Yes or no). Last date of occupancy:� G % COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): A 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):&O. Water meter readings, if available: IYJ4 , Last date of occupancy/use: OTHER(describe): .Ulf Pumping Records GENERA% NFORMATI099 . � �YY Source of information: q l "77 � � Was system pumped as part of the'inspection (yes or no):426 If yes, volume pumped: gallons gallons-- How was quantity pumped determined? Reason for pumping: , ,rto7- "G/sl�� TYPE OF SYSTEM , Septic tank,distribution box, soil absorption system Single cesspool Overflow cesspool,S' .V&Privy )j9 Shared system(yes or no)(if yes;attach previous inspection records,if any) Innovative/Altemative technology. Attach_a copy of the current operation and maintenance contract(to be obtained from system owner) til�Tight tank A-6 Attach a copy.of the DEP.approval t ,1�20ther(describe): App xim ease a 1 omponents, date-installed (if known)and source of information: Were sewage'odors detected when arriving at the site(yes or no): Page 7 of I 1 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 66 Cranberry Lane en ervi e,Mass .' ; Owner: Maryjo Mansfield Date of Inspection: 8 14 01 BUILDING SEWER(locate on site plan) _ Orangeberg pipe from the �l Depth below grade: cast iron from- the house to _Materials of construction: 4_cast iron 40 PVC other(explain)i-ain cesspool.Sch. 40 4" PVC Distance from private water supply well or suction line: lD 1' pipe from #2—#3 Comments(on condition of joints, venting, evidence of leakage, etc.): Joints appear tight,No evidence of leakage,The syG m- ; G vented through the house vents. . " SEPTIC TANKJI, x4'(locate on site plan) Depth below grade: Material of construction:424concreteA/4 metal AJ4 fiberglass.1 lX olyethylene ,!L*ther(explain) -- �/d ' ` If tank is metal list age:&i9 Is age confirmed by a Certificate of Compliance(yes or no)�V4(attach a copy of certificate) Dimensions: Sludge depth: All Distance from top of sludge to bottom of outlet tee or baffle: AM , Scum thickness: A14 Distance from top of scum to top of outlet tee or baffle: AM Distance from bottom of scum to bottom of outlet.tee or,baffle: 4)h How were dimensions determined: 04 Comments(on pumping recommendations, inlet and outlet tee or baffle condition,, structural integrity, liquid levels as related to outlet invert,evidence of-leakage, etc.): Septic tank is nest present _ GREASE TRAP9,t?e0ocate'on site plan) Depth below grade:AW Material of construction:44 concrete4_metaLt/64 fiberglass fLA polyethylene dOP other' (explain): AW Dimensions: N#? Scum thickness: A 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: A)R Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity;liquid levels as related to outlet invert,evidence of leakage, etc.): - ' C;rPasP trap s nnt. -n�eht_ 7 Page 8 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ' Property Address: 66 Cranberry Lane en t ervi IT e, ass ; Owner: Maryjo Mansfield Date of Inspection: 8/14/01 TIGHT or HOLDING TANK4&e—,(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: 4)14 Material of construction: x)A concrete .44 metal ekl fiberglass polyethylene ahQ other(explain): x1� 1 Dimensions: Capacity: .Ulf gallons . Design Flow: W 4 gallons/day Alarm present(yes or no): Alarm level: V4 Alarm in working order(yes or no): Date of last pumping: AIW Comments(condition of alarm and float switches, etc.): Tight or holding tanks -are not present. DISTRIBUTION BOX,( (if present must be opened)(locate on site plan) 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.): Distribution •box is not present. PUMP CHAM BER4.&Je,(locate on site plan) b Pumps in working order(yes or no): Alarms in working order(yes or no):�lQ ; Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): . Pump chamber i s not present - -8 Page 9 of I 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .PART C SYSTEM INFORMATION(continued) Property Address: 66 Cranberry Lane Centerville,Mass. Owner: Maryjo Mansfield Date of Inspection: 8/1 4/01 SOIL ABSORPTION SYSTEM (SAS): �ocate on site plan,excavation not required) If SAS not located explain why: Type v YP - AD leaching pits,number: �} 4/0 leaching chambers, number: - ,�9 leaching galleries,number: ' Qleaching trenches,number, length: 0 V6joeching fields,number, dimensions: [ P"overflow cesspool,number: Lthinnovattva•/alternative system Type/ ame of technology: . Comments(note condition of soil, signs of hydraulic failure, level of p no ding, damp soil,condition of vegetation, etc.): ` Loamy sand to. medium fine sand No signs hydraVulic- failurQ or ponding.Soils are dry.Vegetation is normal CESSPOOLS: Zcesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: 29f Depth—top of liquid to inlet invert: Depth of solids layer: l -�"� Depth of scum layer: 1— -%v9rL , Dimensions of cesspool: Materials of construction: e Indication of groundwater_inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of,vegetation, etc.): Same as above PRIVY4)�(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.): Privy -is not 12resent_ a ~ . 9 Page 10 of OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PA RT.0 SYSTEM INFORMATION (continued) Property Address:66 Cranberry `Lane Centervi e,Mass. Owoer: Maryj o Mansfield t Date of Inspection: 8 1 4/0 1` SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposil 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. r . f { r o r a a . y G ti .�i� e � � y 6Ir Page 11 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ` SYSTEM INFORMATION(continued) Property Address'.66 Cranberry Lane n ervi e,mass. Owner: Maryjo Mansfield - Date of Inspection: 13 1 4 01 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water A"A feet x Please indicate(check)all methods used to determine the high ground water elevation: k�lte om s stem desi plans on record -,,If checked,date of design plan reviewed: (abutting proper observation hole within 150 feet of SAS) , rt oca oar o Health-explain: Checked with local excavators, installers-(attach documentation) ` Accessed USGS database-explain: You must describe how you established the high ground water,elevation: Used water contours map Gahrety & Miller Model 12/16/94 k � •'►.TTIrn,'ffr.T� TT�JR•l.1TRTnrt SSR.fTlT:-.Tt-r••TTT:TfTTCfTrm ilcT.t'N 1'1'C7l7CRnT . T7T1T•�1i�'Tr••:..�-.r... I'OHN OF-Barnstable WARD OF IIEALTII Sl1IlSURFACF 9F,HAGF DISPOSAL ,SYSTEM INSPECTION FORM - PART- D .- CERTIFICATION ...T..t.r...-::,—r.,,..••.,,-.,:rtr+n•nn,�,�,e•,.t,.z.r.,,,,-•—,T,:m,-.,r,.,s.--r+.rn.n..rer+�,n.,.,.,.., ".,�. - -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 66 Cranberry Lane Centerville,Mass. ASSESSORS MAP, BLOCK AND -PARCEL: # OWNER' s NAME Maryjo Mansfield PART U CERTIFICATION I NAME OF INSPECTORJoseph P`:Macomber Jr. COMPANY NAME J.P.Macomber & 'Son Inc;r! ' y COMPANY ADDRESS Box 66 Centerville,Mass.02632 Street To►n or C1ty State LIP 0 .1578 COMPANY TELEPHONE :( 508 )` 775 3338 = FAX (508 T) 79 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage; dis.posaj system at this address and that the information reported is true , accurate, and omplete as of the time ' of :inspection . The inspection was performed and any recommendations regarding upgrade ; maintenance , and repair are consistent with my training and experience `in the proper function and maintenance of on- site sewage disposal systems`. Check one . 4 ; '�1,;,,�• .1L'' System PASSED The inspection which' I have 'conduct has not found any information which indicates that the system fails to adequately protect public- health or the envi'roilment 'as defined' in 310 CMR 15 . 303 . Any failure criteria not eva•luated•- are' as stated in the •FAILURE CRITERIA section of this form, System FAILED* The inspectionwtich I •'have con acted has found that the *system fails to protect the public hea.lth and the environment in accordance with Title 6 , 310 CMR • 15 , 303., . and as specifically noted on PART C - FAILURE ` CRITERIA of this- inspection form , ' Inspector Signature. - Da'te OnG copy of this ce ificatioh must be provided to the OWNER the BUYER where applicable ) and the BOARD OF HEALTH. � �, * If the inspection FAILED, the owner orrcperator shall u pg 'within o'ne year of the date of the inspection, unless alloweddorthe requiredm otherwise as provided 'in 3.1or CHR 16 . 305 , partd.doc 6 '/ t VILLA.6E Gil' E �_-�.��lJ` ��`,.� .��.w..___.��'"7`'` •._._..- _ gym._: Y - D D Patt T E y �� mlpii s A 4t C E cr , 'N' O NWEALTH OF M/SAHUSE THEOMM CTTS BOARD OF HEALTH /.e)�.tj................OF.....................12N S t' ... P P a 3 y,Otd Appliratinn for.. Disposal Morks Tonstradinn Vier it Application is hereby made for'a Permit to Construct (VI) or Repair ( ) an Individual Sewage Disposal System at I .I. � � - ..... ........-. . --.....-- -------. •u•........................................ � ation rV ` ai ............ � • _ ...... ....... Ck �..r_." M. .. ......... ... �. Own Add r s J e�s'C. Installer � Addr •-- Type of Buding 3_ Expansion Attic ( ) Size Lot. .......Sq. feet 'DwellingNo. of Bedrooms............:.. Garbage Grinder ( ` ) 04 Other—Type e of Building ............... No. of ersons_._......._____..__. • _ Showers — p., yp g ............. p ( ) Cafeteria ( ) 04 Other fixtures Design Flow....::........11�.....................gallons per person per day. Totaldaily iflow.._..........__. .-------. ........:...gallonsU Septic Tank—Liquid capacity. ._gallons 'Length.E..b..... Width:-_____�__-.. Diameter________________ Depth:4........... x Disposal Trench=No ................:.. Width..................:. Total Length..................... Total leaching ....sq. ft. 3 Seepage Pit No________________//. Diameter.:__.._( Depth below inlet.._........... Total leaching area. osq. ft. Z Other Distribution box (�/)' Dosing ( ) Percolation Test ResulYs2 Performed by`.__ Y1 _ -•----. a .' _ N�1... Date.- L� $ 44 Test Pit No. 1................minutes per inch Depth of Test Pit.._.. ....... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.......... Depth to ground water......................... a :.. .. ........ --•- .. .......... ......................... ....... g-• O Description of S ....................... .t Cly� SGIh(� O �O 4 ..... ... ...._....11 Q......_ cca, l ...._ ib :.1q .................................................. Uw ----------.-emu- -----.'.....-- -_-_-•--•----...........O........ . ---._..._,..__.....••--••--•--....:............................................... ' Nature of Repairs or Alterations—Answer when applicable...........................:.............................:......................:..........._.. -•--....-•-•-•-------•-•----•...........................•--•---..._._.._.._-----.._................._............----------------•-------------•--•-•-------.._......._....__._..__..................._. Agreement The undersigned ,agrees to install the aforedescribed Individual SewagetDisposal System in accordance with the provisions of L -':I LE 5 of th State Sanitary Code— The undersigned further agree no o plac the system in operation u it ertiticate mpliance has been issued by the board of healltli. G Cj .....�'.._"..__..1...:_........ ......................-Signed....-_6-�_ ;6... Application Approved B PP PP Y.._...... ........................................ Date Application Disapproved for the following re ons_................................................................................................................ .................................................---`•-`-(-. ........•--.......---........_..........__:.........__....----•---._.......__.............•--............_........D�............_ .... ......................._.... Issued. - - --•--.............-•--- Permit No......... Date No.. /f �"It:...................... THE COMMONWEALTH OF MASSACHUSETTS B9j!9 RV-OF HEALTH ................OF......... Appliration for Disposal ,lVarks Tomitrudion famit Application,is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: 4 .........................................................................................4.. .............................I Deation.rA eL...................................... -?Vc TCRANbF Lot N 0.. .............................. ....... . ....... ........ , ................ .... Owner Address .................................... A5 Le � Instal I ler"'1111111*1-cn,- Address................... Type of Building Size Lot.?�AC� ......Sq. feet.,- U It �, I V Dwelling No. of Bedrooms...........................................Expansion Attic Garbage'6rmider aOther—Type of Building ............................ No. of persons............................ Showers Cafeteria Otherfixtures ........................................................................................................WW . Design Flow..............................Q;..........gallons per person per day. Total daily flow............................................ all Cd Seil ptic Ta'nk Liqui8l�capacity.', -ga loffs Leh # 1 %. , 1,- Width .� J-4 ri V I Disposal Trench—No..................... Width_._.......... Length Seepage Pit No2.0 C, , A ....... Total Leng Total leachi-ing area_._.................sq.fi. / ..........w.... 5iarn:eteC=.....!.0...... Depth below inlet......!�a........ Total leaching area2h:19sq. ft. Z Other Distribution box (7) Dosing-tank 04 Percolation Test/i�esi&lts Performed by.......Lk�X:-\....C.Q-P e- FVA E�l Date Date......... I a C. 6-j vy..........i.................. ........................... ,.-I Test Pit No 1 ...minutes per inch Depth of Test Pit...... 'Depth to ground water................... 14 rX4 Test Pit N6!)21-!!:�-..z.,.;-)riiinutes,!'pe'r,;'inch c, Dipth of'Test Pit...... torgroundjwater:j., .............................................I........*----------��ti.................................................................................. 0 Description of Soil.........kao ........................................... ................................................................................................ q(,!.....7in............................................................... -----------------------" VJ.CLV,�, OF �- - - f� , - ...............................i�.................................. .......................... .......? . / /,7— ............................................... U Nature of Repairs or AltierationV-L:An'swer when applicable.................................................................................................. ......................................... ... .. .. .............................................................................. ...............w.....................�w.......�T.......................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITU!- 5 of I,th,7State Sanitary Code— The undersigifediift,fhJ/ag`rees-not,to place,the system in /operation until vCertificate o-eCompliance ha; been issued by the board of health. cle'le Cr� Signed......Z� r 1-a..... v- ................................. ........................... A lication A �id B ....... t, ppppfo ..................... ......................... . ........................................ Date Applic;Aion Disapproved for the follbivihj iedsons:........................................................----------------------7............................... L 6, 1 r . ..... ........ Dat� A i-Y61 PermitNo..__...-- ........... ..................................... Issued........................................................ Dae --------------- -------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 19 6,!:—: ........... ..........0 F..................................................................................... Tertifirate of 09—omplitturr CERTIFY That the Individual Sewage Disposal System THIS IS T , constructed (V/) or Repaired by..... .... . _ R . . ...t.&.....................................................................................................o....................................... at....� Z........z1...... ........Z-v PVe.............Ik 6_ 4E. ... .................................................... .has been installed in accordance with the provisions of TIT LE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._7 __—1 16 Q — /I ........................... dated_......_L��...... ........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................................. ........................................... Inspector.................................................................................... ---------- 3'� THE COMMONWEALTH OF MASSACHUSETTS' .,�OARD OF HEALTH No. .8 OF.........../-'�V 9 9 41!5 7 /9 8(-,C-,7 //6 0 .............. .......................................................................... ....................... Fn........................ Disposal Works Tanstrudivit.rrrutft Permission is hereby granted..... j ....... .......................................................................................... to Constrtict (V) or Repair an Individual Sewag,e_Disposal §yst ....................................................... at No......�Ql ........Y.....K�?11 M&�.y.......LY ............... Street as shown on the application for Disposal Works Construction Permit No3�7_0 0.. Dated......................................... ............ ........................ Board of Health DATE...............UN. .......... ........................2...... :.�"+.$• ... �� .. .. .. i :.... k .� :.....'.. 1 ..,a._..r v .... ... `X� f. Cam^ ±u 4 F. N'xw.a'a i rL ::<-Yr..", ,T !',y ..1. _ .i .i•.:S.f, tS .='1w.` .r.k ♦.M- .. ...n ,. ... .......: .:_.;'S n,..._,___"._._..:_ 1.:`3.` e y a i _-T --O/JNOF5RRgSTR�L ,E A55E550RS MAp 23`f LOT 6(o �.5�4.5' 2o'MInL 2 P.ERSTON E _ � I r - roP o zoNlu0 eaPP,N B E FOVNP. IO MIN. 5ETBACICS: FRONT- SEPTIC TANK DIC5T. B09X. LEACHING FACILITY SIDES REAR' Q - 101.E ------- _ / -�RO�IND cove 51.67 1000 GAL. 5r1.57' 51.3 h ° 0 53 3up 95,s' SECTION SENAGE ,a. 01, s�4_ I HRSHED TEST HOLE LOGS DESIGN! FOR BE�Rozo1�1 ,�- 1 bJ E L.L.I Q� Doww CAPE �i�1C� • �' ,Le rEST 6Y� PERC.RATE-4 2 MIN./!N. DATE: "�,.�5 �� FLOW RATE I IOGAL./SAY ZO C Pp. . W/TNE5.5� 1-A, LS 1'T'IJ'E Q- 5EPTIC TANK .530 (1,5) -1 q S GAL Q#r (o I O7 -REQ'D. SEPTIC. TAAIK 1000 CAL, + �> LEACHING FACILITY Tr l0 6- 188(4 SIDFWaLLTf /2) = 78.5 (2,5)=97COG/r► �� J eorrory • Zhu. SC�E�� $f, — ry TOTAL 266.7 5F = S99.5G/vf U5E 1 LEACHING PIT IO FFF DIR , 6 jam® LOT J EFF DEPTH i W LO f21aVEle _ �• � — -� 960— 45,3' co NOTES _. GCE — I. DATUM(MSL)tTAKENFiZOM I"►TR�NISQUADRhNGLE MAP L ..�'�/ 'Q � I SAkiQ 2. MUNICIPAL WATER 1 5 AVAILABLE I'. I U y'� ' M 41i.3J 3. DESIGN LOAO/NC FOR ALL PRECAST 1JITS:AASNO-�t0-44 i — 4.PIPE c/dINTS SHALL BE MADE wA7ER TIGHT. i _5- COJVSTRUCTION DETAILS TO 8E IN ACCORDANCE WITH Uo �A COMM.OF MASS. STATE ENVIRONMENTAL CODE rime 7L E'�C. v i`3Tf is D 'G. T1 6 PLAN FOR PROPOSED MORK ONLY AND SNoOLO NOT q0 BE'USED Fog PROPERTY:. CN. STAKIAj*. `tH Of ARNE e I �S1T __ fD. ZE;4A6E. PLAN' ,$ anu► �L OGI/� CD G P.,f? dd3�!"!f7 tEGPJ : :2s3aa L O .�C /� q - - $ LOT 4 CR ;J�:i$EIZRY ,t,t. NRi�d fS FctS1E.-P \ CIVIL ENGteta:ERS � 4 — •2$ RFFEREItifCE.. {PROP,)—o---a— DGG JQ�j �S'CJ t�G LAND SURVE�Ot�g t CONC.BOUND •PREPARED DArLF ARtJE JALA, � Mo1n st , � � ��{� z Qrmou a 7 T Es uc B SI D O l r� A E -x = Y - - - _ m.. - __.. ----- -- _- --. ..._ .._ .board.aF _ .. ._ -ALE. - - -- w_.__. -----9-25•.- �. . tom' :. JD.8 J�Bd� gar I b d ��T. D --- APP E3tE�: DAT - I'th ,r �'1