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HomeMy WebLinkAbout0159 FLINT ROCK ROAD - Health 159 Fly It 1Rock Road Barnstable A= 3 16 — 080 - 009 Commonwealth of Massachusetts f Title 5 Official I Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 159 FLINT ROCK ROAD Property Address JOHN AND DOROTHY OCONNELL Owner Owner's Name , information is for every rewired BARNSTABLE MA � 02630 06/10/20'T6 q page. City/Town State Zip Code .: Date of Inspection Inspection results must be submitted on this form.,Inspection forms may not be°altered in any way. Please see completeness checklist.at.the end of the form. . a Important:When filling out forms A. General Information C � on the computer, �p, D 4w'�'�D use only nl the tab 1•. Inspector: _ key to move your cursor-do not JOHN P GRACI SR use the return Name of Inspector µ key. GRACI SEPTIC INSPECTIONS LLC- .,. rab Company Name e PO BOX 2119 { Company Address _ TEATICKET MA -02536 City/Town State Zip Code 41- _508-6 694 S1468 6 Telephone Number '' License Number B. Certificatione 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. lama DEP,approved system inspector..pursuantto Section 15.340 of Title 5 (310 CMR 15.000). The system:' ® Passes n Conditionally Passes . El Fails ❑' Needs Further lu*ation by the,Local Approving Authority 06/10/2015 Inspector's Signature , Date The system inspector all submit a,copy of this inspection report to the Approving Authority (Board of Health or DEP),with1 30 days of completing this inspection.If the system is a shared system or. has a design flow of 10 00 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP..The original should be sent to the system owner and copies sent to the buyer,if applicable; and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the`.system will perform in the future under the same or different conditions of use. , t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 17 r- 1 1 - ; .. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal,System Form -.Not for Voluntary Assessments 159 FLINT ROCK ROAD n Property Address JOHN AND DOROTHY OCONNELL ° Owner Owner's Name k information is required for every BARNSTABLE „MA 02630 06/10/2015 page. City/Town °_State` `' .Zip Code Date of inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always'complete alI of,Section D A) System Passes: t ® 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:, SYSTEM APPEARS TO BE STRUCTURALLY,SOUND AND FUNCTIONING PROPERLY AT TIME OF INSPECTION. 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 to nkis less than 20 years old is available. ❑ Y� ❑'N 0 ND (Explain below): NA t5ins•3113 - ' Title 5 Official Inspection Form Subsurface Sewage Disposal System•+Page 2 of 17 E I Commonwealth of Massachusetts Title 5 Official ' Inspection+ Form Subsurface Sewage Disposal System Form -'Not,for Voluntary Assessments M 159 FLINT ROCK ROAD - + . Property Address JOHN AND DOROTHY OCONNELL - Owner Owner's Name '• - required for every.information is BARNSTABLE MA .. 02630 -06/10/2015 require , page. City/Town t State - Zip Code! Date of Inspection- B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational: System. will pass with Board of Health approval if pumps/alarms are repaired 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 pipes) are replaced. ❑ •Y ❑ N . ❑',N.D (Explain below): ❑` obstruction is_re'Moved ❑ Y ❑ N' ❑ ND.(Explain below): ❑ distribution box is leveled or replaced ❑ Y, ❑ N ❑" Nb (Explain below): NA 3 El The system required pumping more than 4 times,a year:due to broken'orobstructed pipe(s). The_ system will pass inspection if(with approval.of the Board'of Health)" ❑ brokenrpipe(s) are replaced a ❑e Y., ❑'N ❑ ND (Explain below):' ❑ 'obstruction is removed ❑, Y ❑ N' 0 'ND (Explain below). NA C) Further Evaluation is'Required by the Board of Health: r 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 notfunctioning'in a manner which willfprotect,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-3113 s Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of.17 Commonwealth of Massachusetts W Title 5 Official Inspection Form_ 01 Subsurface Sewage Disposal.System form -'Not for Voluntary Assessments ,M 159 FLINT ROCK ROAD. Property Address ' JOHN AND DOROTHY OCONNELL ' Owner Owner's Name information is gARNSTABLE °'MA k 02630 06/10/2015 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". . v. Method used to determine distance: NA . " This system passes if the well water analysis, performed at a DEP certified laboratory,;for fecalr 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 forma t 3. Other: " v NA fi D). System Failure.CriteriaApplicable to All Systems:y. You,must`indicate "Yes" or"No"to'each of the.following for all inspections: F Yes No , ® Backup of sewage into facility or'system component due to overloaded or 0 clogged SAS or cesspool Discharge or ponding of effluent to•the surface of the groundtorsurface-waters due to an overloaded or cloggedhSAS 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 Y2 day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection '17' 'e A Subsurface Sewage Disposal System Form - Not for Vol untary.Assessments , ,M 159 FLINT ROCK ROAD Property Address JOHN AND DOROTHY OCONNELL ,. Owner Owner's Name information is gARNSTABLE a MA 02630 t)6/10/2015 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 El z obstructed.pipe(s). Number of times pumped: - ® - Any portion of herSAS, cesspool or privy is below high ground water elevation. ® Any portion of cesspoor6r 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 li '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 colifor'm'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 f custodymust be attached to this form. • and chain,of ] . The system'is a cesspool serving a facility with a design flow of 2000gpd ® r .10,000gpd: The system fails. l have determined that one or more of the above failure ❑ ® criteria exist as described in`310 CMR 15.303, therefore the system fails. The: F. 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 rnust'indicate either"yes" or"no" to each of the following, in addition_to.the'. " questions in Section D. - Yes No ❑ Y. ❑ ; ' 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 El Area IWPA)'or a-mapped Zone II of a public"water supply well If you have answered-"yes"-to any question in Section E.,thesystem is considered a•significant.threat,, or answered"yes" in•Section D above the large system has failed.7he 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. t5ins•3113 , Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 z Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal;System Form - Not for Voluntary Assessments ^M 159 FLINT ROCK ROAD Property Address JOHN AND DOROTHY OCONNELL Owner Owner's Name information is every BARNSTABLE MA 02630 06/10/2015 required for 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) ® E:] Was the facility or dwelling inspected for signs of sewage;back up? . , ® 0 . Was thelsite inspected for signs of break out? ® ❑ Were all system components;-excluding.the'SAS, located on site? ® El Were the septic tank manholes uncovered, opened, and theJnterior 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 ® E ; 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 jnformation. For example, a plan at the Board of Health.' . " Determined in the field (if any of the failure criteria related to Part Cis at issue ® r approximation of distance is unacceptable) [310 CMR•15.302(5)] Z. D. System Information,, t. . - Residential Flow Conditions: Number of bedrooms (design): " 3 3 Number of bedrooms (actual): s DESIGN flow based`on 310 CM'R'15.203 (for example: 110 gpd'x#of bedrooms):. 330 t5ins•3/13 w ° Title 5 Official inspection Form: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 159 FLINT ROCK ROAD Property Address _ JOHN AND DOROTHY OCONNELL Owner Owner's Name information is required for every BARNSTABLE MA 02630 06/10/2015 page. CityFrown State Zip Code Date of Inspection D. System Information Description: 1000 GALLON SEPTIC TANK DISTRIBUTION BOX AND H-10 6X4 LEACH PIT Number of current residents: OCCUPIED Does residence have a garbage grinder? ❑ Yes ® No t Is laundry on a separate sewage system? (include laundry system inspection Yes ® No information in this report.) ` Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes.® No Water meter readings, if available last 2 ears usage d - TOWN 9 ( Y 9 (gP ))� Detail: 2014 58000 2013 25000 Sump pump? ❑ Yes.,® No Last date of occupancy: OCCUPIED. Date Commercial/Industrial Flow Conditions: Type of Establishment: .NA NA Design flow(based on 310 CMR 15.203): ` Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): NA 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: NA t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 P Commonwealth of Massachusetts 4' Title 5 Official- Inspection Form; Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 159 FLINT ROCK ROAD Property Address Spa _ JOHN AND DOROTHY OCONNELL • . Owner Owner's Name information is required for every BARNSTABLE MA 02630` . 06/10/2015 � �' page. City/Town State s Zip Code Date of Inspection D. System Information`=(cont:) Last date of occupancy/use: NA Date Other(describe below): NA General Information Pumping Records:.,, NA'. Source of information: ' Was system pumped as-part of the inspection? ❑ Yes ❑ No If yes, volume pumped: _; -gallons ns How was quantity pumped determined? NA NA Reason for pumping: { Type of System: ® Septic tank,distribution box, soil-absorption system ❑ Single cesspool ` Overflow cesspool } ❑ Privy ElShared system (yes-or no) (if yes, attach previous inspection records, if.any) .c Innovative/Alternative technology. Attach a copy of the'current operation and maintenance contract(to'be obtained from system owner) and'a copy of latest a �inspection,of the l/A system by system operator,under contract ❑ ,. Tight tank.*`Attach a copy of^the DEP approval ❑ Other(describe): t&ns•3/13 4 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 y Commonwealth o`f Massachusetts " Title 5 Official Inspection Form Subsurface Sewage Disposal'System Form - Not for Voluntary Assessments �M 159 FLINT ROCK ROAD . Property Address *. JOHN AND DOROTHY OCONNELC Owner Owner's Name information is gARNSTABLE MA '02630 06/10/2015 required for every page. CitylTown State Zip Code Date of Inspection D. System Information'.(cont:) _ Approximate age of all components, date installed (ifkriown) and source of information: 1998 F •Were sewage odors detected when,arriving at thej site? ❑ Yes ® No Building Sewer(locate on site plan): De thrbelow rade: (44) FORTY FOUR INCHES p 9 feet Material of construction: ❑ cast iron.; ® 40 PVC ❑ other,(explain): . Distance from private water,supply well or suction line: GREATER THAN'10+' feet Comments .(on condition.of joints, venting, evidence of leakage, etc.); SYSTEM APPEARS TO BE STRUCTUARLLY SOUND°AND�FUNCTIONING PROPERLY A AT TIME OF INSPECTION. Septic Tank (locate on site plan) ' Depth below grade. . . P (36) THIRTY.SIX.INCHES = t feet Material of construction; ® concrete El metal" ❑ fiberglass ❑ polyethylene ❑ other(explain) NA .. F , If tank is metal, list age:, " NA years Is age confirmed by•a Certificate of Compliance? (attach a copy of certificate) ❑` Yes ❑ No Dimensions ' ` : 1000 GALLON` r ' Sludge depth: ,. (14) FOURTEEN INCHES.. t5ins•3113 Title`5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts .' W Title 5 Official Inspection Form- Subsurface Sewage Disposal System Form.- Not for Voluntary Assessments ,M 159 FLINT ROCK ROAD Property Address JOHN AND DOROTHY OCONNELL. Owner Owner's Name information is required for every BARNSTABLE _ ' MA 02630 06/10/2015 page. City/Town -,State Zip Code 'Date of Inspection D. System Information-{cone:) Septic Tank (cont) Distance from top of sludge to bottom of outlet tee or baffle (20)TWENTY INCHES r x Scum thickness y (1) ONE.FOOT, . L F (6)SIX INCHES Distance from top of scum to top,of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle NA MEASURED, How were dimensions determined - - Comments (on pumping recommendations, inlet and outleftee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage;etc.): SYSTEM APPEARS TO BE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY AT TIME OF INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS ` I - I Grease Trap,(locate-on site plan): .. a NA Depth below grade: v feet Material of construction: ❑lconcrete 0 metal ❑ fiberglass 0 polyethylene 0 other(explain): NA ' Dimensions: NA. Scum thickness: : q NA Distance from top of scum to top of outlet tee or baffle _ NA Distance from botto of scum totottom of outlet tee or baffle NA m Date of last°pumping: NA Date t5ins•3/13 y Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts. W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form ,;Not for Voluntary Assessments 159 FLINT ROCK ROAD Property Address JOHN AND DOROTHY OCONNELLf Owner Owner's Name information is required for every BARNSTABLE MA 02630 06/10/2015 page. City/Town i. State Zip Code 'Date of Inspection D. System Information (cost:) Comments (on pumping recommendations, inlet and outlet tee or baffle-,condition, structural integrity, . liquid levels as related to outlet invert; evidence of leakage, etc.): NA ` Tight or Holding Tank (tank must be pumped at time.of inspection) (locate on siteplan):.:. NA Depth below grade: ` Material of construction: - e ❑ concrete, E ❑ metal ❑ fiberglass - ❑ polyethylene other(explain); NA NA Dimensions: Capacity: _ NA gallons NA 4 Design Flow: gallons per day s ` Alarm present: ' ' `., ❑ Yes ❑ No Alarm level' NA Alarm in working order: ❑ Yes~ n ❑ No r NA Date of last pumping: ', - . "` ,• - y � Date - Comments(condition of alarm acid float switches, etc.): NA "Attach copy of current,pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 1T Commonwealth of Massachusetts- W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 159 FLINT ROCK ROAD Property Address JOHN AND DOROTHY OCONNELL` Owner Owner's Name information is " y required for every BARNSTABLE `MA 02630 06/10/2015 page. City/Town State Zip Code ` .Date of Inspection D. System Ifformation '(cont.) Distribution Box (if present must be opened)flocate on site plan): Depth of liquid level above outlet invert BOTOM OF PIPE 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.): z ` DISTRIBUTION BOX APPEARS TO BE STRUCTUARLLY SOUND AND.FUNCTIONING PROPERLY AT-TIME OF INSPECTION Pump Chamber(locate on site plan) �. Pumps in working order:, E Yes ❑ No* ' t . Alarms in working order: - - ❑ Yes •❑ No* Comments (note condition of pump chamber,condition.of pumps and appurtenances, etc.): NA *if pumps or-alarms are not in^working order, system is a.conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located,explain why: NA t5ins•3/13 r,» Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 l Commonwealth of Massachusetts Y W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 159 FLINT ROCK ROAD Property Address JOHN AND DOROTHY OCONNELL' Owner Owner's Name information is gARNSTABLE 4MA ' 02630 06/10/2015• required for every page. City/Town State:.'` Zip Code Date of Inspection D. System Information (Cont.) ­ Type: ® leaching pits number:. ❑ leaching chambers •. number: leaching galleries number: ° ❑ leaching trenches number, length: leaching fields; number, dimensions: ❑ overflow cesspool number:. innovative/alternative system " Type/name of technology Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): , 6X4 LEACH PIT APPEARS TO'BE STRUCTUARLLY SOUND AND F..UNCTIONING°PROPERLY AT TIME OF INSPECTION. VIDEO INSPECTED EMPTY AT TIME OF INSPECTION NO VISABLE STAIN LINES Cesspools (cesspool must be.,pumped as part of inspection) (locate-on site plan)- Number and`•configuration Depth—top of liquid to'inlet invert ` NA Depth of,solids layer NA - Depth of scum layer t t NA -r Dimensions of cesspool NA Materials of construction j NA Yes No Indication of groundwater inflow r ❑ ❑ , l5ins•3/13 Title 5 Official Inspection Form:Subsurface_Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts " W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for.Voluntary Assessments . �M 159 FLINT ROCK ROAD Property Address JOHN AND DOROTHY OCONNELL Owner Owner's Name information is required for every BARNSTABLE MA 02630'. 06/10/2015 page. City/Town State Zip Code Date of Inspection' D. System Information (cont:) y Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): w NA Privy (locate on site plan): { Materials'of construction: . h NA Dimensions - :- Depth of solids NA Comments (note condition ofsoil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): NA • . - .. ' .a - F ,•- ' FEE - ' i - is .. � z • t5ins-3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 - Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 159 FLINT ROCK ROAD Property Address JOHN AND DOROTHY OCONNELL Owner Owner's Name information is required for every BARNSTABLE MA 02630 06/10/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: t ® hand-sketch in the area below ❑ drawing attached separately f D CK o. 0 2 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 r Commonwealth of Massachusetts N . f J W Title 5 Official Inspection Fora.. o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M . 159 FLINT ROCK ROAD Property Address JOHN AND DOROTHY OCONNELL 7F Owner Owner's Name information is i 4" required for every BARNSTABLE MA 02630 _ 06/10/2015 page. CitylTown State Zip Code' *' Date of Inspection D. System Information (cont.) Site Exam: F- ® Check Slope ❑ Surface water ❑ Check cellar f ❑ Shallow wells Estimated depth to high round water: V 12+ FEET = p 9 9 feet Please indicate all methods•used to determine"the high ground water elevation: ❑ . Obtained from system,design plans on record., If checked, date of design plan reviewed: ❑ 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:�9 HAND AUGER a s:, r Before filing this Inspection Report, please see Report Completeness Checklist ori,next page. t5ins•3113 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 16 of 17 n Commonwealth of Massachusetts W Title 5 Official,,Inspection Form Subsurface Sewage Disposal System Form -:Not for Voluntary Assessments, °wM 159 FLINT ROCK ROAD Property Address ` JOHN AND DOROTHY OCONNELL Owner Owner's Name information is required for every BARNSTABLE MA`, 02630' 06/10/2015 , 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 , Z System Information Estimated depth to high groundwater. ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file r t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System a Page 17 of 17 AsBuilt Page 1 of 1 4 L0CAf16N 4, SEWAGE' PERMIT M0. D J o T. 9 .7T/,,u'r/11i _k : AR) ef 3 8 V I L LAGE °,: N`� 15cl I M S T A LL.ER'S NAME Z ADDRESS TO ;r B U I L D E R 0R OWN.ER DATE PERMIT ISSUED DATE COIMPLIANCE -ISSUED ( . vim' •�, � ,,, _ A r. r r x '8ti r f4`. http://issgl2/intranet/propdata/prebuilt.aspx?mappar=316080009&seq=1 0 2/20 B 010 CATION _ SEWAGE PERMIT NO. 9 YI L L AG E 11s C 9 15q �5 saQiis 1-A-6)e7 INSTA LLER'S MANE 8 ADDRESS B U I L D E R OR OWNER DATE PERMIT ISSUED k.6 0ATE COMPLIANCE ISSUED � Izo s� lc TA-UN'� - �- PfurP-oc- k- 2d Fics............._.. THE COMMONWEALTH OF MASSACHUSETTS \,t © BOARD OF HEALTH r\ ----......./ ............OF............. ...... ................... a FI fttllt,���ltrtt�tlat� for �t�� � � Works C��n�trtz.r Permit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at: ...... . . .oc n-AddressNq. ..................... ....... �Gd f.... .... . ....................... T •.... .....-.-...... ... owner Address a --•••-•-- .....-••........ ........•-... ... ... .. ..............••• --••------- --.....-- -- In ller Address d Type of Building Size Lot...... J'�.�.Sq. feet U g— ___________________Expansion Attic ( ) Garbage Grinder ( ) Dwelling No. of Bedrooms......................... pa., Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P4 Other fixtures ------------------------------•• W. Design Flow............................................gallons per person per day. Total daily flow...................... V.....gallons. WSeptic Tank—Liquid*capacity.f QTO.gallons Length................ Width................ Diameter................ De th................ 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 ( ) � QQ f1 / r '� Percolation Test Results Performed by------------------------------�.�___4•1�.11�4�.Date......_U .1./ --._.. Test Pit No. I... ._ -__minutes per inch Depth of Test Pit.................... Depth to ground ater,..._.._._.._._._...._.. Test Pit No. '_..minutes per inch Depth of Test Pit.................... Depth to ground water........................ Description of Soil = •--•••... ........................................------------- ----------------------------------•-----------------------------------------------............................................................... 0 Nature of Repairs or Alterations—Answer when applicable.........................................................:..................................... •-•- ---•-•--••--•••--•••••._...--•••-••....---••-•-••••••••••...............................••-....••••••-•-•-•---••--•••--•--•----•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with the provisions of TI1=4 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation un '1 a Certificate Compliance has been issued by boar o lth. Gw Signed..................... .............. ........ . .......... ..... . --.. y .. D Application Approved BY --.ec.-...... Application Disapproved for the following reasons-------------------------•--...--••----------------------------•-•-----------•--•-------------•-•------.._..... ..............•-•---•-•------•-.......----.............----•------.........------------------............._.........----•-------------------------••-----------------------------------•••••••--.._...-- Date PermitNo....... -------------------------------------- Issued........................................................ Date ...a...�......e... --- .W—w------------------------- � r NOW-OT—P L Fizz THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � t 1............OF...............:....-..............._-..........................---..................-- Appliratiun for Biipuual Works Tonstrnr#ion rruti# Application is hereby made for a Permit to Construct S,, ) or Repair ( ) an Individual Sewage Disposal System at: ✓f,ocation Address / os Lo,/t+Ny + Owner r7 r' Address W _--�. "d�'^a"'''".'�X",,,..-.�.✓ _..'�.�_.'�:'_`•'(....st"+ C.0............. a'" ^:._ *i �� +�.Z � `f y '" Installer /Address a' r S feet Type of Building � Size Lot_._...a_....:.. Dwelling—No. of Bedrooms.............. ................._.._...Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures .................................. -- :--•---------------- W Design Flow............................................gallons per person per day. Total daily flow..................... °' 7.....gallons. WSeptic Tank—Liquid capacity_;V.*?%.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. Other Distribution box ( ) Dosing tank Percolation Test Results Performed by....................... ...._.....Via.•Date........:,:__....... Test Pit No. 1... P __minutes per inch Depth of Test Pit.................... Depth to ground water........................ Lz, Test Pit No. 24L+ ..'-....minutes per inch Depth of Test Pit.................... Depth to ground water........................ y O _De l w1 iwrf '' "�„G�^`�.r:.t1 ' y.'�;+.�"✓ f` iG+la...�'-� �.�� «�"l'Zr r. escr>ption of Soil r ..... :: ------------ '� ---• x � ; w = ,,; .......... _.. U Nature,of Repairs or Alterations—Answer when applicable............................................................................................... ------------------- ------••---------•------••--•--•-•------•-••-•-•......----•--•---...........---•---•-•-•-•-••••--•-••...-----•-----•-•---•-----•-••--------•-•-•--•--•--••-•-•••--••------...-•---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with the provisions of TITLi, 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 ttie board_6� lth.,n 4 fi/ Signed f .---- - -- D Application Approved By........... j D.......... "'�-f, ----•---•---•------- ---- .•...- ate Application Disapproved for the following reasons:---•........................................•-------------....------------------•-•-----------•-•-.......---•-- ....................•-•-•----------•--...... :•••-----•-------•--......-••----------•------••--.........----.......................-----...•--...•.................................................... Date Permit No....... ..-(A0------L.r �-------------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH, ...... �.....OF...............�'r' ..................... 77- Trrfifiratr of Tomplittnre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by........................_4 'r -'t//•`/f.... ' ---•--------. ..................... ,rf �.�-• �� / �•• ` � , Installer at---.......... ---- ... . "�=-` s ---------------------------------••---•-------•-------------------------•-----•---------.......-•----..... has been installed"in accordance with the provisions of TITLE 5 o The State Sanitary Code as desc 'bed in the application for Disposal Works Construction Permit No.- S dated 1 ---------- THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUAR NTEE THAT THE SYSTEM WILL FUNCTIOP SATI FACTORY. DATE..... . ...................... Inspector.................... ----- . .............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF; HEALT X (3$ ................... OF......... ;� '�?c'j '' � -, MoVouttl Works Tonutrudton rrrmit `Permission is hereby granted._ _ -•----•-•...............•----•---•--•---•-----•-••-----•-•-•-•.............._....................to Construct (A) or Repair? ( ) a Incividualr.SewagejDisposal System atNo................... A ` % :--� ...�..f_`:! . .�.. r✓y' .......................................................... ----- .. ' Street as shown on the application for Disposal Works Construction Permit Nam' �9±..... D t ....... 11 Z., •----••------------------- . ...... . •..... -....-----•-----------------•-•---- .._..-•-- Board of Health DATE................... _.��--- •�-�--------•-•--••---....__.... FORM 1255 A. M. LKIN, INC., BOSTON l T� } F,l. 1. }h :• �_. ' ' . _. •-'�a.•� • ,�!.` ..J r.�.' ! /� Y 3'V•'�j,4�Cy'.�'I• j� ,.. t s ` ?O FT .MIN. -- v� ARE MQRE TNAi`J` 2••B LOW ; :1 F. CONG•.t"CTE .CCYER/< e. ` ;} ( :�NALL BF BROUGHT TO GJ;,4 vE' �i•.,'✓ EXTRA .. .•'� CONGiQCre ' MJNVP/TCi,+E� HEM �Y C^ ST /rPON CO;/ER Sf�.4LL-L3E, USED `ry OR/vE rt/I4 y �rr•� / ` •-2 ; era. CO/VCR�T�' a ' v , Cr { r rr ✓� i �AOE / l�SCU YER CL ZAiV S"ANO :I "q^pin. LiQu/o LEVEL •: •� '. tom-::.•• s_,• _� =..• ,z ' 4: SCNFavcbo :PY� P�pE LAYER G�4L. :MIN. P/TCN- /OOD o • . • . • • •a 04� 'la PAR /•"T SEPTIC:: TANK D/sT. o • o e. e e e o s, e • o a q 1VA5NF0 .S717ME 9OX list a a ► 0 •d'o w p � • •EFFECT/VC' '�,�"j� . ; '�/4 9- 1 /2 e ° v • o Dt`PTt/ • • • ':',� v o W.A5HED STONE. Jt of ZZCo .�.C� = ^o+! / N • o • e • • •'. o 0 s o: o • p e e . • • • •` p v PREGgS T SE�`PAG E` � •• O.�'� Q: ¢ � o o r � • a e e • . • � ��' e a O/7 OR EQL.!/V, . lA1VC T 4&4RVaTiOws97,E INVERT AT Bll/L:D/NG /D 4.OFT P T: L�1'�ipG. �3 6 FT D/.4M: i 7s� l/Y�,FT,SEPTIC:.TANK I03,B.FT / is —��,'FT O1,4M, C SEE TABUL.4TJQN� �OIJTtE.T SEf?T/C TANK .103 ¢ GROUND WATEX TABLE 7LET J/STR/BI/j/ON.BOX o 2 �' SECT/4N OF f. QUTLETD/STR/�IJT/ON.BOX. 13 F� INLET LEA.C/•//N4 OFT :: SEWAGE �ISP4S�1 L SYSTE/r1 LEACHING PIT JULArlDN I Scat M =o" O/MENS/oN A w D.ESIGN CRITERl�i D/r�ENs�aN $ Ca FT + 0•F D/M NS/ON T / LIMBER OF,BEDRaOMS 3 • GARCAGED/SPO,SAL U,vi _ c SO{L LOG SOIL TEST TOTAL EST/Mr4'TEO FLOW S GAL.1OAY 1, 450 L TEST /. :SOfL 7L'STr-*2 F f iillUMdER GtF EtACNING. P/TS___.� f`EL�1� �04• �f2 ELFY, pA7 OF SaJ(, TEST S/OE L,E`AGH/NG PER P/T 77 to SQ• PT. RESULTS IV/TNESSED BY P/�j G o/�/LO�(/_ � 3UTTOM L.E�9CN/NG PER ?/T�� SQ, �T,; �. ��'�• LoAM PeMCOLAT/ON RAT• ,El �_ MJN,IJ/VCN TOYAC° LE`RCN/NG AREA 33� SQ, FT. I �• ♦sumSO" ,. P.FtCOLi4T/O V RATE A2 MIN, /NCH_ RESERI�E GE,QC'N/NG ARE/+ S ..-FT. t F f / •�ri rF ,� ,.���{' _ tyJ ,. , . So /L. TGS.T' 407 -9 Fl/^/T_ Oc,E i2/3 SAND in(ISTA fi y EL 0IR EDGE ENG/NJ0 ITII1/G CO,PVC. r \ A r 71Z MAIN ST, fHYANNIy, MASS. . _ �`- CGRO UN L + b {�i4 TE.!P ENCov MrE e�o t�/ENT ,.•� ! �y c es / 1 G/eO uiYQ ;-VA TAR �9T �L.�v:. > t;J +.t4°r '3 7M4 s. {`],i « ti::` `....•+ �'.t4 t ...i,. 1 t .','k t r,. '.s i�t7-Et!Y�,Yt t�`.@r,y, ';,..€ YR AI'._..` )Ly.a.; ,�Fa :..'S p ti.< _ j,t`.4¢e+ x'� Y t s,.'.7, - a —r�r. Y f+ . t t , L ` t{//{..-Ss ♦ 1 y ., • jkc;-1 ct ;.' - ' r .t ",r I : ! •L ..r , ,.�. 1r , L '';, , /6-.��i ,Q' \O Qf 'F ,. .sue g ,o. ,, 1 Gq 7 ,r 1 ti \90 r�1. ; i. N ti ./93 3 J � /Z:9a p ". 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Y . t+r Mkt o"t .' $� c I 4 I/,I,...":, 41--., �/._,..[-'I..�.I.—I.,Q.��.I"I.. F �� A L ECG y ` . (6; G.y: . . s. 'ERTIFIE P ,OT PI.AF '/..I I�I ® s , '� Eds' ED SPOT El EVATI ON ��0I.. �a� Q,,, � �0/. wt� �ie�✓T" �o�� ,��,a� I ; - .". ... C<aw`,n_n c_b�' I,V.L S r I.dl �l.d ._.._ wt. APB VED , BOARD OF NEP�.�' �i 0 � +i,al " I.vS i ` j DATl _ AGERT #S 2L:E'.",/ 4A' .�:1ATEA .3f31d` i4 i m'^P•�osa/as. .s.,ne.A� ®aa�.av< --- `' r _,_ .i����-V. i. .fI "LGA' C';� °AI 3 1 IG C�..�IV .' di s ai>1 0€ a; I%, fi ',s 1 ;, "`- �,,, dENT K �t` Efi. 1 ',` I °.CERT.IFY Tt Ae x,THE PROP03E qq66�� c b e P Q•p{y g__ "' g,-}-ry '(//f R0B ,", ° q iy,n ,�w /� Tu o p �y r s� 'I+.� tFsi�dT9 G+�.' �6��J[y�,1y[S..q■SFiai7! I i4VLD SN®e� �� �� ,`��41 /. �� C,�/����.11r•DO[tl�V e? �C' iV �":.� 1 i'7�J f L A17. {� i. '� 4R •!!,'.;t!.{°k. { 1 -/ �•`�•�@Y "-. �1 t.,• �je +Td' f..�l, �rf6.Jl,Z y� �V`19' 0!\-� TO 1- i�'` ZONING LAWS ♦ p yae 7 f tt 2' .,p�,/� L '� .p i` y(� ry , y ,y jh i.ly. 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