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HomeMy WebLinkAbout0079 MARBLE ROAD - Health 79 MARBLE RD, BARNSTABLE A=316-035 .............. #,I Commonwealth of Massachusetts Title 5 Official Inspection Form Y Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "f 79 Marble Road, Barnstable M-316 .P-035- Property Address Morag Masll Owner owner's Name information is 79 Marble Road, Barnstable - MA 02630 » May 3, 2012 required for every Y • page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information . , on the computer, use only the tab 1. Inspector: •.., � O " U key to move your - - cursor-do not "» - Troy Williams use the return Name of Inspector key. Troy Williams Septic Inspections � Company Name 19 Hummel Drive' r Company Address - -. - •, . . - raw South Dennis MA }' 02660' Cityrrown ». State 'Zip Code (508) 385- 1300 S1,682 Telephone Number License Number B. Certification certify that I have personally inspected the sewage disposal system at this address pnd that t# __+• information reported below is true, accurate and complete as of the time of the inspection. Th"spe9c on was performed based on my training and experience in the proper function and rn jenance of-on sttw sewage disposal systems. I am a DEP approved system inspector pursuant to,"Uction lez.340 of Title 5(310 CMR 16.000).The system: I , ® Passes+ ❑ Conditionally Passes ❑ Fails =� ❑ Needs Further Evaluation by the Local Approving Authority, May 3 2012 Inspector's Signature ��� r Date' The system inspector shall submit a copy of this-inspection report.to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner. and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-11/10 ; Tale 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 y f . r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °< 79 Marble Road, Barnstable M -316 P-035 Property Address Morag Masil Owner Owner's Name information is 79 Marble Road, Barnstable MA 02630 May 3, 2012 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System meets minimum standards set by Massachusetts DEP at the time of inspection only.This inspection is not a guarantee or warranty on the future working conditions of leaching, pipes, components or the future structural integrity of said components and only represents conditions found at the time of inspection only. 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): , N/A ti t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts ' lugTitle 5 Official Inspection Form.. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Y 79 Marble Road, Barnstable ' M -316. P-035 Property Address Morag Masil Owner Owner's Name information is 79 Marble Road, Barnstable MA 02630 May 3, 2012 required for every , page. Cityrrown State Zip Code Date of Inspection B. Certification'(cont.) a B) System Conditionally Passes(cont.): * ❑ Observation of sewage backup or break out or high static water level in the'distribution box due to broken or obstructed pipe(s)or due to a broken, settled or.uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced . - ❑ Y ❑ N ❑. ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ; ❑'ND(Explain below): ❑ distribution box is leveled or replaced f ❑ .Y [1 ,N ,,❑ ND(Explain below):. N/A ❑ 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 0 N .❑ ND(Explain below): N/A f• C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing•to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system.is not functioning in a manner which will protect public health, safety and the environment: - a ❑ 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 - r F , L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments " 79 Marble Road, Barnstable M-316 P-035 Property Address Morag Masil Owner Owner's Name information is required for every 79 Marble Road, Barnstable MA 02630 May 3, 2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ . The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method.used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: N/A 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 %day flow t5ins-11/10 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts, Title 5 Official, Inspection Form ' Subsurface Sewage Disposal System Form-.-Not for Voluntary Assessments ', -' iv*' ' ' 79 Marble Road, Barnstable a 'M. 316 3P-035 Property Address. >�._ • '. - Morag Masil e Owner Owner's Name ' information is required for every 79 Marble Road, Barnstable ' MA 02630 *4 'May 3; 2012 page. Cityfrown « State Zip Code Date of Inspection ' B. Certification (cont.) p Yes No �R° y r-; �, 4 • I Y*� a • ' ❑ ® Required pumping more than 4 times in the last year NOTdue to clogged or ' ' obstructed pipe(s). Number of times pumped: , ® 'Any portion of the SAS, cesspool or privy is below high ground'water elevation: c 4 ❑ ®, Any portion of cesspool or privy is within.100 feet of.a surface water supply,or tributary to•a surface water supply. • ' t �' ❑ ® `rAny portion of a cesspool or privy is within a Zone 1 of apublic well. .[I ® Any p 'rtion.of a cesspool or privy is within 50 feet of a,private water supply well. `'® Any portion of a cesspool or! yprivy is less than.100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This • system passes if the well water analysis,performed at a DEP certified ' laboratory,.for fecal coliform bacteria indicates•absent and the presence of ammonia nitrogen and nitrate nitrogen is"equal to or less than 5 ppm, provided that no other failure criteria are triggered:A copy,of the analysis _ and chain of custody must be attached to this form.] The system is a cesspool serving.a facility with a design flow of 2000gpd, ❑ ® 10,000gpd.. ;+ yr. ❑ ® ,°, 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. r ' Yes No ►- , '.._'"s' ❑ ❑ r 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 El ,.the system is located in a nitrogen sensitive area (Interim Wellhead Protection ❑ "Area`-�IWPA)or a mapped Zone II of a public water supply well . If you have answered"yes',to`any question in Section'E the system is,i onsidered a significant threat, s or answered"yes" in Section D above the large system has failed. The owner or operator of any large ,. system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. , t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage_ g Disposal System•Page 5 of 17 _ / 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 79 Marble Road, Barnstable M-316 P-035 Property Address Morag Masil Owner Owner's Name information is required for every 79 Marble Road, Barnstable MA 02630 May 3, 2012 page. Cityrrown 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? ® ElWas the facility,owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms`(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR.15.203(for example:.110 gpd x#of bedrooms): 330 gpd t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 A Commonwealth of Massachusetts' .• Title 5 Official Inspection Form - ", Subsurface Sewage Disposal•System Form-Not for Voluntary Assessments , °~ .79 Marble Road, Barnstable Tyat, '-M`=316 .P'035 Property Address °` ► F Morag Masil Owner Owner's Name y information is required for every 79 Marble Road, Barnstable 4. _ MA 02630`r. .r „ May 3, 2012 page. Cityrrown - s State Zip Code Date of Inspection r D. System Information : Description: •;; . ,� ate. ,,; "+ Number of current residents: • Does residence have a garbage grinder?. 'a El Yes''® No Is laundry on a separate sewage system?[if yes separate inspectionMrequired]A ` ❑ Yes?® No Laundry system inspected?4 " -; a•n, •ED,Yes• ❑ No, Seasonal use? ,� a, - ❑ Yes"®*'No 11=89;000 gals. F` Water meter readings,-if available(last 2 years usage(gpd)) 10=48,000 gals. ' Detail: , ; Sump pump? . E]:Yes ® . No Last date of occupancy: occupied • . Date t Commercial/industrial Flow Conditions:. r' N/A:' Type of Establishment:. y N/A. Design flow(based on 310 CMR 15.203) Gallons per day y(god) Basis of design flow:(seats/persons/sq.ft., etc.): N/A ' Grease trap'present? - ,❑ Yes ❑° No *. a Industrial waste holdingresent? •' `� `• tank,present? ,❑ Yes`❑ No' Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: N/A t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 7 of 17 • _ t Commonwealth of Massachusetts , 113 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °t 79,Marble Road, Barnstable M -316 P-035 Property Address Morag Masil Owner Owner's Name information is required for every 79 Marble Road, Barnstable MA 02630 May 3, 2012 ' page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) ' - Last date of occupancy/use: N/ADate r 'Other(describe below): General Information ' Pumping Records: Source of information: No pumping info was available. Was system pumped as part of the inspection? ❑ Yes ® No • If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool , ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator-under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 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 `y< 79 Marble Road, Barnstable, m t M '316 P-035 Property Address Morag Masil Owner Owner's Name information is required for every 79 Marble Road, Barnstable - MA 02630, May 3,'2012 page. Cityrrown State Zip Code Date of Inspection D. System Information (cost.) Approximate age of all components, date installed (if known)and source of information: Tank, d-box and leaching pit were installed on A/12/83 per compliance. Infiltrators were installed on 7/22/97 per compliance. Were sewage odors detected when arriving at the site? ❑'Yes ® No Building Sewer(locate on site plan): Depth below grade: 181'+ ' feet Material of construction: f ❑ cast iron ®40 PVC ❑rother(explain): , i II r. ion line: N/A Distance from private water,supply we o suction- n feet . Comments(on condition of joints, venting, evidence of leakage, etc.): , Flushed lines and found clear at the time of inspection. f Septic Tank(locate on site plan): < D 3'with riser to 6" Depth below grade: feet • Material of construction: ® concrete ❑ metal ❑.fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate). A❑ Yes ❑. No. Dimensions: ' 5'X9'X6' 1000 gallon 4" Sludge depth: ; t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °c 79 Marble Road, Barnstable M-316 P-035 Property Address Morag Masil Owner Owner's Name information is 79 Marble Road, Barnstable MA 02630 May 3, 2012 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) 21811 Distance from top of sludge to bottom of outlet tee or baffle Scum thickness thin layer 6,1 Distance from top of scum to top of outlet tee or baffle - . Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? probe/measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pvc inlet and concrete outlet tees were found present and in working order. No evidence of leakage or damage was found. Tank was not in need of pumping at this time. Grease Trap(locate on site plan): Depth below grade: N/A feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): N/A Dimensions: N/A Scum thickness N/A Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A Date of last pumping: N/A Date t5ins-11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 10 of 17 I _ Commonwealth of Massachusetts lugTitle 5 Official Inspection Form t ` Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 79 Marble Road, Barnstable W- M -316 P-035 Property Address Morag Masil Owner Owner's Name information is required for every 79 Marble Road, Barnstable "MA 02630 May 3, 2012 page. City/rows State Zip Code Date of Inspection D. System Information (cont.) - Comments(on pumping recommendations,"inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): N/A _ A Tight or Holding Tank'(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: N/A Material of construction: Elconcrete Elmetal ❑fiberglass polyethylene ❑ other(explain): N/A Dimensions: N/A Capacity: N/A gallons i N/A Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working'order: ❑ Yes ❑ No Date of last pumping: v Date Comments(condition of alarm and float switches,etc.): N/A y .. o "Attach copy of current pumping contract(required). Is copy attached? El Yes ❑ No t5ins,-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r� 79 Marble Road, Barnstable M -316 P-035 Property Address Morag Masil Owner Owner's Name information is 79 Marble Road, Barnstable MA 02630 May 3, 2012 required for 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 level Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box was found level and in working order. 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.): N/A Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments, 79 Marble Road, Barnstable M -316 P-035 Property Address s Morag Masil Owner Owner's Name information is required for every 79 Marble Road Barnstable MA 02630 May 3, 2012 , page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits- number: 1-6'X6' pit 2'of stone 4-infiltrators ® leaching chambers number: " with 4'of stone Elleaching galleries number: with 14" under i ❑ 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.): Pit was found with water level up to outlet invert. Checked stone and found dry.and clean around infiltrators. No evidence of hydraulic failure or problems in the past were found at the time of inspection. 1 f . Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration N/A Depth—top of liquid to inlet invert ,, N/A Depth of solids layer a - , - N/A, ' N/A Depth of scum layer. N/A Dimensions of cesspool Materials of construction N/A a Indication of groundwater iinflow ❑ Yes ❑ No t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' 79 Marble Road, Barnstable M -316 P-035 Property Address Morag Masil Owner Owner's Name information is 79 Marble Road, Barnstable MA 02630 May 3, 2012 required for 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.): N/A Privy(locate on site plan): Materials of construction: N/A Dimensions N/A Depth of solids N/A Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection,f orm .' . }_ • Subsurface Sewage Disposal System Form -Not for Voluntary Assessments- 79 Marble Road, Barnstable ' : . w. ... rM 316,^P-035 Property Address Morag Masil t Owner Owners Name information is •. , , required for every 79 Marble Road', Barnstable MA 02630 May 3, 2012 . 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 bones below:.. ® hand-sketch in the area below ' ❑ drawing attached separately '' • t ', r y�+' K� •`,. 1. - III •. 1 •tom - 38 3 z'Af } t5ins-11/10 a Title 5 official Inspection Pone:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 79 Marble Road, Barnstable M -316 P-035 Property Address Morag Masil Owner Owners Name information is required for every 79 Marble Road, Barnstable MA 02630 May 3, 2012 page. Cityfrown 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: 75.0' 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: 11/17/80 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: AIW 247 Zone B 23.7' '• 3.0'adjustment You must describe how you established the high ground water elevation: Test hole recorded on plan showed no water found at 12.0'. Hand augered 3.5' below bottom of leaching with no water found at a depth of 110'. Groundwater adjustment at the time of inspection was 3.0'. Bottom of deepest part of leaching at 9.5'was found not to be located in the high groundwater elevation at the time of inspection. • 4 + a. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 4 . Commonwealth of Massachusetts' Title 5 Official. Inspection Form w « Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ' 79 Marble Road, Barnstable ` M -316 _P-035- Property Address fi Mora g Masil ,r Owner Owner's Name = information is 79 Marble Road, Barnstable MA 02630 required for every May 3, 2012 page. City/Town State, ,. Zip Code Date of Inspection E. Report Completeness.Checklist'' " ® Inspection Summary: A,-B, C,'b, or E checked � y ® Inspection Summary D(System,Failure Criteria Applicable to All Systems)completed', ® System Information= Estimated depth to high groundwater F• �' ® Sketch of Sewage Disposal System either drawn on page 15 0e attached in separate file ' r - • 1, ✓' v _ � 15iru•11H0 t Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 i' TOWN OF BARNSTABLE '0 LO 2k'I'i01" —7 Gl SEWAGE # / 7 a� VILLAGE FL.Sr W—e. ASSESSOR'S MAP & LOT `03�3' INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY e-tf-c 5VIa= i em �k�1c,�✓ LEACHING FACILITY: (type) I�`��n Ch F7 krt- nQ1\— (size) NO.OF BEDROOMS i BUILDER OR OWNER PERMTTDATE: J " �d' 1�7 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist. on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist. within 300 feet of leaching facility) Feet Furnished by 2- �1 Z o i c r No. ` � Fee 5$ 0. 0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for Miooml *proem Con.5truction permit Application for a Permit to Construct( )Repair(x)j Upgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No. 79 Marble Rd Owner's Name,Address and Tel.No. 3 6 2—7 41 7 Barnstable, MA Ira Silverman Assessor'sMap/Parcel V,d^ 0 ,5,e!r 79 Marble Rd, Barnstable, MA Installer's Name,Address,and Tel.No. 7 7 5—3 7 7 6 Designer's Name,Address and Tel.No. �'�Jtic S2r.vice X 108 , CentQx_yj_11 "" -�2632 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(no) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. F Description of Soil sand Nature of Repairs or Alterations(Answer when applicable) d_bvx--aTrd7" it g-@ s =n= p a='-=="-' l.y ` �;,Xyl_ 0%, -S t Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site ge disposal system in accordance with the provisions of Title 5 of the Environmental Code and not t ce the syste o ration until a Certifi- cate of Compliance has been issued by this ar f Healt Signed Date Application Approved Date f 7 Application Disapproved for the following reasons Permit No. Date Issued No. ` ! 'M1 �b� f . Fee $5 0.0 0 THE COMMONWEALTH OF MASSACHUSETTS y�AEntered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Yes 2ppfication for �Digaar *pgtem Congtruction Permit Application for a Permit to Construct( )Repair(X�5 Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No`j 79 Marble Rd Owner's Name,Address and Tel.No. 362-7417 Barnstable, MA Ira Silverman Assessor's Map/Parcel > ^ 19 Marble Rd, Barnstable, MA Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. Wm_F,-R49M+ksvrn--SrZ2gsptic Service Centpr_vi1.1. 7-MA--te2632 Type of Building: Dwelling No.of Bedrooms 3 Lot Size. . sq. ft. Garbage Grinder(nc) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title k i Size of Septic Tank 1 Type of S.A.S. Description of Soil sand r +l. Nature of Repairs or Alterations(Answer when applicable) infiltrators. of-- 'Clot �t� Li W>-y V\ Ca t uc1 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site ge disposal system in accordance with the provisions of Title 5 of the Environmental Code and not t ace the s s in o eration until a Certifi- cate of Compliance has been issued by thi ar f Healt . j )-/�'4 9 Signed Date Application Approved �r Date 2`Z 7 Application Disapproved for the following reasons Permit No. '��� Date Issued ---------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS Silverman BARNSTABLE, MASSACHUSETTS, Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( ).Repaired ( X )Upgraded( ) Abandoned( )by at 79 Marble Rd, Barnstable has been constructed in accordance with the prov'+�1^�and sy tem Construction Permit No. "- ��dated Installer blrlsbh--sr'S'€$jpC'-'S_T*V'Designer The issuance of this pent s 11 of be construed as a guarantee that the s,�~to will unction as/deessigne�� Date 7 Inspector/ .,✓r 4,t4y THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Silverman Xigpogar *pgtem Congtruction Permit Permission is hereby granted to Construct( )Repair(XX)Upgrade( )Abandon( ) System located at 79 Marble Rd, Barnsta e 42.E Installer: Ofa F .O iftsq _Z—r-� .] Sar Ce and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: `Construction must be completed within three years of the date of this �'t. Date: / Approvedll�Is NOTICE: This Form is to�be used for the Repair of Failed A 4 � Septic.Systems Only CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) 1 I,---^� L-e-8 hereby certify that the Application for disposal works construction permit signed by me dated concerning the property located at `7,11 meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic stem70V.'K--.' • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED : DATE: -LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER: [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. i 1 No..e :71Ay. ; .y Fps....... .................. `}� `-' HE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..............OF....... lZNST9.ZC�=..._................... Ap, ptiration for Ui"vii al Workii Tonilrnrtion Frrutit Application ishereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: ........../ ..F .E.. .�_-�.. ............................. _2azzs-............. ..----- 3 3 .............--........ Locatio� ddre c 12 o ; t No. r©2 I 4L .. .....�' . ............._ S Owner Adder a .. ..t.---•-l./.e�G.G.LeCrl!_[1.............................................:.............. ... �••-•-----..;.�..� ...�r1 .._.. �1� Installer Address d Type of Building Size LotA,,,.�a.....Sq. feet U Dwelling—No. of Bedrooms.... ....................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria GaOther fixtures ------------------------------- -•------ ---------------------------------------------------•---- ••--------------------- W Design Flow........ .. . g P$•Peon P� Y Y .1�.........................gallons er per da Total dail flow............. .. _......... .. }ons. WSeptic Tank—Liquid capacity./41M.gallons Lengthel...-6.... Width i-"?... Diameter................ Depth...,.."¢.. x Disposal Trench—No. .................... Width.................... Total Length...................... Total leaching area....................sq. ft. Seepage Pit No.....,�_..;......... Diameter..Q........... Depth below inlet................ Total leaching area...Z .7..sq. ft. Z Other Distribution box (g) Dosing tank ( ) Percolation Test Results Performed by.L..7....................................... .. �f... � d..._._....Date- a Test Pit No. 1..4..4..minutes per inch Depth of Test Pit.... ¢... Depth to.group water________________________ (Z4 Test Pit No. 2.Z.¢....minutes per inch Depth of Test .... Depth to ground water_......_—.....___. P4 -••--•---•-••---•- --•---------------- Description of Soil... . ...... 1 G e �!/......_FQ.! ... Ot a ------------------------•-•-•--.--------- -- --------------•••-- - �-�---------��`�j- ...... ----�---------------------------------------------------------------------------------- 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 iITLiE 5 of the State Sanitary Code—The undersigned further agrees not to place the system i operation until a Certificate of Compliance has been . sued by tlr-board of health. Signed-- - ,P ''`' '�........ .... ...... ............... ;...... Date r Application Approved BY.......�.... �, •. ��% % -` ~l`-83 Date Application Disapproved for the following reasons-----------------------------------------•---------------...---•-----------------•---------------•----•---------- ..................••---------••••-----••--••-------••---...------------•......••-------•-----•--•-••-----------•-•-•-----•-•-•-•-•-•--------------••••---•••---••-•....••---••------•--•--•-••.......... Date Permit No......................................................... Issued......... Da No....&Ps .-/Q. f Fss.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH a�/.�............OF........ �-/V.� A$4.F ................. Application for Ui!ipaaal Workti Tunutrurtiun ' rruti# Application is hereby made for a Permit to Construct ( ,?f'j or Repair ( ) an Individual Sewage Disposal System at: �� c�....... �el r. ...�", .......... ........�...............------..... . ....._.. .... ............... tion--Address �JL„� �/{(�/��/' jp�-. (Pr/�7]L/ott N�o. A//jJ.�./ �y`'/•.yC _ ............................ ..�.�.(...6...Y.i_/.� / ... -:-Z_[�[�(..........•!/ :/ 1 ( :.:•rhr Owner Addres ............................................ ----------... ....1. 1. _._�"' t�2.1 „ �r . J!^ Installer Address d Type of Building Size Lot..-_ ,:. '�...Sq. feet U Dwelling—No. of Bedrooms.....,-l...�`?�:��'_Ry.....Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) —` Cafeteria ( ) Q-1 Other fixtures ...........................:................._......•.--••..... '_.. .�s Ev�oo .... W Design Flow......... lU........................gallons per per.-ZNper day. Total daily flow.............. ._. ..:Vgallpns. W SepticLiquid pacity..,/a allons Length..s��...L6:-_ Width.. "/_'`�. Diameter........ .._._�_.__--__ Depth.... x Disposal Trench i N o ................. Width.................... Total Length......... Total leachingarea......... .......sq. ft. Seepage Pit No...___1.......... Diameter..1.0......... Depth below inlet.....05t........... Total leaching area....ZC sq. ft. Z Other Distribution box ( Dosing tangy ) `` a Percolation Test Results Performed by---4..A.t.......................................................... bate.... 8Q.__---.. Test Pit No. I.....4_4mmutes per inch Depth of Test Pit......M--f_. Depth to ground water..................... 44 Test Pit No. 2_...:f4...minutes per inch Depth of Test Pit.....1.04_*,.. Depth to ground water........................ - ------------------- . O Description of Soil.... ,-�........... a-!V.......jZ10--�-•-.. G► 4._-.---4.p-a..............-........................................... :� U --•-•---•-••-••---......--•---••••-•---.-:....•-••----...--•-----------------------•-•. W U Nature of Repairs or Alterations—Answer when applicable............................................................................................... �. . Agreement: 1111%-.; N The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with T TT •-� the provisions of T mT.. : 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. .. .__ Date Application Approved By......... '" ._ _C.c_1' :.r r � - --_.---• --------•-•• --•- --....- Date Application Disapproved for the following reasons:--••----------••-----•---•-••-•-•-•---•------•-----•-••-•---------------•------•---.....---••-•-----........... ...........................••----------•--•-------•-------•-•...............-•---------•-•.....-----............_._......_..•------------•---•------------------•-•---•--------•----•------•-••---------- Date PermitNo......................................................... Issued-........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH °+ ..........OF.......... :..:...................................... ....... ....... Trrfifiratr of Toutpfiana THIS IS TO C TIFY hat the Individual Sewage Disposal System constructed l ) or Repaired ( ) by----------------•------- _ v ----...................... --------•-•---•---•---•----••--•-----•---••----•-•---••---••--••-...__...............---•...----....-- nstaller at............ -----�t--- .. --•-----�......--•-------------•---•-•--•---------•---••---••---------.....--•-•••--- has been installed in accordance with the provisions of TITLr:. j of T he State Sanitary.Code as described in the application for Disposal Works Construction Permit \'o.... -r�' Q ------------- dated_.:...... ............................._....... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONAS A GUARANTEE THAT THE SYSTEM �LL{�UNCTION SATISFACTORY. DATE �v�l Inspecto17. _ THE COMMONWEALTH OF MASSACHUSETTS ,•g'" BOARD OF HEALTH . ` ............../..Q..f !.l ......OF.--------....RA4.1q..!`.U'......------------...-•---.... ��- � �-. • No ............:....� FEE.........__............. Biupma orku T6u utrurtion rrutit Permission is hereby granted............ . ... -. to Construct ( or Repair ( ) an ndividual Sewage DisposaLSYstem at No.......-_?1:9 ... .. ............... ......... / . '1 Si t�?L ....................................... Street ^•,.'.+.4,•<.,.",,. as shown on the application for Disposal Works Construction Permit No.........._________�Dated.......................................... "~•- l... ._:.,-- - ------------------------------------------- ar of Health a?; DATE -""�. --------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS y. po r zz /o7 3� `o u � rj; glll 9� I poi 3/ r 6 / ? Z, a I � v i �glti G , r' CERTIFIED PLOT PLAN IN q0 � r�Z 5� !a>S 3 33 ors VLAV1_,Z?k_ ZZ Z IRA R.THACHER, JR. - ��:: gam' REG. LAND SURVEYOR f sS 'ni it Dt:721M SO. YARMOUTH , MASS. - i2c= �.aw ./cssr.✓r;r✓cry i�S-� �'nliJF DATE r- >- g/ SCALE %"= S/O• i .� i4�P2 aliEO — DRAWN BY /AZT SHEET / .OF Z 7 CERTIFY THAT THE cX�STi�✓y P`AN OF M N Fo Mgss °L� L�.%iuN SHOWN ON THIS PLAN �:>� CONFORMS TO THE ZONING BY- LAWS G r IR RICHARD. ico 1AMES %;4: /1 OF THE TOWN OF I � 17 J,. - lv O'HEARN CA Ka JR. 9 No. 694 o ` A 1fo.23214 O GIs Q/STe'A S IT SUES i REG. LAND SURVEYOR • �y INVERT ELEVATIONS' NOTES:. SOIL TEST e DATE OF SOIL TEST 11117 __Qo INVERT AT BUILDING 9 2-9' FT. ALL WORKMANSHIP AND MATERIALS WITNESSED BY INLET SEPTIC TANK 9 Z. 7 FT. SHALL CONFORM TO D.E.Q.E.. TITLE 5 PERCOLATION RATE MIN./INCH OUTLET SEPTIC TANK 92-5- FT. AND THE tOWN OF RULES INLET DISTRIBUTION BOX 9 2. Z FT. AND REGULATIONS FOR SUBSURFACE OBSERVATION HOLE I OBSERVATION HOLE 2 DISPOSAL OF SANITARY SEWAGE OUTLET DISTRIBUTION BOX 90.0 FT. ELEVATION LEVATION= -93. 7 9 / 7 INLET LEACHING PIT FT. Loam LO.-7M BOTTOM LEACHING PIT c35' 7 FT. - 8" S 1,0 UB moo/ �2„�,f-c d DESIGN CALCULATIONS C. I _ 3� •. C'o,9✓S NUMBER OF BEDROOMS .. . . . . . . . . . . . . . . . . . . .. . . . . . . GARBAGE DISPOSAL , UNIT... . . . . . . . . /yowF TOTAL ESTIMATED FLOW (LL0 GAL./BR./DAY x 3 BR.).., 33 0 GAL./DAY - Z " FcOz ^�Er�. F/NE REQUIRED SEPTIC TANK CAPACITY. . . . . . . . . . . . 4-9S GAL. 7 2'' ACTUAL SIZE OF' SEPTIC. TANK TO BE INSTALLED... . /O4O GAL. LEACHING AREA REQU!R'<<JIENTS { SIDE WALL AREA--6"GAL./S.F _8 4 - /4� Ems= 8/• 7 BOTTOM AREA(2-$ GAL./S.F. r 2. 2 GAL. //z ^/o /�z d LEACHING L,PACITY ( BOTTOM t-SIDEV.ALL ).. .... . . . . . . 3/¢x s>rsX a•83-t 9./4•X G x/aX 2.0 2. 2 GAL. ` RESERVE LEACHING CAPACITY. . . . . . . . . . ` . TOP OF —_ E FOUND. SCH. 40/O / MAN• t4�� ELEV.= /oolo CONCRETE CLEAN SAND COVERS P!/.0 PIPE CONCRETE MIN PITCH 1/6 PER. FT COVER 2'/o MIN. PITCH ��HOFMgsrq 12 MAX. Ria�� �yG� N ? ` Z" LAYER OF 1/6" 1/2'° < o�r+M y - (FLO�J LINE �11 , WASHED STONE re.ev p -� 3/4 - I 1/2 �►st�F ,.: 4 CAST IRON �-t- ° ''°- PIPE - MIN. PITCH + � ° , w l0 �1(ASHED S�'ONE SAN ;/4" PER FT.. DIST. o � �_ ' ° � F- PRECAST LEACHING l ( DOS: BASIN OR EQUIV. Ld ° W c /00 0 GAL -n -- �-T ��r,�r3t __MASS. SEPTIC s TANK �o FT n/.O ,,,, O FitAR1*J, INC., RLS, IRS 1346 ROUTE 134 EAST. DENNI'^ , MASS. I PROFILE OF GROUND WATER TAB:_E SEWAGE DISC OS��L SYSTEM JOB N0. /Z¢S c:i_!ENT T�,,�c.v�n NOT TO SCALE DATE 7 �o �/ ESSEET Z OF Z 1 • e �y' lot 3f L,.'OfZ Xi T ION �/ � SEWAGE PERMIT NO. /Y/�v a VI :_1. A6E - 1 INSTA LLER'S _NAME i SAD/DRESS BUILDER OR OWNER DATE PERMIT ISSUED ���,�3 DATE COMPLIANCE ISSUED :6u \ IV D- -7 �' 5 i TOWN OF BARNSTABLE f LOCATION �� t+�wb�-c_. Y� SEWAGE.# . f.:..7- Gt� i VELLAGE !S c.�n.S�r s.Ia� ASSESSOR'S MAP &.LOT' Q INSTALLER'S NAME,&PHONE NO. �t SEPTI C TAN K CAPACITY LEACHING FACILITY: (type).J�'�_C t1 cn�'1� (size) NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: 'I " I d' ' 1�7 COMPLIANCE DATE: ' g 7 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by : -=n 0 ay . y 24-5 � 0