HomeMy WebLinkAbout0525 MARSTONS LANE - Health 525-MARSTON LANE, BARNSTABLE
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COMMONWEALTH OF MASSACHUSETTS
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EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
a DEPARTMENT OF ENVIRONMENTAL PROTECTIQl
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TITLES._. 1i�.� � :P:r:�„t
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY•ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART T A-
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'',CERTIFICATION;
Property Address: 525 Marston LnF .,
'T'Cuinmaquid
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Owner's Name: James'Bairy ,. 3c1:r�# ; :� .ph *d ,,,tit, , CT 2 l
Owner's Address: 525 Marston Lm f c, �Q4*o 2QQ® 1
'. *tt'�'.A".Al,#��4 4j`"P•at n,: t" "7� F�A,ys
Cummaquid �.
Date of Inspection: " OCTOBER 18;2000`6
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Name of Inspector:(please print) Jay Quinn � r.ra;,, ,� � � ��� � •.1i
Company Name:J.B.Systems
Mailin Address:P.O:Box 12$1 , ,t
. 'Dennis Port,Ma 02639 h t ll^+ ti!;'e ST:` ..iifs) -A!, F3 i1(,•
Telephone Number: 508,737.0361
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CERTiFICATION STATEMENT 1S ,7 -` � . . .. t� i,.i�,. :,� y��►�- ::�?a��:r , � ,a� p.
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 propel furictiion`arid'maintenanee of ovsite sewage dispos4system& h am,a DEP
approved system inspector pursuant to Section 45.340 of,Tide 5(310 CMR.15 000).;The system,,,,
•=s 'i � � y{ C a ':r r �}."ry � f - ji+J:.0,",# y{':l 1't'✓`'�:?�L'E' � ha.c{t [rt +jt`t
• ,�f?fir -,+• . .. ., i r r� 'e`iri -X•�`PasS2S�+�"t,} ,�;,'��..a,..`���.; y;�� f d,,,�'�'s.r�.� €1.^'"f � �•::.T: ,,,,.t ,
Conditionally Passes ` _9z�` '-+' t�:;N.#
Needs Further Evaluation.by the Local Approving Authority ,
Fails
+
•t "« i 'Inspecto(li _ �.' Sr.�u; 'yl^,.a•�, a 1i'�'�'ij.•� rr.'- �',�..k. ar+ xy,,Tt+ �- + t:i r"
r's Signature:
- ... .. �. #e: .. , •` fi- to 1,: -.n t-.i� :.t. T a 7.'t -ri i a,-��
M-
Thesystem
stem inspector shall submit a c of the inspection
y pe copy s nspecrio report tothe 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 subrnit.the report to'th�e appropriate regional office of the
DEP.The original should be sent to the system owner and copies sent to the buydr,',i applicable,and the approving
authority.
Notes�and Comments :., F a
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- .µ.• y�i. „fi flrc¢y 1�{s✓`•L2-{`f.V��iw4 SIC'�'r• 1• i���•.d d�. Y�i�M�t
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****This report only describes conditions at 'the time of ins ectiod and utoder the conditions of use at that
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time.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
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Page 2 of 11
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OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS, Ya v
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM,_: :°`
PART A
CERTIFICATION(continued)
Property Address: 525 Marstons Ln.
Gwnmaq °""
Owner: James Barry, ` = '`. 9. r. •k °:'
Date of Inspection: /19/00
Inspection Summary: Check A,D,C,D or E"%AI:WAYa complete all of Section D
A. System Passes:
_. in 316 CMR
information which indicates that any of the failure:criteria,
described
found an nfo
�_ I have not ou y
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. ,
r
Comments:_ System has been regularly maintained and is-working`-
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass"section need to be replaced or yr4 ;t',^
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 sta(,emorp.jf,,`not-detern?ined"'please.,,
explain: !; r i ..{r !. a iS•te '. .:i'_• }.. . . e, rr .`.! .. t ., .+':.� .'t7,1' t ;a. f': .
rP t .`. r t;:; P .,._�t ` +.' ,+ . 5'• -+ 1 �� .a-. s.,,�:r, t l -!;;4 : aC.., ,'tl, it : F . ra ,r'*
'Fhe�septic tank is metal�arid over 20 years'old' or_the;septic tank(whether metal or not)is structurally
unsound,exhibits substantial"irif tiarion`oi eaifiltrat�ot�.ot:tank.failure is:unminent System wYll,gass al►; i-, Qn 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:
Observation of sewage backup,or break out or high static water level in the distribution box due to broken or
abstracted pipe(s)'oi due to a'liroken;settled or uneven distribution box:-System-will,pasa rtispection,if
approval of Board of Health)
broken ptpe(s)atv replaced
( ;+i :rt )4, 4 'J,«. .. . r ,,u •' f r��. �', t_ „(4L�t, }'+)n
6bstr`uction is removed ''
distribution box is leveled or replaced ,.,
:� -° .,.i:, ,_e:4 :.+: i ,+. _ r., -t. .. .w.. . ,. ,`.el ..:!,�',i' ,E.F :3`•.,i 3 �,: i" {.:r-r... 1. A:?., , .
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s)::fihe`system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
..,., Sep � , !ti l a. .,'za.. -tr"'_.f .e!. .,. :,'F`3 .,a: ,. iK .•� 1•.r r,_ '6 ,•e ,..t'2 a „ .�'�' F i, ,. .fit+i Y' � T to f.' .,!'
i�'',.1...... r ,.�: : $r3.k,.t€.,'i'i''..:i tk '4' i,.. I. :4 = "ri :.S•., °3 �ltr'� �+:, j!+ r'Fs.�`'.. },,:7 cr i?.1 Y.i'r' '='.fir..a..;S J3:F';
T117 exnlAln'
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Page 3 of i 1 -
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OFFICIAL INSPECTION.FORM-NOT FOR VOLUNTARY ASSESSMENTS
. �SUBSURFACE'SEWAGE DISPOSAL"SYSTEM IN. SPECTION'FORM,;,� ..�.r
'PART<A�.. ' � ��i" *rr
.. ._. �
CERTIFICATION(continued)
Property Address: 525 Marstons Ln.
Cummaquid
Owner: James Barry ` r 1 't �`, ':�":�"#~i, 1c< J io
Date of Inspection: 10/18/00Ji '"Sri �
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 systemg,
is failing to protect public health,safety orthe 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:
i"`.r ., :,.'a *a.1•,.�,.*,+'�.:.�,i ifj.14' '�tto(y�..-A S. 'I1`J�; :€6:;r°„t �'X'�^„,-ri�,�,F�'V.�`.►�ti�"ti��i� � '.3��}
_ Cesspool or privy is within 50 feet of surface watery
..y•Cesspool or.privyis within 50 feet of a,bordering,vegetated wetland;or a salt.marsh,:1 { - }
.�,t4. k6''S :'S.� ..�m :.� $�iC�t.^tSF r/irF'7�tik,A}M' a•tF+`F.51 �.r� . 4t.+..n 4:.,x'i. ftr4.n �{1 SFF�5.3L1 l7};his Hai '
lr' "1i 7t ir k:.�`•. - '..
2. System will fail unless,the Board of Health(and.Public,Water.Supplier,if any).determiues that the -"
system is functioning in a manner that protects the public health,safety and environment �t;r-- '
ES ,. '�f�:� 4'�..��X r .,.. ii ti�.}4.: ci �' ..J :h f���y ��- :�', ayt',zr"t.e.-;�'• _,
The system has a septic tank and soil absorption system_($AS)and the SAS!is withina100 feet of a"
surface water:supply or;tributaryto;a surface water supply,*z5..g»;,i�
s .The system has a septiCCc;tank and SAS Viand the SAS:is within a Zone j,,of a,pubhc water supply.
e.s . ..+' ::.,. >� _�. ,y..y S '�!d.J t crp`��}L ,�_! •�4 Yi.1;"f #�'�.� �r r s� 7 r2�.. SZ`s �,�'A41 a"�e g:.,�,1.� k�.!
,< The.system has,a septic tank.and SAS-and the SAS is-within 50 feet of a private water supply well.
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. "..t ..?,<'.�i tt:^ 4°,;�ts..;��i':i;:t!•�.� i:�. ar�'`s�sr{; .. ;?.:� _
_ The system has a septic tank and SAS and the SAS is less than 100Rfeet but 50 feet or mare,from a
privatemater supply,well";.4,Method used to determine distance.-i ', . ,*k :w#,� :•. ,, >;r
. r ... � ,Y....S.;� .la. �,�f.,•�r;Yi.'�,S e....:Sr a«...�.a .e��a..`�6; >,`:t !1S.}.e t#x•. l't. '��,#�a1'...ef:�s�x.��,,�Kt 1�4�V .
"This system passes if the well water;analysis,:,performed at aDEP,;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.
V.1-7
3. Other: v
y�W;�:!3'1's•:V _ts°: Fa,��, ,.��r� s �i�.,.�e�YN. .... .., ..t:�i{°' f .„C�3�_.ea, 1?'�
x t tl.. �i�) �! {:. yr. .1?' .. . �+..:.Fx.t• .r- i•: W--. . ,W. fir f,ru f:.,� 1 .�ay:`•'�#
Page 4 of I I
OFFICIAL INSPECTION,FORM'r---NOT FOR\VOL,,UNTARY.'ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PARVA,"",
CERTIFICATION(continued)
Property Address: 525 Marstons Ln.
Qum R=uid
Owner: James Bgm
Date of Inspection: 10/11L00
You MW indicate"yes"or"no"to each of the following.for'.4Linspections:t
Q'�Yes N`d'&.t1,' -4., j r-T1 it ;«;I;,;i
""'X'1.Backup,of sewagelnto facility or-"SY#terh'dbmo6iieiit due to-oveload Drol6gge&SAS16rcesspool
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
X Static li4iiid,.Ievel'itithe'diitribuiidiibokabciv&oiitl4,invtd-dueto:an'overi6aded�or,clogg6d SAS or
cesspool
__2L Liquid depth in cesspool is less than 6"below invert or available volume is less than'AdOy flow
X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
_,X Any portion of the SAS,cesspool or privy is below high ground water elevation.
_X Any piartton of'cesspool or{anvyis within`100 feet of a surface water supply:artnbutary to a surface
water MZ,"'r.1 f Jr
Any portion of I a cesspool or privy is within a Zone I of a public well.
f
portion o .a:cesspool b,r,privy,is Within'50 I feet 6f-i'private water.supply Will.a-..-,r
X Any portion of a cesspool or privy is less than 1-00,fbet:,but greater thaii 50 feei,,,from wprivate,water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
4 verforined'a I t's-DEP certified labdratofy,for,coliforiii bacteria. ,and Watilii organic,c4inpounds
indicates that the well is free from pollution from that facility and the presence of ammonia
Initf6genAnd,nitrate`
nitrogen is-'equa'l.t-o'o"rl6is�thai.;S�"Ppm,.provided-that i'no-other faflurecriteria
are triggered.A copy of the analysis must be attached to this form.)
_RO_(Yes/No)The system h&.I have.determined one 6 or more of the iboVi fiiIiire criteria exist as
described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of
rr= z-,,iiealthtodeterrmn'e:what wilt be-neceisary,,t6 correct the,failure.;'.;,-
4
E. Urge Systems: (1) "If d, C11) 1i
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.. no __ .........
the.system is within.400 feet of a surface drinking n waterr supply
— the system is within 200 feet of a tributary to.a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone 11 of a public water supply well
Page 5of11
significant threat under Section it 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.
OFFICIAL-INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE:DISPOSAL`S YSTEMIIMPECTION=F.ORM' I'��
uARl B c F 4 t t�anlx fa d'a°J tty* a'�c sf,r
CHEM 3IST ' M,
Property Address: 525 Marstons Ln.
Cummaquid " }+
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Owner: Jame BgM
Date of Inspection:
Check if the following have been done. You must indicate"yes"or"no"as to each of the following.
t"a jP
Yes No
X_ _ Pumping information was provided by the owner,occupant,or'.Board,,ofHealthy t 9,v.v,
iy:�,t .FM.vJt -:Y>"�, a +i� FC� gir`;[4. :`�. �p F... ;� �..,^"tyni.�'��7s,'s��.A..s r'f3 tl.,-'fr'♦���+
X_ Were any of the system components pumped out in the previous two�weeks,?ri,
X , Has the system received normal flows in the previous two week.period.?t,+ �i•, ;t, r z s„ ; ,,,
__._ X Have large volumes of water been introduced to the system recently or as.part of this inspection
— N/A Were as built plans of the system obtained and examined?(If they were no/t;'a ailabWriovte as N/A)�?f
X Was the facility or dwelling inspected for siga,of sewage back up?..r r � m z;(1,flolrl
X Was the site inspected for signs of break out?
T 4
..«t,—. a t ;•:, ard"����«x.7 { �i�yd.! *i,:r'3�a*�� ra '1'{--�i4 r
Were all system components, excluding the SAS,located on site rAuf'a
Were the septic tank manholes uncovered,opened,and the interior,of the tank inspected for
condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of
scum
X _ Was the facility owner(and occupa'sif different from_owner)'pr'ovided with information on the proper
maintenance of subsurface sewage disposal systems 7
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a• r#R i.si.a f a` r 4
The size and location of the.Soil Absorption.System.(SAS).on the site,has been determined:based on C*b
Yes no j' ,.Y,
X Existing information.For example, a plan at the Board'of Health*
X_ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of.•ft 1
distance is unacceptable)[310 CMR 15 302(3)(b)]
;ar E ' ? `+d
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Page 6 of 11
III%
OFFICIAL INSPECTION FORM ; NOT,YORkV
OLUNTTARYA, $S -$SMEN TS
SUBSURFACE SEWAGE DISPOSAL, SYSTEM INSPECTION FORM
P-8 xleklp .'
SYSTEM INFORMATION
Property Address: 521 Margin LLi,
Owner:James BaM
Date of Inspection: _jQLJ&QQ—
FLOW CONDITIONS
7 ""�
"
Number of bedrooms n): of bedrooms o
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):_130
Number of current residents: 0
Does residence have a gaftgelgeiiider,(yes or no):,,yg. o-
Is laundry on a separate sewage system(yes or no):pa_ [if yes separate inspection required]
Laundry system inspected(yes or.no)-,y-ev;!-.
Seasonal use:(yes or no):3 ue
Water meter readings,if available(last 2,years.usage(8pd,))--,
Sump pump(yes or no):w_
Last date of occupancy.jV._.-90i 1 .....
COMMERCLkLMflDUSTR1AL..-,-
Type of establishment:T NA:/
Design flow(based on 310 CNM 15.203): J!,I-, o�:w,-,-'t gpd,!i,
Basis of design flow(seats/persons/scAetc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no):
No waste discharged to the Title� �system,5 -(yes or •
Water meter readings,if available:
/use:
Last date of occupancy
OTHER(describe):
!"t�!Y"'
Pumping Records
Source of information: Barnstable B.O.H.
Was system pumped as part of the inspection(yes or no)-—no
If yes,volume pumped:_____gallons How was quantity pumped determined?
Reason.forpumping,
TYPE OF SYSTEM
X m ..: .1;
Septic tank,distribution box,soil absorption.-syste
Single cesspool
Overflowtosspoott,.,i
Privy
—Shared system(yes or no)(if yes,attach previous inspection mcoids"if'a n*y'!)
—InnovativetAlternative technology.Attach a copy of the current operation and maintenance contract to be
obtained from system owner)
Tight tank _Attach a copy of the DEP approval
Other(describe)-
Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
+'-SUBSURFACE�SEWAGE'DISPOSAL`SYSTEM'INSPECTION.FORM '
* r 4 z r w �. R w, r,. �, .
"PART C`. ;4 ,,> , - «;;. {
SYSTEM INFORMATION(continued)
Property Address: 525 Marstons Ln.
Cummaau id
-
<
Owner: James
Date of Inspection: 10 1 0/ 8/ 0
BUILDING SEWER(locate on site plan) -
. ,r ,rr•:lc'�It�ft-Z.t ;�+a�.7 y ii`S' `.+.r�x�.ar= ';} -t ^t �!t:�}i =.,'.d�'�4''
Depth below grade: NN/A—
Materials of construction:_cast iron _40 PVC'other(explain):.
Distance from private'water supply well or,suction line •
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK: X (locate on site plan):, «
Depth below grade:
Material of construction: X concrete metal_fiberglass
other ex lain
If tank is certificate)etal list.age: __ Is age confirmed rmed by a Certificate of Compliance(yes or no)' (attach a copy of N
Dimensions: 10.5'L X 4.5'W X 5.5'H (1000 GALS.) ' °
Sludge depth: 3" �' € r�. : ' *f , f,a:i ,,
Distance from top of sludge to bottom of outlet tee or baffle: . .8� '
Scum thickness: 0„ �:� .� ,�o?ap: •> „I n<„i,f fit: ; '. yt
,.
Distance.from top of scum totop ofoutlet-tee or,baffle67' .<1:.+:__,,,;�,:�:'_•yz„rh�.t���.�, ,,»�3,'a W»fi,•;y�, ,st.rr���,�,
Distance from bottom of scum to bottom of outlet tee orbaffl&,20"
How were dimensions determined: T pe&Slud eg 7ud tg
v ,.
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural mtegnty,liquid levels=
as related to outlet invert,evidence of leakage,etc.): System Iast pumped in 19- recommended to have systemµ'
pumped as part of scheduled
maintanance
�,. ;;o-
'IeU i t 3 .:#i
GREASE TRAP:N/A(locate on;site.plan)c�4: i,,-h -t,.;. 'IQ �1.:. ll.
De th below •• T 4. _ .� x .�...w _. ..
_' . .
Material of construction:'concrete metals'+-fiberglass _polyethylenes `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: 2 -
Date of last pumping: '
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
Page 8 of 11
OFFICU'L'INSPECTION;FORM' NOTFOR VOLUNTARVASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL-,SYSTEM INSPECTION FORM
C!
SYSTEM INFORMATION(continued)
04
Property Address: 525 MarstonsIr ...
Cummaggid
Owner. James Ag[y
Date of Inspection:_JXjjMQ '
IV TIGHT or HOLDING TANK:NIA (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:- T,
Material of construction: concrete—metal _ fiberglavif
Dimensions:
Capacity:— gallons
Design Flow: pllons/day
Alum present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float;switches;etc.):
DISTRIBUTION BOX: X(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,iqual;'dny;evidehti of.sblids-carryoveil any evidince of�
leakage into or out of box,etc.):—D-Box is lev6l'and-)W6rkin&;;1i1,'7!rf'4:j,11—,i.if 1; 1�1: �;:"l 1T 7. 4 11: r�
correctly10)
PUMP CHAMBER: 1'J/A(locate on site plan),Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and
"A
C!, T
Page 9 of 11 71
OFFICIAL•INSPECTION-FORM NOTk.FOR VOLUNTARYtASSESSMENTS
SUBSURFACE SEWAGE-DISPOSAL SYSTEM INSPECTIONFORM,
_. PART�Cr �.-. r _ . ,.
SYSTEM INFORMATION(continued)
Property Address: 525 Marstons Ln.
_Cummaquid �,f yp
Owner• James BgM
Date of Inspection: 10/18/00
SOIL ABSORPTION SYSTEM(SAS):X_(locate on site plan,excavation not required)
.t
If SAS:-not lainwh located ex , „1. � � i
p y , -•�.�:Dn r:>F ti .r 1 ':, P .t fA,.': -ib
Type
X leaching pits,number: 2 '
leaching chambers,number:
leaching galleries,number: r
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.):_No signs of hydraulic failure and has normal vegitation
growth v
CESSPOOLS:N/A ,(cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration: `
Depth—top of liquid to inlet invert: f "
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool: ,
Materials of construction:
Indication of groundwater inflow(yes or no):
r
Comments(note condition of soil, signs-of hydraulic failure;level of ponding,condition of vegetation,etc.):
` . Y. _, .... ". •�_ _ • • R « 1 -1' • fill
PRIVY: N/A(locate on site plan)
Materials of construction: -.
Dimensions: < F R
Depth of solids: :"`` •._ r ,
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):' ,
Page 10 of I I
OFFICIAL INSPECTION FORM NOTFOR'VOIJUNTAkY ASSESSMENTS°
SUB5URFtIE'SEWAGE DISPOSAIE s SYSTEM INSPECTION FORM
p: T C
SYSTEM I46RMA'I'I614(co4inu,4j-
r
Property Address: 525Marstons Ln. '$`' " ..•
Cuinmiqu_id
Owner:
Date of Inspection: 0_1,/18100 t
...o.,.....w. ..•....,........ s,we r...,.,,.......,..., u...x..wr ....w«.. ..,.,,. -N,.r ... .....,. y,.,.„.,.. _.....+....e.,..r.,.«..,�.r..x . .. ,_,_. ......,.... ... ...�.w,.
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch 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 entersthe building.
' _ '�?:L'it.. ,.li i.:�.i�., •.Jib. ,... ..
;} .•its si' :�. '7 f.f .� . t�r� ::f)'L .?._ !`t:P 7!! >.,, .•'kr , r3i-:i i7,.;
9.
{fr f = e� .fy1'i rr'.=` e.f: 'r �i-.�1 rT;:'R�;u �f"" `;`.F r:.1 i r.F � „'.:,} �� ''} a .*: •�4 +`�
,i:14i _i {.. •d f:'0
t1Q, ?..1 "r': 'J.,r +..? 7:-.gi 0./_
i
Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
d .
Property Address: 525 Marston Ln.
Cummaquid ,
Owner:James Barry
Date of Inspection: 10/18/00 F
SITE EXAM
Slope N/A
Surface water None -
Check cellar Yes 1
Shallow wells None '
Estimated depth to ground water 15' . feet' "t
Please indicate(check)all methods used to determine the high ground water elevation: t
Obtained from system design plans on record,If checked,date of design plan reviewed:
X 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: Used hand auger,and dug test hole at
lowest point on property,no water
observed. - t
L 0 C !�V,
N SEWAGE PERMIT NO.
eu —
VILLAGE
ifl� ,C3A�'�s7�le
INSTA LLER'S NAME i ADDRESS
1 l fwic4
0 U I L 0 E R OR OWNER
G�1s A*o
F1) ATE PERMIT ISSUED Z-
f
DATE COMPLIANCE ISSUED 92ygh
���� �
'� 2��
�� ��
a� ��
�� 5��� �o ���
� S
THE COMMONWEALTH OF MASSACHUSE17S
BOARD OF HEALTH
........... ......OF........ .............................................................
Appliration for Disposal Works Tonstrudion rrrmd
Application is hereby made for a Permit to Construct (X) or Repair an Individual Sewage Disposal
System at:
Z.0 65
............... ...................... ........ 2............... ......................................................
1) Location-Address .........or Lot No.
L
. ......................................... .................................... ....................................................
.....6;n;; Address
4�. X.?. ................................................ ..................................................................................................
Installer Address
Type of Building :2 Size Lot..44E,5Z...Sq. feet
Dwelling—No. of Bedrooms................3............................Expansion Attic Garbage Grinder (X)
P4 Other—Type of Building ................*............ No. of persons............................ Showers Cafeteria
P4 Other fixtures ...............------------------------------ .............................................................................
ylaa;............."...*...
person .........................
Design Flow_........Jl��..........................gallons pef-95p/,
son per day. Total daily flow........ 330 .............gallons.
Septic Tank—Liquid capacity./6;�V_gaflons Length..&-''9.... Width.�4�L/!?.. Diameter................ Depth...�Lf.
Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft.
>
Seepage Pit No........ ........ Diameter.... ....... Depth below inlet....:!��.......... Total leaching area---4.f I s! ...sq. f t.
.....
Z Other Distribution box (X Dos in V
0.4 JF,
Percolation Test Results Performed byiZ.(_._.. . ........................ �!............................... Date . ...
u__ water...._.......__._..._....
Test Pit No. I................minutes per inch Depth of Test Pit..................... Depth to gro n
Test Pit No.j....L ...minutes per inch Depth of Test Pit.../_!A..... Depth to ground water....................
.............................................................................................................................................................
0 Description of .......7- ........ ........................i--,l------------------------------------------
...............
---------------
-1_V&ZF..... ...................................
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
........................................................................................................................................................................................................
AgTeement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TL I'L LF, 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has)b ed y t bp of Jrath.//y1b ed by th
S ... . .. ..... . ......... .....................................
----------
Date
..........P f 2,
Application Approved B . .................
�ppr y g- ............................. ................................................. ....rZ...2/.....Date--------------
Application Disappr e or he following reasons:..........................................................................................................____
-------------7------------ ..... ..... ........................................................................................................................................................
Date
PermitNo................................................. Issued.---............ _...-•-••-......•---..
Date
-LNo.4
�? THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
r+
....... t''"-- M..fi'A/.........OF........ i�� �/.S.r"9ff.c.E.......................
'Applirtt#ion for Disposal Works Tonstrurtion Famit
Application is hereby made for a Permit to Construct (x ) or Repair ( ) an Individual Sewage Disposal
System at: J
.............. —:.•?f S;7f�/...5�:::: ........................ .....0..�1?�, .... �+... ............................I...........................
Location-Address or Lot No.
....................................................... .............................................•.......................••••........................
l Owner Address
a ,�r .�l��,r...... r`'%ti•G`, -------------------------------------------
...............................................ir...............................................
nstaller Address
U Type of Building Size Lot.:_�,�?':.5� :`:�_1....Sq. feet
1-1 Dwelling—No. of Bedrooms........................................Expansion Attic ( ) Garbage Grinder (,< )
`4 e of Building ( )
a Other—Type g ............................ No: of persons:--•-.......--------•-•-.. Showers ( ) — Cafeteria
Other
W fixtures ---......--•--••-•-----•--------..
day. Total daily flow Flow..........11 .. ..... a onspwi%§Pe
04 W Septic Tank—Liquid capacity j�;?V.gallons LengthJ/.:-0.... Width. 'w.. Diameter................ Depth..:`�_ I..
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No........`>........ Diameter....,/..,f/-.'........ Depth below inlet...... 4.p......... Total leaching area.e&q....sq. ft.
Z Other Distribution box (X ) Dosing tank ( )
a Percolation Test Results Performed by, ..r .. �.; ?6;.... �'.�................ Date. ........
2� ..............
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
G4 Test Pit No._.....e-.Z...minutes per inch Depth of Test Pit../.#.#...... Depth to ground water..... ...............
O Description of Soil. -. .... .?./" . ;P..Z5 oic---..... .................
;W.........
,[......... ;rM .......�J. . ¢'?rn/:2.. ......; . t"�r ac?4 c...................
2J.:'� .....v"'2. ...._...5.'v7 _� ...5:. ....................................._.
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 T I T LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee ed by t`f
d,�'•�.... . . .• .th.._b..o... of th.
Signed. V .......-- .---...-----•-------•--•........... .........---7Date
......
..
Application Approved dB .+------- .................
................--•------ vl Date
Application Disappro�e .t'r�he
followin.g...r..e.a.s..o..n..s.:... ......-----------•---•---------.......-----------•--------•----------•---:•---•-•---•----...---...._.._
................................. Z .......................................-...........................................................................................................—
Permit � ....................................._ Issued...........................................
Date
Date
THE COMMONWEALTH OF MASSACHUSETTS
,BOARD OF HEA H
f. .............. OF... ,4.,�,... ........................,...........................
�pif irtte of � nt�rlittnrr
T$IIS IS TQ CERTIFY, That the Individual Sewage Disposal System constructed ( r Repaired ( )
by......j•r,1xa ... / Z.....................•------...._..----...----......-- ----------------------------------...--------...-----..._.....--------..:-.....---....---.....-•--•------
1 alter
------------------------•---...
/ has been installed in accordance ith thre provisions of TIT r7r `p �of The State Sanitary Codefas described in the
application for Disposal Works Construction Permit No._$__:Z,_A/2.,f................. dated_ ...........7...........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISF TORY.
DATE.................................................. ....... Inspector............ I��._...........................................
THE COMMONWEALTH OF MASSACHUSETTS .,
BOARD OF H TH
,/��,,C.........................0F... �Qr,,t�..:.it.:. .............................................t' ni . ( 'II � rnr#uan rani
Permission is ereby granted... .f ,-
1{ .
to ConstrW-V
Repair ( n di 'dual Sewage isposal System
atNo....-- ..... ... .........•- .......�4.•K..............
Street
as shown on the application for Disposal Work Construction Permit o..S1,?.'/�Zf Dated.._ ,/G . ._. ..............
< :- y._. .
DATE ......... � � - = .... ................ -,'Board of Health. ... .......�...._
IV
• FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
SOIL. TEST _ INVE % tLtvAII�N� NOT,ES:
DATE OF SOIL TEST 7 zG 8 INVERT' AT'_.BUILD'ING 29,:0 FT. ALL WORKMANSHIP AN'D 'MATERIALS.
INLET' SEPTIC
TANK FT. SHALL CONFORM - TO D.E . TITLE. 5
WITNESSEp. BY
l OUTLET c?TIC TANK FT AND THE TOWN' OF B STA'81.�ftULES.
k'Fi;T'
♦ PERCOLATION RATE - Z MIN:/INCH AND REGULATIONS FOR SUBSURFACE
INLET D1STRIBUTI,ON BOX �`� G • F-T
OBSERVATION HOLE ,* 3 'OBSERVATION HOLE 2' DlsPosAL OF SANITARY _ SEWAGE
ELEVATION = moo;5 ELEVATION= OUTLET DISTRIBUTION BOX FT
INLET LEACHING: PIT � F.�- FT.
BOTTOM; LEACHING PIT FT.
DESIGN ' CALCULATIONS
NUMBER: OF BEDROOMS .. . . . . . . . . . . . . . . . . . . . . . .. . . ... . . 3
GARBAGE DISPOSAL UNIT...
�.� I '� G.,=,k ✓i 'i_ TOTAL ESTI`MAT:ED- ,FLOW ( GAL./BR./DAY x � BR ):.. � GAL./DAY'
REQUIRED SEPTIC. TANK CAPACITY. . .. . . . .'. . . . . . . . . . . 060` GAL.
ACTUAL SIZE-, OF. SEPTIC TANK TO BE INSTALLED... i.s a GAL. ?)Z c ,• PER' T1T:C
LEACHING- AREA. REQUIREMENTS i`.
SIDE WALL AREA 2..5^GAL../S.F. .
BOTTOM AREA GAL./,S.F.
•;.,' .v.v;:jt7F'y ;' -7Q tom.. .
LEACHING CAPACITY ( BOTTO:M+SIDEWALL �).. .... ... . . . . GAL.
RESERVE LEACHING. CAPACITY. . . GAL.
TOP,; OF
FOUND: .:
ELEV:=96•U /'/fT 40-
CONCRETE 4 SCH CLEAN , SAND ..,
r. CODERS PVC PIPE . ,-.
MINCONCRETE -
' � ,.. PITCH
.I/8 ,PER. F:T.. ER.. `x�M
C I`
2%.MIN. PITCH
F7 12 MAX.
-
• � 1AMfs H
FLOW LLNE N o
WASH H E D R STORE
_ E•Qtsz
I/8 I/2
-A.p z /9 �: o.
4 . CAST' tRON D 3/4.- L I/2
WASHED STONE:. SOH a
PIPE MIN: PITCH :
1/4 ^ PER FIST: ,
FT ` 0 1— PRECAST LEACHING 1
BOX`: oD' v W n' q BASI OR EQUIV. I
e •:'i. , 'O -�' `�.�'` O D �o'� #�.✓ : �/' �1.v r`-i/r L.�/,'�'� i
GAL
n . W
. .. SEPTIC .:.
Gar
a
. -INCNCRLS�
RHEARNJ OR TANK
1 13 4 8 ROUTE 134
EAST-, DENNIS; MASS. r
PRO:FILE'. OF: a :-,GROUND WATER. TABLE - I
JOB}.NO.aa 1l/ :CLIENT C
SEWAGE DISPOSAL SYSTEM . .
NOT: T O=.SC A s ': �• 7• _ !.
-
DATE SHEET`
t'
LftPv r
B,"l TOP OF gY0PAN7_
r ,
93, -
O 0 5� ,��\�..
\\' .
D3.3
/SOD GAL SFPT6C7,," <
/p F r D/A LFACti PIT
i
274. 45
Lots` �8
•,� � ti ra
NOT A :�' `w
EX j ST ))JG _. _ _ _ _ _
C� N TQJ 1=� --� �j C O r11 P 1�) �N� � W �i T'1� LU C I�
u SNAL1. IT-_ Y---Tt';PkM ! NtID ' 3Y L �_. D � i`J �
SC- jc`LJk � Or N S\v�`i .N1. CON 7\Z? sj
IE � .25.?.C K 3 0 r r
r
� '? � 1`?�c Y. R� 7S
' (PF Fl. 3vl \Z 7 2G E2
2 x i �7- `�G Ar N D F 1�! A 1� ,� D S rr A 1, SCALE: / •. . 7 APPROVED BY DRAWN BY .
. I;;; DATE:
DRAWING NUMBER
""aAm
POST ISAS-14E