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HomeMy WebLinkAbout0078 MAUSHOP AVE - Health • • Avenue r •• • • I 1 y Commonwealth of Massachusetts y Title 5 official Inspection Fora i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y Property Address �r oy.�i y.y��,a y► �!lyulf +Wrk,&! ®o.�ort 3.2y Aa e;As37 ON ner Cw ner's Name information is required for every �7 page. CityrTown State Zip Code Date of Inspection Inspection results must be submitted on this fors. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. '"lingouforrn'e" A. General Information filling out forrrs on the cor ,puter, use only the tab 1. Inspector: 0. 1 ( key to move your �o V cursor-do not /� TIJN/NG pON/G use the return key. Na rye of Inspects 90", /p�1J/ �i�idO.s/16/�G4:5 / � Si.►!/itt/ kCompany Narrtr Company Address s re r F s. NAIVSAI/f/V 109/•0 City[fown State Zip Code !"01 -I/V-, Telephone Number e!lu S"d License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority r Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****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. t5ns•3113 Title50fficial lnspeclionForm:Subsurface Sewage Disposal System-Page 1 of17 Commonwealth of Massachusetts Title 5 Official Inspection Form f Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �,,M 7�'��✓us��� oaf ' Property Address Oro ner Oro ner's Niarne requiretiois f3 '04Ni5p,W Lf �ypss, D G4i. 9/�✓�� required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E /always complete all of Section D A) System Passes: I have not found an information which indicates that an of the failure criteria described Y Y 'in 310 CMR 15.303 or in 310 CM R 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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 Healt h. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3113 T be 5 Official Inspecton Form:Subsurface Savage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5. Official Inspection Form Subsurface Sewage.Disposal System Form -Not for Voluntary Assessments �M Property Address O,v ner Ow ner's Name information is required for every. City/Town State Zip Code Date of trlspection 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 ofHealth): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ND C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or.privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordehng \egetated wetland or a salt marsh t5ins•3/13 Title 50ffidal Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form a Not for Voluntary Assessments Property Address Ow ner Owner's Nam information is required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) W4 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: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ fW 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 ❑ Q . Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ❑A/A Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal S item•Page 4 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �^M 78 11 IMIVAr -Mop PropertyAddress T Ow ner Ow ner's Mrre information is required for everyi�Z� TifL f /r1•rk{s 9 D! 9/i�� page. Cdy/Town State Zip Code Date of Inspection B. Certification (coot.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ I Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ❑H� Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ❑jlI,*. Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ❑111A Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ El At Any portion of.a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed ata 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 flowof 2000gpd- 10,00 Og pd. ❑ The system fails. 1 have determined that one or more of the above failure criteria exist as described in 310 CM 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. yA For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ the system is located in a nitrogen sensitise area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t6ins•3113 TitleSOfficial Inspection Form:Subsurface Sewage Disposal System•Page 5of 17 Commonwealth of Massachusetts 3. Title 5 Official Inspection Form x o Subsurface Sewage Disposal System Forth -Not for Voluntary Assessments �M /I 1/ 8' n o of Property Address �F4- * Z:11/110,10 AA1 ON ner Ow ner's Name information is required for every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ['� ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ [A Were any of the system components pumped out in the previous two weeks? [A ❑ Has the system received normal flows in the previous two week period?. It Have large volumes of water been introduced to' the system recently or as part of El this inspection? Were as built plans of the system obtained and examined?(If they were not El 10 available note as NIA) S.�l�fi6A' [� ❑ Was the facility or dwelling inspected for signs of sewage back up? 14 ❑ Was the site inspected for signs of break out? ❑ Were all system components, excluding the SAS, located on site? QI ❑ 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? 1 ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ Existing information. For example, a plan at the Board of Health. El El approximation 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): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): t51ns•M3 Title5 Official Ins pectionForm:Subsurface Sewage Disposal System-Page 6of17 I ' Commonwealth of Massachusetts Title 5 Official inspection Fora 3 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Ivor, Property Address ON ner OMf ner's%rne information is required f or every ' ST�nLe '+'Atfs d 2G01 9 page. Cityfrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? (Include.laundry'system inspection El Yes No information in this report.) Laundry system inspected? ❑ Yes ❑ No .�•�' Seasonal use? ❑ Yes 9 No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes M No Last date of occupancy: ���w d CG/1�isA I ate Commercial/industrial Flow Conditions: Allf Type of Establishment: Design flow(based on 310 CM R 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 Title 5 Official-Inspection Form Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �. Property Address ON ner Owner's Nam information is1�/h/S�Ai3, required for every 7 page. City/Town State Zip Code Date of hspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 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: I 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/Altemative 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 VA system by system operator under contract ❑ Tight . A f P g t tank Attach a copy of the DE approval. ❑ Other (describe): . t5ns-3113 Title 5Official lnspecton 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 Property Address - Om ner Ov ner's Name information is i3 required for every igia+�l�l/,S>�.dtLf D2lmG 9��� page. City/Town State Zip Code Date of Inspection D. System Information (coat.) Approximate age of all components, date installed(if known) and source of information: 2ryW$ 1f4,Y4s ST V-r- Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: Ek cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Na. Comments (on condition ofjoints, venting, evidence'of leakage, etc.): V. Septic Wank(locate on site plan): Depth below grade: feet Material of construction: EX concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: ✓r'�'�,�',,�ff' 7d0 a Cbd Sludge depth: t5ns•all 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 Property Address ON ner Cw ner's Nam information is �( required for every ✓ /� S.S d ZED page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 2G � Scum thickness Distance from top of scum to top.of outlet tee or baffle I� „ Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): /r✓L g $ Qdr t f T '7's 41010 a S?/ry-CrWO-01 .' 5,0 a y O ,t MOM 1W12 �Vf y LriyTi� 'Ut/TL SrT J.�yfxs's, rS�O'$/!�S a��Cfyf!/.t// Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title50fficlal Ins pec bon Form:Subsurface Sevege Disposal System-Page 10of 17 Commonwealth of Massachusetts Title 5 Official Irispecti®n Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address aw ner Ovv ne's Name information is f�/)c, .t I' / required for every ��S• O��a/ page; City/Town State Zip Code Date of Inspection D. System�Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): or Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No 5ns-3/13 Title5Official InspectionForm:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments rp 7E �S.�Oro / . . Property Address O✓v ner Ow ner's Name information is /5,Oh/STi � ,r j�'�required for every page. Citylfown State Zip Code . Date of trlspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert AO' &11;ryD Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any /U evidence of leakage into or out of box, etc.): �oerlS �fVst 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.): * If pumps or alarms are not in working order, system is a conditional pass. . AIA Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 TifIe5Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address ON ne ON ner's Name information is �a dSTi�i�l f 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/altemati\e system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): d�' s i> >� r4 7j I•1 V 17 7fjC/T ry?S s✓ 5o/.1. JS S�r!✓r�y' D�f Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3113 Title 5Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7f *,44!sAW -#Uf, Property Address ON ner Cw ner's f brre information isequiredore very 494WAIS A f *1A55 "- P.244 1 -91a/13 page. City/Town State Zip Code Date of Inspection D. System Information (Cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 11-4 Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.-3/13 Titfe5offiwl InspectoriForm: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 Property Address Ow ner Owner's Nlame information is required for everyiJl✓JNST3i �1*_ /��f+SS.,02.GC 7 yf,3f/� page. Oty[Town State Zip Code Date of Inspection Do System Information (cunt.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: hand-sketch in the area below drawing attached separately 5ns•3/13 Title50ffidalIns pection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address f� Owner Owner's I�me information is ��fr.��t required for every page. aty[Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: Check Slope 7w I Surface watery N� I� Check cellars J Shallow wells /f✓b.�s Estimated depth to high ground water: tom, 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 rediewed: . 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 docum entation) mentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: I-dPAV- 84fAt- "o,l SIV rAWA �braa7w Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Titie50fficial InspectionForm:Subsurface Sewage Disposal System-Page 16of 17 r Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface sewage Disposal system Form Not,for Voluntary Assessments 7, ,d7�F Property Address Nis✓ �� f I Ow ner Ow ner's lame information is "A V,.04L! �a?l0� ` required for every �L�ffJ �,..3fv 3 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ❑ Inspection Summary: A, B, C, D, or E checked ❑ Inspection Summary D(System Failure Criteria Applicable to All Systems) completed ❑ System Information-Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins o 3/13 Tide 5 Office]Inspection Form:Subsurface Sewage Disposal Sjstem-Page 17 of 17 Iur Septic I 1w it Works .._ It is important to understand how your system works and how this treatment affects it in order to protect your investment. The typical system consists of three (3) main components. The Septic Tank The Distribution Box , The Drainfield The Septic Tank Waste exits the house and enters the septic tank where solids settle to the bottom, grease and scum from the household detergents float to the top, and liquids stay in between. The solids that settle create their own bacte- ria which decompose the solids naturally. There is no need to add additional enzymes and bacteria to the tank. The tank eventually fills with solids and.scum requiring it to be pumped. A septic should be pumped every two (2) years. The Drainfr.eld The liquid(gray water) flows to the distribution box where it is evenly dispersed into.the drainfield. Finally, the drainfield begins treating the gray water. Microorganisms in the soil consume organic pollutants in the gray water and the pure water is absorbed by the ground below. How Problems Start From the first day of use, the drainfield of your septic system begins to deteriorate. Some solids, grease, and scum always pass through the septic tank into the laterals. This is because of natural solu- bility or the lack of setting time in the septic tank during periods of heavy use. Problems especially arise Zn when the septic system is not maintained and the septic tank fills with solids and scum that overflow into the drainfield. As the drainfield becomes clogged, the water flow becomes restricted. Since the water cannot drain into the soil, it filters upward causing ponding, foul odors, wet spots in the yard, and an unhealthy envi- What Causes Problems What you don't read about is that bacteria has a waste called biomat, and they also create a gas, bacteria eats human waste. It does not eat, hair, wool, polyester and other particles. The biomat is like grease. The gas cre- ates burbles and this causes particles to float up the T and into the distribution box and into the leeching fa- cility, plugging up the stone. Septic tanks should be pumped every two (2) years. Cesspool Cesspools were made by digging a hole in the ground and walls were made of stone then later on they were built with concrete blocks. The waste entered the cesspool, and solids settled to the bottom, the liquids seeped out the sides into the soil. Cesspools should be pumped every year. State Environmental Code Title V Chap. 5 Inspection Procedures Guidance on Completing Inspection Form Part A Certification. The Certification Section has two principal functions. First it provides identification information on the property being inspected and the"inspector. Second, it presents the results of the inspection relative to the failure criteria outlined in 310 CMR 15:303. In the certification statement; the inspector is certifying that the conditions existing at the time of inspection are accurately presented in the inspection report. The inspector is not certifying that the system is adequate for the current use of the system nor for the future use of the system. TONY CAPONIGRO 216 North Main Street Mansfield, MA 02048 Title V Inspections - `I / ' I s ' 3 If � .,mow� s+.A-..• ..- x `:,:��'...- ......w _._.p..-.��r<•i{MYr..-,i.r-✓`++.^d. `q...e•1•'--.'+,- f ^ice 7 E toll SEW GE M0• f t ApOItESS NAME INST A E E R•S •M I � ISSu ED , OATS PER . • • P` 1 ANCE ISSUED DATE C0 alik"' `p- LOCATION i _ ;076 SEWAGE PERMIT NO. VILLAGE r I N S T A LLER'S NAME & ADDRESS B U I L D E R OR OWN ER DATE PERMIT ISSUED ' DAT E COMPLIANCE ISSUED :. ��� � � �'` � � � " �j l � �. ► 1 < • 1.:, r No.... .... t . Fas. P........ � THE COMMONWEALTH OF MASSACHUSETTS d BOARD OF HEALTH Qr ✓✓ lY App.ltrttttou f nr Dhipuiitti Workii Tonitrixr#uan Permit Application is hereby made for a Permit to Construct or Repair ( ) .an Individual Sewage Disposal System at ' .. Lo ioi ddr t No. l r ......_... _.... ...... ..... ......•-•-•-• ....... . -----•••... ..._....... wner Address a u.!�...... �........: / .+ate.................•-•------. .......... ---- ti.��,.0!S 4­` ............ Installer ' Address Type of Building Size Lot... feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Builditi .......... No. of, ersons...........:............... Showers — Cafeteria a' Other fixtures ..: Q ......................................... ................................................ . ...._.....---..--.-•--.------ W Design Flow............55......................gallons per person day. Total dqj'�y �iow....................��..®.............:_ to WSeptic Tank—Liquid capoa�t�'�O..gallons h.�.�Z... Widt�l -2- _. Diameter:............... De tl® x Disposal Trench—.No. .................... Width........... Total Length.........___.. 'Total leaching area._�3 G1 O Seepage Pit No..................... Diameter....................•Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box oX) Dosing t nk Percolation Test Results Performed by.. .....`.?..H°`......................................... Date..3�`� a 1�8r err b._. .......2©,�..... Test Pit No. I................minutes per inch Depth of Test Pit... Depth to wter....... ...........r�... (i, Test Pit No. 2................minutes per inch Depth of Test Pit...��'€'__..... Depth to ground water.__.._....��-...... ... n *..........TM. �........... ....... O DescriptiRn of Soil �•��.. ...............o ® 6. `04�€ {op �o —jZO .}�q. �,� bou�'► C�........� 1 it...... - .....--..rr-. }� "........��t......_ Zl r, ...1�. � oc�w� �o �6- 132 ° 1,; 1� Vt },P...._.... ^rr" ...._..... 1................................................ . w ®"'^ c �� ro ,�' �3•2 '- NGS coa�c-se- sir . ,----------------- •--••-••••••••---•----•-•-•-••--------•-•••--••---••••---•••-•••--.........•••-•........................_......_...••. VNature 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 TL Im 5 of the State Sanitary The undersigned further agrees n ce th ste operation until a Certificate of Compliance ha een is ed by th board f h lth. rA Signed h ..... ^. --. ....... ................ .._. .Dat C C Application Approved By....... ......-- -•••-••.. ......... . Dat Application Disapproved for t following reasons:.......... •-------••....................•-----...............-•--------------............_...............,.. ............................................................••-----------•---•--...--•---.................---------.......•.............-•-•-•---........-•--•-.........-............................. DatePermit No.. .............................. ............. Issued_....................................................... Date � 1 �• ty: y :.ny b � C y����+ � -' � `1 -y!`� .P3 ••arr� - G/ .+:n ■ i `'"yt}Y +Y. 5 Fit _......... 'THE•COMMONWEALTH OF MASSACHUSETTS r BOARD OF HEALTH ................ OF..... 1.a.... i Appliratioll for Mipaiial Works Towitrnrtion rrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at -•••,� -------- ----- ------ -------------------- --- -----11, k--- ------,.._.. (C,� t' of F.ot No s-�" l . �- oy ► ' ors , ? (._� - - ........................J ......... ...................... ••_..... •--•-•••---•---•---•-•----•-•.......--- ----------......----•-•---•-................ ✓ rt L�x Owners e. Address....._..... ^-.... ..... .<o �__ to u S- ''.: 1 y Installer Address .�} .. ��� Type of Building Size Lot ..... .a_-•----.---...Sq. feet U Dwelling—No. of Bedrooms........._______..................._........Expansion Attic ( Garbage Grinder ( ) 04 Other—Type of Building ........._............_..... No. of persons._ __......_` :' Showers ( ) - Cafeteria ( ) a' Other fixtures .._ Q ......... ............. ..................................... Design Flow_____________................ .__..._ gallons per person a day. Total daily flow............................................ to s, Septic Tank—Liquld capacltyNoda_gallons �. h .��___ WYdth_:�',�? Diameter............____ Depth... Disposal Trench—No. ...9nS=...... Width...> ?. Total I:ength .`� Total leaching area__�� d....sq,ft� Seepage Pit No __ Diameter De th belowr inlet.......:: :__.__... Total leaching area__:._._.._.__.._aq. ft. 3 Pr X . •aP r Z Other Distribution box tDosine t a nk ( t)� -----�- `" Percolation Test Results Performed by.. tn...._� ,.... ..... . Date:_. . Test Pit No. 1................minutes per inch Depth of Test Pit_ ��'�' Depth toprwaater...... -a.._�.--- GL, Test Pit No. 2................minutes per inch /Depth of Test Pit_ ��O ___.__. Depth to round water___..__%32 O --`i wr7r �r�`gaw, Co l�t�rt �rfi1ou�n� Gla 1 oc. Description-of Sotl ' ` 12ar'- �.�8roa�t Se �0.vt f \' J11, Za �:etrnvv� o ` - 1�`? �y V ......... ( {.... _...{ _-- --ram s n 7p� `.... Yr1 ...._.�O...R..!• C iG ^C G �`j`t._._._. !.�$._©_•_. �3�.. 0.Y1 --•-----•-- ..... .................... - 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 LI LLZ 5 of the State Sanitary-��-Code�- The undersigned further agrees not top cc th ste operation until a,Certificate of Compliance has( een issued by'th -board 'f hZIth. Signed - . 4 - -• a �--, Dal (� Application Approved By.. .......... _..V : ---- ----------- 1- „- • r+ Dat Application Disapproved,f or t f ollo'wing reasons:_- ...•••. -----•-- ••-••- •---•-•-- ----- ••••-••-•--•--...•---••.....•................ ...........................................................:...........................................................................................................................................- Permit No...�C_' ���-� -------- Issued............... ....................................Dau 4 Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH- ' ................O F........�--- `(9grtif irate of Tompliattrr THIS IS TO RTIFY T at•the Individual Sewage Disposal System constructed or Repaired by-...... . ... .................. ...---••-- I � a A•`7lnst erg ,� �J at... ".. _-. .... r ;� I/�S .U � • spas been i talled.,n accordance with the provtsiolas1of` ALE 5 of T e Spate anitary Code as described in the �a application for Disposal Works Construction Permit No............__........................... dated.-.............................................. -THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST, UE® AS A GUARANTEE THAT THE SYSTEM. WILL FUNCTION SATISFACTORY. r DATE.................. w 1..1..__..._.. . ..................................... 1 �.-�_ � ��--•-•------------------------- Inspector .---..... �_... -•--•-•-•-•-- --� 6wr.:r .w•h c,q,..l :.:.c ,}�fl e, ...t'.�a w w - e e w 5 d w;�wn m.... -•Jr2ie- N• -..w e•w.Y a i. a ro>k k+rFvaA �_,�ro THE COMMONWEALTH"OF MASSACHUSETTS � A' `'` OARD OF HEALTH m / � ofc� ...........I.................................. ......... . N o... �....1�/ FER........................ Rsvi*'�. IV k To strnrtion rrmtt j ' Permission is hereb rantecT..- _..---•--- V�� _�'.°0� 5 � � 4 to Cons ft ( or Re or - a diry 1id>� �S ag t-s-poal t�tp L_ ....... �at No..' ru ._. T .......................................... S ..,r .............................................................. s Street �.. <<'' as,shown on the application for Disposal Works Construction Permit No.__�S.6!�at ____-�� .... ��_........ oa d o lea t ..DATE...------- 1 _ .................................... r b - 926 main street 362 4541 yarmouth mass. 02675 dJOwn Cd.Pe eftbfineefiftg civil engineers&land surveyors structural design Arne H.Ojala P.E.,R.L.S. land court . Richard R.Fairbank P.E. surveys i site planning sewage system designs December 10, 1985 inspections Barnstable Board of Health Barnstable Town Hall . permits South Street Hyannis, MA 02601 Gentlemen: This is to certify that the sewage system on Lot 5 Maushop Ave. was installed in accordance with Down Cape Engineering, ' plans # 85-286 dated, 10/29/85. Sincerely, �! , fme H. R.L.S. , P. kmk cc: Russ Gibson E ON -' SEWAGE SECTSQ Icc'� d -_SEPTIC TANK- - D BOX - -LEACH - - TOP OF FDN OF�{8T0 WASHED STONE •So•� 'I.�.TFa n_I lo''ts�•�._C+�+1'( ;' lot ,. 1�`. � ,r � - , IIV• r { \OUT• ) 1LZQQG IN• OUT• I 19li z� "l0•v�d SEPTIC �IB•3� I ,l o o ed /� �� CJCtldI� � a TANK 1� ELEV. ELEV.- ELEV. ELEV,. T'• S 1GS !` !�' r j , r >�- I l` ELEV. WASHED'S ONE u�<,` �`�C•PE;�Vio�1g �s • . WNaSNrc0 Sto►J� '' TEST HOLE LOG - - S•t•c-t•Z-*j H-4u_ � . g.y.L4 � /11 .TEST BY • . . . _ . .- - - -- - ----. ;.._ •� ^'� ' �'r+i. 1 g WITNESS 7 TEST DATE ¢/ BE6ROOM HOUSE DESIGN . T.H. # 1' ELEV. 00 ELEV. NO• ( i` V DISPOSER - DISPOSER + (. PERC RATE MIN/fN. W l o FLOW RATE:&3 s�,(GAL./DAY) SEPTIC TANK 330 . b _ - . REO'DSEPTICTANKSIZE AlN ` 3S - c C�c.y k- LEACH FACILITY; / , �c�i/ \\ ` 10«L t SIDE WALL _ ( 1 a G/D. rt:r-fo�ti to k -330 �. BOTTOM _—(I .o) _ _33. (s iD h V cr_�trs r. 13Z �� TOTAL 3c�s _ .330. USE: T��-� LEACHING ��8 83--� lta9 85•c� .�- : ,,�� x nd-'Llo 4C- k WATER ENCOUNTERED ALoN C_ C NOTES: (UNLESS OTHERWISE NOTED) _ 1.DATUM(MSL)�TAKEN FROM. HYAN��S QUADRANGLE MAP \ - 2.MUNICIPAL WATER JS -._.-., AVAILA13LE of M 3.PIPE PITCH:14"PER FOOT x '. 4.DESIGN LOADING FOR ALL PRE-CAST UNITS:AASHO• 10 -44. ARNE H. y� S.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES:(2)FT. OJALA \ , --:•-• 6:PIPE JOINTS SHALL BE MADE WATERTIGHT CIVIL v, 7.CONSTRUCTION OF-TAILS TO_BE ACCORDANCE WITH COMM.OF MASS. 3079?� ' STATE ENVIRONMENTAL CODE TITLES ,p / Q(- SITE f"L:/'YN S. Tt..NS 1;,L-A. , PQL.7.ta'ic acU w .iC C.r,��C a._a�'g+�o.J�U / �P�}N MgJq LOCUS l �c(-1 -� L��/t✓ __ moo`' ARNE 9G�\ t �.Z�BLS t r _.� 1✓�� _ REG.PROFESSIONAL ENGINEER'Ti 7. H cn f 026 4 REF: down Cape eftlesneeriolf 9e^s '� ,1 PREPARED FOR. CIVIL ENGINEERS BOARD OF HEALTH ; LAN SURVEYORS REG.LAND SUR YOR j D CONTOURS (EXISTING)------------- ���� SCALE I = �� a (PROPOSED)-O-O�-O- APPROVED DATE ��'z � = MA W. HS — ZgCv DATE � o - . I . I I ,. I . . I . � I I � I . I ,�%� I I I.. . . � .� . 1. . . , . .. . . . I r1i I - I I � I- . . . .41, 1 .,,�l� � �17_;a 1� " . .� -1 1. I , I . , I 11 I . i., , . . 1. 1. � , 4, I 1, I � `_ . � I " .I ... .1 .)-. I I . I . �. I , , ­ . . .. . � . . . � I I . I . ,,�o'��.%,, -. 1. � .. , � I / AI 4;,, . .. I -. � I - I , '.. � �:. - � I ,-� _- � -�, --1 ,�- �, ",- - �z ,. � , . �� lr�� _­­� . . - -.I ­1 .1.- - , - . I.. . . I * � . I . - f --�- f�­�� � �.,;�, , - ' ' . - . .. I.:, - I � w - I- I I . . - - I. 1. 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