Loading...
HomeMy WebLinkAbout0023 ACORN DRIVE - Health 23 Acorn.Drive . Osterville A =-120 - 036 0 a y 3 t i e e x_ r �,. Commonwealth of Massachusetts lao- b �P Title 5 Official Inspection Fora' la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Acorn Drive Property Address Dana Powell c Owner Owner's Name information is re Osterville MA 02655 1`-10-20 wired for every 4 - 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. 0\\,-I1 0Ffhff�������� firlling out forms en 3 �`p�� 9cl ' A. Inspector Information 5AV iy33 on the computer, James D.Sears �; ,FAMES :' use only the tab key to move your Name of Inspector 3: ;cn S cursor-do not Robert B.Our Co. INC '•.o o; use the return Company Name 'try . '5 ••' key. 363 Whites Path IC—V Company Address +�itnuttma�0 South Yarmouth MA 02664 City/Town State Zip Code 508-477-8877 S 1623 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CM 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails S i . 1-10-19 I ector'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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official . Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 23 Acorn Drive Property Address Dana Powell Owner Owner's Name information is required for every Osterville MA 02655 1-10-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 1 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: The system is a 1500 Gal.Tank D Box and 20 chamber's. 2) 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Acorn Drive Property Address Dana Powell Owner Owner's Name information is required for every Osterville MA 02655 1-10-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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 ❑ Y ' ❑ N ❑ ND (Explain below): I ❑ 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): '3) .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. a. 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: t5insp.doc-rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 ' Commonwealth of Massachusetts Title 5 Official Inspection Form k7zr Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Acorn Drive Property Address Dana Powell Owner Owner's Name information is required for every Osterville MA 02655 1-10-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: r Yes, -No ' ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool El ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc-rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Acorn Drive .. Property Address Dana Powell Owner Owner's Name information is required for every Osterville MA 02655 1-10-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet 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 2000 gpd- 10,000 gpd. ❑ ® The system fails. I 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. 5) 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 CA. 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 sensitive area (Interim Wellhead Protection Area —IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 i Commonwealth of Massachusetts F Title 5 Official Inspection Form Flo Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Acorn Drive Property Address Dana Powell Owner Owner's Name information is required for every Osterville MA 02655 1-10-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15:304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no" for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health l ❑ ® 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 backup? ® _ ❑ Was the site inspected for signs of break out? s ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ •® Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Acorn Drive Property Address Dana Powell Owner Owner's Name information is required for every Osterville MA 02655 1-10-20 page. City/Town State Zip Code Date of Inspection D. System Information 1. 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 Description: 1500 Gal. Tank D Box and 20 Chamber's. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2018-25,000GaIs g ( y g (gp )) 2019-23,000 Gal's Detail: Sump pump? ❑ Yes ® No . Last date of occupancy: NA Date • 1 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 ' t f Commonwealth of Massachusetts Title 5 Official Inspection Fora �a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Acorn Drive Property Address Dana Powell Owner Owner's Name information is Osterville MA 02655 1-10-20 required for every , page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No r Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: . Source of information: 11-19-19 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons a How was quantity pumped determined? Reason for pumping: w ' t5insp.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 i Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 23 Acorn Drive Property Address Dana Powell Owner Owner's Name information is required for every Osterville MA 02655 1-10-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool i ❑ 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): Approximate age of all components, date installed (if known)and source of information: 2010 Permit #2010- 124. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 3111 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH -40. l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form , Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . 23 Acorn Drive Property Address Dana Powell Owner Owner's Name information is required for every Osterville MA 02655 1-10-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: 21"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) ❑ Yes ❑ No Dimensions: 1500 Gal. Precast H-10 1 , Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 2911 0„ Scum thickness Distance from top of scum to top of outlet tee or baffle 8" ' Distance from bottom of scum to bottom of outlet tee or baffle 1811 How were dimensions determined? Asbuilt-Plan-Tape Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank at 21" below grade. In cover at 4"w/out cover at 1". In and outlet tee's. No sign of leakage or over loading. t t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form l➢' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Acorn Drive Property Address Dana Powell Owner Owner's Name information is required for every Osterville MA 02655 1-10-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts , Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Acorn Drive Property Address Dana Powell Owner Owner's Name information is required for every Osterville MA 02655 + 1-10-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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? t ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 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 is 20" below grade. Box is clean and solid. No sign of overloading or solid carry over. ' I t5insp.doc•rev.7/28/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form rye Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .� 23 Acorn Drive Property Address Dana Powell Owner Owner's Name information is required for every Osterville MA 02655 1-10-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: , Type: , ❑ leaching pits number: ® leaching chambers number: 20 ❑ leaching galleries ' number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .� 23 Acorn Drive u Property Address Dana Powell Owner Owner's Name information is Osterville MA 02655 1-10-20 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is 20 Biodiffusers. Leaching is clean and dry. No sign of over loading. 12. 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 18 Commonwealth of Massachusetts M Title 5 Official Inspection Fora �< Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Acorn Drive V Property Address Dana Powell / Owner Owner's Name information is required for every Osterville MA 02655 1-10-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of pond ing,.condition of vegetation, etc.): , f f t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form <ia Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Acorn Drive Property Address Dana Powell Owner Owner's Name information is required for every Osteryille MA 02655 1-10-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. 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 } A� • -a= , „ 33-9 t5insp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 ` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t 23 Acorn Drive Property Address Dana Powell Owner Owner's Name information is required MA 02655 1-10-20 requiredd for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10, 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: 4-22-2010 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) i ❑ 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: , T.Kon Design plan 4-22-1010' no G.W.. Bottom of chamber's at 3'6" below grade. Bottom of chamber's at 6'-6' above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5lnsp.doc-rev,7/26/2018 . Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Acorn Drive Property Address Dana Powell Owner Owner's Name information is required for every Osterville ' MA 02655 1-10-20 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached ; For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included �® t5insp.doc-rev.7/26/2018 , Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 TOWN OF BARNSTABLE LOCATION aeam SEWAGE# 7,oa p s, f'Lc l VILLAGE -o SA\p-rt y,Wk ASSESSOR'S MAP&PARCEL \Zo - 3 (o INSTALLER'S NAME&PHONE NO. ��p e w"i( SEPTIC TANK,A—ACITY VS o 10 LEACHING FACILITY: (type) py ftr(: 3(o 1;& (size) i s u 2 n NO.OF BEDROOMS 3 OWNER W C:A A 0 PERMIT DATE: S- - Zp t y COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility t Z- 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 e=4AAO�CL %0n'S eS- c-�-L d Il •fV z- 13 % al.3 `1$•5 � Ztn•3 8y 3S•b� . No. 2 `0 ' ! 4 Fee �® /J THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:T PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Digool *pgtem Cow9tructiori permit Application for a Permit to Construct( ) Repair W Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lo No. Owner's Name,Address and Tel No. a 3�mo r-A Pr--A Assessor's Map/Parcel Installer's Name,Address,and Tel.No. V t Designer's Name,Address and Tel.No. fuk� a 7 3 �� Ccp�w�ot a �c J..t4j.,pnJW S —iC £'.N3"1-kr" R I"A"OVAL tj .4-,&j S-q 04, 4 Type of Building: Dwelling No.of Bedrooms 3 Lot Size t$, 4 q o sq.ft. Garbage Grinder ( ) Other Type of Building S No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 o gpd Design flow provided 3 S�S', 2 gpd Plan Date _ y - (0 Number of sheets 1 Revision Date Title Size of Septic Tank \S 0 0 \t \O Type of S.A.S. d o /Vre 3�i b Description of Soil C_t. �fie_V Nature of Repairs or Alterations(Answer when applicable) Tt r-k --T-6 Date last inspected: 20 to Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. r S' ne Date Application Approved b Date Application Disapproved by: Date for the following reasons Permit No. O I � Date Issued ' "51.0 No. Fee t tr !` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ,g. PUB;LIC;HEALTH DIVISION - TOWN OF BARNSTAB6E, .MASSACHUSETTS g} f . f; 01ppYication for.43i5pogal �pgtem Congtruction Permit µ t ' Application for a Permit to Construct( ) Repair Upgrade( ) Abandon O ❑ Complete System ❑Individual Components Location Address or Lot No. ' Owner's Name,Address and Tel No. .23 �"�ern �r wo_ ao �R T tisk 4"A� �owt1 UMa r�J�tV. v✓\� �tv,, 3�+ k. A y� Assessor's Map/Parcel 3 b d3 Atorr Installer's Name,Address,and Tel.No. 5 o 8 yap V 01 t Designer's Name,Address and Tel.No. fU� a 7 3 ci 3 77 c*pw,d� �ci.l-v,en_W j 1e � -4.Ar 5 -j o� qw o f� Type of Building: Dwelling �No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building '2Q S No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) -3 3 0 gpd Design flow provided gpd Plan Date S y ' (U Number of sheets I Revision Date Title Size of Septic Tank S O 0 1t \ o Type of S.A.S. do A rc 36 t G ' Description of Soil } Nature of Repairs or Alterations(Answer when applicable) 1--2 `(b>yyl, --yo 7)- i Date last inspected: 2C,(0 Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si, ned Date Application Approved by Date /Q Application Disapproved by: Date for the following reasons Permit No. �'�G/D �' p941 Date Issued 0 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired O Upgraded ( ) Abandoned( )by C c_ru v d¢ r.{mac.n,n S-c.! _ at A-C-c,v'Yn has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. �;)O/C `/-;)-.q dated Installer C--<) 06 f vvQ rt Designer. �-C , cry�[' #bedrooms 10 Approved desi n flow gpd The issuance of this permit shall not be construed as a guarantee that the system wilt fu cti as desig d. Date Inspector r -�f ----- ------ --- No. C�/ �� l Fee f/00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS xl gpoal *pgtem Congtruction Permit Permission is hereby granted to Construct ( ) Repair ( yO Upgrade ( ) Abandon ( ) System located at J 3 /9c o r ,IX ' 1) r ,, O S�V 1(L 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 pe , Date _515),,1D Approved b .t Town of Barnstable FIB r '� Regulatory Services Thomas F. Geiler,Director BARNSTABLE. : Public Health Division MAB& Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: 5-2�'16 Sewage Permit#_ZOW-t Ly Assessor's Map/Parcel tL o /3� Installer& Designer Certification Form Designer: SG EqntOeeriOS ToG Installer: _Ca(?eu; de- L'-rllerP�CsZ� LLG Address: 2�5y Ccanbecry Nt�lnw�y Address: east LUareinAVO Mt4 02,53$ C�Lo��V V� -e 6 Z-io 3 Z On S- ZO 1 o �L 0- tns was issued a permit to install a (date) (installer) septic system at 3 Pfco(n Paul based on a design drawn by (address) SG eeri�l� , TY) dated Nab y 2616 (designer) t �I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes i.e. greater than 1.0' lateral relocation of the.SAS or any vertical relocation of any component of the septic system) but in accordance with State & Loca) Regulations. Plan revision or certified as-built by designer to follow. Stripout (if req ' nspected and.the soils were found satisfactory. a� s„oFr�, cG ti JOHN 1,. o CHURCH:'L � JR. ' (Ins is Igna e) CIVIL No 41807 h.. esigner's Signatur (Affix 911esi - er's m Here) ) PLEASE RETURN . O BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS;. FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. ti'ud'tirt fumis\designercertilicatiun Rorm.duc i Town of Barnstable P# Department of Regulatory Services Public Health Division Date . s�xtvar,�us, • ems. 200 Main Street,Hyannis MA 02601 Date Scheduled a0 /0 TimeJ0 Fee Pd. b Soil Suitability Assessment for Sewage Disposal Performed By: 1lic6c( QfMe00 EZ%GS L;, Witnessed By: h✓ LOCATION& GENERAL INFORMATION Location Address 2 3 Actor ,r, -D r i v C 0 STc✓v+t t o Owner's Name LO tal d D Address '�3 �Cc�vn t7f �. GSftrsUte Assessor's Map/Parcel: , ZO�f'3(n Engineer's Name &4-4'e Se-S LU_ 4 TG E-vijtaee(thS NEW CONSTRUCTION REPAIR Telephone# S© g2i=quzi 506..273-037"1 Land Use S'*e.tamely &L"Cl Slopes(%) IJ- Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water:Well ft Drainage Way ft Property Line 7 00 ft Other ft SKETCH:(Street name,dimensions of lot,'exact locations of test holes&perc tests,locate wetlands in proximity to holes) Parent material(geologic) 00k-W&5v, Depth to Bedrock 7 1.2C H 655 Depth to Groundwater. Standing Water,in Hole: I2c k'i5 Weeping from Pit We '7 120" w,915 Estimated Seasonal High Groundwater '7 1Z0j1 cgs DETERNIINATION FOR SEASONAL HIGH WATER TABLE Method Used: jG� Qu�kk?yl Depth Observed standing in obs.hole: 'tzc ____ ___- in, Depth to soil mottles: 712Ls Depth to weeping from side of obs:hole: 12U in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj,factor ._ Adj.Groundwater Level z PERCOLATION TEST bate 2-28/0 Thee.-Lb N Observation I Hole# — Time.at 9" _ Depth of Perc _36 .5Y T Time at 6" Start Pre-soak Time @ _ Time(9"•6") End Pre-soak /0 .l Rate Min./Inch L..2 Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) j Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# i Depth from Soil Horizon Soil Texture Soil Color Soil .. Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency.% ravel 0 2_ F0I A I E L S i e,Y�3/i — i2-310 Q 1-s 36-120 C M S 2.- 51 4, 1605e DEEP OBSERVATION HOLE LOG Hole# Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) 1A b-tZ A/C - 12-3b 13 GS 516 36-t2v G s Z. ialb /cvSe DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell). Mottling (Structure,Stones',Boulders. Consi ten ° ra Flood Insurance Rate May: Above 500 year flood boundary No— Yes ✓_ Within 500 year boundary No Yes Within 100 year flood boundary No, Yes Depth of Naturally Occurring Pervious Material• Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? -- ti Certification ' I certify that on 10 27'gq (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise ZCUI ience described in 310 CMR 15.017. Signature , Date 9—/G" Q:\S.EPTiC1PERCFORM.DOC 1t' l 3 v THE COMMONWEALTH OF MASSACHUSETTS AR® Z....oF. ... . . . ... ...... .._........ oz0 W (� P l App iration for Uhgp a ai Wurkii Towitruition Pumit Applicati is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ........: --- .a......._..../t.....----aw. Z/.... ----•.............................•----..... ---- ------------....----..........---•------------ ---Locatio -Addr ss or Lot :�o. i � _.._ ... �1............. ------------------.---- --.._....----..._..._._.__.._............... �ner Address ......--•..7g-- -------------•-•------... --......-•--------•-•-----............---••--••-•------...--------•---•-----.-•-----------•------ Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion 4ttic ( ) Garbage Grinder ( ) pa,, Other—Type of Building ____________________________ No. of persons-------- :__._____.. Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------------------- - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity/,46Q'.gallons Length................ Width................ Diameter............... Depth................ Disposal Trench—No......:.............. Width.................... Total Length.................... Total leaching area—_____._••..-------sq. ft. Seepage Pit No-------------------_ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results. Performed by------------------•--•-•-••••••-•-•••••--•-••-•-•-•--•------•------•----- Date.................................. Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water................_....... --------------------------------------------------------------------------------•••-••---........•--......................................................... 0 Description of Soil-------•-----•-------------------------------•----................----•---•-•--=--------------------------------------------------------------------•................. W -------------------------------------------------------------------------------------••-----•-------------- VNat re o Repai s or Alterations Answer hen applicable__..v ?� 1 _._ 1�_...__l� lr...__.�� � _____. �•-•-•-•--- � Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with TT r'1'^ the provisions of T t:. of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha bee sued by the board o health. Signed. �l..�IA_ all�_�1 .................... y.? ....'!!_.... Date Application Approved By.. . .. •• !l�._( .... ............ ........•-- Da Date Application Disapproved for the following reasons------------------------•---------------------------------------------------------------------------.......----- -•...................•----•---•-•-•-•••-...••---......_....•••-•-••-•-•-•••-•---------.......-••••-••••-•-------------••-•-•-••-••-•--- ••----•---------•-••-•••••-•-•----•-----------------•••---•--- Date PermitNo.----------•-• -13-�------------- Issued....................................................... Davt fC Fps THE COMMONWEALTH OF MASSACHUSETTS B..... A R.D.. .. .. F ...... ......A.. L Vl �.. ...OF.-------- - 1 --- ------�.--"----•----------------- Applirtttion for Uiopoottl Works Toottr"rtion jJrrmit Application is hereby made for a Permit to Construct ( ) or Repair { ) an Individual Sewage Disposal System at: r Locatio}1 Address r' or Lot No. l 7!;, f �` 1i :.. /./ _l�✓:'.._.. r'i�y'.//-----•..... .................................................................................................. net Address Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Ejttic ( ) Garbage Grinder ( ) p`4 Other—Type of Building ............................ No. of person .............. Showers ( ) — Cafeteria ( ) QI Other fixtures _____________________ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. GG Septic Tank—Liquid capacity/942_.gallons Length................ Width................ Diameter---------------- Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--_---------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-----______--___..._____ a' ..................................................-......................................................................................................... 0 Description of Soil.........................................................................................................................-----------------........................... ----- ----------- -------- --------------------------------------------------------------------------------- o -- --- -----------------...........••• i ? r ...._..___ . � !Re a Alterations—Answer hen applicable.- .__._ JU Nat re l f J Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of 1 i:i p of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance hasen,a§sued by the and Qf-health. Signed. .sf/ /_ _:... ✓", ..._ .,= ,% �.1lca g - f3 �r 1 ;' Date. Application Approved By....t .........1.�t(i( - i i!" �r ,/-� -�---- -•---•------. ....................................•... e Date Application Disapproved for the following reasons----------------------------•----•------------------------------------- ...................................... •--------••----------------------------------------------------------------------•-•-•-----------•--•-•-----------------------------------------------------------------------------------••----•------ / Date Permit No.---------2 + 1 ( -------------- Issued.................. ............................... c THE COMMONWEALTH OF MASSACHUSETTS BOARD HEAVTH ......OF........... ......................A. �rrtifirtttr of f�ottt�ltttorr �1�'G�. f��'£--� TH S IS TO CERTIFY, Th t the n-di, k,u ,age Disposal System constructed (�) or Repaired ( ) by......... j ij ....�y-1 ram/ C --------------------- --------------- at----------- - ----• -----•-----•}--------- has been installed in accordance with the provisions of TITS 5 of T S,k to Sanitary Co��desfri>�J? the application for Disposal Works Construction Permit No.... _ "'"-.. ....... dated_.-.._-_, __lIT .......THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THHE SYSTEM WILL FUNCTION SATISFACTORY. DATE..................... ✓r ......�-----•------. Inspector........ THE COMMONWEALTH OF MASSACHUSETTS BOARD F M�_'A�..y ....................f `Jl/ o F.---- / 1 NO...�1..�.... 1 FEE.... ............. .. i o tt r '�� tr ' n lerzff �q Permission is hereby granted.......... --- :....s. �� . ..._._•���-- -u-.-- -L to Constrty .F ) or pit an I div' pal S wage D' osal Q- at No..... --- ------• Y .1...V L / a?. 7` ! L-- --- > ........................ Screet `1 �`?� as shown on the applicatio for Dis osal Works Construction Per No. __........ Dat ..._ .__ ........... ...... _ --------------------- �i... 6/C ----.... t ..... �' - - Board of'-Health DATE................ .. ...........----------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS . FINISH GRADE OVER D-BOX= 45.0'+ 4"SCHEDULE 40 PVC MIN. SLOPE 1 TOP OF FOUNDATION = 46.6 '�' - FINISHED GRADE OVER BIODIFFUSERS= 44,4 _ 45,1 GENERAL NOTES f- PROVIDE EXTENSION RISER SLOPE @ 2% MIN. WITH COVER OVER INLET& FINISH GRADE OVER TANK EL.= INSPECTION PORT WITH 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISHED GRADE OUTLET TO WITHIN 6"OF F.G. 45.8'+ REMOVABLE WATER-TIGHT COVER OVER ACCESS BOX TO WITHIN METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FOUNDATION = 46.0'± 3"OF F.G. (ONE PER ROW) CODE AND ANY APPLICABLE LOCAL RULES. _ RISER TO WITHIN 6"OF FINISHED GRADE 20"MIN.ACCESS 36"MAX -- --- } 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE COVER(3 TYP.) 9"MIN. I DESIGN ENGINEER. EXIST. SEWER PIPE PROP. PVC 36"MAX. 36"MIAX. TOP OF SAS/B.O. = 42.10'N. 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEWER PIPE 5"DIA. OUTLET(S) SYSTEM UNLESS OTHERWISE NOTED. 2" DROP MIN. MIN.slope@�� 6" 3" 3"DROP MAX. 3" 9" PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN MIN.SLOPE 1% JOINTS (TYP.) ELEVATION =42.10' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A PROP. PVC 10" 4"PVC IN FROM 1.08, Q " 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF SEWER PIPE 14" 42.75' SEPTIC TANK 1 4"PVC OUT TO (TYP.) t 13 THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. *43.2': O LEACHING FACILITY 0.59' 7.13+(T�'P) I o /° 43.00' 1 5. SLOPE ALL SOLID PIPE AT 1.0 MINIMUM. 12" 6" II 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. 48" OUTLET TEE 42.00' MIN. 41 .83' 41 .61' 41 .02' (laid flat) 2.875'(34.5">--I (TYP.) 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AS BAFFLE 6" CRUSHED STONE (TYP.) 5'MIN. FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS 10.0'TO FND REQ'D OVER MECHANICALLY 14.375' NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH COMPACTED BASE 20.0' AND DESIGN ENGINEER. 6"CRUSHED STONE 5 OUTLET DISTRIBUTION BOX (TYP.) 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 46.00'ESTABLISHED OVER MECHANICALLY TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV= < 34.60' BIODIFFUSERS (END VIEW) ON A NAIL SET IN UTILITY POLE NO. 738/1 AS SHOWN ON PLAN. COMPACTED BASE BASE. FIRST TWO FEET OF OUTLET 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION PIPES TO BE LAID LEVEL. 20 - BIODIFFUSERS �PROFILE)PROPOSED 1500 GALLON CONCRETE SEPTIC TANK THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT LENGTH 10' 6" WIDTH � DEPTH �� (Dimensions per Wiggin CROSS SECTION VIEW *PER WIGGINS (BY ADVANCED DRAINAGESTEMS, INC.) 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES *CON irii-i�. 4.ih iU VERIFY EXISTING SEPTIC TANK PROFILE Precast Corp., Pocasset,MA) DISTRIBUTION BOX DETAIL (DB-5B*) 2® � ARC36 (#3613BD) BIODIFFUSERS TO THE DESIGN ENGINEER. ELEVATION PRIOR TO ANY WORK & 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. NOTIFV ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING II' TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM O / r PERC NO. 12911 APPROPRIATE AUTHORITY. ,)O8 INSPECTOR: David W.Stanton, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS 1� ` ► I LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE OIL / EVALUATOR: Michael Pimentel E.I.T. THEY SHALL WITHSTAND H-20 LOADING. C.S.E. APPROVAL DATE: Oct. 27, 1999 0�5 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. DATE: April 28, 2010 1r / • 1 �rg�C TEST PIT#: 1 14. WHERE REQUIRED CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITAB LE �J`V % / \ • •.o ' • r r ' �� ELEV TOP= 44.60' MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, `Q� J�1 4s� . •'�' ''� �`` ''' ELEV WATER= < 34.60' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). M `1 y0 w • o�'�� , '�� ~ ~� �� PERC RATE <2 min./inch 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN L f,{ -� _ SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. W P G DEPTH OF PERC= 36-0-54" 16. PROPOSED PROJECT IS LOCATED WITHIN: 4- :' TEXTURAL CLASS: 1 ASSESSOR'S MAP 120 PARCEL 36 o Z MAP 120 OWNER OF RECORD: WALDO I. JR AND DISA N. POWELL PARCEL 36 y LOCUS s ADDRESS: PO BOX 665 n QPJ /45--- 18,490 S.F.± _µ-ZONE 2 r 0" 44.60'1 Fill OSTERVILLE, MA 02655 �O / L.� \o \ J \ I 8" 43.93' 44x7 �L� \ c9�, , 1 J! Loamy Sand A/E 10Yr 3/1 12" 43.60' FEMA FLOOD ZONE C cgs - %� l . •~ II 11 Loamy Sand COMMUNITY PANEL# 250001 0016 D 44x3 Q' LANDSCAPE AREA \ �'� �� � • B 10Yr 5/6 17. DEED REFERENCE: DEED BOOK 6672 PAGE 293 Benchmark / G� � � • (�� �f "� Jr :,n l,'� 41.60' Nail in U.P. 738/1 / PROP. DB-5B DISTRIBUTION BOX % \ ; °' 1 /2 // Per6 18. PLAN REFERENCE: PLAN BOOK 187, PAGE 93 I Elev. -46.00 Ir s JP f Approx. M.S.L. Oltl _ l�2 i ' ( t `; \ )fr0 54" - 40.10' 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. � E p,6 SO , 4" �'� � • ' . ,��� � QgJ�, � 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY DA Aug\` Q 44x3 ��` N �- -''y O TP 1 ' � i �� C Medium /6nd FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE.ASSUME ANY LIABILITY FOR SEPTIC SYSTEM UPGRADE JC ENGINEERING WILL NOT ASS - , a 5 6j JQ y s 'L�' 44x6 F� • n • (loose) / \ / LP i / �-� 12.9' (3 LOCUS PLAN �0 HC-1 EXISTING LEACHING PIT TP 2 �"S SCALE: 1"= 1000' " 120 34.60 4- REMOVED AND REPLACED WITH CLEAN STUMP 4 COARSE SAND PFR 310 CMR 15.255(3)--� (TYP)44x6 No Mottling, Standing or Weeping Observed DESIGN DATA TEST PIT DATA LEGEND PROPOSED INSPECTION PORT WITH 4) O O PERC NO. 12911 ACCESS BOX TO GRADE (TYP OF 5) g \�,� CID O '� 5�P �� INSPECTOR: David W.Stanton, R.S. � -- /� 50x0 EXISTING SPOT GRADE PROPOSED TOTAL 20 ARC 36 (#3613BD) t C /�Pg�G #23 NUMBER OF BEDROOMS (DESIGN) 3 EVALUATOR: Michael Pimentel, E.I.T. 50 - - -- BIODIFFUSERS IN A FIELD CONFIGURATION EXISTING C.S.E.APPROVAL DATE: Oct. 27, 1999 EXISTING CONTOUR DESIGN FLOW 110 GAUDAYlBEDROOM 3-BEDROOM DATE: April 28, 2010 ----�50�---- PROPOSED CONTOUR �r PROPOSED DWELLING TOTAL DESIGN FLOW 330 GAUD" EXISTING CESS POOL TO BE PUMPED, FILLED CLEAN-OUT TOF =46.6'± ° - TEST PIT#: 2 /°DESIGN FLOW X 200 ❑H�,� EXISTING OVER-HEAD UTILITIES WITH CLEAN COARSE SAND&ABANDONED--' � 660 GAUD" ELEV TOP= 45.60' �-�� USE PROPOSED 1,500 GALLON SEPTIC TANK ELEV WATER= < 35.60' W W--- EXISTING WATER LINE \ PERC RATE = GAS EXISTING GAS LINE PROPOSED 1,500 GALLON SEPTIC TANK Oy SUN ROOM DEPTH OF PERC = % TEST PIT LOCATION s INSTALL 20 - ARC 36 (#3613BD) BIODIFFUSERS TEXTURAL CLASS: 1 j�6' °ems C-2 O O O PROPOSED 1,500 GALLON SEPTIC TANK SYSTEM CAPACITY (TOTAL L.F. OF BIOS)(4.8 SF/LF)(0.74 GPD/SQ.FT.)=GPD 0" 45.60' PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE Jy (100.0')(4.8 SF/LF)(0.74 GAUSQ.FT.)= 355.2 GAL. LEACHING/DAY Fill SWING-TIES 8" 44.93'B H A/E Loamy Sand O PROPOSED DB-5B DISTRIBUTION BOX r�G TOTALS: " 10Yr 3/1 44.60' DESCRIPTION HC-1 HC-2 ,\O 12 � PROPOSED ARC 36 (#36136D)BIODIFFUSER h3�� 0� TOTAL NUMBER OF BIODIFFUSERS: 20 B Loamy Sand BIODIFFUSER CORNER(1) 12.9' 40.5' ,���' TOTAL NUMBER OF COUPLINGS: 0 10Yr 5/6 TOTAL LEACHING AREA: 480.0 36" 42.60' BIODIFFUSER CORNER(2) 24.4' 54.3' TOTAL LEACHING CAPACITY: 355.2 REV. DATE BY APP'D. DESCRIPTION BIODIFFUSER CORNER(3) 37.5' 53.0' PROPOSED SEPTIC SYSTEM UPGRADE BIODIFFUSER CORNER(4) 31.2' 38.7' NOTE: PREPARED FOR: EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE C Medium Sand CAPEWIDE ENTERPRISES DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER 2.5Y 6/6 MAP 120 "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO ADVANCED (loose) DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003 (LAST MODIFIED LOCATED AT NOTES: PARCEL 37 MAP 120 FEBRUARY 18, 2010). TRANSMITTAL NUMBER=W000052. 23 ACORN DRIVE 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE PARCEL 38-02 OSTERVILLE, MA TOP EDGE OF EACH SEPTIC SYSTEM COMPONENT. 120" 1 35.60' SCALE: 1 INCH = 10 FT. DATE: MAY 4, 2010 0 5 10 20 40 FEET 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE No Mottling, Standing or Weeping Observed ,� 'A°` LOCATION OF THE PROPOSED LEACHING FACILITY TO ENSURE MAP 120 - t - - - ---- ---- � __- __-- --_ __- __- ___ - �� .ioai"� ;,, PREPARED BY: CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. RESERVED FOR BOARD OF HEALTH USE o c�u "'LL A REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS PARCEL 38-01 c � JC ENGINEERING, INC. No `"8" 2854 CRANBERRY HIGHWAY ARE NOT CONSISTENT WITH TEST PIT DATA. r {� EAST WAREHAM, MA 02538 3.) ENTIRE PROPERTY IS LOCATED WITHIN A DEP APPROVED SITE PLAN 508.273.0377 ZONE 2 AND THE ESTUARINE WATERSHED. SCALE: 1"= 10' Drawn By: MCP Designed By:MCP I Checked By:JLC JOB No.1806