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HomeMy WebLinkAbout0065 ACORN DRIVE - Health ( Osterville` R A = 120 034 r , � � I C ®®gip 04 2016 13:13 Jim The Inspector Man 5085349919 page 1. F ® ba0- 03 Commonwealth of Massachusetts W Title 5 Official 'Inspection Form CAI. Subsurface Sewage Disposal System Form Not for Voluntary Assessments -mo 65 Acorn Drive A] Property Address Bernard & Jane Powers a �§ Owner Owner's Name . information is -a required for every Osterville MA 026:55 .9-2-16 �. page. City/Town ` State = Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any " way. Please see completeness checklist at the end, of the form. Important:When filling out forms A. General Information r. 11111tt4rry7 use only he tab `````on the computer, S..OF.1t7gsS,����,' 1. Inspector: , r q�, , key to move your Qom', yam_j cursor-do not JameS'D.Sears _' JAMES ,m key the return Name of Inspector g u . SEARS Capewide Enterprises LLC f Q i0 o- r�s Company Name. i ���.,f�•ro.�6-��a. 153 Commercial Street 'i�FS INSPEGd��` e Company Address _— gn,krur»ttau����� enn s . Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S1623 Telephone Number License Number i. 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 ❑ cionditionally Passes ElFails Needs Further Evaluation by the Local Approving Authority l a 9-2-16 spec tor's..Signature Date r 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 t - 10,00b gpd or,greater, the inspector and the system owner shall submit the report to the_appropriate, regional office of the DER 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 thine of in 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. f5ins.doc-rev.6116 - Title 5 Official Inspection Form:subsurface Sewage Disposal System page-1 of 17.. Sep 04 2016 13:13 Jim The Inspector Man 5085349919 page 2 \ Commonwealth of Massachusetts, Title 5 Official Inspection F®rm Subsurface Sewage Disposal System Form -Not for Voluntary Assessments` 65 Acorn Drive Property Address Bernard & Jane Powers ' Owner Owner's Name _ information is Osterville required for every. i MA 02655 ° 9-2-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,CD or E/always complete all,of-Section D - i A) System Passes: 1Z I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. ` Comments: '"The system is a 1000'Gal Tank and two pit's in dine r B) System Conditionally Passes: E ,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 boz for"yes", "no" or not.determined" (Y, N, ND) for the following statements. If"not` determined," please explain, is 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. l ❑ Y N,. Eli-ND (Explain below): i l5ins.doc•rev.6/16 .„ Title 5 Official Inspection Form:Subsurface Sewage Disposal System-.Page 2 of 17 s r Sep 04 2016 13:13 Jim The Inspector Man 5085349919 page 3 Commonwealth of Massachusetts; - E Title 5 Official Insprection. Form Subsurface Sewage Disposal System.Form-Not for Voluntary Assessments � l . 65 Acorn Drive Property Address Bernard& Jane Powers - - Owner Owner's Name information is Ostervllle required for every -MA 02655 9-2=16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ' Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms.are repaired.' B). System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level.ln 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 ❑ NEl ND(Explain below): obstruction is removed' y ❑-Y ❑ N, El. ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (EzplainJbelow): I - ❑ The system required pumping more1. than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with apiproval of the Board of Health): broken i e s are replaced . p P O p � ❑ Y, ❑ N ❑ ND (Explain below): obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): i- 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:El . Cesspool or privy is within 50 feet of a surface water s ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh ' tSinaGoc•rev,fJ16 Title 5 Official Inspection Form:Subsurface Sewage Disposal$yetern•Page.3 of 17 Sep 04 2016 13:13 Jim The Inspector Man 5085349919 page 4 r Commonwealth of Massachusetts Title 5 official Ins section- Form Subsurface Sewage Disposal System Form = Not for Voluntary Assessments 65 Acorn Drive Property Address Bernard & Jane Powers l Owner Owner's Name information is QSt2fVllle required for every MA 02655 9-2716 page. City/Town State Zip Code Date of Inspection B. 'Gertification (cont.) t 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 aseptic 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**. r Method used to determine distance' I This system passes if the well water analysis; performed at a DEP certified laboratory, for fecal coliform bacteria indicates ab sent 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. i , i D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No. El ® Backup of sewage�lnto facility or system component due to overloaded or ` clogged SAS or cess • 99 pool Ej ® Discharge or pondi;ng of effluent to.the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool I. A, Static liquid level in the distribution box above outlet invert due to afi overloaded or clogged SAS or"cesspool ❑ ® Liquid depth in is less than 6"below invert or available volume is less than '/day flow 1011 7- l5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal Sysferri•Page 4 of 17 Sep 04 2016 13:13 Jim . The Inspector Man 5085349919 page 5 Commonwealth of Massachu'settsil Title 5 Official Inspection Form Subsurface Sewage Disposal System Form =Not for Voluntary Assessments 65 Acorn Drive E Property Address Bernard & Jane Powers' Owner Owner's Name information is �StefVllle required for every d MA , 02665 „ 9-2-16: page. Cityrrown i State Zip Code Date of Inspection B. Certification (cost.) 1 , Yes No 0 ® Required pumpingEmore than 4 times in the last year NOT due to clogged or obstructed pipe(s)J 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 celsspool or privy is within a Zone 1 of'a public well. W I , ❑ [K Any portion of a'ce'sspool or privy is within 50 feet of a private water supply well. El ®+ 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.] I ' ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® 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. E) Large Systems: To be considered a large system the system must serve a facility with a. design flow of 10,000 gpd to 15,000 gpd. For large systems, you`must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No j ` ❑ ❑ the system is within!400 feet of a surface drinking water supply ❑ ❑ the system is within`200 feet of a tributary to surface drinking water supply El the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area IWPA)or a mapped Zone II of a public water supply well 1 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. t5ins.doc-rev.6/16 Tifle 5 Official Inspection Form:Subsunace sewage Disposal System•Page 5 of 17 Sep 04 2016 13:13 Jim The Inspector Man 5085349919 l page 6 e Commonwealth of Massachusetts Title v Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 65 Acorn Drive Property Address Bernard & Jane Powers Owner Owner's'Name information is required for every Osterville I MA 02655 9-2-16 page. CityfTown State Zip Code Date of Inspection C. Checklist - k Check if the following have been done. You must indicate "yes"or"no"as to each of the following: I Yes No j .0 ❑ Pumping information was provided by the owner, occupant, or Board of Health. i ❑ . Z Were any of the system components pumped out in the previous two weeks? ❑ E` Has the system received normal flows in the previous two week period? El E 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 WA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? Z. ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? .0 ❑ 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: - E ❑ 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 ®s approximation of distance is unacceptable) [310 CMR 15.302(5)] t D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 ',Sin s.doc-rev.6116 - - Title 5 Offlclal Inspection form:Subsurface sewage Disposal System•page 6 of 17 .. i Sep 04 2016 13:13 Jim The Inspector Man 5085349919, I page 7 Commonwealth of Massachusetts 4 Title 5 official Inspection Form Subsurface Sewage.Disposal'System form Not for Voluntary Assessments 65 Acorn Drive Property Address Bernard &Jane Powers j Owner Owner's Name information is Osterville required for every MA 02655 9-2=16 page. Cityfrown State Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal. Tank and two pits'in line. s ' I I - i i I Number of current residents: 0 • Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes .® No information in this report.), I • LaUndry system inspected? ❑ Yes ®. No Seasonal use? ❑ Yes �. No Water meter readings, if available (last 2'!years usage (gpd)): 2014-39,0000ais 2015-29,000Gal's Detail: • i, Sump pump? ❑ Yes No Last date of occupancy: NA Date Commercial/Industrial flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15 203)I Gallons per day(gpd Basis of'design flow(seatslpersonsiscl.ft: etc.): 1 Grease trap present? El Yes ❑ No I Industrial waste holding tank present? ( ❑ Yes ,❑ . No Non=sanitary waste discharged to the Title 5 system? ❑. Yes ❑ No, t • Water meter readings, if available: 151ns.doc-rev.GAS - r - Title 5 Official Inspectiori Form:Subsurface Sewage Disposal System•Page T of 17 Sep 04 2016 13:13 Jim .The Inspector Man 5085349919 page 8 { Commonwealth of Massachusetts I Title 5 Official Inspection Fora " Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 65 Acorn-Drive Property Address Bernard & Jane_Powers Owner Owner'sName information is I required for every Osteryille MA 02655. 9-2-16 page. Cityfrown I State Zip Code Date of Inspection D. System Information-(cont.) ' I Last date of occupancy/use:- } Date s Other(describe below): 9 General Information Pumping Records: Source of information: i 13 /14/ 16 Was system pumped as part of the inspection?" El Yes ® No If yes, volume pumped gallons How was quantity pumped determined? i • Reason for pumping: Type of System v s Septic tank, 0111111111111 soii absorption system - El Single cesspool Overflow cesspool i 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 Ibe obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach t g a copy, of the DEP approval. - • r ❑ Other (describe): t5iris.doc•rev.6116 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 8 of 17 Sep 04 2016 . 13:13 Jim The Inspector Man 5085349919 page 9 € Commonwealth of Massachusetts; r Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r a N 65 Acorn Drive ' Property Address - Bernard & Jane Powers 1 Owner Owner's Name information is required for every Osterville MA : 02655 9-2-16 • page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,'date.installed (if known) and source of information: NA Were sewage odors detected when arriving at the.site? ❑ ,Yes ® ' No Building Sewer(locate on site plan): t •' �Depth below grade: =28"feet Material.of construction: i ❑.cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well orsuction line: , feet Comments(on condition of joints, venting, evidence of leakage, etc.): 4 PVC SCH 40. Septic Tank (locate on site plan): . ' • Depth below grade: 17feet 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: " 1000 Gal. Precast H-10 Sludge depth: 1„ t5ins.doc•rev.6116 - .Title 5 Official Inspection Form,Subsurface Sewage Disposal System-Page g of 17 t F ' Sep 04 2016 13:13 Jim The Inspector Man 5085349019 page 10 Commonwealth of Massachusetts; Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 65 Acorn Drive Property Address Bernard & Jane Powers Owner Owner's Name information is required for every A'Osterville M : 02655 9-2-16 • 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 29 Scum thickness 't , Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom'of outlet tee or baffle 17 Howwere dimensions determined'? • Asbuilt-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 17" below grade w/center cover at 6"..Inlet oldwall type baffle, outlet. baffle. No sign of leakage or over loading. Grease Trap(locate on site plan): 1. • - Depth:below grade: ; feet { Material of construction: - - - i concrete Elmetal El fiberglass ❑ polyethylene D other (explain): Dimensions: Scum thickness Distance from top of scum to top of outlei tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle { Date of last pumping: Date l5ins.tloc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 or 17 Sep 04 2016 13:14 Jim .The Inspector Man 5085349919 page 11 Commonwealth of Massachusetts: 4 r Title 5. Official Inspection Form U rf_ S bsu ace Sewage Disposal System For Not for Volunt aryAssessments ' 65 Acorn Drive Property Address -- -- i Bernard & Jane Powers Owner Owners,Name information is required for every Osterville MA 02655 9-2-16 page. City/Town State Zip Code Date of Inspection D. System Information (cone) t Comments(on pumping recommendations, inlet and outlet tee or baffle condition;structural integrity,. liquid levels as related to outlet invert, evidence of leakage, etc,): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: y .Material of construction: ❑.concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other (explain): Dimensions: Capacity: ' F i gallons Design Flow: 4. ganons per day - Alarm present: g❑ Yes ❑ 'No , Alarm level: Alarm in working order. ❑ Yes ❑ No Date of last pumping: Date _ . Comments (condition of alarm and float switches, etc.): . t l *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 15ins.doc-rev.6116 Title 5 Official Inspection Form:SubsuAace Sewage Disposal System•Page 11 of 17 Sep 04 2016 13:14 Jim The Inspector Man 5085349919 page, 12 .� Commonwealth of Massachusetts Title 5 official Inspection For Subsurface Sewage_Disposal System Form -Not for Voluntary.Assessments 65 Acorn Drive' t Property Address Bernard &Jane Powers Owner Owner's Name information i e required for every Osterville MA .02655 9-2-16 page- Citylrown State Zip Code Date of Inspection D. System Information '(cont.) Distribution Box (if Present must be opened) (locate on site plan)' Depth of liquid level above outlet invert No Box 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.): i l l i, • i . Pump Chamber{locate on site plan): i Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No . Comments(note:condition of pump chamber, condition of pumps and appurtenances, etc.): I " If pumps or Alarms are not in working order, system is a conditional pass. I Soil Absorption System (SAS) (locate on site-plan, excavation not required): i , If SAS not located,'t explain why: t i . ` t5lns,doc•rev.6116 - - Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 or 17 i Sep 04 2016 13:14 Jim The Inspector Man 5085349919 page 13 Commonwealth of Massachusetts - Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 65 Acorn Drive Property Address Bernard &Jane Powers Owner Owner's Name information is Osterville MA 02655 9-2-16 required for every — ` page. Cityfrown State Zip Code Date of Inspection D. System Information (cont) Type F. ® leaching pits number: 2 ❑ leaching chambers : number: leaching galleries number: ❑ leaching trenches number; length:. ❑. leaching fields number, dimensions: ❑ overflow.cesspool number. El innovative/alternative syst'en1 Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): - Leaching is two 1000 Gal. Precast pits in line, Pit# 1 at.1' below grade, dry w/one line out. W/outlet tee. -Pit#2:at 3'below grade w/cover at 1'. Pit dry wlclean walls. No sign of over or high stain line: Cgsspools (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.00c-rev:6I16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Sep 04 2016 13:14 Jim The Inspector Man 5085349919 page 14 s Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments V F 65 Acorn Drive Property Address Bernard & Jane Powers Owner Owner's Name information is required for every Ostervllle MA` 02655 9-2-16 ' 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.): . 5 i Privy.(locate on site plan): Materials of construction: .Dimensions j Depth of solids ,1. Comments(note condition of soil, signs of hydraulic failure, level�of ponding,' condition of vegetation, etc.): i I 15ins.dcc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System a Page 14 of 17 Sep 04 2016 13:14 Jim The Inspector Man 5085349919 page 15 Commonwealth of Massachusetts Title 5 Official Inspection Form A - Subsurface Sewage Disposal System Form - Not for.Voluntary Assessments 65 Acorn Drive Property Address Bernard.& Jane.Powers Owner Owner's.Name information is required for every Osterville MA 02655 9-2-16 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) a 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 .3,3 -W +a- - ISins.doc•rev.6116 - Title 5 Official Inspection Form:Subsurace Sewage Disposal System•Page 15 bf 17 Sep 04 2016 13:14 Jim .The .Inspector Man 5085349919 page .16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 65 Acorn Drive f x Property Address Bernard & Jane Powers Owner Owner's Name ---_ information is Osterville MA 02655 9-2-16 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cost.) Site Exam: - ❑ Check Slope . ❑ Surface water ❑ Check cellar ❑ -Shallow wells N� r 12'+ Estimated depth t high ground water: feet Please indicate all methods used to determine the high ground water elevation: Obtained from systeria design plans on record If checked, date of design plan reviewed:. Date ® Observed site (abutting property/observation hole within 150 feet of.SAS). n Checked with local Board of.Health-explain: ❑ Checked with local excavators, installers-(attach documentation) a ' Accessed USGS database explain: `You must describe how you established the high ground water elevation: 12' No G.W. on file'atB.0.H.. System area& lot high from road 12'+. Before filing this Inspection Report,please see Report Completeness Checklist on next page. 15ins.doc•rev.6116 - Title 5 O(fidal Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 k Sep 04 2016 13:14 Jim The Inspector Man 5085349919 page 17 l;} Commonwealth of Massachusetts ' Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments, ;4 s 65 Acorn Drive F. Property Address Bernard & Jane Powers Owner Owner's Name information is required for every Osterville. MA 02655` 9-2-16 page. City/Town State Zip Code Dale 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 Y Z Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file " v rya { y C t xl I 15ins.doc•rev.6116 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 TOWN OF BARNSTABLE LOCATION ��'.� Opme SEWAGE# V toa;�1® r. VILLAGE® C ST&PVILC ASSESSOR'S MAP&PARCEL 0LO/3e INSTALLER'S NAME&PHONE NO.0 G&—)ib. &TEWOU56S u-C 477g82`1'_ SEPTIC TANK CAPACITY /" t Goo �ALt.®1� LEACHING FACILITY:(type)W)5Q0 C.JtL C,610Jei15aS (size) 12 o 8 x X, NO.OF BEDROOMS 3 OWNER Oc-:Rm4ca) Z JdAJE ?0Q0&1Z5 PERMIT DATE: ;14- 2.01(p COMPLIANCE DATE: 7' X i-o10((® Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility �� Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) A Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) tj A Feet FURNISHED BY CIOC-hi e D 6 �J T&Pe21SCS C�C-C ki _ W 5 4 6�A-corh d���- ® ® a� 2 = ��, C-3 3Sa C-LI C-s =39•�� U-3^ W? FPWAT pds=y3.4` l O ,� z O No. 04V Fee C THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppYication for -Misposal .6pstem Construction VPrmit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 165 A u W 1�1Z` �5 4, Oyv,nerr'�amee,4d BLb rees�,and Tell..oNo. Assessor's Map/Parcel I CQp (t�3310 AdDA" �OPAJE 0STaY(C.rC45 Installer's Name,Address,and Tel.No. 5109-47`T-R 21-7 Designer's Name,Address,and Tel.No. e4pi=4)tpC Et470 AZ(565 CrC- 153 Cl�i+c 11�1ri e-�P Type of Building: Dwelling No.of Bedrooms 13 Lot Size ,Q06± sq.ft. Garbage Grinder( ) Other Type of Building ��--S�h�fC l?-(�[� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3(n5 gpd Design flow provided gpd Plan Date (G ";Z/ —2 0 16 Number of sheets ( Revision Date Title 675 A C.O-A.-) 0 A,(L)-G Q 1 IAV l c-Lr_- Size of Septic Tank l , 0 d® C—,AL-0-&) Type of S.A.S.00 SGY? C—rW-Dii t%aK Description of Soil L­Q,4AI� SAOD Q l d" / 5 6E Pe.-AU Nature of Repairs or Alterations(Answer when applicable) U S c i I o oo s 6irT i c. l 4P`=- TO -77) CO-) 6 ve) C u.t,sj (N(& a4&!LA Ujnt1 Date last inspected: 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 He Signed d Date '"0 Application Approved by Date C, P Application Disapproved by Date for the following reasons Permit No. .. Date Issued No. a" �4 IF THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,, MASSACHUSETTS Yes 2pplitation for Dis.p sal 6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ).Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 465 AeQW D►2, bS i, O�yvner's Name,Address,and Tel.No. yv -F C�rc dt� .T4A! � owG S Assessor's Map/Parcel j'ap j I O /4C[�7ZclJ ORttJE OS-t- �l/tic Installer's Name,Address,and Tel.No. SOIs-4 77-g _T-7 Designer's Name,Address,and Tel.No. G4At-(, EN7't� Pk(5CS Type of Building: Dwelling N6.,'of Bedrooms 3 Lot Size O(d± sq.ft. Garbage Grinder( ) Other Type of Building �?�^�(bEx.JTfsC . No.of Persons Showers( ) Cafeteria( ) Other Fixtures' i Design Flow(min.required) d gpd Design flow provided 3!�69, gpd Plan Date ID ";Z I ",l p 1(o Number of sheets ( Revision Date Title (>s AC07>� Op,(.UG Size of Septic Tank , 0 O 0 iaA, C.44)1y Type of S.A.S.CA) 5c,j' C-V_Lorj Description of Soil c..p,�A�.ty S: x9D�� j,`r +7G/�Jj 5 b Nature of Repairs or Alterations(Answer when applicable) O S 6 &Y_IS-Tf.L)e 11000 .56FT t C. CAAA - TO New 1) - C)d C-�osi tkAo4loG c4&Yn&&.9 L,t-+-A Fes" ZD-F �4 F S[,►Tt�U��c X1 Date last inspected: 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 He t Signed Date 6 Application Approved by '�� Date i Application Disapproved by Date J for the following reasons Permit No. &-V 10 Date Issued �U ------------------------ ------------------------------------------------------------------------ I THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance- THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) W Repaired( K) Upgraded( ) Abandoned( )by CADEW(M �ef;-1 T 6PiQ1 �C at <OS j4C.Qk,&J _n Al V[ d Z5T. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No,906 4L)-o dated InstallerCAP&,JIVE EN'TEx'Nig L&Q, Designer vTG #bedrooms 3 Approved design flow n 3 gpd The issuance of t is permit shall not be construed as a guarantee that the system wil function �s designed) Date �] Z 1 !s Inspector ✓� p ��� -------- ---!---------------------------------------------------------------------------- No. Fee I ------- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS - Mispo8aY 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair(x) Upgrade( ) Abandon( ) System located at `�� and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construct*ot`just be c mpleted within three years of the date of this permif C__ f j Date �- Approved by 1 4 r ��� • 94311 P. 001/001 art r Town of Barnstable Regulatory Services • Richard V. Scali,Interim Director • BABN8rABt.B. • ,6 39. Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508.862-4644 Fax; 508-790.6304 Installer& Designer Certification Form Date: 7 2Z-1 b Sewage Permit# AoBf_�XA0 Assessor's Map\Parcel Designer: 3-G �ngcr�c_ e�to -r � Installer: CaPt-Jicle. eVJ.e,cPriSe Address: 2g51 GtaoberT �i hUJA Address: 153 Cehnn►erc621 EG25k waff�y►ann HA t5253 $ Mask�ee, � 02 fo �/ q On (date) (installer) was issued a permit to install a septic system at (0 5 A co,r Or,, D 6 V e- based on a design drawn by (address) T G To(-. dated Tuvie 21 , z.oi b (designer) 1 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. Strip out (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 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Focal Regulations. Plan revision or l certified as-built by designer to follow: Strip out(if required) was inspected and the soils i were found satisfactory. I certify that the system referenced above was construe ? of the M approval letters (if applicable) nee with the terms JOHN L G�r� CHUR 11.1.JR ( staller' Sign e) �S signer°s Signa (Affix igne s St mp Here) PL ASE RET TO BARNSTABLE PUBLIC S N. CEItTI)FYCATE OF COMPLIANCE WILL O BE ISSUED UNTIL BOT IS it OI2M AND AS- THANK YOU ' BUILT CARD ARE—RECEIVED III THE BAR.NSTABI.1; PU C HEALTH DIVISION Q:\Septic\Designer Certification Aorta Rev 8-14-13.doc Town of Barnstable P# , '' ►'� Department of Regulatory Services s Public Health Division Date 200 Main Street,Hyannis MA 02601 .{ lF0 Alltt� 1.►, Date Scheduled t ' Time U Fee Pd._ 3 Sail SuitabilityAssessment or Sew uu tt__ .f ge i$po al Performed By: (4Y`edLFC �' ! Cam— Witnessed By: Ji J LOCATION&.GENERAL INFORMATION Location Address Owner's Name QERA/ (v R� JR 6trL&k.tlt,.. A�+g4WC- POwc� Address i l©ACot.Xi ij D, D�Ti3t2�1/C.E t✓ Assessor's Map/Parcel 01034 CAFC-4.-%D6 (­,p AL5tS U-C Engineer's Name _ NEW CONSTRUMON�f REPAIR � e,Telephone# 0 2-4-7 7-2f8?7 508-2 73-,0 3 77 Land Use-—S(n4c- 6yot(V LY iin Slopes(96) Z Surface Stones Distances from:• Open Water Body - ft Possible Wet Area ft Drinking Water Well ft Dmihage Way -r ft Property Line - ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&Pere tests,locate wetlands in proximity to holes) r , i Parent material(geologic) 8D 'a ' Depth to Bedrock ;;I i 3 2-Lk �.SS Depth to Oroundwater. Standing Water in Hole: 7�3 L ID5 S Weeping from Pit Face 7 32 \055 Estimated Seasonal High Groundwater 7 12J 2-„Ao4 5 DETERMINATION FOR SEASONAL-HIGH WATER TABLE Method Used: tO(CerF 0 0se(U-i(cri 715 Z Depth Observed standing in obs.hole: In. Depth to soil mottles: 7 Depth to weeping from side of obs.hole, In, Groundwater Adjustment — tt. Index Well-# Reading Date: — Index Well level „ Adj,factor Adj.Groundwater Level_ PERCOLATION TEST ngta 6-!-/b Observation ' Hole# Time at ry" Ia•21 a�w . Depth of Pere 22 -YO Time at V /0%28 01- Start Pre-soak Time® E End Pre-soak - s Rate Min./Inch 2 Site Suitability Assessment: Site Passed S(eS Site Failed: Additional Testing Needed(Y/N) A Original: Public Health Division l Observdtion 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:ISEPTICIPERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# 2 Depth from Soli Horizon Soil Texture Sdil Color Soil. Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. Isis tency.96'atavei) /Oyr — ' z icy 52 G L 5 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. e DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders., DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Boll Other Surface(in.) (USDA) (Munsell) Mottling (Structura,Stones;Boulders, Consistency. Flood Insurance Rate Man: Above 500 year flood boundary No Yea Within 500 year boundary No Z Yes,; Within 100 year flood boundary No.V Yes.,;,— Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervio s material exist in all areas observed throughout the area proposed for the soil absorption system? 7 e-.5 If not,what is the depth of naturally occurring pervious material? Certification I certify that on 1 b`27_9 9 (date)I have passed the soil evaluator examination approved by the . . Department of En vironmental Protection and that the above analysis was performed by me consistent with the required training or'se a eri cc escribed in�10 CvM 15.017. • Signature _ Date Q:WBM(-VBRCFORM.DOC 'S12,15% C0MTVIONWE.AI;11--H OF MASSACISET-`S .EXECUTIVE OFFICE OF ENYviRONMEN-TAL_AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION MAP Y PARCEL y . LOB` • -- TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A 5 CERTIFICATION Property Address: S- • Owner's Name: s RECEIVED Owner's Address: _! gkA L � - Date of Inspection: JUG 2004 f 7-OWNBARN Name of Inspector: (please print} t�l� EOLTH D STABLE Company Name.—A t i r�gP&Abns EPT. Mailing Address: a bow ru Telephone Number:� $-?ftl'-71SD�3 CERTIFICATION STATEMENT I certify that Lhave 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 Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: j ,9z&VDate: It 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. Notes and Comments ****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. _ ...y,Tt t. T�xA •f t�; Title 5 inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) ' y Property Address: Owner: Date of Inspection: b Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A.'/System Passes: P I have-not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: 1 B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be laced or repaired.The system,upon completion of the replacement or repair;as approved by the Bo Health,will pass., Answer yes,no or not determined(Y,N,ND)in the for the following statem .If"not determined"please explain. The septic tank is metal and over 20 years old' or the septic whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank fail is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approv y the Board of Health. 'A metal septic tank will pass inspection if it is struchm lly s d,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is availabl ND explain: Observation of sewage backup or break or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,seal uneven distribution box.System will pass inspection if(with approval of Board of Health): t_ b en pipe(s)a zeplaced bs isr moved distril)u&n box is L—Ailed ar replaced ND explain: The system r ired pumping more than 4 times a year due to broken or obstructed pipe(s).The sys will tem pass inspection if th approval of the Board of Health): broken pipe(s)are replaced... obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 4. C r lei tLe Owner: Date of Inspection: 61 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 th ern is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR . 03(i)(b)that the system is not functioning in a manner which will protect public health,safety a the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland a salt marsh . s ' 2. System will fail unless the Board of Health(and Pub ' Water Supplier,if any)determines that the system is functioning in a manner that protects the pu is health,safety and environment:- _ The system has a septic tank and soil abso on system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface ater supply. _ The system has a septic tank and S and the SAS is within a Zone i of a public water supply. The system has a septic tank SAS and the SAS is within 50 feet of a private water supply well. ' _ The system has a septic and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". ethod used to determine distance *"This system passes if well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile or is compounds indicates that the well is free from pollution from that facility and the presence of amm is nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are ggered.A copy of the analysis must be attached to this form. 3. Other: Y , 3 Page 4 of l l OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE OSAL_SYSTEM INSPECTION FORM PART-A-.. CERTIFICATION(continued) Property Address: �7_ G'c�� ` Owner: Date of inspection: 0 D. System Failure Criteria applicable to all systems: all You must indicate`yes"or"no"to each of the following for inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool -QG Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than'/2 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 I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than i00 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 coffam bacteria and volatile organic•compowads indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is.equal,to-or less than 5 ppza provided that no other failure criteria are triggered.A copy of the analysis muk be attached to this form.] (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15303,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 nine#serve a facility a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the follo g: (The following criteria apply to large systems in.ad " the criteria above) yes no _ the system is within 400 feet of a ce drinking water supply the system is within 200 fe of a tributary to a surface drinldng water supply the system is located' a nitrogen sensitive area(Interim Wellhead Protection Area IWPA)or a mapped Zone H of a publi r supply well If you have answered' es"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D ove the large system has failed The owner or operator of any large system considered a significant thr der Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The s ern owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST ' Property Address: Owner:_Iss MA Date of Inspection: t 4. Check if the following have been done You mast indicate"yes"or`no"as to each of the following: Yes No _ Pumping information was provided by the owner,occupant,or Board of Health or Were any of the system components pumped out in the previous two weeks ? 0( _ 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) j Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? _ Were all system components,excluding the SAS,located on site? interior of the.tank inspected for the condition _ manholes uncover opened,and them nnspect Were the septic tank �, P , 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: Yes no , — 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 CUR 15342(3)(b)J 5 Page 5 of i l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARYASSESSMENTSFORM SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION PART C SYSTEM INFORMATION Property Address: , Owner: Date of Inspection: FLOW CONDITIONS. , RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): 3' DESIGN flow based on 310 CUR 15.203(for example: 110 gpd x#of bedrooms):330 Number of current residents: / � - Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no):ALb[if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): A9 Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): l Last date of occupancy: C COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CUR 15. ): Pd Basis of design flow(seats/perso sgft,etc.): Grease trap present(yes or n ._ Industrial waste holding present(yes or no): Non-sanitary waste dis azged to the Title 5 system(yes or no): Water meter readm ,if available: Last date of occu cy/use: OTHER(d tribe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): If yes,volume pumped:`_,gallons—How was quantity..pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system Single cesspool a 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) _Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,da ins led(if known).and source of information: �6 Were sewage odors detected when arriving at the site(yes or no):�� Page T of 1 i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address Owner: Date of Inspection: BUILDING SEWER(locate on site plan) . Depth below grade: o�l Materials of construction: jC cast iron IX 40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting;evidence of leakage,etc.): t �-t I►►O 2 at r,e COkS'E i"� !. V. V G le W l 1V CA&%�G SEPTIC TANK: a (locate on site plan) n Depth below grade: J Material of construction: plconcrete metal fiberglass_,polyethylene —other(explain) __ If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of . certificate) Dimensions: l Dm 4 Sludge depth: 1 E. Distance from top of slgdge to bottom of outlet tee or baffle: 430_ Scum thickness: r� Distance from top of scum to top of outlet tee or baffle: 7 ,• Distance from bottom of scum to bottom of outlet tee or baffle: 15 How were dimensions determined: _ sy Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related 1p outlej my�evidence of leakage, tc.): t ` r(,( ; Q �/ MA y- t,�Jl att GREASE TRAP: (locate on site plan) Depth below grade: Material of construction: concrete metal class_polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top outlet tee or baffle: Distance from bottom of scum ttom of outlet tee or baffle: Date of last pumping: Comments(on pumping r mmendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet inve evidence of Ieakage,etc.): 7 Page 8 of l 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner- Date of inspection: O TIGHT or HOLDING TANK: (tank must be pumped rime of mspection)(locate on site plan) Depth below grade: Material of construction: concrete me fibe glass,polyethylene other(explam): Dimensions: Capacity: Rallo Design Flow: � y Alarm present(yes or no): Alarm level: Alarm working order(yes or no): Date of last pumping: Comments(condition of arm and float switches,etc.): DLSTRIBUTION BOX:,.,t—k (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: A 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.): y- b U PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or Alarms in working order(y r no): Comments(note condi ' of pump chamber,condition of pumps and appurtenances,etc.): T J 8 I Page 9 of 11 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner Date of Inspection: 1-7 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number. leaching chambers,number. leaching galleries,number: k leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, A etc.): CESSPOOLS: (cesspool must be pumped as o 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 groundwat inflow(yes or no): "' Comments(note cond' on of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY• (locate on Od plan) Materials of constru ion: ' Dimensions: Depth of solids: Comments(no condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspection: ` SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. d c� Page 11 of i l OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL, SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) f� Property Address: ..r , I! Owner:, Date of Inspection: 6 f C( SITE EXAM Slope Uj'Q Surface water WO Check cellar Shallow wells�a Estimated depth to ground water (50 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must dqsgnbe ow you established the high ground w ter elev Lion: SV5 SQ eLe%/0EdLk- .0 e�. 11 TOWII OF BARNSTABLE Y LOCA.TION ,�co(n Dc)u ( SEWAGE # �. VILL AC:F G f4e ASSESSOR'S 11AP & I,O'T INSTALLER'S•NAME & PHONE NO. � i� S'u)q 7;5`333�" SEPTIC TANK CAPACITY �� 8p�' �Pvlhg A I LEACHING FACILITY:(type)���� .* _ (sizc)�1000 NO, OF BEDROOMS_j PRIVATE WELL OR I?11BLIC WATER' BUILDER OR OWNER DATH PERMIT ISSUED: - i. DATE COLiPLIANCE ISSUEDi VARIANCk GRANTED: Yes No e t � w ` � , i`� �n m � �� �� J Ill � �� � �a � \ � �� � � � �'`,> ., . THE COMMONWEALTH OF MASSACHUSETTS , BOAR® OF HEALTH 420 -©31-/ - ---Town...................OF.........Ba.rns;ta.h1e-------------------------------..--.----------_- Appliratiuu for Biupuml Vurkii Cnuuitrurtiuu truth Application is hereby made for a Permit to Construct ( ) or Repair kXj an Individual Sewage Disposal System at: ....6 5 Ac o r 11-..Dij -p-._.Q. t ar-Y_z.1.J-p.-•................. ...... ----- -.......................................... Location-Address or Lot --o. la-t i.5...Ar1TL...smijL.YL...................................................... ................................................................................................. Ow.er Address a ....5__P_._Macombar_----•---------------------------------•-----•-..__....---•- ------......... ................................................... Installer Address d Type of Building Size Lot............................Sq. feet DwellingXXNo. of Bedrooms............?.............................Expansion Attic ( ) Garbage Grinder ( ) PL4Other—T e of Building No. of persons................------------ Showers — Cafeteria 04 Other fixtures --------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length---------------- Width---------------- Diameter---------------- Depth................ x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-_------------------ Diameter.................... Depth below inlet....._.............. Total leaching area..................sq. ft. 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--_----------------__-.. fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ---------------------------------------------------•---...--------------.._............--••••_----••......................................................... 0 Description of Soil........................................................................................................................ ..................-............................ VSaad...&...Gxavea1---------------------------------------- W U Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------ •---------------------------•------------------------------•-----------...----------._.............•----..1_-1Q0.0-_.ga1,1-oxi...tank_-._1_--1-IIQQ Ja1-....=�i-t . Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iT p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss d tt t board o healt . Signe ! 12/12/88 Date Application Approved By----------- .-------- .... ...cam k •-•-•----------------••--•--- -------- Date Application Disapproved for the following reasons-------------------------------------------------•------------------------------•------------....------........_ .................................••---------•---....-----------...-------•---------._...-•-••-------...--------------------------------------------------•-------------------------------------...--•--- Date PermitNo...... ...................... Issued........................................................ No._'Fl:...7.Y.f- Fmic THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........rC.o_w.n...................OF.........n;, I- -----------_------------_----------_----- Appliration for Disposal Works Towitrurtion runfit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: 6 5 2kcc)r n .D r ........................ ............................................... ­--------------------------------------------- Location-Address or Et No. ....................................................... .................................................................................................. Owner Address ............................................................. .................................................................................................. Installer Address Type of Building Size Lot--------------_-----------Sq. feet U Dwellings No. of Bedrooms...........................................Expansion Attic Garbage Grinder Other—Type of B ............................ N . ............................ Other fixture uilding s .........................................o...of persons.............................Showers Cafeteria- Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width........---..... Diameter--..---......... Depth................ Disposal Trench—No..................... Width.............--..... Total Length.................... Total leaching area....................sq. f t. Seepage Pit No--------------------- Diameter.................... Depth below inlet..........._........ Total leaching area..................sq. f t. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit...........--.--.... Depth to ground water-----.-..--..--.-...._._ rZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.....--........_._.. Depth to ground water----------------------_ P4 ............................................................................................................................................................. 0 Description of Soil...................................................................................................................................................................... �4 .-Tr U ...........................................................................S.a)ad...1-y-0 .. D-VaL...................................................................................... W ........................................................................................................................................................................................................ M. U Nature of Repairs or Alterations—Answer when applicable.............................................................................................. ........................................................................I.................................. 1:71,10.0.0...g.al......Pit Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of .I i LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board off',health. Signed V�_ VA,_/ Z . .1---2---/---1---2--/---8---8 Date ------ Application Approved By....... --- ------------------------------- ........?��..... '2 Date Application Disapproved for the following reasons:.............................................................................................................. ......................................................................................................................................................................................................... Date Permit No...._ ' ...... .... ..!K...................... Issued....................................................... D THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH i a r a S I-a,)I C? ..........................................0 F........... ..............'!�....................................................... ToWrtifiratr of Tompliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired (X�, b J .F1 l4acorn'bo-�.r y---------------------!............................................................................................................................................................................. at..............G`5 Acori.,L Drive Ostarvi.11e Installer ...........................................................................................................................................................------------_------------- has been instilled in accordance with the provisions of TITIE 5 of Th eState Sanitary Code as described in the "-- 7Y application for Disposal Works Construction Permit No........OR S�-----------------7_...... dated--...-_..................... .................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector............... ................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Barnol-able ................................OF...........................L....................................................... NoSs.-7i1.,X.... ............ FEE.....4... ............. Disposal Vorkg TWInotrurtion Prrutit Permission is hereby granted................J. P Macoia'—r ............................................................................................................................. to Construct or Repair (X), an Individual Sewage Disposal System 6'; Acorn Drivo ....... r 0st,.� ville at No..................................................... ............................................................................................................... Street C _? as shown on the application for Disposal Works Construction Permit N . ..... Dated.......................................... .............................. ­ ------------------------------------------------------ DATE_......... Board of Health .................................. FORM 1255 HOBBS & WARREN. INC., PUBLISHERS ES FINISH GRADE OVER D-BOX 5 - FINISH GRADE OVER CHAMBERS= 52.0' - 52.2' GENERAL NOT T.O.F. EL-= 53.5'� j SLOPE(�2% MIN- OVER SYSTEM 3/4"TO 1-1/2" DOUBLE WASHED f PROVIDE EXTENSION RISER i REMOVABLE WATER-TIGHT COVER OVER STONE TO CROWN OF PIPE 1- UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION WITH COVER OVER INLET& RISER TO WITHIN 6"OF FINISHED GRADE 4" SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL OUTLET TO WITHIN 6"OF F.G. MIN SLOPE 1% BOX TO F.G. (SEE NOTE 21) 2" OF 1/8"TO 1/2"DOUBLE WASHED CODE AND ANY APPLICABLE LOCAL RULES. FINISH GRADE F.G. OVER TANK EL.= 51 .9'± 5"DIA. OUTLET(S) STONE OR GEOTEXTILE FILTER FABRIC 2• ANY CHANGES TO THIS PLAN MUST BE APPROVI r ED BY THE BOARD OF HEALTH AND THE f I IPLACE RISERS ON ALL , DESIGN ENGINEER. 17-1 TOP OF SAS= 49.51' CHAMBERS WITH --EXISTING 4" PROPOSED 4" 369"MIN."MAX. 9"MIN. INLET PIPES TO 6"OF 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SCH. O PVC 48.68 36"MAX. BREAKOUT EL= 49.18' FINISHED GRADE SYSTEM UNLESS OTHERWISE NOTED. SEWER PIPE SEWER PIPE 4. TO PREVENT BREAKOUT,THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 6" 3" 3"DROP MAX 3 9" - '± PROVIDE WATERTIGHT o 40 MIL GEOMEMBRANE LINER NER S PLACEA DISTANCE AT 15'AROUND THE PERIMETER OF THE SAS. UNLESS -- - 2" DROP MIN �� M!N-SLOPE +% L-94 _ AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 4" PVC IN FROM JOINTS (TYP.) �'�'- 1 * SEPTIC TANK 4"PVC OUT TO o o o THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. 14" 50.0± LEACHING FACILITY o0 0 0 0 5. SLOPE ALL SOLID PIPE AT 1.0%MINIMUM. CONTRACTOR TO PROVIDE o SPECIFIED DROP BETWEEN oo o 0 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. CONTRACTOR SHALL 0 INLET AND OUTLET CONTRACTOR OUTLET TEE 49.00' MIN- ~ 48.83' I 2 00 0 0 o 0 0�0 000 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK SHALL VERIFY SIZE 48 VERIFY CONDITION OF \ AND CONDITION OF EXISTING TEES GAS BAFFLE 6"CRUSHED STONE �� �1 p FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY o� - ( I i i � NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH I COMPACTED BASE I _I 4.0, � AND DESIGN ENGINEER. TANK NECESSARY 4.0' 1 8.5' (TYP) 4.0' 4 83' 4.0 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. BENCHMARK ELEVATION OF 52.06' 5 OUTLET DISTRIBUTION BOX (TYP.) TO BE INSTALLED ON A LEVEL STABLE 25.0' ESTABLISHED ON A CONCRETE BOUND,AS SHOWN ON THE PLAN. BASE. FIRST TWO FEET OF OUTLET , GROUND WATER ELEV.= < 40.80' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION PIPES TO BE LAID LEVEL. 46.68 12 83 5'MIN. THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT 2 - 500 GALLON CHAMBERS `'` ��`iv+(uI✓i� i`,�" " ,i`v'U I 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK CROSS SECTION VIEW 'CONTRACTOR TO VERIFY EXISTING : L. T 1 `� TYPICAL CHAMBER PROFILE TO THE DESIGN ENGINEER. u H-10 CHI � �"��R DETAILS ELEVATION PRIOR TO ANY WORK& H-1 O D I S i R I H I .) I I�. N H(,-)A O ETA)L 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE _ ___._ ____._._.______ __._.__ ___._. _� ___..___ - 11 DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING TEST PIT DATA REGULATIONS.TOWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM ! NOTES: ' ,�' r. * '� PERC NO 15060 APPROPRIATE AUTHORITY. 1.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF ii ! .r* ��• ;11 _ "� "� INSPECTOR: David W. Stanton, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED U.I THE PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST + f `"``t f. °' c: � ° 1 PIT DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL IE .rf' � EVALUATOR: Michael Pimentel, EIT,CSE UNDER MORE THAN 3 FEET OF COVER OR LOCATED UNDER PAVEMENT, DRIVES, OR \J / 1 ! TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H 20 LOADING. ,�� BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. �� `' ; C.S.E.APPROVAL DATE: Oct. 1999 ``l N: _ . z 't , ''� "! `� $ DATE: June 1, 2016 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. N_\ �' / 2.) ENTIRE PROPERTY IS LOCATED WITHIN A DEP APPROVED ZONE 2,THE ! ,�` 0 GUYWIRE , HEAD PROTECTION OVERLAY DISTRICT,AND THE ESTUARINE " k a.4~ f �: 'r `' p0?21 TEST PIT#: 1 14. WHERE REQUIRED,CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE WELL " WATERSHED. � � MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. / ELEV TOP= 51.80' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, EXIST. LEACHING PIT TO BE PUMPED&FILLEC g1' \ ;�' �^�+. fi ` !`, a FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). • • ELEV WATER= < 40.80' WITH CLEAN COARSE SAND&ABANDONED - s •' •`, j" 'k ,' WC t 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN '•�1� ,fi " • • , ART PERC RATE = 2 min./inch SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. CS rnQ\ i'" 5�� ` : } • •'s' ✓' `• 1 '+ 16. PROPOSED PROJECT IS LOCATED WITHIN: c� �� 3�' po ` . • .:�• ; -- f• '$ cranberry DEPTH OF PERC 22' 40" Bogs TEXTURAL CLASS: 1 ASSESSOR'S MAP 120 LOT 034 QQ`�j O,p =_ • i <y. ,f M > ; _ OWNER OF RECORD: BERNARD F.AND JANE E. POWERS 51.80' tG / 52_ '. r;a ��• , LOCUS 0 ADDRESS: 110 ACORN DRIVE TO BE ABANDONED -\ / �� / ;:: \ - f { �- ____ � � �' j A<E Loamy Sand OSTERVILLE, MA.02655 LP ZONE � ? _.- g{} �• FEMA FLOOD ZONE X U , 10" 50.97' COMMUNITY PANEL# 25001 C0544J B Loamy Sand 10Yr 5/8 17. DEED REFERENCE: DEED BOOK 19942, PAGE 190 MAP 120 A,. % ,� '�� 1`Y <, •I�. 22" -. 18. PLAN REFERENCE: PLAN BOOK 187, PAGE 93 zoo PARCEL 33 / >3 �. �� erc 40 \ 6'0 `` /i� P ?two• 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. �o�� a . Ir • .. 52" 47.47' po gyp, I2 't , 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY j \ GARAGE �` , 'ii�• Q '` !�d' �� FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. \ STOOP •:j' ash - i. .. • C Fine Coarse Sand 21. A 4"PERFORATED SCH. 40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A 2.5Y 6/6 REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. EXISTING y LOCUS PLAN 3 BEDROOM ` / DWELLING SCALE: 1"= 1000' TOF = 53.5'± � ` 132" 40.80' EXIST_ SEPTIC TANK TO BE ! / / (BASEMENT) r No Mottling, Standing or Weeping Observed UTILIZED 1N TI^"" "^"'�°, ' \ - �I �S T PIT DATA LEGEND DESIGN PERC NO. 15060 / WOOD DECK � INSPECTOR: David W. Stanton, R.S. � x50.0' EXISTING SPOT GRADE NUMBER OF BEDROOMS (DESIGN) 3 _ - � � \ DESIGN FLOW 110 GAUDAY/BEDROOM EVALUATOR: Michael Pimentel, EIT, CSE - 50 - - - EXISTING CONTOUR C.S.E. APPROVAL DATE: Oct. 1999 PATIO MAP 120 TOTAL DESIGN FLOW 330 GAUDAY --�� PROPOSED CONTOUR f PARCEL 34 DATE: June 1, 2016 50 PROPOSED SPOT GRADE .s' 660 i B.H. 12,000 S-F.± DESIGN FLOW x 200 % = GAL/DAY TEST PIT#: 2 DC-1 ` a USE EXISTING 1,000 GALLON SEPTIC TANK ELEV TOP= 51.80' EXISTING GAS LINE ---� ELEV WATER= < 40.8C __-__ " ' EXISTING OVERHEAD WIRES 22" BC-1 � ` ` PERC RATE = N/A INSTALL 2 - 500 GALLON CHAMBERS � �� EXISTING WATER LINE \ w/ AGGREGATE DEPTH OF PERC= N/A TEXTURAL CLASS: 1 no TEST PIT LOCATION PROPOSED J..a . PROPOSED 2-500 GALLON �' DISTRIBUTION BOX �i _ � LEACHING CHAMBERS SENGTH +L CAPACITY (LENGTH + WIDTH) (2 SIDES) (2' HIGH) (0.74 GPD/S.F.) = GAL/DAY EXISTING 1,000 GALLON SEPTIC TANK WITH AGGREGATE 44 5" / (25.0' + 12.83') (2) (2') (0.74 GPD/S.F.) = 112.0 GAUDAY 51.80' I (4, � 0" PROPOSED 4" SOLID SCHEDULE 40 PVC PIPE x51.7 ��- BOTTOM CAPACITY A/E Loamy Sand 13 PROPOSED DISTRIBUTION BOX 10Yr 3I1 MAP 120 x52.1 TP' �3 Fk`a (LENGTH x WIDTH) (0.74 GPD/S.F.) = GAUDAY 10" 50.9T 25.0 x 12.83 0.74 GPD/S.F. = 237.4 GAUDAY O PROPOSED 500 GALLON LEACHING CHAMBER PARCEL 49 51x8 ( ) ( ) ` N (3) p0 � B Loamy 10Yr 5/8 d s2 n p p� MAP 144 --� W `� �,� ��h`� PARCEL 3-002 TOTALS: REV. DATE BY APP'D. DESCRIPTION 5`3 TOTAL NUMBER OF CHAMBERS 2 1 TP :q '� TOTAL LEACHING AREA 472.2 sQ.FT- PROPOSED SEPTIC SYSTEM UPGRADE 1 EXISTING 6 52" 47.4T TOTAL LEACHING CAPACITY 349.4 GAL./DAY GARDEN ,Zha PREPARED FOR: CAPEWIDE ENTERPRISES x 52 v x51.9 f Benchmark C LOCATED AT PROPOSED (2) 7 9., Concrete Bound INSPECTION PORT Fine Coarse Sand Elev. = 52.06' 2.5Y 6/6 65 ACORN DRIVE Approx. M.S.L. OSTERVILLE, MA 02655 SCALE: 1 INCH = 10 FT. DATE: JUNE 21, 2016 SWING-TIES 132x52.1 " ao.so' MAP 144 0 5 70 20 40 FEET No Mottling, Standing or Weeping Observed `'!"of a'"Ssgc BC-1 DC-1 _.. JOHNL ti DESCRIPTION \i PARCEL 3-001 °` u , PREPARED BY: RESERVED FOR BOARD OF HEALTH USE CHURCHILLJR. JC ENGINEERING, INC. FT- CORNER OF STONE(1) 34.6' 40.6' j 41807 2854 CRANBERRY HIGHWAY CORNER OF STONE (2) 46.5' 49.6 °po�. riS� � EAST WAREHAM, MA 02538 CORNER OF STONE (3) 45.6' 387 SITE P LA N e 1& 508.273.0377 CORNER OF STONE (4) 33.3' 26.1' SCALE: V= 10' Drawn By: BJW Designed By: BJW Checked By: MCP JOB No.3