HomeMy WebLinkAbout0175 ACORN DRIVE - Health 175 ACORN DRIVE
Osterville
A 144 — 024
7
i
TOWN OF BARNSTABLE
LOCATION (7 5 Adop ' Pave SEWAGE# fit®aO- i
VILLAGE 6!TeP-V(LC,9' ASSESSOR'S MAP&PARCEL"
INSTALLER'S NAME&PHONE NO. ®Ve2 Cds
SEPTIC TANK CAPACITY C ALC-O Nl
LEACHING FACILITY:(type) (size)
NO.OF BEDROOMS
OWNER DAM16(.ot.E C HAR130KIMCAU 9=C;CTc-i4O
PERMIT DATE:17 1(h--Ao;o COMPLIANCE DATE: 17-a 3 u1®AO
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility /4 Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) N LA Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) -L,4 Feet
FURNISHED BY Ra— e ,Z1l 009 �0
I*15 A CceW Dl�,
376
A-5 :��5
A loz, 33'
Al V
6 3 q6
13°1
I
C3
No. Fee
THE COMMONWEALTH OF MA'SSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
2pplication for Th6p al *pftem QCow9truction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade(X Abandon( ) IXComplete System ❑Individual Components
Location Address or Lot No. I_1574d O W Vk osrr. Owner's Name,Address,and Tel.No.
O�Nl6C.C� C40we0oJuggo
Assessor's Map/parcel (.�. (��'
Installer's Name,Address,and Tel.No. 5 r y�Z'gg Z� Designer's Name,Address and Tel.No.
3o6ext— 9 ��*L � 5 , S S
Type of Building:
Dwelling No.of Bedrooms Lot Size I I 1 g(6 sq.ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 3 O gpd Design flow provided 14 0 57, gpd
Plan Date 1 —Z Number of sheets t Revision Date
Title I Z,�\ /'CC.E) .� DAALU6 os7) gAzt L4(,6_
Size of Septic Tank I sbd (, ;i. JJS Type of S.A.S.N SQa [, 461 *2C&
Description of Soil u LU" OWD P[.AL I
Nature of Repairs or Alterations(Answer when applicable) ZL.VC(� A.)61C) ��y� 490 SELLG.'�i1r6Jtf�
0
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 Health.
Signed Date —I4— .1o7.C)
Application Approved by Date
Application Disapproved by: Date
for the following reasons
Permit No. ;�q 9-0 ;7—C 5 Date Issued
No. 4 3'" 6 Fee /
if
THE COMMONWEALTH OF MAS5SC'IUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Z(pprication for Mi.5po5al 6pgtem Congtruction Permit
Application for a Permit to Construct O Repair O Upgrade Abandon O 1Complete System ❑Individual Components
Location Address or Lot No. 1"1 AQ Q kW b-k 045T. `Owner's Name,Address,and Tel.No.
O d!fV t c.c G C q/t1X 100o E64U
Assessor's Map/Parcel '`'C "Tt
Installer's Name,Address,and Tel.No. 5 0 44 9 8 Z 7 Designer's Name,Address and Tel.No. O - -7 3 Y
Type of Building: i
Dwelling No.of Bedrooms ! Lot Size 1111910 sq.ft. Garbage Grinder
A
` Other Type of Building 124=G( �"�"(/�-�. No.of Persons Showers( ) Cafeteria( )
Other Fixtures s'
Design Flow(min.required) t3 3 V ! gpd Design flow provided T 0 5. = gpd
1.Plan Date --7 - ,,p, ,�� Number of sheets Revision Date
Title US ACOR-6J Df�JLfc— (Ois •L/I L(.9
Size of Septic Tank t 500 (—;ALL.0Q& Type of S.A.S.(3)
Description of Soil l U" -5-*tj _ct S C.Aly
Nature of Repairs or Alterations(Answer when applicable) :ZN6jt FL.(.. tJ(SIX) L s o() 64LDlj g(jT(�
N sy-) (1 - 6 0 Y- IU nn C—AC.L,b&.J L..&1�.>eE(tUC-r Cb4f444 64C 5
LU e'LZ-f�I F'EG.T D E 6 Q [�` a rJ S f�i 6"D 62
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 BoaCofealth.
Signed Date "� � � ;L 0),C)
Application Approved by Date :7 r,
Application Disapproved by: } Date
for the following reasons
Permit No, d y 2-C) ' 1 5 Date Issued to
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed,( ) Repaired ( ) Upgraded ( ,
Abandoned( )by K OP O ( () - QC.)
j at has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. 7-c'�O '� 1 5 dated
Installer Q p 4GkT q f U Q ( 0 . Designer T.G. t—L—hj l 13C-�.I A.)6-- =L) C_
#bedrooms Approved design flow gpd
The issuance of this pertnit shall not be construed as a guarantee that the system wi`14 function as design d.
Date Z Inspector (�-
. E
i
No. 0 Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS
1wi.5po al,*pgtem Con.5truction permit
Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( x) Abandon ( )
System located at r '� V A r—oiz=w DA i U(� 1S
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty "
to comply with Title S and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of this permit.
Date (6 2-C) Approved by
� 1
y
r t
Town of,Barnstable
'O'►a.� Regulatory Services. �+
Richard V. Scali) ..Interim Director ,+
s. i. ..1AMSTA .0
+ BLE.
9 � Public Health Division NO
►+ Thomas.McKean, Director
200 Main Street,Hyannis; MA 02:601
Office: 508-862-4644 Fax. 508-790-6304 �
Installer& Designer Certification Form
:Dater -tlaslaa Sewage,Permit# ; - ;),1 S Assessor's Map\Parcei '!'t
Designer: OE-.. Installer: e
Address: Z 8 S L1 CroA► Oe ey- ti(9 W n_. Address. 343 , W00-k. Acre
- Erik .. u?areJ,r►arn; N.h _d2:53� Sdw�k �e,.rnn�1,� 1V1�
On was issued a per to install ''a
(date) (installer)
septic,system at 175 Acorn Owe _ _ based on a design drawn by
(address)
—SC Cn` irt� u_ci in 9 `106 dated 3kl� 7. ;LA..O
(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 & Local Regulations. -Plan revision or
certified as-built by designer to follow. Strip out(if required) was-inspecte.d land the soils
were found satisfactory.
I certify that the system referenced above was constructed i iance with the,terms
of the IAA approval letters (if applicable) N of y�ss
o�,ya q�yG
_ CHURCHIIL Jit. N.
( 'staller's ture) CIVIL.
.41
A
(D' ner's Signature' (Affix De t PP 17e
PL SE RETURN.TO ARNSTABLE PUBLIC HEALTH D SION.. 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.,
QASeptic\Designer Certification Form.Rev 8-14.43.doc
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Xs
Subsurface Sewage Disposal System Form-.Not for Voluntary Assessments
0
175 Acorn Drive
Property Address
.Pratt.
Owner Owner's Name
information is 0
required for every Osterville Ma 4-26-18 CP
page. Cityrrown State Zip Code Date of Inspection
- r:4
Inspection results must be submitted on this form. Inspection forms may,not bealtered In any
way. Please see completeness checklist at;the end of the form.
Important:When
filling out forms A. General Information
on the computer,
use only the.tab 1. Inspector
key to move your
'{ cursor-do not Chad Hathaway
use the return
key. -Name of Inspector
H.P:S.
Company.Name
P.O.Box 1.51
I _
Company Address
Forestdale Ma 02644
City/Town State- Zip Code
774-274-2581 12866
Telephone Number License Number'
B. Certification
I`certify that I have personally inspected the sewage disposal system at this address andthat 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 15.0001,The,system:.
® Passes ❑ Conditionally-Passes ❑ 'Fails;
❑ Needs Further-Evaluation by the Local Approving.Authority,
4-26-18 .
1nspector's'sig ure - Date
The system jnspector.sha'su dq 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 orgreater,the inspector and the'system owner shall submit the
report to the`appropriate regional office of the DEP.-The original should be sent to the system owner
and copies sent to the buyer, if applicable,and the approving authority.
****This report-only describes conditions at the time of inspection and underthe 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.
Sins•3/13
Title 5'01ficial Inspection forth:Subsurface Sewage Disposal.System Pagel of V7
f
Commonwealth of.Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form,-Not for Voluntary Assessments
b 175 Acorn Drive .
Property Address
Pratt
Owner Owner's Name
information is Osterville Ma 4-26-18
required for every T
page. City/Town State Zip Code Date of Inspection
B. Certification;(cont.)
Inspection Summary: Check. A;B,C,D or E/.always completeall of Section D
-A) System-Passes:
Z I have not found any information which indicates that any of the.failure criteria described
in'310 CMR 15.303 or in 310 CMR 15.304 exist..Any failure criteria not evaluated are:
indicated below.
Comments:
System:consists of 2 cesspools. Main cesspool then a overflow cesspool..both cesspools were
pumped dry-at-time of inspection by Debarros Septic Pumping
B) System Conditionally.Passes:
❑ One or more system components as described in the"Conditional Pass section need t6be
replaced or repaired.The system, upon completion,of the replacement or repair;:as approved by
the Board of Health,r Will.Pass.'
Check the box for"yes",-no"or"not determined"(Y, N, ND)_fortt a following statements:;if"not.
determined,' please explain.
The septic tank is metal and over'20 years old*or the septic tank(whethermetal 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 Cer ificate_of,
Compliance indicating'that the-tank is less than 20 years old is available "Iv
❑ Y ❑,,.N ❑ ;ND:(Explain below):
Title 5 Official Irupedton Forth:Subsurface Sewage oisposal System•Page 2 of 17
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-:Not for Voluntary Assessments
175 Acorn Drive.
Property Address
Pratt
:Owner Owner's Name
information is
required forevery Osterville Ma 4-26-18
page. Cltyfrown State Zip Code Pate 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 in the distribution box due
to broken or obstructed pipe(s)ordue 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:aeveled or replaced ❑ Y ❑ N ❑ ND(Explain below)'
❑ The system required.pumping more than 4 times a,year due to broken or obstructed.pipe(s)'.The
system will pass inspection if(with approval of the�Board of Health):
❑ broken pipes)are replaced. ❑ Y' ❑ N ❑ NO(Explain belowy
❑ obstruction is.removed . C1.Y ❑ N ..❑.,.ND(Explain'below):
C-) Further:Evaluation is.:Required by;the Board of Health:
❑ Conditions exist which require furthe-revaluation by the Board of'Health.in order to determine`iif
the system is.failing to.protectpublic.health, safety or the environment:
1 System will pass unless Board ofi'Health determinesIn accordance with.310 CMR
15.303(l)(b)that the.system is not functioning in a manner which will protect public health;:
safety and the.environment:: .
❑ Cesspool.or privy is.within 50 feet of a surface.water.
Cesspool or privy,is within 50 feet of a bordering.}vegetated wetland or asalt marsh
15ins-3113 Titles Oifidal Impedion Fd m-,Subsurfaoe Sewage l)isposal Systein•'Page 3;6f'17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
175 Acorn Drive
Property.Address
Pratt
Owner
Owner's Name
infornation is
required for every Osterville Ma 4 26-18
page.,. Cityrrown State Zip Code Date of Inspection
B. Certification (cont)
2. System will fail unless the Board of Health (and Public Water Supplier,if any)
determines'that the system is functioning,in a .manner_that,protects1he 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 SA&.and the SAS is within.a.Zone 1 of a public water
supply.
E] The system has aseptictank 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 5a 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,nitratenitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are.triggered. A copy of the analysis must
be attached to this form:
3. Other:
D) System Failure Criteria Applicable to All Systems.
You must indicate"-`Yes":or`rNo"to each of the followmg;for all inspections;
Yes No
Backup of sewage',into facility;or systemcomponent due to overloaded or
clogged SAS or cesspool
Discharge or ponding of effluent to the surface of.the ground or surface waters_;
due to an overloaded orclogged SAS or cesspool
Static liquid level i.n the distribution box above outlet invert due to an overloaded
N or clogged SAS or cesspool,
® Liquid depth in cesspool ii less than 6"below invert or available volume i-s less
than%day flow,
tSins a,3l13 Title 5 Official Inspection Pone:Subsurface Sewage Disposal System Rage 4 of 17
Commonwealth of Massachusetts,
Title 5 Official Inspection Form
Subsurface,Sewage Disposal System Form. -Not for Voluntary Assessments
s 175 Acorn Drive .
Property Address
Pratt
-Owner Owner's Name
information is '
required for every Osterville. .. . Ma 4-26-18
page. City/Town State Zip Code Date of Inspection
B. Certification (cone.)
Yes No
El_ ® Required:pump I ing.more than 4.times'in the last Year NOT due to clogged or
obstructed pipe(s).Number of times pumped:
E ® Any portion of the SAS, cesspool or privy is.below,high ground water elevation.
El E Any portion of cesspoolor privy is within 100 feet of a surface watersupply or
tributary to a.surface water supply..
Any portion of a cesspool or privy is within a Zone 1 of a'p.ublic well.
Q Z. Any.portion of a cesspool'or privy is within 50 feet of a private water supply well.
Ej Z Any portion of.a;cesspoo 11 l: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,:p.rformed at a DEP certified
laboratory,for fecal�coliform bacteria indicates absent and the.presence
of.ammonia nitrogen and nitrate nitrogen is-equal o or less than 5 ppm,
provided that no other.failure criteria are triggered.A copy of the.analysis
and chain_of custody mustIbe aft ached-to`this form.]
Ei ® The system is a cesspool serving a facility with a design;flow,of-2000gpd-
10,000 gp
d:
0 ® The systein fails. I have determined that one or more of the above failure.
criteria exist as described in 310 CMR 15.303, therefore:the system fails:The
system owner should contact the Board of Health to determine what will be
necessary to.correct the failure
E) Large Systems: To be considered am 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 6IIowing,:in.addition to the
questions in Section D.
Yes No
[] El , the system iswithin 400 feet of.a surface drinking water supply
E [] 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'suppI welt
If y6u,haVe answered"yes"to any question in Section E fteVy tent 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 15.30.4.The system owner should contact th6.appropdate
regional office of-the Department.
,i5ins-3/13 Title 5.officiat Inspection Form:Subsurface Sewage Disposal System c.Page 5 of:17
Commonwealth of Massachusefts
Title 5 Official Inspection Fora
Q
Subsurface Sewage Disposal System Form.=Not for.Voluntary Assessments
175 Acorn Drive
Property Address.
Pratt
-Owner
Owners Name
information is. Osterville. Ma 4-26-18
required for every '
page. cltyrrown State Zip Code Date of Lnspktron
C. Checklist
Check if the following have been done.You must indicate"yesor"no°;as to.each:of the following:
Yes No
❑ Pumping information was provided by the owner, occupant, or Board of:Health
❑ Were any of the system components pumped Out In the previous two weeks?
Has the system received normal flows in the previous two week period?
Have large volumes.Of,water been introduced to the system`recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined?(Ifthey were not;
available note as N/A)
0 ❑ Was the facility pr dwelling inspected for signs of sewage backup?
❑ Was the.site inspected for signs of break out?
® ❑ Were all system components,"excluding,the SAS, located.on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of,the baffles or,tees,:material.of constrdcti6h,
dimensions, depth of liquid,depth of sludge and.depth of.scum?
Was the facility,owner.(and occupants if different from owner) provided;with
® El
information on the proper maintenance of subsurface sewage;disposal"systems?
The size and location of the Soil Absorption System(SAS)on the site has
beendetermined based on:
❑ ® Existing information. For example,_a plan at the Board of,Health.
El ® Determined in the field (ifany of the failure criteria related to Part-C. is at_issue
approximation of distance is unacceptable) [310 CMR,16302(5)]
D. System. nformation.
Residential Flow Conditions:
Numberof bedrooms (design): Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15,203(for example: 110 gpd x,#'of bedrooms);:
t5ins•'3113 Titles.Official Inspection Form:Subsurraca Saws 9.
e.Disposal System•.Peg 6 of�17
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form.
Subsurface Sewage Disposal.System Form-Not for Voluntary Assessments
..''L 175 Acorn Drive
Property Address
Pratt
_Owner .Owners Name
information is
required for every Osterville 4-2 6-1,8
page. Cityrrown State Zip Code Date of Inspection;
D. System Information
Description:
2.
Number of current residents: -
Does residence have.a,-garbage grinder ❑ Yes .Z No
is laundry on 6 separate sewage system?(Include laundry system inspection
information in this-report) 0 Yes :M. `No
Laundry system:inspected? 0 Yes. N. No
Seasonaluse? ❑ Yes ® No
Water meter readin s; if available,' Iott 2 ears Us8 e d
g � . y 9 (gP ))�
Detail: ,
Sump pump'?. ❑ Yes' Z :No
current
Last date of occupancy'.., Date,
Co►rimercial1industn'M Flow Conditions::
Type:of Establishment:
Design flow(based on 316:_CMR 15 203) Gallons perday..(gpd)
Basis,of design floW'.(seats/persons/sq.ft.;etc); -=
Grease trap present?` ❑ 'Yes ❑ ;No
Industrial waste holding tank present?y R Yes ❑, No
Non-sanitary waste.discharged to the Title 6 system?. F1 Yes ❑ No.
Water meter readings, if available:
l5ins•wl1 ?file 5 Official Inspeefim Form:Subsurface,Sewage Disposal System:•Pa Of 17
. f
Commonwealth of Massachusetts:
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
175 Acorn Drive
Property Address
Pratt :• . ,
Owner
Owners:Name
information is Osterville Ma 4-26-18
required for every
page. Cltyrrown state Zip Code Date of Inspection
D. System Information (cont
Last date of occupancy%use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: pumped every 2 years(owner)
Was system pumped as part of the inspection? ® Yes. ❑ No
If yes.Volume pumped: 2000 gallons
. gallons
How was quantity pumped tletermined? estimated on cesspool'size and room on truck
on for pumping: cesspools
Reps.
Type of.System:.
D Septic_tank, distribution.box, soil,absorption system
ED Single cesspool
Overflow cesspool
0, Privy
Q. Shared,system.(yes or n.0.),(if:yes,,attadh.previous insp@ction 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 th2:1/A system by system operator under.cohtract:
;.,
❑` Tight tank.Attach a copy of the DER approval':
El Other(describe):
tSins-3113 Title 5'Offidal Insp cm Form:Subsurface Sewage Disposal System F Page.8 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection. Form
Subsurface Sewage Disposal System Form-Not for Voluntary:AsseSsments,
175 Acorn Drive
Property Address
Pratt
Owner Owner's Name
information is
required for every Osterville. Ma 4 26-1$_
page: cltyrrown State Zip.Code Date of Inspection.
D. System Information (cont.)
Approximate age of all components,date installed(f:known);and source of.information
1970-
Were sewage.odors detected when arriving at;the site? ❑ Yes ® No
Building Sewer.(locate on site plan):
2'
Depth below grade feet"
Material of construction:
cast iron ❑,40 PVC, ❑other(explain):
Distance from private water supply well or.suction liner
feet. .
Comments(on°condition of joints;venting;evidence-of'leakage, etc.):
Septic Tank(locate on site..plan);
Depth below grade: feet:
Materiai of construction:
®concrete ❑ metal. ❑fiberglass': -❑ polYethylene [],other(explain).
If tank is.metal, 1istage
years
-is age confrmed,bya Certificate of Compliance?(attach a copy of certificate): ❑ Yes. ❑ No
Dimensions
Sludge depth:
t5ins:3/13 Title 5 Official Inspection Form Subsurface SwMe Disposal System•Page 0 of 17
Commonwealth of Massachusetts
Title 5 Official inspection Form
Subsurface Sewage Disposal.System.Form-Not for Voluntary Assessments
175 Acorn Drive
Property Address
Pratt
-Owner Owner's Name
information is
required for every Osteryille Ma .4-26-18.
page. Cltyrrown 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
SCUmithickness
Distance from top of scum to top-cUoutlet tee Or baffle.
Distance from bottom of scum to bottom of:outlet tee,or baffle
-How were dimensions.:determined? - -
Comments (on pumping recommendations, inlet and putlet tee-or baffle condition, structural integrity;
liquid levels as related to outlet invert, evidence of leakage, etc.);
.Grease Trap.(locate on site'plan)`
Depth below'grade; feet,
Material of construction:.
El concrete ❑ metaf ❑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
i5ins•3113 Tiue s official Inspection Form:Subsurface Sewage Disposal System Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
M Subsurface Sewage Disposal.System Form-Not for Voluntary Assessments
175 Acorn Drive
Property Address
Pratt
Owner Owner's Name
information is Osterville Ma 4726-18.
required for every
page. City/Town State Zip Code Date of.lnspection
D. System Information .(cont.)
Comments on pumping recommendations, inlet and outlet tee or baffle.condition; structural`integrity;
liquid levels as-related to outlet invert, evidence of leakage, etc.):
Tight.or Holding Tank(tank must be pumped at time of inspection)(locate:on site plan)":-
Depth below grade:
Material of construction:
concrete ❑ metal: ]fiberglass ❑polyethylene.: ❑other-(explain):.
-Dimensions:
Capacity: gallons
Design Flow-,
gallons per day .
Alarm present: El Yes ❑, No
Alarm level: Alarm in working order:. Q Yes [] No
Date of last,pumping: Date` 7.
Comments(condition of alarm and-,float switches; etc.):
Attach copy of current um in contract; re uired . Is co attached � Yes No
P - p 9 �. q.. ) py
tsins•IM: Tide 5 Mial Inspection Form Subsurface Sewage Disposal System.-Page'11:of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
175 Acorn Drive
Property Address
Pratt
-Owner
.Owner's Name
information is
required for every Osterville Ma Da26-18
page. Cltyfrown 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 -
Comments (note if box is..le-w-f-and distribution to outlets equal, any evidence of.SOlidS carryover, any
evidence of leakage into or out of box, etc.):
t
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 am not in working order, system is a conditional pass.
Soil.Absorption System,i SAS)(locate on site plan, excavation not_required)`
If SAS not located, explairrwhy:
t5ms';3/13 Title 5 Of dal lnspidon Form,Subsurface Sewage DisposalSystem•,Page 12 of 17
Commonwealth of Massachusetts
�, Title 5 Official -Inspection Form
Subsurface Sewage Disposal.System Form-Not.for Voluntary.Assessments
175 Acorn Drive
Property Address
Pratt
Owner
Ownel's Name. •
information is Osterville Ma 4-26-18
required for every
page. Cityrrown State :Zip;Code Date of Inspection
D. System Information (conQ
Type:
leaching pits number:
❑ leaching chambers :number:
❑ leaching>galleries number:
❑ leaching trenches number,length;
❑ leaching fields number,'dimensions -
overflow cesspool number..
2
❑ innovative/alternativesystem
Type/name'of technology:
Comments(note condition of soil,signs of hydraulic failu(e, level of pondmg; damp soil, condition of
vegetation, etc,):
Cesspools(cesspool must be pumped as part of mspection),(locate.on sit6 plan);
Number and configuration 2) main witl ;ovecflow
Depth—top of liquid#o inlet invert: 'be
4":below:invert 2ND 42"
below invert.
6" Est 4112
Depth of solids layer' - -
3"9st no scum.:la*in 2""
Depth of scumlayer
Dimensions of cesspool 6'wide 8'tall
block
Mate.rials.of construction
Indicationofgroundwaterinflow El Yes 'M No
t5ins:e.3l13. ..-Title S:of@cial Inspection Form:Sutisuddce Sewage Disposal System.-Pabe 13-of V
Commonwealth of Massachusetts
• Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
175 Acorn Drive
Property Address
Pratt
Owner
OwneTs-Name
information is Osterville Ma 4-26=18
required for every
page. Cityrrown State, Zip Code Date of Inspection
D. System Information (cont.)
Comments"(note condition of soil, signs.of hydraulic failure,:level of ponding, condition:of vegetation;.
etc.:
Privy(locate on site,plan)
Materials of construction: -
Dimensions, _
Depth;of solids _ ..
Comments(note.condition of'soil,signs.of hydraulic failure; level of ponding, condition of vegetation,
etc.):
tins 3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-:Page 14 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
wi
175 Acorn Drive
Property Address
Pratt
ki
Owner Owners Name
information is
required for every Osterville W 4-2&18
page: Cltyrrown State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage DisposalSystem: Provide a view of the sewage'disposai system,.including ties to
at least two permanent reference landmarks or benchrnarksL Locate all wells within 100 feet. Locate
where public water supply ente"rs_the building. Check One,of the`bokes'below:'
hand-sketch in the area;below
❑ drawing attached separately
1
A
t5ins.-:3/73 Tide.5-official Inspedonfortn`Subsurface Sewage Disposal Systerti�.Page_15af97
Commonwealth of Massachusetts:
Title 5 Official Inspection Form
Subsurface Sewage.Disposal System Form-Not for Voluntary Assessments
175 Acorn Drive
Property Address
Pratt
Owner Owner's:Mame
'information is
required for every Osterville Ma -26-18,
Page- Cltyrrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
Z Check Slope
® Surface water
0 Check cellar'
M Shallow wells
Estimated depth to high 25'
_groundwater:
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:_ Date
❑ Observed"site,(abutting property/observation-hole within 1504eet of SAS)
❑ Checked with local Board of Health'-explain
❑ Checked with-local excavators installers-{attach documentation)
Accessed USGS,database ;explain:,
town,gis mappping'
You must describe.:how you established_the high ground water:elevation
lot is el. 28 where cesspools are located
Before filing this Inspection Report,please see Report Completeness Checklist on next page:
t5 ns e.3N3. Tide 5:OTcial Inspe0on.Fono:Subsurface Sewage Disposal System•Page.16'of`77
-Commonwealth of Massachusetts..
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form--Not for Voluntary Assessments
175 Acorn Drive_
Property Address
Pratt
Owner Owners Name
information is
required for every Osterville Ma 4-26-.18
page_ Cityfrown State Zip Code Date of Inspection
E. Report Completeness Checklist
❑ Inspection Summary:A, B, C, D; or E'checked
El inspection Summary.,D(System Failure Criteria Applicable to All Systems):completed
❑ System Information—Estimated depth ci high groundwater
❑ Sketch.of Sewage Disposal System either drawn on page:15 or:attached'in separate:file
tSlns;�;3113 Title 5 Official Inspection Form..Subsurfsce Sewage Dlsposal System-;Page 17of.1T
• Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
,M 175 Acorn Dr.
Property Address
Timothy J.Mclnerney
Owner Owner's Name
information is required for Osteryllle Ma. 02655 2/17/2011
every page. City/Town State Zip Code Date of Inspection
1. 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: A. General Information
When filling out
forms on the W�I computer,use 1. Inspector:
only the tab key
to move your Robert Paolini
cursor-do not Name of Inspector
use the return
key. Capewide Enterprises,LLC.
Company Name
k P.O.Box 763
Company Address
Centerville Ma. 02632
City/Town State Zip Code
(508)477-8877 S14454
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000).The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
2/17/2011
InspVcOrs Signatur Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
i
****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.
V
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
r
l
r
i ,
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
�^M 175 Acorn Dr.
Property Address
Timothy J.Mclnerney
Owner Owner's Name
information is required for Osterville Ma. 02655 2/17/2011
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® I have not found 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 septic system is in proper working order at the present time.
B) System Conditionally Passes:
El 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):
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
^M 175 Acorn Dr.
Property Address
Timothy McInerney
Owner Owner's Name
information is Osterville Ma. 02655 2/17/2011
required for
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if (with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y [:IN ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if (with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
r
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
wM 175 Acorn Dr.
Property Address
Timothy J.Mclnerney
Owner Owner's Name
information is required for Osterville Ma. 02655 2/17/2011
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply weld**.
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than 1/2 day flow
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
r
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
;M 175 Acorn Dr.
Property Address
Timothy J.Mclnerney
Owner Owner's Name
information is required for Osterville Ma. 02655 2/17/2011
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® 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.
El ® 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 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 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correc"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
❑ ❑ 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
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.
15ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
cwM 175 Acorn Dr.
Property Address
Timothy J.Mclnerney
Owner Owner's Name
information is required for Osterville Ma. 02655 2/17/2011
every page. CityrFown State Zip Code Date of Inspection
C.-Checklist
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of.water been introduced to the system recently or as part of
this inspection?
® 0 Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has
been determined based on:
❑ ® Existing information. For example, a plan at the Board of Health.
El ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
I
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
w 175 Acorn Dr.
M
Property Address
Timothy J.Mclnerney
Owner Owner's Name
information is required for Osterville Ma. 02655 2/17/2011
every page. Cityfrown State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 2
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ® Yes ❑ No
Seasonaluse? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d NA
9 ( Y 9 (gP ))�
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: 2/17/2011
Date
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
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
175 Acorn Dr.
M
Property Address
Timothy McInerney
Owner Owner's Name,
information is required for Osterville Ma. 02655 2/17/2011
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: Capewide Enterprises,LLC.
Was system pumped as part of the inspection? ® Yes ❑ No
If yes, volume pumped: 800
gallons
How was quantity pumped determined? Measured
Reason for pumping: Check for groundwater
Type of System:
❑ Septic tank, distribution box, soil absorption system
® Single cesspool
® Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 175 Acorn Dr.
Property Address
Timothy J.Mclnerney
Owner Owner's Name
information is
required for Osterville Ma. 02655 2/17/2011
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer (locate on site plan):
16"
Depth below grade: feet
Material of construction:
❑ cast iron ❑ 40 PVC Orangeberg
® other(explain):
Distance from private water supply well or suction line: 10'+
feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Joints appear tight.No evidence of Ieakage.System vented through the house vents.
Septic Tank(locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions:
I
Sludge depth:
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
° 10 175 Acorn Dr.
M
Property Address
Timothy J.Mclnerney
Owner Owner's Name
information is Osterville Ma. 02655 2/17/2011
required for
every 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
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
How were dimensions determined?
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
175 Acorn Dr.
Property Address
Timothy J.Mclnerney
Owner Owner's Name
information is required for Osterville Ma. 02655 2/17/2011
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity: gallons
Design Flow:
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins•11/10 Title.5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
^M •'°p 175 Acorn Dr.
Property Address
Timothy McInerney
Owner Owner's Name
information is required for Osteryille Ma. 02655 2/17/2011
every page. Citylrown State Zip Code Date of Inspection
i
D. System Information (cont.)
Distribution Box(if present must be opened) (locate on site plan): 1
Depth of liquid level above outlet invert
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.):
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.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
i
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
i
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
^M 175 Acorn Dr.
Property Address
Timothy J.Mclnerney
Owner Owner's Name
information is required for Osterville Ma. 02655 2/17/2011
every page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration 1 Main 1 Overflow
Depth—top of liquid to inlet invert
6"
Depth of solids layer.
4"
Depth of scum layer
1"
Dimensions of cesspool Both 6'x8'
Materials of construction Concrete Block
Indication of groundwater inflow ❑ Yes ® No
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
F Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
c�M •° 175 Acorn Dr. j
Property Address
Timothy J.Mclnerney
Owner Owner's Name
information is required for Osterville Ma. 02655 2/17/2011
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments note condition of soil signs of hydraulic failure level of ondin condition of vegetation,
( 9 Y p 9�
etc.):
Sandy dry soil.No signs of hydraulic failure.Overflow CP had V of water at time of inspection.Stain
line was 3' below invert.
Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Map Page 1 of 2
Town of Barnstable Geographic Information System
P o � �
Parcel Viewer Custom Map Abutters Ma Size Zoom Out In
K �� r
01
r 9 * Y1 C
1 i•, _
�' �
0 6
" r .,.
�R kr} Way v
iJ0 p sI.K.
1'Wty� N "o x l�A ,FrvIN'�" yhr �,�
41
1 � ,
4 vv
a ✓
6 47,
nor w•. w ',
�1
� r
' l Fee t
Set Scale 1" = 20 I Aerial Photos I MAP DISCLAIMER
(:nnvrinhf 00r1r.-9010 Thum of Rnrnetnhle UA All rinhfc recant,
http://66.203.95.236/arcims/appgeoapp/map.aspx?propertyID=144024&mapparback= 2/23/2011
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
175 Acorn Dr.
Property Address
Timothy J.Mclnerney
Owner Owner's Name
information is required for Osterville Ma. 02655 2/17/2011
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
❑ Shallow wells
Estimated depth to high ground water: Bottom of CP 16.7'
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: Date
® Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health - explain:
❑ Checked with local excavators, installers - (attach documentation)
® Accessed USGS database - explain:
You must describe how you established the high ground water elevation:
USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate #2 annual ranges of
groundwater elevations.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
^M 175 Acorn Dr.
Property Address
Timothy J.Mclnerney
Owner Owner's Name
information is required for Osterville Ma. 02655 2/17/2011
every page. Cityfrown State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary:A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
J�
l .
QG
Q�
ACORN DRIVE
N 53'55'10" E N_ 53'55'10" E -
21.81' CB FND
BROKEN ,t d
STAKE .
(�)� R--52.50'
L=123.90' ti o� moo
LOT .32
o .o0 11,855SF � � ��
04
�S 0? �p
Zo 13.6' 7g
'02Q
Z
CESSPOOLS O
80'f CB FND
S 53-55.10- 54.71' 25'f
SG�
EXISTING STRUCTURES / /D
(INCLUDED IN LOT COVERAGE
CALCULATION) ics
e' /L
7i1Ca?/l5 yc�
THE SEPTIC LOCATION WAS DRAWN BASED ON JAC.-CN
SKETCH ON FILE AT TOWN OF BARNSTABLE <, EU?dKER �»
HEALTH DEPARTMENT. 19 140.32553 oa
°sS�ONAL LAND SJP
BSS
D ES I G N
CERENGINEERING CERTIFIED .PLOT PLAN I LOCATEDTM= THAT THE STRUCTURES ARE
0 LOT 32 AS SHOWN.
- &SURVEYING PREPARED FOR
ww.bssdesign.com BRIAN PRATT
uv IV,If
=»evism>�w 175 ACORN DRIVE PROFESSIONAL D SURVEYOR
u~M OSTERVIILLE, MASSACHUSETTS
N PAX 500�am DATE. �C 2� Z O
zoning district RC 20 Building Lot Coverage flood zone: C assessi:144 024
Required Setbacks exist 15.86% drawn: EJP scale: 1 = 30'
front yard: 20' Prop: checked: date: DEC 2. 2011
side.& rear. 10' allowed: job number. 11208 dwg number.P19-116
T.O.F. EL.= 26.3'± FINISH GRADE OVER D-BOX= 24.8'±
FINISH GRADE OVER CHAMBERS = 24.0' _ 25.1 G F N E RAL N OTL
fPROVIDE EXTENSION RISER REMOVABLE WATER-TIGHT COVER OVER SLOPE @ 2% MIN. OVER SYSTEM 3/4" TO 1-1/2" DOUBLE WASHED 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION
WITH COVER OVER INLET& FINISH GRADE OVER TANK EL.= METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL
FINISHED GRADE RISER TO WITHIN 6" OF FINISHED GRADE STONE TO CROWN OF PIPE
OUTLET TO WITHIN 6' OF F.G. 24 p,+ 4 SCHEDUL o 40 PVC INSPECTION PORT WITH ACCESS CODE AND ANY APPLICABLE LOCAL RULES.
f @ FOUNDATION = 25.2'± 5" DIA. OUTLET(S) MIN SLOPE 1 /o BOX TO F.G. (SEE NOTE 21) 2 OF 1/8 TO 1/2 DOUBLE WASHED
- 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE
24"MIN.ACCESS - - DESIGN ENGINEER.
COVER (3 TYP.) 9„ r STONE OR GEOTEXTILE FILTER FABRIC MIN- PLACE RISERS ON ALL
36' MAX. I TOP OF SAS = 22.13' 3. 4" SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL
PROP. SCH. 40 9" MIN. 9" MIN CHAMBERS WITH
PROP. SCH. 40 36" MAX. SYSTEM UNLESS OTHERWISE NOTED.
PVC SEWER PVC SEWER 21 .30 36" MAX. BREAKOUT EL- 2 1 .8O' INLET PIPES TO 6 OF
FINISHED GRADE"." 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN
61, 3„ 2" DROP MIN. ELEVATION =21.80' FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE SAS. UNLESS A
MIN.SLOPE @ 1% 3" DROP MAX. 3�� 9��
MIN.SLOPE@1% L=14'± PROVIDE WATERTIGHT 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF
0 0
00
* _ 13" �-JOINTS (TYP.) oo��
* 22 5 14„ 21 90' SEPT C TANKOM 4" PVC OUT TO 0 O 0 0 0 0 o o 0 0 o THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION.
23.1 ± O LEACHING FACILITY o 00 0 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM.
22.15' INLET TEE oo o o 0 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL.
48" OUTLET TEE 21 .70' MIN. 6 21 .53' 2 00 0 � � 00 000 � � � � � oa 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK
0 0 0 o FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS
TEES TO BE CENTERED GAS BAFFLE 6" CRUSHED STONE o o 0 00 o NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH
DIRECTLY UNDER RISERS OVER MECHANICALLY o o AND DESIGN ENGINEER.
26.8' OFFSET TO FND COMPACTED BASE 2 0'
8.5' (TYP) 2 0 4.0' 4,0' 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. BENCHMARK ELEVATION OF 24.00,
6" CRUSHED STONE 5 OUTLET DISTRIBUTION BOX 29 5, (TYP.) ESTABLISHED ON NAIL IN OAK TREE AS SHOWN ON PLAN.
OVER MECHANICALLY TO BE INSTALLED ON A LEVEL STABLE 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION
COMPACTED BASEM M 08 M ZS8 BASE. FIRST TWO FEET OF OUTLET GROUND WATER ELEV.= < 13.00
PROPOSED 1 ,500 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. Z19.30' 12.83' THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT
1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES
LENGTH 10'-6" WIDTH 5'-8" DEPTH 5'-8" � CROSS SECTION VIEW 3 - 500 GALLON CHAMBERS 5 MIN. �� ���'�i;�c1-� ,�;�� ;��L�v TO THE DESIGN ENGINEER.
`CONTk,r ,,i viC i v VERIFY EXISTINi� (Dimensions per TYPICAL CHAMBER PROFILE
ELEVATION PRIOR TO ANY WORK& SEPTIC T A 111 `)RO F I L E ACME/Shorey) D I STk i u u I iON BOX DETAIL CHAMBER DETAILS 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. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING
BEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM
SWING-TIES I , v ` C? `- -' %,1 C /`1 APPROPRIATE AUTHORITY.
`-� - IV I / PERC NO. TPT-20-123
DESCRIPTION HCA HC-2 \ \ \` `3 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED
iJ INSPECTOR: Donald Desmarais(BOH) UNDER MORE THAN 3 FEET OF COVER OR LOCATED UNDER PAVEMENT, DRIVES, OR
SEPTIC COVER IN (1) 33.1' 55.4' \ / I , •_. .. 11__W_� =- r -t�
- - �; EVALUATOR: Michael Pimentel, EIT, CSE TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING.
C.S.E. APPROVAL DATE: Oct. 27, 1999 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES.
• . �` ,-
SEPTIC COVER OUT(2) 37.1' 48.7' \\ , � � � 0• -
n June 18, 2020
DATE: 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE
CORNER OF STONE (3) 477 46.7' -
- TEST PIT#: 1 MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY.
CORNER OF STONE (4) 36.9' 40.0' \ \ \\ ;� C .. �Vo12 8 , ELEV TOP- 24.00' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY,
\ Gv ��-^,} - ' e - FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3).
CORNER OF STONE 5 59.8' 17.9' � \ \ I ;P(�?2 -
CO O .,`O �O \ f� �fr» ` f ELEV WATER - < 13.00' 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN
CORNER OF STONE (6) 67.0' 30.1' GOB �'�,P \ ' \ v ,- - .� ' �`1, 1 "'' ��� ( / PERC RATE - < 2 min./inch SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK.
\O /
`J l 16. PROPOSED PROJECT IS LOCATED WITHIN:
9 ; `t DEPTH OF PERC = 6,. -24
ASSESSOR'S MAP 144 LOT 24
> > \ TEXTURAL URAL CLASS: RECORD
EDGE_OF PAVEMENT (TY�( ' '- r
; _ �� _.w �-�5 \,' 1 T S. I OWNER OF : DANIELLE CHARBONNEAU FLETCHER
�- -- / / \ _- ADDRESS. 175 AC
O ' /
�+ •� !� . � „ ranberry OSTERVRN DRIVE
02655
N� •
\ i * Bogs i 0" 24.00'
��� ;r Loamy Sand
LOCUS g
/ • ii A FEMA FLOOD ZONE X
6„ 10Yr 4/1/ 23.50'Perc
COMMUNITY PANEL# 25001C0544J
� i J ,� / � � � • i t � '// MAP 144 Loamy Sand
x t �. � � __. ' �' B 24" 22.00' 17. DEED REFERENCE. BOOK 31370, PAGE 283�.__ _ - - f 10Yr 5/6
LOT 9 I 18. PLAN REFERENCE: PLAN BOOK 187, PAGE 93
19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION.
ZONE III
U.P. #735-9I `._� ,•" it a
�U4 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY
MAP 144 / 1 I �'� ''�� � �ti rt __ FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY
x �%`�' r j '_ •IhN FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE.
1, LOT 24 N
11,810± S.F. �)) �j• II �� Q
l�tt `� `.� 21. A 4" PERFORATED SCH. 40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A
' j(. �• • DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3" OF FINISH GRADE. A
i 1 X o. d '-� i p �� • • Medium Sand REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS.
CV) - - / G \ X l 2 /l �1 C 2.5Y 6/6
22. OWNER/APPLICANT/ CONTRACTOR SHALL BE RESPONSIBLE TO OBTAIN ANY AND ALL
a \ \ <e 7 `n� X • REQUIRED PERMITS AND APPROVALS FOR THIS PROJECT.
O°�° \ `'y - N��\� '� ; LOCUS PLAN 23. IN ACCORDANCE WITH 310 CMR 15.401 -15.404, THE FOLLOWING LOCAL UPGRADE
-,h' x APPROVAL IS REQUESTED FROM CMR 310 CMR 15.211(1):
m \ \ #175 ` 1.) A 2.0' WAIVER (20.0' - 18.0') FOR THE SETBACK FROM SAS TO THE HOUSE FOUNDATION.
a
EXISTING X U SCALE: 1"= 1000' 132" 13.00'
3-BEDROOM \ �� X w No Mottling, Standing or Weeping Observed
- -
\ DWELLING / ` C-2 X� LEGEND
X DESIGN DATA
TEST PIT DATA
So \\ / GP5 \\ i PERC NO. TPT-20-123 50xC1' EXISTING SPOT GRADE
o x NUMBER OF BEDROOMS (EXISTING) 3 INSPECTOR: Donald Desmarais (BOH)
SD \\ TOF=26.3± \ I _ - 50 - EXISTING CONTOUR
INV.=23.1'± \ x NUMBER OF BEDROOMS (DESIGN) 3 EVALUATOR: Michael Pimentel, EIT, CSE
x n PROPOSED CONTOUR
�,A \ .o (5) I \ DESIGN FLOW 110 GAUDAY/BEDROOM C.S.E. APPROVAL DATE: Oct. 27, 1999
G� \ x DATE: June 18, 2020 50 PROPOSED SPOT GRADE
MAP 144 �� \ ell I PROPOSED TOTAL DESIGN FLOW 330 GAUDAY
LOT 17 2� DECK _ x _ TEST PIT#: 2 - ---- EXISTING UNDERGROUND GAS
PROPOSED � \ INSPECTION DESIGN FLOW x 200 - 660 GAUDAY
\ D-BOX I PORT ELEV TOP = 24.00' 0 H W EXISTING OVER HEAD WIRES
\ x USE PROPOSED 1,500 GALLON SEPTIC TANK
� ELEV WATER = < 13.00'
W W- EXISTING WATER LINE
1 HC-1 \ �, 0 PERC RATE _
-
\ 25 1W TEST PIT LOCATION
O \ I DEPTH OF PERC =
\ (4) 4 INSTALL 3 - 500 GAL. CHAMBERS w/ AGGREGATE TEXTURAL CLASS: I x E✓ O O O PROPOSED 1,500 GALLON SEPTIC TANK
\
INV
SIDEWALL CAPACITY
EXISTING CESSPOOL TO BE �`� � - - w PROPOSED 4" SOLID SCHEDULE 40 PVC PIPE
'TR 2 <�9 a X (LENGTH + WIDTH) (2 SIDES) (2' HIGH) (0.74 GPD/S.F.) = GAUDAY
0
PUMPED, FILLED w/CLEAN ?A• C; �� ��, (29.5' + 12.83'
SAND &ABANDONEC i _ / PROPOSED THREE (3) ) ( 2 ) ( 2' ) ( 0.74 GPD/S.F.) =125.3 GAUDAY A Loamy Sand 24.00'
P PROPOSED DISTRIBUTION BOX
- - - X 500-GALLON LEACHING 10Yr 4/1
I \ O / / , X CHAMBERS 6" 23.50' �p PROPOSED 500 GALLON LEACHING CHAMBER
BOTTOM CAPACITY
\ (2) 3 TP 1 \ I (LENGTH x WIDTH) (0.74 GPD/S.F.) = GAUDAY B Loamy Sand
\ \\(1 ( ) 4x0' EXISTING LEACHING PIT TO (29.5' x 12.83') (0.74 GPD/S.F.) = 280.1 GAUDAY 10Yr 5/6
\ \ \ I BE PUMPED, REMOVED & 42" 20.50'
\ \ SHED \ �� REPLACED w/ CLEAN SAND
TOTALS: REV. DATE BY APP'D. DESCRIPTION
X(x TOTAL NUMBER OF CHAMBERS 3 , PROPOSED SEPTIC SYSTEM UPGRADE
PATIO TOTAL LEACHING AREA 547.8 SQ.FT.
/�- \\ 3�� % / TOTAL LEACHING CAPACITY 405.4 GAL./DAY PREPARED FOR:
NOTES: \ / �' ROBERT B. OUR CO., INC.
Medium Sand
1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF Benchmark ,1 \\ 11 // �,�` i r/ PROPOSED 1,500 C 2.5Y 6/6 LOCATED AT
EACH SEPTIC SYSTEM COMPONENT. Nail In Oak Tree \ v i 12"/ - GALLON SEPTIC TANK
Elev. = 24.00' 175 ACORN DRIVE
2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE Approx. MSL
PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT OSTERVILLE, MA 02655
DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF / MAP 144
HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. // us n' i`�'� 132" 1 13.00' SCALE: 1 INCH = 10 FT. DATE: JULY 7, 2020
BLOCK 3
LOT 12 No Mottling, Standing or Weeping Observed ��sA °F ass o s to zo 4o FEET
3.) ENTIRE PROPERTY IS LOCATED WITHIN A WELLHEAD PROTECTION , �� s� 1000090000101
__
OVERLAY DISTRICT, GROUNDWATER PROTECTION OVERLAY DISTRICT, CH RCN LL. JR. ��, PREPARED BY:
HI
ESTUARINE WATERSHED AND A MASS DEP APPROVED ZONE ll. RESERVED FOR BOARD OF HEALTH USE CIVIL JC ENGINEERING, INC.
4.) SWING TIES SHOWN ON THIS PLAN ARE PROVIDED ONLY AS A COURTESY N0. 41807 2854 CRANBERRY HIGHWAY
FOR THE INSTALLER. INSTALLER SHALL VERIFY SWING TIE MEASUREMENTS !�� EAST WAREHAM, MA 02538
IN THE FIELD PRIOR TO INSTALLING THE SYSTEM. CONTRACTOR SHALL SITE PLAN 508.273.0377
NOTIFY ENGINEER IF MEASUREMENTS APPEAR TO BE INCORRECT. - - -
SCALE: 1"= 10'
Drawn By: AB Designed By:AB i Checked By: MCP JOB N0.5167