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0015 ALISON CIRCLE - Health
15 Alison Circle, Osterville A= 146 - 043 TOWN OF BARNSTABLE LOCATION /5' SEWAGE# :VILLAGE 0 sl,,,,[ram ASSESSOR'S MAP&PARCEL /S/(d qJ INSTALLER'S NAME&PHONE NO. _d1�o¢LcC(�t ��,1e, .SQ /77 7Y 77 SEPTIC TANK CAPACITY I ov U /i i o f'x/J/-/y LEACHING FACILITY: e T (h'P ) �a�� Olv� ?!w! i�zv (size) //. ✓a S" NO.OF BEDROOMS OWNER �5*),,-, Rar 1-lc u PERMIT DATE: c l(, 2v if ; COMPLIANCE DATE: V t it Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility /yam c // Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Z - ., 1� 3( as•� 37, gy c,9.v TO OF/BARNSTABLE L6,.:ATION /rs0 `�e l SEWAGE # / �Cp c-D� ViLi,AGE ����I(P J �A�S/S,ESS S MAP & LOlrcf -30 XA1SPEA�I=NAME&PHONE NO. SEPTIC TANK CAPACITY OOO �CP LEACHING FACILITY: (type) (size) NO.OF BEDRO BUILDER OF OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table.and 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) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 1 0 r� a� No..; Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in co puler: w PUBLIC HEALTH VVISbN - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for ;Disposal 6pstem Construction 'Permit Application for a Permit to Construct( ) Repair(W. Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. I`/(,l t j 3 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel O_ A 1 i 5 0t•') 5-'CP" i 41h,111 9�*Vl e-5 Installer's Name,Address,and Tel.No. 04p&.;.,,L,r C,n•Jrsj—k$ Designer's Name,Address,and Tel.No. J—C ('o130K -2(,3 261-/ Cfry„�sri7 'YHewy Type of Building: Dwelling No.of Bedrooms Lot Size 164 sq.ft. Garbage Grinder( ) Other Type of Building �;1,,1_ y No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided S 2, gpd Plan Date r Zr, ( Number of sheets 1 Revision Date Title I 91;So n C_r fCC( Size of Septic Tank i 0©0 Ir :�i L- , Type of S.A.S. ST6-e,L-� S_ X 25- Description of Soil �oJy� e- r r 1p 3c-'` (,,WSI SA11- Nature of Repairs or Alterations(Answer when applicable) X S 16 Tb 1) (;O f (_, N Q,e,) LrAd zC� A4 Date last inspected: 210 1 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. igne Date Application Approved by Date l51 k Application Disapproved by Date for the following reasons • 1 �� Permit No. Date Issued No. V') _ Fee THE,COMMONWEALTH OF MASSACHUkTA Entered in co puter: PUBLIC HEALTH;6"VW Sl 'N,- TOWN OF BARNSTABLt,4M ACHUSETTS y Ye ltlYlcatlDiY,poOLL_p'i8posar 6pstem ConstrUctiO permit Application for a Permit to Construct Repair(� Up grade(,.)�Abandon( ) El Complete System ❑Individual Components i4,.^ Location Address or Lot No. !cJ G(q 3 Owner's Name,Address,an_d Tel.No. Assessor's Map/Parcel 15 4 1/j 5 0 y1 C /GEC 0 5TE5?0}I 51"(r4- i L �'l�!a ; �r Installer's Name,Address,and Tel.No. L' p CHP„fef Designer's Name,Address,and Tel.No. y7�8�77 J�o�3o 2ZT ! c.� � gF•,w, Type of Building: ,j Dwelling No.of Bedrooms Lot Size I(o (v'7 to + sq.ft. Garbage Grinder( ) Other Type of Building � _j No.of Persons Showers( ) Cafeteria( ) Other Fixtures `1 _ Design Flow(min.required) C gpd Design flow provided Z gpd Plan Date (4 1 S1 Number of sheets Revision Date Title Size of Septic Tank loon /�XA Type of S.A.S. S�l t Q1�35 f.jd 11. Description of Soil - Nature of Repairs or Alterations(Answer when applicable) � S may_ Date last inspected: So 1 l Agreement: The undersigned agrees to ensure the constructio'yan'I maintenance of the afore described on-site sewage disposal system in p- accordance with the provisions of Title 5 of the Envirot{mental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. ign Date — l G - Zo( ! Application Approved by Date q 4, Application Disapproved by Date # for the following reasons Permit No. ! -�^ j Date Issued P ;5 - •- - - - -- ---------- -- --------- - - - - - - . THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Qtertificate of Compliance f THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(y) Upgraded( ) Abandoned( )by ` r . --i-I- �I L t C at f A�r S o n ( ;i c ,It C,IL T C--rt .i 1( a has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.,? dated J �� Installer ��aqu4-,) (�k =er- a( ;'1 * Designer +' #bedrooms Approved design flow ' ,� gpd The issuance of thi pe it shall not be construed as a guarantee that the system will nc io as designed Date Inspector + _ - - -----_-----__.------- ----- - - -------No. / 1R / Fee . THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction 3permlt Permission is hereby granted to Construct( ) Repair(x) Upgrade( ) Abandon( ) System located at 1 00 ; a,n C)5 j C/Z, #,,, I I � x 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:Construction mT be completed within three years of the date of this pe' rmit. Date � ' Approved b}�` .7/07/2011 02:0.5 5082730367 :0302 P. 001/001 Town of Barn stable Regulatory Services Thomas F. Geil'er,Director 9ARN8SA6L6, : Public Health Division �'i0r ,a,�• Thomas McKean,Director i 200 Main Street, Hyannis,MA 02601 I Office: 509-862-4644 Fax: 508-790-6304 Date: 7-7- 1 1 Sewage Permit#20 c t—c81 Assessor's Map/Parcel Installer &Designer Certification Form Designer: 'SC En9toeafoa. T�nC, Installer: _Ca(�ew;df_ Cnfrer�c(sz� LGC Address 2&5 y C Hiahw! Add ress: c7 D�.?&3 Easi tuore.hA"I Nft 62"3$ ��4 ✓I'3 ►� On C404A,s c�e s 0 was issued a permit to install a date (installer) septic system at Ciccke� based on a design drawn by (address) �G L-n9�oeercl)� , T�nG- dated / (designer) I certify that the septic system referenced above was installed substt.nt'!ally according to. the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were.found satisfactory. 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 ce.rrified as-built by designer to follow. Stripout(if re q nspe3ted and the soils were found satisfactory. r +M OF,�� , CHIJkC!ilLL `:;• JIY. I�• ( staller'S, afore) CNIL �• No C1807 rV}� esigner's Signatur (Affix esi e s nl'. (Iere) LEASE RETURN O BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS F;)RM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLKPVBLIC fIFAI.,TH DIVISION. THANK YOU. —' y.lullicc I'ornis\drsign�rccnitic�iiun Iiiint.Juc Town of]Barnstable P.0 gyp' ' Delpartinent of Regulatory Services Public Health Division a�xrarr►ara, � Date lFD Mltt�,� 200 Main Street,Hyannis MA 02601 Date Scheduled Time Fee Pd.` ®� Soil Suitability Assessment for Sewage Disposal Performed By: Ih� c nk4_,,P1menW ELT, C56- Witnessed By: DmW DeswaCa(5, Q.S LOCATION& GENERAL INFORMATION Location Address Owner's Name Address loiZ�V - Assessor's Map/Parcel: t{tp /0 Y� Engineer's Name C i CL L�ylti / .W 1 �' #3C Cr1�irI2ennJ NEW CONSTRUCTION REPAIR Telephone# S U a— u'1 — �� '� 508 273-03`77 Land Use 3t�nsle tomUy dwelirn 2_ 5 . Slopes(%) Surface Stones Distances from: Open Water Body — ft Possible Wet Area ft Drinking Water Well ft Drainage Way — ft Property Line �ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands(n proximity to holes) S¢e. AtkaC)Ae�_ 1aVI ' Parent material(geologic) Dui wo5� - Depth to Bedrock ' Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater 712_(. '-5 S DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: DtrecA Obseruatr" Depth Observed standing in obs.hole: I Z(1. In, Depth to loll mottles: , Depth to weeping from side of obs,hole: — in, Groundwater Adjustment jn ^_ in Index Well# — Reading Date: Index,We11 level ^ Adj.factor� Adj.Groundwater Level PERCOLATION TEST Date -3_i( Thne 111 All l Observation Hole# Time at 4" Depth of Perc 310 54 Time at 6" ' Start Pre-soak Time @ i t'b 5 Ar End Pre-soak l I%'o A q Rate MinJlnch 2 Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) N Original: Public Health Division . Observation Hole Data-To Be Completed on Back---------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:ISEPTICIPERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Surface(in.) (USDA) Other (Munsell) Mottling (Structure,Stones;Boulders. o rsistencv %OravPp 8- 3(6 C3 G S "I O it s/(. 3G-126 G C3 Z, Y"A Neese. . DEEP OBSERVATION HOLE LOG Hole#Depth from Soil Horizon Soil Texture Soil Color Surface(in.) ' o Soil Other (USDA) (Munsell), ) Mottling (Structure,Stones,Boulders. E.Ti en % el F; S /0 Yr S/b - 36-(2fo C- C S • 2.5 i t0111 DEEP OBSERVATION HOLE LOG Hole#_ Depth from' Soil Horizon Soil Texture Soil Color Soil Surface(in.) (USDA) (Munsell) MottlingOther (Structure,Stones,Boulders. it %Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface in. ( ) (USDA) (Munsell) Mottling (Structure,Stones.Boulders. on ' ten Flood Insurance Rate May: Above 500 year flood boundary No— Yes Within 500 year boundary No Yes Y Within 100 year flood boundary No . Yes •! Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes If not,what is the depth of naturally occurring pervious material? Certification I certify that on /e-27"91 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and ex erience described in 310 CMR 15.017. Signature Date Q:%SEVn0PERCFORM.DOC .................................. .................................. .............: .................. COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS John Grad DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY CORE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A t n CERTIFICATION d Property Address: 15 ALISON CIRCLE OSTERVILLE MAP 146 PAR 043 L 30 Name of Owner BARTKUS /Ff` Address of Owner: SAME Date of Inspection: 8/16/99 9 (O Name of Inspector:(Please Print)JOHN GRACI or r 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) i� '999 Company Name: n/a Mailing Address: n/a Telephone Number: n/a CERTIFICATION STATEMENT 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 inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes The inpection is based on criteria defined in Title V Conditionally Passes code 310 CMR 15.303.My findings are of how the system is Needs Further Ev uation By the Local Approving Authority performing at the time of the inspection.My inspection does Fails not imply any warranty or guarantee of the longgevity of the septic system and any of its components useful life. Inspector's Signature: Date:8/17/99 The System Inspector sha#submita copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING SYSTEM EVERY TWO YEARS. revised 9/2/98 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 15 ALISON CIRCLE OSTERVILLE MAP 146 PAR 043 L 30 Owner: BARTKUS Date of Inspection:8/16199 INSPECTION SUMMARY: Check A, B, C, or D: ' A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: System passes Title V inspection f • B. SYSTEM CONDITIONALLY PASSES: nLa 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. n[a The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. �nta Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced Wa The system required pumping more than four 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 obstruction is removed w. revised 9/2/98 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 16 ALISON CIRCLE OSTERVILLE MAP 146 PAR 043 L 30 Owner: BARTKUS Date of Inspection:8/16/99 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, _ The system has aseptic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance nLa_ (approximation not valid). 3) OTHER revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 15 ALISON CIRCLE OSTERVILLE MAP 146 PAR 043 L 30 Owner: BARTKUS Date of Inspection:8/16/99 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped nta. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply ortributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X 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.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic ompounds, ammonia nitrogen and nitrate nitrogen. X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 15 ALISON CIRCLE OSTERVILLE MAP 146 PAR 043 L 30 Owner: BARTKUS Date of Inspection:8/16/99 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined.Note if they are not available with N/A, X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout, X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [1 5.302(3)(b)] X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 15 ALISON CIRCLE OSTERVILLE MAP 146 PAR 043 L 30 Owner: BARTKUS Date of Inspection:8/16/99 FLOW CONDITIONS RESIDENTIAL: Design flow:-Q g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual):$ Total DESIGN flow: = Number of current residents:5- Garbage grinder(yes or no):NQ Laundry(separate system)(yes or no): No If yes,separate inspection required Laundry system inspected(yes or no):M Seasonal use(yes or no):M Water meter readings,if available(last two year's usage(gpd): nta Sump Pump(yes or no): NQ Last date of occupancy: n& COM MERCIALIINDUSTRIA Type of establishment: nLa Design flow: nLa gpd(Based on 15.203) Basis of design flow: nLa Grease trap present:(yes or no):JW Industrial Waste Holding Tank present:(yes or no): NQ Non-sanitary waste discharged to the Title 5 system:(yes or no):NQ Water meter readings.if available:nLa Last date of occupancy: nLa OTHER: (Describe) n& Last date of occupancy: n& GENERAL INFORMATION PUMPING RECORDS and source of information: NONE System pumped as part of inspection:(yes or no):NQ If yes,volume pumped nLa- gallons Reason for pumping: n& TYPE OF SYSTEM XSeptic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes.attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other: nLa APPROXIMATE AGE of all components,date installed(if known)and source of information: 1977 Sewage odors detected when arriving at the site:(yes or no) 11LQ revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 ALISON CIRCLE OSTERVILLE MAP 146 PAR 043 L 30 Owner: BARTKUS Date of Inspection:8/16/99 BUILDING SEWER: (Locate on site plan) Depth below grade: V Material of construction:_ cast iron _40 PVC X other(explain) Distance from private water supply well or suction line: TOWN Diameter: nta Comments: (condition of joints,venting,evidence of leakage,etc.) Wa SEPTIC TANK: X (locate on site plan) Depth below grade: 4 Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) Wa If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NQ nLa Dimensions: L 8'6'H 5'7"W 4'10" Sludge depth: 3 Distance from top of sludge to bottom of outlet tee or baffle: 3'L" Scum thickness:3 Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: J! How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE TR T RAL Y SOUND. RECOMMEND PUMPING SYSTEM EVERY TWO YEARS GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain) Wa Dimensions: nLa Scum thickness: Wa Distance from top of scum to top of outlet tee or baffle:l7La Distance from bottom of scum to bottom of outlet tee or baffle Wa Date of last pumping: nLa Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) Wa revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 ALISON CIRCLE OSTERVILLE MAP 146 PAR 043 L 30 Owner: BARTKUS Date of Inspection:8/16/99 TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: nLa Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) nLa Dimensions: nLa Capacity: nLa gallons Design flow: nLa gallons/day Alarm present: NQ Alarm level:jjLa_ Alarm in working order:Yes_No_: NQ Date of previous pumping: nLa Comments: (condition of inlet tee,condition of alarm and float switches,etc.) nLa DISTRIBUTION BOX: _ (locate on site plan) Depth of liquid level above outlet invert:Wa Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) nLa PUMP CHAMBER: NO (locate on site plan) Pumps in working order:(Yes or No): NQ t Alarms in working order(Yes or No): MO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) Wa revised 9/2/98 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 ALISON CIRCLE OSTERVILLE MAP 146 PAR 043 L 30 Owner: BARTKUS Date of Inspection:8/16/99 - SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: nLa Type: leaching pits,number: 1000 GALLON LEACH PIT leaching chambers,number: ji& leaching galleries,number: j3& leaching trenches,number,length: n[a leaching fields,number,dimensions: n[a overflow cesspool,number: nLa Alternative system: n[a Name of Technology: _n(a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT IS STRUCTU ALLSOUND AND F NTIONIN PROPERLY-THE PIT HAD 2'OF LEACHING LEFT AT THE TIME OF THE INSPECTION. CESSPOOLS: (locate on site plan) Number and configuration: Wa Depth-top of liquid to inlet invert: nta Depth of solids layer: n1a Depth of scum layer. n& Dimensions of cesspool: n!a Materials of construction: nta Indication of groundwater: Wa inflow(cesspool must be pumped as part of inspection)n& Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n& PRIVY: _ (locate on site plan) Materials of construction:nLa Dimensions:nta Depth of solids: nLa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Wa revised 9/2/98 i Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 16 ALISON CIRCLE OSTERVILLE MAP 146 PAR 043 L 30 Owner: BARTKUS Date of Inspection:8/16/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a peck o � yG� revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 ALISON CIRCLE OSTERVILLE MAP 146 PAR 043 L 30 Owner: BARTKUS Date of Inspection:8/16/99 - NRCS Report name: nLa Soil Type: nLa Typical depth to groundwater: nLa USGS Date website visited: nLa Observation Wells checked: NO Groundwater depth:Shallow _ Moderate _ Deep _ SITE EXAM _ Slope _ Surface water _ Check Cellar Shallow wells Estimated Depth to Groundwater 12 Feet Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record _ Observed Site(Abutting property,observation hole,basement sump etc.) _ Determined from local conditions _ Checked with local Board of health _ Checked FEMA Maps _ Checked pumping records _ Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS revised 9/2/98 Page 11 of 11 I, 14P BORTOLOTTI CONSTRUCTION,INC 765 WAKEBY ROAD, MAIISTONS MILLS, MA 026 '8"! 508-771-9399. 508-428-8926 FAX: 508-428-9399 ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO FORIib�' PART A CERTIFICATION Property Address: D�] *ie- rDate of Inspection — Inspector's Naer's Name and Address: _ �� CERTIFICATION STATEMENT• I certify that I have personally inspected the sewage disposal system at this address and that the informa- tion reported below is true,accurate and complete as of the time of inspection. The inspection was per- formed based on my training and experience in the proper function and maintenance of on-site.sewag.e disposal stems. The System; Passes Conditionally Passes Needs Further Eva ation By the Local Aproving Authority Fails Inspector's Signature: Date: ; The System,Inspector shall submit a ` py of this inspection report to the Approving authority within thir- ty(30)days of completing this inspection. If the system is ashared 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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION S 1M ARY• A)SYST PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CNM 15.303. Any.failure criteria not evaluated are indicated below. B)SYSTEM CONDITIONALLY PASSES; One or more system components need to be replaced or repaired. The system, upon comple- tion of the.replacement or repair,passes inspection. Indicate yes,nor,or not determined(Y,N,OR ND). Describe basis of determination in all instances. If not determined",explain why not. The septic tank is metal,cracked,structurally unsound shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing sep- tic tank is replaced with a conforming septic tank as approved by The Board of Health. Sewage backkup or breakout or high static water level observed in the distribution box is due to broken or obstructed pi.pe(s)or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of The Board of Health): . - 1 - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Broken pipe(s)replaced Obstruction is removed Distribution Box is levelled or replaced The System required pumping more than four 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 Obstruction is removed C)FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by The Board of flealth in order to determine if the system is failing to protect the public health, safety and the environment. 1)SYSTEM WILL PASS UNLESS BOARD OF HEALTH.DETERMINES THAT THE. SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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. 2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTION- ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 Feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is with a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 Feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 Feet but 50 Feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. D)SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of efluent 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 clog- ged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in.the last year 1y91 due to clogged or obstructed pipe(s). Number of times pumped -2- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile or compounds,ammonia nitrogen and nitrate nitrogen. , E)LARGE SYSTEM FAILS: The following criteria apply to a large system.in addition to the criteria above: . The design flow of a system is 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 11 of a public water supply well. The owner or operator of any.such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Check if the following have been done: (/Pumping information was requested of the owner, occupant, and Board of Health. V None of the system components have been pumped for atleast two weeks and the system bas been receiving normal flow rates during.that period. Large volumes of water have not been - introduced into the system recently or as part of this inspection: V As-built plans have been obtained and examined. Note if they are not available with N/A: / The facility or dwelling was inspected for signs of sewage back-up. he system does not receive non-sanitary or industrial waste flow: The site was inspected for signs of breakout. r;All system components,excluding the Soil Absorption System; have been located on site. The septic tank manholes were uncovered,opened,and the interior of the septic tank was in- spected for condition of baffles or tees, material of construction,dirnensions,depth of liquid, -depth of sludge,depth of scum.. 4--the size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. -3- . _ X - - ti SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART 13 CHECKLIST(conlinued) The facility owner( occupants,ants, if different from owner)were provided with information on p the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION FLOW CONDITIONS RESIDENTIAL: Design Flow: allons Number of Bedrooms: Nun b r of Current Residents: Garbage Grinder: Laundry Connected To System: Seasonal Use: Water Meter Readings, if available: Last Date of Occupancy-1F 1pl-e!" C0MMERCULANDUSTRI_AL• (� Type of Establishment: Design Flow: gallons/day Grease Trap Present: (yes or no) Industrial.Waste Holding Tank Present: Non-Sanitary Waste Discharged To The Title V System: Water Meter Readings,If Available: Last Date of Occupancy: OTHER: Describe Last Date of Occupancy: GENE;, INFORMATION PUMPING RECORDS and-source of.informati n: $ `� System Pumped as part of inspection:_ If yes,volume utnped: gallons for pumping:Reason o pu p g TYPE OF SYSTEM: Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy hared System(If s,attach previous inspection records, if any) Other(explain): AP ROXIMATE A E of all components,date installed(if sown)and source of information: 40 fs /9 ewage odors detected w en.arriving at the site: -4- `SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION,FORM PART C GENERAL INFORMATION (continued) SEPTIC TANK: ✓. ' � Depth below grader Material of Construction: ticoncrete metal FRP Other (explain) — Dimisions:$; 'X(o` XS' Sludge Depth:. Thickness Distance from top of sludge to bottom of outlet tee or baffle: , Distance from bottom of scum to;bottom of outlet tee or.baffle: x/4 : Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation tQ outlet invert, structural integrity,evidence of leakag ,etc.) ks Q 0 a ?-4 ii a 19d v GREASE TRAP: Depth Below Grade: Material of Construction: concrete metal : F" Other' (explain) — — — — Dimensions: Scum'Thickness: Distance from top of scum to top of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) ' TIGHT OR HOLDING TANK::. Depth Below Grade: Material of Construction: concrete --metal FRP Other(explain) Dimensions: Capacity: - gallons Design Flow: gallons/day Alarm Level: Comments: (condition of:inlet tee,-condition of alarm and float switches,etc) DISTRIBUTION BOX: A4 Depth of liquid level above outlet invert: Comments:(note if level and distribution is equal,evidence of solids carryover;evidence of leakage into or out of box;etc.) . PUMP CHAMBER: Pump is in working order: Comments: (note condition of pump chamber,condition of.punips and appurtenances;etc.)_- -.5- t . SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM - PART C SYSTEM INFORMATION (coulinued) SOIL ABSORPTION SYSTEM(SAS): ✓ (Locate on site plan, if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: y Leaching pits, number:Leaching chatubers, number: Leaching galleries,number: Leaching trenches, number, length: Leaching fields, number, dimensions: Overflow cesspool, number: Comments: (note condiiation of sop, signs of hydraulic fai ure level of o/nding,condition of vege lion, etc. lwe CESSPOOLS: 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(cesspool must be pumped as part of inspection) Comments: (note condition of soilk, signs of hydraulic failure, level of ponding,condition of vegetation, etc.) PRIVY: Materials of construction Dimensions: Depth of Solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.) — -- —---- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continue(l) SKETCH OF SEWAGE DISPOSAL SYSTEM: - Include ties to atleast two permanent references, landmarks or benchmarks: Locate all wells within 100 Feet: US ea I - S _ n c. ' DEPTH TO GROUNDWATER: i Depth to groundwater: 17 Feel < Me of Determination or ppro�cimation: ©X� �° l y'® L ,✓ �A -7- t" a NJ ..... THE COMMONWEALTH OF MASSACHUSETTS OAR,!..... ..F Application,IS hereby**made for a Permit to Construct (--;:�®r Repair an Individual Sewage Disposal System a or Lpt ----------------- Owner Address Installer Address '7 Type of Building a. 0 Description of 4"o -''--' -------------------------------------------------------------- ............................ ------------------'------'-----------'--- ACrcrnzoor: The undersigned agrees to install the uforcdeuoribed Individual Sewage Disposal System in accordance with the provisions of Article XI 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 boa of h th. Sign � . . »*= Application Approved __ ^^_ ApplicationDate Disapproved for the following reasons:.........................................................................................................__ ---'-----'-----------'--'----------'—'-----------'--'----------'------------- o"te PermitIssued...................... ................................. ' n"* � NO.&. Finc............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H EA TH/ . . Appliration -for Ubgpvottl Works Tonotrnrtion Vrrniit Application is hereby made for a Permit to Construct (�) or Repair ( ) an Individual Sewage Disposal System at: l��f ..------.......•. ' Lo cation.'Address f� ter. i_ or Lot,No. W '� Owner r / , Addr ss r --•--•--•-•-------------------------•--.....-----•........................•.. •................. ••----•----••••••--••-----....••---•-•---.........._.............................................. Installer rr Address J f / f' UType of Building ' Size Lot......_.`.................Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures _.. -...-- - -- . ----•-•...................•--•---------•- --•---..........----- U ------------------•------- W Design Flow............... ........_..._,.__._.._gallons per person per day. Total daily flow---_-___---_. ______---___--__--__-.._-.....gallons. Septic Tank—Liquid capacity�(/6/gallons Length................ Width________________ Diameter---------------- Depth---------------- xDisposal Trench—No- ____-___--�--__- Wid'th--------------- 6t I Length. ZTota1 leaching area--------------------sq. ft. Seepage Pit No------f--- � Di ameter -------Depth below inlet__________________"Total Leaching area.-__-_-_-.-..__-_sq. ft. z Other Distribution box ( )` Dosing tank ( ) d h— /aGl;�;7 /D— / 7-7G a Percolation Test Results Performed bY................................................... ...................... Date---------------------.... ....... Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water._.-___.._.--_-_-_-.._. f� Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water_..__-_--___--._---_.._. --------------- ;r n O Description of Soil _-- (' , ° ------------- U 04 1 ' Nature of Repairs or Alterations—Answer when a--- -------------------------- ---------------------------applicable -------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------------------•----•--------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I 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 of.health Sin g Da • � Date Application Approved BY--- --•-•- ----- � �' 7-`7 Date Application Disapproved for the following reasons:----•-----•--------•--...--•--•-•------••.....................•-•-•-----•---------........----------..........-- -•-------•-•-••-•-••--------•----•-----------------------•--•---------_..._ Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS 6�BOARD OF HEALTH/ ......%...": ..........................OF...........`............. ....................................................... Trrtifiratr of fPToutphattrr THISJSZO�CERTIF� 'the,-Individualt Sewage Disposal System constructed (��) or Repaired ( ) by ' �' ALInstaller - ----------------------------- ------_ -•---_ ---_---- ---•-----•------------••----•--- has been installed in accordance with the provisions of :A,,c�le XI of The State Sanitary Code as descri ed in the application for Disposal Works Construction Permit No ------. _Y�----------- dated_./�-_�_7.-n ................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE. r f - ----•-•-•--------11) Inspector`. z '� r'� '-,` `"" THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL-TH/ f �(� L . ..• • c.- OF -< .................................................. '--••--• ... FEE........................ Dinpogttl,lVarks ClIonotrurtionf rrmit � VLF-i L +.-��i.�' --•-y" - . Permission is hereby granted_._.._ : -•------•----•----- to Construct _____'_._ ................................................. -•-----•------------------.-•-•--- (/)Repair ( ) an Individual Sewage Disposal System" / /, rr /..- C---- . , r .r S / as shown on the application for Disposal Works Construction P i No....... ........ ... ted-. '..1__ 7C- .........._. -------- ---- ------- -------------- q DATE------- 7 ......................................... Board of H a th ------`--L__. -------- -- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS Ao ,VC' v�Y M f ,+ I r r Q- 0 f11• 1 1 too-ccA. , a*� RiCNAF S •inn i CP i NO 124*48 nTG n sut i (- 1000 P i T {ov °10 �c.�aasto�t LaG��rtca� 2�5-c�-�/ILI,.G a 17t� G • C.G R T i I=Y ;I--i A r T I-k c_ �o�►J A'( i c�tJ 5 Ua�,vv�.I Pt-b,61 kz e_r a R c i•1 C-a k�Eizl`ci,► �i:AiLi�L�(S W ITN SIVE I.'I"C-- • }ZCQUI;ZeMe JIS 01-- TtAtE: -6 iowQ rP $AV Qs T*A 3LF-- LaI.ty CoueT P44 w 3ZZ'L� '� RcGtSn:�Z�Q i..Ak.ia 5v2��Yo�s `('k-115 pi_Ak--1 IS +_!OT B�iSc.� U� !�i".I vS't'E�'v"lt_LG u �rC�•S�i� li�lSt"�vRrlc:t.1 iI2�/��( ' TtaG G�i=�ii�i S rit�GiJlX.7 k-L'T BC- Ul>cra Tc.+ O(!:Tt-ZM�%,4t= Lc;T" L1t a-5 I P V l.iGn.�lT CAPE t4/mE:UL. / Cca J 11 1 JIN J�u1\�1 3IVr T.O.F. EL.= 47.2'± INISH GRADE OVER D-BOX= 45.0'± 4" SCHEDULE 40 PVC MIN. SLOPE 1 % PROPOSED 4"PVC VENT 11 S FINISHED GRADE OVER BIODIFFUSERS= 45.00' - 47.43' GENERAL NOTES f PROVIDE EXTENSION RISER SLOPE @ 2% MIN. WITH COVER OVER INLET& REMOVABLE WATER-TIGHT COVER OVER INSPECTION PORT WITH 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISH GRADEF.G. OUTLET TO WITHIN 6"OF F.G. RISER TO WITHIN 6"OF FINISHED GRADE ACCESS BOX PER WITHIN METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FND. EL.- 45.2'± F.G. OVER TANK EL. = 45.5'± 5" DIA. OUTLET(S) _- _ 3"OF F (ONE PER ROW) CODE AND ANY APPLICABLE LOCAL RULES. - - __---- � � ----- � - } 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. PROPOSED 4" 9"MIN. SEE NOTE 21 EXISTING 4" PVC SEWER PIPE 36"MAX. 5.0' MAX TOP OF SAS/B.O. - 42.43' 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEWER PIPE �i SYSTEM UNLESS OTHERWISE NOTED. y, I" 3" DROP MAX " PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 6 3 2" DROP MIN 3 9 L = 14± JOINTS (TYP.) ELEVATION =42.43' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A MIN.SLOPE 1 10" 4" PVC IN FROM 1.33' f 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 14" *43.2' - SEPTIC TANK 4" PVC OUT TO 0 90, (NP') 10.75"(TYP) 16 THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. CONTRACTOR TO PROVIDE • LEACHING FACILITY + 1 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. SPECIFIED DROP BETWEEN INLET AND OUTLET CONTRACTOR CONTRACTOR SHALL 12" 6" 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. SHALL VERIFY SIZE 48" VERIFY CONDITION OF OUTLET TEE 42.50 MIN. 42.33 42.00' 41 .10' laid flat 2.875'(34.5")--I 5.0' (NP.) 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION OF EXISTING TEES GAS BAFFLE 6" CRUSHED STONE FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS R EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY (NP') MIN. 11.5' NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE EQ'D 25.0' AND DESIGN ENGINEER. 5 OUTLET DISTRIBUTION BOX (NP.) 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 46.19' ESTABLISHED TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV.= < 34.50' BIODIFFUSERS (END VIEW) ON THE CORNER OF AN EXISTING BULK-HEAD AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. BIODIFFUSERS (PROFILE) THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW (BY ADVANCED DRAINAGE SYSTEMS, INC.) 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES SEPTIC TANK PROFILE ARC 36HC #3616BD1 BIODIFFUSERS (H-20) TO THE DESIGN ENGINEER. "CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR DISTRIBUTION BOX DETAIL \ / \ /TO ANY WORK & NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. - ---��--- -- ---- 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING j TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM 4 --'^�.. r - •' APPROPRIATE AUTHORITY. PERC NO. 13298 INSPECTOR: Donald Desmarais 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS �O C3 it 1 '1 1l EVALUATOR: Michael Pimentel, E.I.T. LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE G�� y THEY SHALL WITHSTAND H-20 LOADING. ��-` ,_` a C.S.E. APPROVAL DATE: Oct. 1999 ;q r 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. be DATE: June 3, 2011 TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE T t •' `� 23 � MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. '4 ELEV TOP= 45.00 ZONE 2 REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, --._� Q, ELEV WATER= <34.50� FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). ZONE 2 _ \ } `~ f ' PERC RATE - < 2 min./inch 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. E - • 01 DEPTH OF PERC = 36„-5A„ 16. PROPOSED PROJECT IS LOCATED WITHIN: N ;. If r r U.P. #1397!_ o M � t .. �� ,/ t TEXTURAL CLASS: 1 ASSESSOR'S MAP 146 PARCEL 43 M I O z it rw OWNER OF RECORD: STEPHEN J. & LINDA A. BARTKUS " Q . ' LOCUS ADDRESS: 15 ALISON CIRCLE 0 Fill 45.00 OSTERVILLE, MA 02655 o, 0 4 4 33' .r 8„ s - o O `4j � B Loamy Sand ti� ��9 �� �" 10Yr 5/6 FEMA FLOOD ZONE C -Y COMMUNITY PANEL# 250001 0015 C MAP 146 4 ` \ oG �� 36" 42.00' PARCEL 44 � J ~ 1/ Perc 17. DEED REFERENCE.: L.C.C. 143323 y 1 `,jop,�l r 1 `w 54" ` 40.50' 18. PLAN REFERENCE: L.C. PLAN 32225-B Z 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. 9 '; 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY 56��g�1� p�� / ,, �• •' _ ( C Coarse Sand FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL, NOT ASSUME ANY LIABILITY c c \ .� E, �<. 2.5Y 6/6 FOR USES OF THIS PLAID OTHER THAN ITS INTENDED PURPOSE. loose 21. IN ACCORDANCE WITH 310 CMR 15.401 -15.405, THE FOLLOWING LOCAL UPGRADE EXIST. 1,000 GAL. SEPTIC TANK _ APPROVALS ARE REQUESTED FROM 310 CMR 15.221 (7): TO BE UTILIZED IN THIS DESIGN 1 �8 (1.) A 2.0'WAIVER(3.0-5.0') FOR THE MAXIMUM COVER OVER THE LEACHING SYSTEM. \ � MAP 146 � o LOCUS PLAN PARCEL 43 40 16,676 S.F.± SCALE. 1 - 1000' 126" 34.50' MAP 146 f ti No Mottling, Weeping or Standing Observed #15 PARCEL45 _ EXISTING DESIGN DATA TEST PIT DATA LEGEND 3-BEDROOM I PERC NO. 13298 DWELLING ) / TOF =47.2'± INSPECTOR: Donald Desmarais 50xO EXISTING SPOT GRADE rx`O NUMBER OF BEDROOMS (DESIGN) 3 EVALUATOR: Michael Pimentel 50 EXISTING CONTOUR , E9 9 � 1 C.S.E. APPROVAL DATE: Oct. (P � DESIGN FLOW 110 GAUDAY/BEDROOM DATE: June 3, 2011 50 PROPOSED SPOT GRADE MAP 146 ,o �`�= o B.H. / 6Oo36 TOTAL DESIGN FLOW 330 GAUDAY o 0 od'. SHED a N �00 TEST PIT#: 1 r� PROPOSED CONTOUR PARCEL 46 \ 1 DESIGN FLOW X 200 % = 660 GAUD" ELEV TOP - 45.00' / 4 TP 2 / C EXISTING UNDERGROUND CABLE LP a USE EXISTING 1,000 GALLON SEPTIC TANK ELEV WATER= < 34.50' \�\ �6 BOX G�'/�� „ _ PERC RATE _ EXIST. LEACHING PIT TO BE PUMPED, C) a 5„ TP 1 { ��?�+ MAP 146 SWING-TIES SCALE: 1 =20 ❑/H/w EXISTING OVERHEAD UTILITIES FILLED WITH CLEAN COARSE SAND I = �\ 450� +� DESCRIPTION HC-1 HC-2 DEPTH OF PERC= --W- �= EXISTING WATER LINE PER 310 CMR 15.255(3)&ABANDONED ---' 1 PARCEL 42 INSTALL 20 - ARC 36HC (#3616BD) BIODIFFUSERS (H-20) 12" BIODIFFUSER CORNER(1) 23.1' 30.1' TEXTURAL CLASS: 1 TEST PIT LOCATION PROPOSED INSPECTION PORT 5" Benchmark WITH ACCESS BOX{TYP OF 4) 4" � a Q Bulk-Head Comer BIODIFFUSER CORNER(2) 34.3' 26.3' SYSTEM CAPACITY `3 1 Elev. =46.19' (TOTAL L.F. OF BIOS)(4.8 SF/LF)(0.74 GPD/SQ.FT.)=GPD 0" 45.00' Q EXISTING 1,000 GALLON SEPTIC TANK 3„ Approx. M.S.L. BIODIFFUSER CORNER(3) 46.1' 51.2' PROPOSED TOTAL 20 ARC 36HC (#3616BD) cA (100.0')(4.8 SF/LF)(0.74 GAUSQ.FT.)= 355.2 GAL. LEACHING/DAY Fill BIODIFFUSERS (H-20) IN A FIELD CONFIGURATION BIODIFFUSER CORNER(4) 38.5' 53.2' g" 44.33' PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE TOTALS: B Loamy Sand 0 PROPOSED DISTRIBUTION BOX 10Yr 5/6 PROPOSED 4" PVC VENT PIPE; EXACT LOCATION PER OWNER TOTAL NUMBER OF BIODIFFUSERS: 20 36„ 42.00' TOTAL NUMBER OF COUPLINGS: 0 0 PROPOSED ARC 36HC (#3616BD) BIODIFFUSER(H-20) TOTAL LEACHING AREA: 480.0 TOTAL LEACHING CAPACITY: 355.2 REV. DATE BY APP'D. DESCRIPTION #15 PROPOSED SEPTIC SYSTEM UPGRADE MAP 146 EXISTING NOTE: PREPARED FOR: 3-BEDROOM EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE C Coarse Sand PARCEL 47 DWELLING DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER 2.5Y 6/6 CAPEWIDE ENTERPRISES TOF =47.2'± "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO ADVANCED (loose) DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003 (LAST MODIFIED LOCATED AT HCA JANUARY 11, 2011). TRANSMITTAL NUMBER=W000052. 15 ALISON CIRCLE N SHED B.H. OSTERVILLE, MA 02655 �� JAI _ _i (1 -2 126" 34.50' ►� SCALE: 1 INCH = 20 FT. DATE: JUNE 14, 2011 o HC 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC 0 10 20 40 80 FEET No Mottling, Weeping or Standing Observed jN of f°Jass SYSTEM COMPONENT. 2) -- ---- --- --- a'�J' JONN L. 9cym. PREPARED BY: 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE PROPOSED RESERVED FOR BOARD OF HEALTH USE C CHILL JR, JC ENGINEERING, INC. LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. (4 0.4 2854 CRANBERRY HIGHWAY REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH p TEST PIT DATA. �s ��. � �� EAST WAREHAM, MA 02538 3.) ENTIRE PROPERTY IS LOCATED WITHIN THE GROUNDWATER PROTECTION OVERLAY SITE PLAN- 508.273.0377 DISTRICT AND THE ESTUARINE WATERSHED. SCALE: 1" =20' (3 Drawn By: MCP Designed By:MCP Checked By:JLC JOB No.2004