Loading...
HomeMy WebLinkAbout0016 AVALON CIRCLE - Health 16•Avalon Circle �... v . Osterville P 'v 145 058 ° - s • � i i - s , 9 R TOWN OF BARNSTABLE LOCATION 17 Avalon _Circle SEWAGE# 2019— / ;_VILLAGE t;osierville ASSESSOR'S MAP&PARCEL lIt$Z061 INSTALLER'S NAME&PHONE NO. �S (866)7z 9-6_01 / SEPTIC TANK CAPACITY LEACHING FACILITY:(ty�e� �,�Ej' s(size) 500 e�l earh. NO.OF BEDROOMS ...3 OWNER PERMIT DATE: 12 20/ COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility S. .Z Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) A/ Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) NIA- Feet FURNISHED BY AMh rA• n I _Xy No. 3 o)l - Fee 0 c THE COMMONWEALTH OF MASSACHUSETTS Entered iri computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppliCation for Misposal *pstem Cunstruttiun permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. f to AVALO M C t C6 S`,r Owner's Name,Address,and Tel.No. Li Soo ANN MALCOLM 'TAOCrrEg Assessor'sMap/Parcel 14S isg Ito AC c - Installer's Name,Address,and Tel.No.SO 9'-q-7`7-88-11 Designer's Name,Address,and Tel.No. 509-,X7 3-67�17 Rob6a-T d 0 v iZ c0 Type of Building: /w Dwelling No.of Bedrooms 3 Lot Size 54000 sq.ft. Garbage Grinder( ) Other Type of Building ���� .( No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3,30 gpd Design flow provided �3'Cq gpd Plan Date 6 2 3—le);L f Number of sheets ' Revision Date Title_ I t - - .� 7 ��� �cST EAV 1 LLC Size of Septic Tank , 1000 A-)5 jType of S.A.S. C;Cj:&D C=4tjLO&J CL��>�� �Cgo,5 Description of Soil [()& Nature of Repairs or Alterations(Answer when applicable) L1 �(�� �f I OCjC� C'-44-"O `- sjeu> 14-ark 7 ) (. ' <btu -,)-0 e4-Gu � W t:J - of Fee- cT- i R 7C- Se�c�.VJtl 1)('r Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance o afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Co d o p the sys i eration it a Certificate of Compliance has been issued by this Board of Health. � Signed Date Application Approved by Date d .- Application Disapproved by Date for the following reasons Permit No. 9 0 21✓-13-u© Date Issued 7� f No. o 1 _ a Fee ` Entered in computer: (.f THE COMMONWEALTH OF MASSACHUSETTS Yes " A- PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 4plitation for Disposal 6pstrut Construction Permit Application for a Permit to Construct( ) .Repair(k) Upgrade(' ),Abandon,( ) ❑Complete System ❑Individual Components Location Address or Lot No. 1(g AVALON L(t , Q s-r Owner's Name,Address,and Tel.No. 11 . 4- I SA ANAI M'AL(:OLM TfttK74sr� Assessor's Map/Parcel 114 S2 (fp 4 CdAk46 (aS'j"aC,�(l"" 4 Installer's Name,Address,and Tel.No. 50$-q`77,-8?-1*7 Designer's Name,Address,and Tel.No. MOR-X73-0-Vff Rds�-T Qj 0lu s . dO a'G Glt)Gr/X)i5�1XA.-z-=&X, ,- Type of Building: Dwelling No.of Bedrooms 3 Lot Size 5.00O + sq,ft.., Garbage Grinder( ) Other Type of Building f No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided a Y4 4 gpd Plan Date �� 3 �};Z,/ Number of sheets ` Revision Date Title-AVAL,00 OUP-d.LE-n 6,S7 !14 - Size of Septic Tank OCO Q;o(1-LD&X Type of S.A.S. (✓mt� ,y�(� G-> t�a.i �a l Bt41.� Description of Soil "j)( � T/aA� $ l' R Nature of Repairs or Alterations(Answer when applicable) USE &-(j5;'rj&j;:� (t don QZ-dU-6YJ �/G,11AVV, oe uj N-2U o�-3a x -M� �1 S'bf) o Date last inspected: Agreement: of ,r The undersigned agrees to ensure the construction and maintenance offthe afore described on-site sewage disposal system in ,x accordance with,the provisions of Title 5 of the Environmental Code-an n to place the system,in operation until a Certificate of . Compliance has been issued by this.Board of Health. Signed l Date r , Application Approved by ` 't. r ,jt,�,,4/,,f,� ' �f(1,t xj, ��_�, Date - (- Dt Application Disapproved by "V l/ - r Date w for the following reasons Permit No. n ✓ ( Date Issued 7- ' -- ----- --- --------------------------- - ------------- ----- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(�) Upgraded( ) Abandoned( .)byG� Q2[ CQU Cyl7 ( �f ) P�f�/7 at t/ A yA t-4m d l ae-L. - Q ST. has been constructed-in accordance- - with the provisions of Title 5 �and the for Disposal System Construction Permit No W,j/ dated -7, ��� Installer P-1AGer G 6 OP, CU . Designer Zc. 6�&x---M k #bedrooms 3 Approved design flow ' gpd The issuance of this permit shall not be construed as a guarantee that the system will fim tion�as desi rgned. Date �1 f Inspector .^"�Il �i(� _-.--.---_._-_•_-_ .-_•_.-_•_-_•---.----•--------------.--•-----.------------------------------------ No. . d V-aterr7 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE, MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair(X) Upgrade( ) Abandon( ) System located k j b AVAL&x) d/ o 4,6 6S-7Z9ZV1e-LC-: 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 must be completed within three years of the date of this permit. ' Approved by '� / ' Date � ®.�_�.�. ld,�,J ��'' ��.!'`,,�-..�*r.(,,a f Town of Barnstable Regulatory Services Richard V. Scali,Interim Director suwsr�ai.e, : . 9MAM Public Health Division 1639, ►++�� Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 8-5-21 Sewage Permit# Z(oOAssessor's Map\Parcel 145/58 Designer: JC Engineering, Inc. Installer: Robert B. Our Co.; Inc. (RBO) Address: 2854 Cranberry Highway Address: 363 Whites Path East Wareham,MA 02538 South Yarmouth,MA On 1 Z( RBO was issued apermit to install a (date) (installer) sentie system at 16 Avalon Circle based�a_design_drawn by (address) JC Engineering,Inc. dated 6-23-21 - (designer) X I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved,changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was .inspected-and the soils were found satisfactory. t 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 inspected and the soils were found satisfactory. I certify that the system referenced above was constructed i" lance with the terms of the I1A approval letters(if applicable) O dp1IM L CHURCHILL AL N (Installer's; nature) CML 41 F (D ne'r's SignatutVARNSTABLE (Affix De t p Here) } PL SE RETURN TO 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. Q:\Septic\Designer Certification Form Rev 8-14-13.doc TOWN OF BARNSTABLE LOCATION /QnI! 6Qh,L.C-- SEWAGE# Z07 (e[' VILLAGE y� ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. ']�.Oa- $d$ .-'887-7 SEPTIC TANK CAPACITY loon1 LEACHING FACILITY:(type) (size) (Z. •S3 X NO.OF BEDROOMS 3 OWNER LISPc ,'I.nn AL-COLWI, PERMIT DATE: '[ 2 COMPLIANCE DATE: g S 2 Separation Distance Between the: Facility Maximum Adjusted Groundwater Table to the Bottom of LeachingFacili �J 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 � ��� . $ r6 A 3 1 22.5 g2.9 � .. 43 A 5o.-i S q s 49.E -0 Commonwealth of Massachusetts • , Title 5 Official. Inspection. Form -! -� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments- `• . ' ``�_�.J3!✓ 16 Avalon Ciro Property Address \ Charles& Cassia Maia Eldridge Owner Owner's Name j information is required for every Osterville MA 02655 1-11-17 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information e-3-1- �a0y 1.„ Inspector: , • t ;; . �. `a Shawn'Mcelroy • a �._ t Name of Inspector ` Upper Cape Septic Services r•. Company Name P.O. Box 73 Company Address E. Falmouth MA' 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that l 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 r ❑ Fails r - t,. I . . . , . , ❑ Needs Further Evaluati n by the Local Approving Authority Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer; if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 �ona, V6 ' A a Commonwealth of Massachusetts ' .a Title 5 Official Inspection Form R; I Subsurface Sewage Disposal System Form -Not for.Voluntary Assessments t� A 16 Avalon Cir Property Address Charles & Cassia Maia Eldridge Owner. ' Owner's Name information is required for every OStervllle MA 02655 1-11-17 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 A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of 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,W 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts t t f Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 16 Avalon Cir Property Address r, =:u•- Charles& Cassia Maia Eldridge Owner Owner's Name , information is required for every Osterville . ' - MA 02655 1-11-17 � . page. City/Town Y State Zip Code Date of Inspection B. Certification (cont.) w ❑ 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 breakout 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): ❑4 '-broken pipe(s);are replaced " '❑ Y ❑ 'N, ❑ 'ND (Explain below): El obstruction is'removed ' •❑ Y ❑ 3N ❑ ND (Explain below): ❑ distribution box is leveled or replaced` '❑ Y ❑ N "❑ ND (Explain below): i ,_ .. ;a r- t .. a _:•!. ... a << . a it .! R.'! -t.. y. ❑ 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 i 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments aF ,f! 16 Avalon Cir Property Address Charles& Cassia Maia Eldridge Owner Owner's Name information is required for every Osterville MA 02655 1-11-17 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 well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes `No ❑. ® 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 Y2 day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 r Commonwealth of Massachusetts i. :a=1 Title 5 Official Inspection Form ,WI Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments -;e a "s;!y 16 Avalon Cir , l J � Property Address Charles&Cassia Maia Eldridge �ta.` • , . .� Owner Owner's Name information is required for every Osterville MA 02655 1-11-17 page. City/Town c 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. ` ❑ ® Any portion of cesspool or,privy is within 100 feet of a surface water supply or ` tributary to'a surface water supply. r• ❑ ® 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 A 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. • r • The system fails. I have❑ determined that one or more of the above failure f® criteria exist as described in 310,CMR 15.303,therefore the system fails. The r r t system owner should contact the Board of Health to determine what will be *. necessary to correct.the failure:'..(. - E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you,must indicate either"yes" or,mo,to, 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 I. ❑ r {❑ Area'= IWPA) or a mapped Zone Il'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. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts +I f Title 5 Official Inspection Form r, JXI hI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments papa 16 Avalon Cir Property Address Charles &Cassia Maia Eldridge g Owner Owner's Name information is required for every Osterville MA 02655 1-11-17 page.e. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage 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. ® ❑ 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts = ' Title 5 official Inspection Form' ' .A Subsurface Sewage Disposal.System Form -Not for Voluntary Assessments a� 16 Avalon Cir I Property Address Charles&Cassia Maia Eldridge r f: : +. Owner Owner's Name information is required for every Osterville MA 02655 1-11-17 - page. CityTTown State Zip Code Date of Inspection D. System Information i . r : . • •-, Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection t; ❑ Yes ® No information in this report.) Laundry system'irispected? f s , ❑ Yes ® No Seasonal use? El Yes ® No Water meter readings, if available (last 2 years usage (gpd)):. , Detail Sump pump? El Yes ® No 1-2017 Last date of occupancy: Y . ., , Date Date Commercial/Industrial Flow Conditions: *" Type of Establishment: Design flow(basedton.310 CMR 15.203): t Gallons per day(gpd) -,-Basis of design flow (seats/persons/sq.ft., etc.): ,.• tf �r i r v, Grease trap present?, ❑ Yes ❑ .No Industrial waste holding tank present? t +" _, ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form R' l'i�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 16 Avalon Cir Property Address Charles & Cassia Maia Eldridge Owner Owner's Name information is required for every Osterville MA 02655 1-11-17 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: Owner--pumped 2016 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool J ❑ 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 it Commonwealth of Massachusetts T . f Title 5 Official Inspection Form ' �H Subsurface Sewage Disposal System Form -Not for.Voluntary Assessments 16 Avalon Cir Property Address Charles& Cassia Maia Eldridge Owner Owner's Name information is r required for every Osterville MA 02655 1-11-17 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: 1979 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site.plan): 18" Depth below grade: , + t" feet Material of construction: ❑ cast#iron ®,40 PVC El other.(explain); , Distance from private water supply well or suction'line: ' feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition.- Septic Tank(locate on site plan): ._• Depth below grade: 12"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: ; . 1000 gal " Sludge depth: .12 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts "2 � Title 5 Official Inspection Form hl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments J�!a 16 Avalon Cir Property Address Charles&Cassia Maia Eldridge Owner Owner's Name informati for every on is required Osterville MA 02655 1-11-17 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 20" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts .. a=I Title 5 Official Inspection Forte -� Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments 16 Avalon Cir 1t� -t J- Property Address Charles& Cassia Maia Eldridge f - Owner Owner's Name information is Cisterville MA 02655 1-11-17 required for 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 timer 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts :a=l Title 5 Official Inspection Form ' �I' fEli Subsurface Sewage Disposal System Form Not for Voluntary Assessments p_ ;! 16 Avalon Cir Property Address Charles& Cassia Maia Eldridge Owner Owner's Name information is required for every Osterville MA 02655 1-11-17 page. City/Town 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 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level and no sign of back-up from pit. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 f Commonwealth of Massachusetts }+ Title 5 Official Inspection Forrn Subsurface Sewage Disposal System Form -Not for Voluntary Assessments !, 16 Avalon Cir Property Address Charles& Cassia Maia Eldridge Owner Owner's Name • . information is required for every Osterville MA 02655 1-11-1.7 page. City/Town _ s State Zip Code Date of Inspection D. System Information (cont.) ; ,. ...►. : ' . _ Type: ® leaching pits number: 1-1000 gal ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: t ❑ 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.): Leach pit in good working order with water level and stain line at 24" below inlet invert. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts :a Title 5 Official Inspection Form f ' 51 Subsurface Sewage Disposal System Form Not for Voluntary Assessments 16 Avalon Cir Property Address Charles&Cassia Maia Eldridge Owner Owner's Name information is required for every Osterville MA 02655 1-11-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts :a=1 p Title 5 Official Inspection Form, �� .i 'i�l Subsurface Sewage Disposal System Form Not for Voluntary Assessments t; _ •t . ` Al I. ! i 16 Avalon Cir Property Address Charles&Cassia Maia Eldridge Owner Owner's Name information is 1711 ill t Oserve MA 02655 1- - required for every •�' page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately ' c aY . t • y 1 + : j C • - Y V •. 'f.• rt i' r. e( l 4 f ff hr r � f . - . • ' r, a r. Y t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form k Subsurface Sewage Disposal System Form Not for Voluntary Assessments 16 Avalon Cir Property Address Charles &Cassia Maia Eldridge Owner Owner's Name information is required for every Osterville MA 02655 1-11-17 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: 12 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: Original design plans show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 f Commonwealth of Massachusetts a l Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 16 Avalon Cir Property Address : Charles& Cassia Maia Eldridge Owner Owner's Name information is required for every Osterville MA 02655 1-11-17 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 r COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS L r DEPARTMENT OF ENVIRONM N C' � RECEIVED C pvc�' V PARCEL SEP 0 12004 LOT __- TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 i { OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS. '3 SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM -� `� PART A CERTIFICATION c31 cn Property Address: 16 Avalon Circle Osterville Owner's Name: Peter Zsiba Owner's Address: Date of Inspection: 8/17/2004 Name of Inspector: (please print) Patrick T. Sullivan Company Name: Ready Rooter Mailing Address: P.O.Box 371 .Sandwich;MA 02563 Telephone Number: (508)888-6055 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 the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The System: Passes Conditionally Passes Needs Further Evaluation by the Local Authority Fails Inspector's Signature: ,� ���� Date: f The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the , DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 16 Avalon Circle Osterville Owner: Peter Zsiba Date of Inspection: 8/17/2004 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D C. System Passes: 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: B. System Conditionally Passes: One or more system components as described in the"Conditional P s"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as proved by the Board of Health,will pass. Answer yes,no or not determined (Y,N,ND)in the for th ollowing statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or tl/e septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration ox 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 strugt`urally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old ispailable. ND explain: f 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 obstruction is removed distribution box is leveled or replaced ND explain: 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):pipe(s)are reP brokenlaced obstruction is removed ND explain: /� Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 16 Avalon Circle Osterville Owner: Peter Zsiba Date of Inspection: 8/17/2004 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the 7B /rdofHealth 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 determes in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which I protect public health,safety and the environment: _Cesspool or privy is within 50 feet of a urface water Cesspool or privy is within 50 feet o a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if ar )determines that the system is functioning in a manner that protects the public health,safety and enyXronment: _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 Zofie 1 of a public water supply. _The system has a septic tank and SAS and the SAS is within/�O feet of a private water supply well. _The system has a septic tank and SAS and the SAS is les.%'than 100 feet but 50 feet or more from a private water supply well". Method used to determine dis nce "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that th�well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen isJequal 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. i i 1 f� f ,l 3. Other: t J J Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 16 Avalon Circle Osterville Owner: Peter Zsiba Date of Inspection: 8/17/2004 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _ —ZBackup 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 and overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than'/z day flow -4/- Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is 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 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,provided that no other failure criteria ^� are triggered.A copy of the analysis must be attached to this form.] 1�.:(O(Yes/No)The system fails. I have determined that one or more of the above 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 a large system the system must serve a facility with a desig flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria ab ve) yes no _the system is within 400 feet of a surface drink/terim _the system is within 200 feet of a tributary to a water supply the system is located in a nitrogen sensitive arehead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section/ the system is considered a significant threat,or answered "yes"in Section D above the large system has faile fThe owner br operator of any large system considered a significant threat under Section E or failed under ection D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the a ropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 16 Avalon Circle Osterville Owner: Peter Zsiba Date of Inspection: 8/17/2004 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? 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 than owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No Existing information.For example,a plan at the Board of Health. _✓_ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 16 Avalon Circle Osterville Owner: Peter Zsiba Date of Inspection: 8/17/2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):3250 Number of current residents:_C-) Does residence have a garbage grinder(yes or no): A. r Is laundry on a separate sewage system(yes or no):►,,�[if yes separate inspection required] Laundry system inspected(yes or no):= Seasonal use: (yes or no): Yc. Water meter readings,if available(last 2 years usage(gpd)): Sump Pump(yes or no): A-X=:� Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 14systeim gpd Basis of design flow(seats/persons Grease trap present(yes or no): Industrial waste holding tank preseNon-sanitary waste discharged to th or no):_ Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: �. �r-- -��,,•� Qxx�c� - � .r11 Was system pumped as part of the inspection(yes or no): � If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYP OF SYSTEM eptic 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) _Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): A, _)C- Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 16 Avalon Circle Osterville Owner: Peter Zsiba Date of Inspection: 8/17/2004 BUILDING SEWER(locate on site plan) ,s Depth below grade: �1( �� / Materials of construction:_cast iron PVC_other(explain): Distance from private water supply well or suction line: �/ A Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: (locate on site plan) Depth below grade:19"' Material of construction: concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: i�- � 5 Sludge depth: 'a Distance from the top of sludge to bottom of outlet tee or baffle: -3'4 Scum thickness: k " 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.): c� GREASE TRAP:_(locate on)site plan) Depth below grade:_ 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 o baffle: Date of last pumping: /� Comments(on pumping recommendations, inlet a Q outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,el ): I Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 16 Avalon Circle Osterville Owner: Peter Zsiba Date of Inspection: 8/17/2004 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��olyethylene_other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working or r(yes or no): Date of last pumping: Comments(condition of alarm and floa switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(not 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 or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,co ition of pumps and appurtenances,etc.): r Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 16 Avalon Circle Osterville Owner: Peter Zsiba Date of Inspection: 8/17/2004 SOIL ABSORPTION SYSTEM(SAS):—Z'(Iocate on site plan,excavation not required) If SAS not located explain why: Type �Zleaching 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.): ^ n 5�`�vl.,�, c9�° ' �y`cAJ-••vsc�`".c �:\t�.r�. �.ram \.-.•:�,� ��.a.4�-tt�.r� V�e��:v��� �,r�U�� �EiV�P,•�� i....�,t.®}^ � ' �j`2�c,ta..J •.v�t.�`Q..I�V , CESSPOOLS: (cesspool must be pumped as part of i pection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(sig/of o): Comments(note condition of soil, 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 hydraup failure, level of ponding,condition of vegetation,etc.): J J i"r • Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 16 Avalon Circle Osterville Owner: Peter Zsiba Date of Inspection: 8/17/2004 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate allwells within 100 feet. Locate where public water supply enters the building. �7 'f O 7 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 16 Avalon Circle Osterville Owner: Peter Zsiba Date of Inspection: 8/17/2004 SITE EXAM Slope Surface water Check cellar'l/"— Shallow wells Estimated depth to ground water( feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record—If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with the local Board of Health-explain: Checked with local excavators, installers-(attach documentation) _,,Z'Accessed USGS database-explain: �,,,lc� A�•er ,� SQ,� You must describe how you established the high ground water elevation: TOAr O SAWNSTABLE SEWAGE# LQCA'�7,AN ,. G�f Ill, ,VII,tAGE ��: `ram ASSI~SSt}R'SPAP LOT SWAM c4�'IIOAjE T�4 f57sZ� SEPTIC TANK CA'ACITY LEACfIYNG FAC1Tit• (size) �" U NO:OF-BEDIKOOM5 3 �v DERoko r PERTDATE cc�>v�r.k R,gATE E Soparattan Distance Between Ebe Max tumAdjusteciGroaridvVaterT ieto`the$nttomofLeacticngFaaitty Feet Pnvate V�tater Supply�Veli and I eac�ng E�ac�ty �any'�r�i#s exist oassta ar unthin 2f30 feet of Iearh�r►g far, ) ;; ': Edge of Wet�aad and feaetung Eaa'lity(If aay wetlands exist - aWWW t 3(30 feet f teacEung f } r Fee[ Funusbed by+: � ,r - f ,Qa ck 6 � Loi 9 d3 . a, A-3 4o�L $9-3 - 3a °� � A,,L-1. 73� Q _ 37 r No....--.... ..... Fes$.....z.$i............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH PJ' Atip iration for Uiwsal Works ntrttrfunt rrntit Application is hereby made for a Permit to Construct ( or Repair( ) an Individual Sewage Disposal �Syst at: © t�V Z�. 2_ _04�.. Z .. .... — •- ---- ---------•----------j-- ------ ---------------- .. ... ........ Loa* n-Ad s �l d or t No. -- _ . ...._ .............................................. ........ ..-.. 7:.... weer . .......................................... •........ . . .............. ......... .. ................................... Installer Address e of Building Size Lot..J.a��r ....Sq. fe t U DwellingNo. of Bedrooms........... ----------------•-Expansion Attic Garbage Grinder (� Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q, Other fixtures ----------------_----------------•------•------ W Design Flow............... 5; ................gallons per person per day. Total daily flow........ .:Q... ............gallons. WSeptic Tank—Liquid capacity/O&Ogallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length......... ....._... Total leaching area....................sq. ft. Seepage Pit No............ .......piameter...... _...... Depth below inlet.... ......... Total leaching area...A.'g4sq. it. Z Other Distribution box ( )) Dosin t ) Vom ~' Percolation Test Results Performed by. l�. _ ....... ., �------------------ Date...�..-.�3:.7�_'......_.. a 2'.minutes per inch De th of Test it................... Depth to ground water........................ Test Pit No. 1.... 0;4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ V. Description of Soil................ Z Z ............... .-.� wi ......... x U ..........................................................•------••---••.••... W U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ............. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal Systemlri accordance with the provisions of iIT .; 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b een issue by he rd of healt Si Date Application Approved By--•••-••-•---•-•-... .... • •--LL�1.lt Date ...._.. Application Disapproved for the following reasons:.................................... easons:.................................... .................................................... .............................•-•--...------•----....------------••--•-•-•-••-----•----------•-----....---'--------------••-------....------••----•-•-•---••---•------•• •------•-•--•---------....••--- Permit No......................................................... Issued.-'.1._14— 77 , _......................................at Date No..- -9•- .....4 FEs.... THE COMMONWEALTH OF MASS ACkUSETTS BOARD OF HEALTH Appliration for Disposal Works 1 strurtioo Prrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual AWage Iisposal Systems at: �,. � � � � �•M, —7 .--: = ...............:...................................... .................................. --...- ...... /17 `y/!/• LL4c��f�'on-A ress� //cJ _ or t No. ..S.S` ..K...:..1... .. .............................. -tom 0 .... :/_�+.._. ... .�.'�_�..�.....:..... y .. w�._. Add j. wner 1 ' a ` .• Y' Installer Address —` T e of Building Size Lot., .' l� °r .Sq. fe�V ,. Dwelling—No. of Bedrooms............. ..........................Expansion Attic ( ) Garbage Grinder /144 04 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) __ ---:s--.---...._..._..gallons. WSeptic Tank Liquid"capacity/_'gallons Length................ Width.. ...... Diameter................ Depth._.._____..._.. x Disposal Trench -- No ................. Width .............. Total Length.........4. ..._ Total leaching area........ ......... q. ft. Seepage P>t`No ___._.-. ' pag �iameter_.._._..... ._. Depth below inlet....... ..... Total leaching„area.......r..�- q. ft. : Percolation Test Resul ( ) pe Dosi..Other Distr bution box N to 2 rformed by_ a '®/ Date ..� �` a -------- --------- -------- --------------------•-----••----- -•-•----------- ...---------.....----- Test Pit No. I................minutes per inch Depth of Test Pit..........:......... Depth to ground water........................ 44 Test Pit No. 2.._..........,..'minutes per i ,h-':Depth of Test Pit _... Depth to gr nd water .....____ ........................................ . ((( o , Description of Soil ;. -- =------_..._ ........ ---•-------- U ...--•---•.--•_. ._.... -----------------------•----------------.....-•---.......--•----•-.. --_..... .... ... -•--•----•------_.. ................................. W VNature of Repairs or Alterations:—Answer when applicable................................................................................................ ..--•---•--------------------------------•----••--_...... Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of ': .,.;., 5 of the State Sanitary Code—The undersigned further agre ' not to place the system in operation until a Certificate of Compliance has b n issue by jhe rd of heal .....y R: S d. ��..�' . -- . -- �f wit ,,r U'� • r �Dat Application Approved BY =='•:_._... ............................................................�..........._ ...............................---- Date Application Disapproved for the`following reasons:................-................................................................................................. Permit No.......................................................... i�. Issued................. ....................................... i;, a•. ' 'Date - THE COMMONWEALTH'6F MASSACHUSETTS' BOARD F HEA TH G 5 � -. OF M Trr rw of (90*pliattrr THIS S TO ER Y, That ;e individual Se ,age Disposat System construc_"ed ( or Repaired ( ) 1 " l by / !" . �� � ' � . Ins• .� �.j' � -....._i J.Ln" . at.......---••----... � .a ---• --'� ....2-.. c -' 1. ✓LY- has been installed in accordance with the provisions of ,DfoThe.State,Sanitary�Cod der ed in the application for Disposal-Works Construction Permit No---- __•.... ........... ....PY J dated._ ..-____ ____--•.. .-_Z+s.............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. S- DATE: . r .. ._......--- Inspector ..... ... }; ---...... THEE COMMONWEALTH OF MASSACHUSETTS ` :r is BOARD OF HEALTH ..... 5. . ..... . ... f , FEE..:...5............. i o It rkVIA otr i'�i. Permission is -reby granted...... .✓--_- ------- ........... Cyr-•--:- ;- -- --- , to Construct r:or Repair ( ) an I ividu ,wage Ls�osal.:' ; i at No...---- .......;24..••--- ' Lt d •............. Stree " r as shown on'the application for Disposal Works Construction Per "No Dated.._._ '<•. •...._.----- `� ,: o d e DATE-------lt 2--F,... -1t=............................. J / FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS T.�1 L`-( FLC��/ a 1 ip ,c '3 33d G•t'•b IC ��.Pt-1G T��l1C = 330� 1�G % • .�S G.RD. i>•-� U S(---- t O C>c) 6 A / ! SFo�•AL PiT - uSE� logo GdL. 4 I�tpcxa ,p u�-, .. Its SF- �c A2.5 � 3'7.rj7•7I�.PD. .,°" • �" 2���",��ty �R •� .., _ sue. 1 .0 •_ Sb �.RD. d� TOTAL -r->SSIGQ = 42S G.pD.' _ ' TA 'i oTo� �,�1 Lam{ r-Low•- 33C? 6.w. �__ .�- �a�p ,_ Pt7--fLG17L&TIOtJ OkA-M Cmj 2-Mi u 02 lL-q;. a ly +.0 �Jtm .017 pd� ' ..�•..,. r w• mo s .�y 1#''yir^" !iR Haq, � -t 4 t } I��•1/{./ `:Ca .'w:� x' ', TEST (') ln Tor Fuo 4 r fr. •_) yC7••2 .jam '� ��1I\�, I \♦ + 4'�P� iw• G a�. 90.1 .' tNv. BOx 4(,,�1 SePnc 10 Z t TA14W. (ooDS•� GAL. �w t►!V• i. P-T t;��� WASNELI h• 5T0�.1� �SS - CEtZ'C'ttr1ED Pt--cb7' Piz,OF=tc.._f:-- LOCAT101-4 Ce-;TeR-v, L try -- 1=v�5 IZ ►.�C> c C A t_t- It r>,'-r C i Z 13 t��! GGtZT1��{ T�-lAT T;Nt_ -DwRh�..L.tw(o SUow►.1 PLAtJ R��cRE►JGE 1-lF.k?L-::D1J G[�1r�PL�(S W 1'Y'k� TNi= �jID� L.t►-tE: Aura �t T���c1< S'GQ�.1l�EMc ►.11':, OF •rNLCT Z'7 rjAlrG t2EGtSf�C.tzED LAWO 5uev&YO"s T141-5 01-A►J 1-5, ►-.(UT 1L'se.=>CL7 CA-4 AW IIJSf :J ,/t C=tJT �iUG •l t�y� .1bUA.I>' Qta{-7 (�•1'ij' t. t:� u•;c�> ��_, k,r.l•i;c_M►►.It_ l..n-C' l_{{J�•� •- LDA�AL. L 0 CAT 10� , ` SEWAGE PERMIT N0. VILLAGE INSTALLERS aAIDE 8 ADDR ES'S 0 U I L D E R OR �WNECI J , . DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED �, � � � � � 7 / � � 02-7 �� it �� i �*.. ?• �, i a j S U _ d 42- P. — a i L IE ' - t. : T - _ ---- - rcnoerl --T L anti, 9{Rap xcrGcS't. i s peni Cron CIu6e'F"-� - - - -. __ �. y ..': II J j ,N Pr Sol� �l,4fe _ o r .i N v - aX ,. t . FINISH GRADE OVER D-BOX= 47.O't , T.O.F. EL.= 49.7 t FINISH GRADE OVER CHAMBERS= 46.2 - 47.5, /4„T ' GENE RAC. NOTES SLOPE @ 2% MIN. OVER SYSTEM PROVIDE EXTENSION RISER 3 O 1-1/2" DOUBLE WASHED REMOVABLE WATER-TIGHT COVER OVER STONE TO CROWN OF PIPE I WITH COVER OVER INLET& RISER TO WITHIN 6"OF FINISHED GRADE 4"SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS 1• UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISH GRADE OUTLET TO WITHIN 6"OF F.G. 0 2"OF 1/8"TO 1/2" DOUBLE WASHED METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL c@ FND. EL.= 46.0'# F.C3.OVER TANK EL. =46.O�t r5"DIA. OUTLET(S) MIN SLOPE 1/o BOX TO F.G. (SEE NOTE 21) CODE AND ANY APPLICABLE LOCAL RULES. 1 _ STONE OR GEOTEXTILE FILTER FABRIC 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE PROPOSED 4" i 9"MIN. „ 1 TOP OF SAS=44.50 PLACE RISERS ON ALL DESIGN ENGINEER. EXISTING 4" 9 MIN. CHAMBERS w/PIPED �, -SEWER PIPE SCH. 40 PVC 36' MAX. j 43.50' 36"MAX. � INLETS TO WITHIN 6"� , 3. 4 SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL -1 SEWER PIPE ! BREAKOUT EL= 44.00 SYSTEM UNLESS OTHERWISE NOTED. OF FINISHED GRADE - -- 3" DROP MAX 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN - 6" 3" 2" DROP MIN 3.� 9" L=14't PROVIDE WATERTIGHT MIN-sLOPE01°y, ELEVATION=44.00' FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE SAS. UNLESS A i; 13" E4" PVC IN FROM JOINTS (TYP.) o � 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF ` *4,� 1'# fPTIC TANK 4" PVC OUT TO 0 O 0 0 0 C� o 0 0 0 O 0 0 o THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. CONTRACTOR TO PROVIDE ! LEACHING FACILITY o SPECIFIED DROP BETWEEN 12" oo 00 o o o I 5. SLOPE ALL SOLID PIPE AT 1.0°10 MINIMUM. INLET AND OUTLET CONTRACTOR CONTRACTOR SHALL OUTLET TEE 43.87' MIN. 43,7Q' o 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. SHALL VERIFY SIZE 48 VERIFY CONDITION OF \ 2 0 o 0 0 = o0 AND CONDITION OF EXISTING TEES � � i 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK GAS BAFFLE OVER MECHANI CRUSHED OCALLY oo 0 0 0 CD 0 oo FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE 5 i 4.0' I 4 0 I AND DESIGN ENGINEER. 8.5 TYP I OUTLET DISTRIBUTION BOX ( ) 4.0 4.83' 4.0 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. SEE BENCHMARK ELEVATION AS TO BE INSTALLED ON A LEVEL STABLE , 25.0' (TYP.) ' SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET , GROUND WATER ELEV.= < 35.20� A I PIPES TO BE LAID LEVEL. 41 .50 12.83' 1 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK 2 - 500 GALLON CHAMBERS 5' MIN. ` THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW �,Hkv1BER LwL 'v IL-_'vV I 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES `CONTRAC _m T� it Y EXISTING TYPICAL CHAMBER PROFILE TO THE DESIGN ENGINEER. ELEVATION PRIOR TO ANY WORK& SEPTIC (� ! I i-�(' ®�ST R�'B k' OX DETAIL H�-2 Q C I� . I S F r 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 100.00' ROUTE 2g , , 6� "� TEST PIT DATA 11 REGULATIONS. OWNER/APPLICANT. NO DETERMINATION HAS BEEN DIS TO OBTAIN SUE AS TO CH DETERMINATION CE NTH DEEDED OFROMNING NOTES: �` I N85°33' 10"VI/ _ /r ---' APPROPRIATE AUTHORITY. PERC NO. 21-155 0 ! / I �� ; �. I 1 I INSPECTOR: Donald Desmarais(BOH) i 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED + 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF x + �! 23 , 1 UNDER MORE THAN 3 FEET OF COVER OR LOCATED UNDER PAVEMENT, DRIVES, OR EACH SEPTIC SYSTEM COMPONENT. w + ° Jt + ' EVALUATOR: Michael Pimentel, EIT, CSE x � � ` -- �� _ '. 'bd , �• j TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING. Z \ �� 1� �✓ C.S.E. APPROVAL DATE: Oct. 27, 1999 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE x i '7• 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT x `r / r �� ' , , DATE: June 1, 2021 DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF t0 ! 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. ,�, ` E (i �!.' TEST PIT#: 1 MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. • _ ELEV TOP= 47.20' I REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, ' 3.) ENTIRE PROPERTY IS LOCATED WITHIN A MASS DEP ZONE II, x / j ' { _ ' � y-/ 1 ELEV WATER= < 36.20 FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3) GROUNDWATER PROTECTION OVERLAY DISTRICT AND THE ESTUARINE x 1 n 11 WATERSHEDS. I 1 ' fit) !� 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN PERC RATE_ <2 min./inch SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. 4.) SWING TIES SHOWN ON THIS PLAN ARE PROVIDED ONLY AS A COURTESY DEPTH OF PERC= 30"-48" 16. PROPOSED PROJECT IS LOCATED WITHIN: L FOR THE INSTALLER. INSTALLER SHALL VERIFY SWING TIE MEASUREMENTSA„4 ASSESSOR'S MAP 145 LOT 58 IN THE FIELD PRIOR TO INSTALLING THE SYSTEM. CONTRACTOR SHALL / J v x _ TEXTURAL CLASS: I - NOTIFY ENGINEER IF MEASUREMENTS APPEAR TO BE INCORRECT. , `r {` ; OWNER OF RECORD: LISA ANN MALCOLM TRUSTEE / t: Yo e' . / \ $ 0 47.20 ADDRESS: 16 AVALON CIRCLE 1 A� / TREE (TYP) �� Fill OSTERVILLE MA 02655 EXISTING LEACHING PIT TO �/ ��, �� K. ,E III LOCUS A 2 loamy Sand 46'20 FEMA FLOOD ZONE X BE PUMPED, FILLED wl / �'2 f PROPOSED SHED % k; /\ • �' 10Yr 3/1 CLEAN SAND & ABANDONED O INSPECTION j f * '� 1 18" 45.70' COMMUNITY PANEL# 25001C0544J �� // PORT - / ' 1 * . - 5 , �- - g Loamy Sand 17. DEED REFERENCE: L.C.C. #222176 1 �°� 3 I , / + - + 10Yr 5/8 O „ 18. PLAN REFERENCE: L.C. PLAN 34608-B � �r (2 ( 25.0' 47x5' ,I R r .`R, �`•�.- � � �; '� j Pe c0 44.70 I 1 anberr // 19. ALL DISTURBED AR HA T yAREAS SHALL BE RESTORED O ORrGINAL CONDITION. TP `•� ; ; �� Bogs r t �� i 48' 43.20' 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY r- ii m FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY X + 15.0' v 0 Q 80 Benchmark • .� •• _ _ - , � -- -`- Medium Sand FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. K C i `* Nail Set in 18"Tree �, .• �� Jar 2.5Y 6/6 TP 1 Elev. = 50.00' h � o r 21. A 4 PERFORATED SCH. 40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A 1 I - DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A Approx. MSL REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. I! 1) 47x2' 47 / ) j PROP. H-20 x5 4)1 PROPOSED TWO (2) " LOCUS PLAN 22 REQUIRED PERMITS AND APPROVALSLOR THIS PROJECT.SHALL BE BLE TO OBTAIN ANY AND ALL i J: + / DISTRIBUTION BOX Yka 500-GALLON H-20 Qv � I LEACHING CHAMBERS x SCALE: 1"= 1000' i 1 / I 10 r w/ STONE X 132" 36.20' m x / - �t X No Mottling, Standing or Weeping Observed _ ---. --- EXISTING 1,TA GALLON / � j � �'^► DATA � ��� PIT_ �� ��� �-+ {-� SEPTIC TANK TO BE - -� ) I 1 ! DESIGN DATA r LEGEND USED IN THIS DESIGN , i Z I I O t E PERC NO. 21-155 g o ,o 1 a DECK PATIO INSPECTOR: Donald Desmarais(BOH) a 50x0' EXISTING SPOT GRADE o -t .-___ ` I x NUMBER OF BEDROOMS 3 0 to N 1 EVALUATOR: Michael Pimentel, EIT, CSE - - - 50 - - -- EXISTING CONTOUR 0 / x DESIGN FLOW 110 GAUDAY/BEDROOM C-1 ' x C.S.E. APPROVAL DATE: Oct. 27, 1999 to I "'' J , TOTAL DESIGN FLOW 330 GAUDAY -� 50 PROPOSED CONTOUR 1 TOF=49.7't / / ;�, /�i ' I DATE: June 1, 2021 DESIGN FLOW x 200 % = 660 GAUDAY TEST PIT#- 2 50 PROPOSED SPOT GRADE TOF=45.6'± I N / HC- r { USE EXISTING 1,000 GALLON SEPTIC TANK ELEV TOP- 46.20' EXISTING GAS LINE #16 w i EXISTING o ELEV WATER = <35.20' EXISTING OVERHEAD UTILITIES j 3-BEDROOMC14�O ! W V� EXISTING WATER LINE DWELLING INSTALL 2 - 500 GAL. CHAMBERS w/ STONE PERC RATE_ SIDEWALL CAPACITY I DEPTH OF PERC �� TEST PIT LOCATION i I TEXTURAL CLASS: I / (LENGTH + WIDTH) (2 SIDES) (2' HIGH) (0.74 GPD/S.F.) = GAUDAY MAP 145 ' / ,; MAP 145 (25-0' + 12.83')(2) (2' ) ( 0.74 GPD/S.F.) =112.0 GAUDAY O O EXISTING 1,000 GALLON SEPTIC TANK LOT 57 1 l .LCj LOT 59 BOTTOM CAPACITY 0" 46.20' PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE I k1b 3 �P� ; (LENGTH x WIDTH) (0.74 GPD/S.F.) = GAUDAY Fill PROP H- r I (25.0' x 12.83') (0.74 GPD/S.F.) = 237.4 GAUDAY 12" 45.20' ® PROPOSED 20 DISTRIBUTION BOX ii A Loamy Sand vP�3 i 18„ 10Yr 3/1 44 70' PROPOSED 500 GALLON H-20 LEACHING CHAMBER MAP 145 / TOTALS: B Loamy Sand LOT 58 ! ' j s TOTAL NUMBER OF CHAMBERS 2 10Yr 5/8 _ _ TOTAL LEACHING ARFJ> 472.2 SQ.FT. 30" 43.70' REV. DATE BY APP'D. DESCRIPTION 1 / / 15,000t S.F. - _� i o l TOTAL LEACHING CAPACITY 349.4 GAL./DAY PROPOSED SEPTIC SYSTEM UPGRADE m / I PREPARED FOR: ¢s 4 c Medium Sand i ROBERT B. OUR CO., INC. 1` � � 8, � � 2.5Y6I6 i LOCATED AT 16 AVALON CIRCLE 100.00' ~ - _ OSTERVILLE, MA 02655 SWING-TIES �� ,- N85°33' 10"VN _ __- ! SCALE: 1 INCH = 10 FT. DATE: JUNE 23,2021 - � 132 35.20 DESCRIPTION HCA HC-2 SN 0 5 10 20 40 FEET No Mottling, Standing or Weeping Observed CORNER OF STONE (1) 33.6' 54.5' t // '` i = A N L � PREPARED BY: w RESERVED FOR BOARD OF HEALTH USE CHURCHILL JR. �N JC ENGINEERING, INC. CORNER OF STONE (2) 43.8' 61.5' _ v _ N 41807 2854 CRANBERRY HIGHWAY AVALON _ , 1 EAST WAREHAM, MA 02538 CORNER OF STONE(3) 60.9' 44.5' CIRCLE EDGE OF pgVEMENT SITE PLAN (40'WIDE I-AYOUT) CORNER OF STONE(4) 54.0' 34.3' 508.273.0377 _ SCALE: 1"= 10' Drawn By: MCP Designed By:MCP Checked By:JLC JOB No 5748