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HomeMy WebLinkAbout0017 AVALON CIRCLE - Health 1.7 Avalon Circle OSterville A= 145-061 / I Commonwealth of Massachusetts Title 5 Official Inspection Form vxl Subsurface Sewage Disposal System Form Not for Voluntary Assessments , m,"'7 C1r Property Address ,f R?/3 Owner 4;"7 0 eq#eOwner's Name �information is •required for every J d—� OZ/ page. CitylTown State Zip Code Date of In ec— Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Infor ation . on the computer, // 0 / use only the tab WC►YHr /ski key to move your Name of Inspector �— cursor use the -do not use Company / /)V //0 key. / G� the return Com Name � / xn iaQ �' O)z Company AddressZ_"_ City/To State Zip Code TS-o�3 ) t v--� QO Co Telepho)4e-Numberz License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance n-site sewage disposal systems.After conducting this inspection I have determined that the sys 1. Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails Inspect 's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate - regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 i Commonwealth of Massachusetts �s a Title 5 Official Inspection Form I. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address AVOW too Owner O „T t r Owners Name information is 1QS4 rv` oa655 a3 required for every ��✓✓ a/ page. City/Town State Zip Code Date of Ins ction C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) Syste asses: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank.failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): tsinsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface sewage Disposal system•Page 2 of 18 Commonwealth of Massachusetts �. P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name information is Ds �. required for every ity/Town -- page. C State Zip Code Date of In pectio C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or.due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): f ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.726/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owners Name 0� a information is O (0 a. required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. . ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool El due or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Se.rage Disposal System•Page 4 of 18 Commonwealth of Massachusetts 3 - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments / 7 A vi!o o c ..., Property Address r Owner Owner's Name information is 05 ���/ O}Vv�l/ required for every 10 ✓ page. City/Town State Zip Code Date of InspEktion C. Inspection Summary (cost.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ 0111�- Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2day flow ❑ 1�—(/ Required pumping more than 4 times in the last year NOT due to clogged or / obstructed pipe(s). Number of times pumped: ❑ t—jQ/ 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. ❑ gor Any portion of a cesspool or privy is within a Zone 1 of a public water supply /well. ❑ [y'/ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis "and chain of custody must be attached to this form.] ❑ system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 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. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section C.4. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zane II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 0 i; / 7 vol low Cl-1 1/1 Property Address Owner Owner's Name l/ information is required for every 0s4ev-11, Ile- page. City/Town State Zip Code Date of Insped1on C. Inspection Summary (cont.) If you have answered"yes"to an y y y question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: YesX ❑ mping information was provided by the owner, occupant, or Board of Health ❑ re any of the system components pumped out in the previous two weeks? ❑ s 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) as 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? ❑ ere the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with ❑ information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS) on the site has been determined based on: Existing information. For example, a plan at the Board of Health. ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] t5insp.tloc•rev.7126/2018 Title 5 official Inspection Form:Subsurface Sege Disposal system•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 117 Ay6ile-o Cie- Property Address Owner Owner's Name �r information is 0s. I e�v) � a n �� required for every T .2/ page. City/Town State Zip Code Date of Insp ction D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms(actual): - 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 3 Description: n/ /00a o �e tz- a w J—)aJe't 6 9,44t -7 Yt ( W Soo �flm a4av"4V w 4t1- - 0 Number of current residents: Does residence have a garbage grinder? ❑ Yes Now Does residence have a water treatment unit? ❑ Yes [-'No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes 9� o information in this report.) Laundry system inspected? ❑ Yes L-�0 Seasonaluse? ❑ Yes P.-No Water meter readings, if available(last 2 years usage(gpd)): — Detail: Sump pump? ❑ Yes Last date of occupancy: Date t5insp.00c•rev.7/262018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v Property Address �Y Owner Owners Name information is ,r required for every page. City/Town State Zip Code Date of I spec on D. System Information (cont.) - 2. Commerciallindustrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): _ Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to.- Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: ©���/ Was system pumped as part of the inspection? ❑ Yes o ;:�If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: — t5insp.doc•rev.7t262018 Tide 5 official Inspection Form:Subsurface Sewage Disposal System•page 8 of 18 Commonwealth of Massachusetts 69 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments /7 qva/0', C r Property Address Owner Owner's Name information is v�A0, required for every l/ D6 .G� page. City/Town State Zip Code Date of Insi ction D. System Information (cont.) 4. Type 7ofSem: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under'contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and so��ce of information: cyv p'�Q 1✓tk� /��iW J•/�•s CZ019 Were sewage odors detected when arriving at the site? ❑ Yes No 5. Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑cast iron 0 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address �2a Owner Owner's Name 0.54,ewo information is114required for every ct' page. City/Town State Zip Code Date of In4action D. System Information (cost.) 6. Septic Tank (locate on site plan): d-0 Depth below grade: feet ;eria'o"construction: concrete ❑ metal ❑fiberglass Elpolyethylene Elother(explain) If tank is metal list age:g years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Old 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 O How were dimensions determined? -- ce Comments (on pumping recommendations, inlet and outlet tee or baffle condi ion, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): _ — Gas, t5insp.doc.rev.7262018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts �. Title 5 Official Inspection Form is Subsurface Sew er-�Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name information is required for every �✓�j _ /� ��b J O'�' �� eZ/' page. City/Town State Zip Code Date of lnspCction D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness --- Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: -- Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.?126l2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments / 7 AA G -14 Property Address Owner Owner's Name I information is required for every page. CitylTown State Zip Code Date of Ins ection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Y,e-� Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments / 7 Property Address Owner Owner's Name /� A information is o V • /4 required for every page. City/Town State Zip Code Date of Insphction D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Sao 6-ci loth aType: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface sewage oisposal System-Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name rrv,a r information is ` `UY re uired for eve J l/ _ q every 4 Ja 2 2j City/Town/Town State Zip D f page. tY p Code ate o Ins ection D. System Information (cont.) 11. Soil Absorption System (SAS)(cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): O `r - A 6 r✓� 4yte� ��►c��n J l gb/15i Oygol'e 4 Cll"4 �i L -744y k ee t 12. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth-top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool - Materials of construction - Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.726/2018 Title.5 OffiGal Inspection Form.Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �ia Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner O wners Name information is I /� required for every 'S Y�P_. ( (/ p2, -2L.;, page. City/Town State Zip Code Date of Insp ction D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: - Dimensions Depth of solids — Comments (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i t5insp.doc•rev.726/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts �. Title 5 Official Inspection Form I. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owners Name information is os_IV %/� � P1 irequired for every /�[ f�`( V_ o� page. Cih'Rown State Zip Code Date of In pectin D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a vie f the sewage disposal system, including ties to at least two permanent reference landmarks benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the bui g. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately a, roll A3 - S, 63 37 t5insp.doc•rev.7/26/2018 Tide 5 official Inspection Forth:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name information is � l _ _v` required for every page. City/Town State Zip Code Date of In ection D. System Information (cont.) I 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells1y�__ Estimated depth to high round water: fe g g feet 'I 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 ❑ served site (abutting property/observation hole within 150 feet of SAS) Checked with local Boa of Health-explain: file ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must de:scri how you established the high ground water elevation: �U�e !/iR•,��k 7�0 lob C71- Wo Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.00c-rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sev2ye Disposal System-Page 17 of 18 Commonwealth of Massachusetts �d Title 5 Official Inspection Form 11. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments i7 Aln/V V7 ct -- Property Address Owner Owner's Name information is required for every page. CitylTown State Zip Code Date of Insp ction E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: A. Inspector Information: Complete all fields in this section. Certification: Signed& Dated and 1, 2, 3, or 4 checked C. Inspection Summary: 1,2, 3, or 5 completed as appropriate 4 (F ' re Criteria)and 6 (Checklist)completed D. System Information: For 8:Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doe•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 t I _ d_7 No. G=Olq � `y Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ipfitation for ]DisPasar &pstPm Construction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.17 by to n C i f L/.c., Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 0� �L✓i lJ� Jean A 6-e-" I taper's Names Address,and Tel.No.(860, cJ Sj p/1 Designer's Name,Addrean�Tel.No(j�"Qg )S"2 7—3600 thel s .�nG• EAS Svrvf_y -1-n 1 2 l Vandu1ji.A . 3 Type of Building: Dwelling No.of Bedrooms Lot Size , 10/0 sq.ft. Garbage Grinder( ) lVo Other Type of Building Sj No.of Persons Showers( ) Cafeteria( ) Other Fixtures Ili Design Flow(min.required) 33,,6 gpd Design flow provided gpd Plan Date NOYa m be e: / e 2.01 f9 Nuumber of sheets Z Revision Date TitleiP" Size of Septic Tank ® _ ` P16A Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable)In S•Ea l I :6o (2.)ne A, i PA h i Yt. C a t,6,rs Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. geed ' Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. C— `�0e) Date Issued No. �`9 •� _ - �w�-s'�`''a�, t � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2ppriratiou for Misposat 00stem Construction j3ermit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.17 4va l o h �'1 J'L Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Os�e�dJ�I 6ean P. ('eo Installer's Name,Address,and Tel. o.(960j 7 9-S`0I J Designer's Name,Addres ,and Tel.No(57,08 52 7r 3400 -Pi c S -rnC• EAS S urve.y -=`nC. ` , • ' ,3 Type of Building: r Dwelling No.of Bedrooms Lot Size 1�' )00 sq.ft. Garbage Grinder( ) lVo n i Other Type of Building,�j na/1. No.of Persons Showers( Cafeteria( ) Other Fixtures Design Flow(min.required) a30 gpd Design flow provided gpd Plan Date T�2n g Nuumber of sheets �_ Revision Date Title C;� �' o ! G��f 0a 4 7. Size of Septic Tank _ Type of S.A.S. r Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected- AgreemInt 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:° i ed Date Application Approved by Date Application Disapproved by '" Date for the following reasons Permit No. ,7 ®G Date Issued' rn_--- --, x a s w THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certlf Irate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired X) Upgraded( ) Abandon/�eed{ )by / at Al/9/4�'t! a-10 1L1 has been constructed in accordance with the provisions of Title 5 and the for isposal System Construction Permit No. �LPlq_ I dated Installer o Designer #bedrooms Approved -design �flow gpd The issuance of this pe t shall n tt be construed as a guarantee that the system wises ll functio r� edi Date /7 Inspector ` s -----------�---/---------------'-------------------------------------------------------------------------------------------------------- _ No. . J %/ q L Fee ! THE COMMONWEALTH OF MASSACHUSETTS T PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misp sal *pstrm Construction pertnit Permission is hereby granted to Construct( ) Repair k) Upgrade( ) Abandon( ) . System located at (����_��,rt_�.,�- 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 co leted within three years of the date of this permit. Date j b7 i : , Approved by r Town of Barnstable r Regulatory Services ti Richard V. Scali,Director. ' '"�`ASS.' ` Public Health Division 1639.Eo3ra Thomas McKean,Director. = 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: 1- 1 ¢- ZO 1 9 Sewage Permit# 7-01 9 Assessor's Map/ParceI Installer& Designer Certification Form Designer: C/� S c5i/aV16 Y AZI Installer: Address: Address: Si3tis2 w1 ( J'4t DZ SG 3 �v ��Z/ily // �fbG- -7z 9-Ali On was issued a permit to install a (date) (installer) - septic system at 7t/Wla,V1 1C aTZ11 ccGr based on a design drawn by (address) rzw#p !, y�;— dated ,y /0, Zo 19 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certiA, that the septic system referenced above was installed with major changes (i.e. `y ar'eater 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. Stripout(if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms of the UA approval letters (if applicable). o DAVID D. (I ller's Signature) " FtAHERTY, JR No. 1211 98QISTE4� SKI tae _ (De-signer's Signatur (Affix D tamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- . ..BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION THANK YOU. gAoffice formsldesignercertification form.doc Town of Barnstable P#t 8 ' Department of Regulatory Services c i Public Health Division Date I " MASS. .1 r 1.6lp.A� 200 Main Street,Hyannis MA 02601 En taxi Date Scheduled �V�iti7T<J L Tfine Fee Pd._ l U i �' Soil Suitability Assessment for S 5e Disposal `s' Performcd•By: �% ����' Witnessed By: �� V LO CAT-ION &.GENERAL INFORMATION Location Address �'1 I Owner's Namel�'�n� �(s J^JJ( I !I--Cl?_�5Y Address / s > d n Assessor's Map/Parcel• ` '-l L�� �� Engineer's Name NEW CONSTRUCTION QREPAIR fzZaS—Ut 7 _ � Telephone I TT Lund Use 3 V A • Slopes(46) v Surface Stones Al T w �/ 17 Distances ftnm: Open Water Body ft Possible Wet Area ft Drinking Water Well eft Dralhago Way ft Property Line 3d S� ft Other Sv ft SIM'TCH:(Street name,dimen ns of lot,exact Iocatlons f test holes&pero tests,locate wetlands•lrn proximity,to holes) 1A� S3 - ► Ge . Parent material(geologic) ��� /« y Depth to Bedmak Depth to Oroundwater. Standing Water In Hole: -12 OW,- Weeping from Pit Fnoa fYlr+�9 Estimated Seasonal High Oroundwater DETERMINATION FOR SEASONAL'IfIGI1 WATER TABLE Method Used: Depth Observed standing in obs.hole: � la, Depth to still mottlas: .._-,4z>U� _7 � in,' Doilth to weeping from side of obs.halo: In. Otoundwalar Adjuithlent___.'i'�--f—•---/a•--�--•ft. / Index Wetl Bonding bate: index Well IeYol w v Adj helor Adj.Groundwater.Level evel, �U i� 4/0 PERCOLATION TEST bats Time Observa7d Hole# "Z L Tinto at 0" Depth of Pero �� my -P/Ki Time at 6" Start Pro-soak Time @ Time(9"•6") End Pro-soak Rate Min./Inch Site Sul lability Assessment: Sito Passed SItp Palled: Additional Testing Needed(•Y/N) Original: Public Health Division Obserwitlon 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 Soli Horizon Soil Texture Shc1 Color Soil• Other Surface(In.) (USDA) (Munsell) Mottling (Stnucture,Stoned;Boulders. Consistency,%'t3ravol) r 4 c-a � yy C� Z�` !�" az��tol •�a��j o a • f/va DEEP OBSERVATION HOLE LOG Hole# Z Depth from Sall Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Conglatency. �o IV4 e' 7 Kty ✓ Ire," DEEP OBSERVATION HOLE LOG Hole# Depth from ., Soil Horizon Soil Texture Soil Color Sall Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.. Consistenox. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sall Color Soil Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. o t • r Flood Insurance Rate Men: Above 500 year flood boundary No— Yes Fri_ Within 500 year boundary No= Yes Within 100 year flood boundary No. r_ Yes Death of Natufally Occurring Pervious Material Does at least four feet of naturally occurring porvlo s mlitertal exist in all areas observed thrpughout the area proposed for the soil absorption system? If not,what Is the depth of naturally occurring pe vious material?�._... Cer'tificatlon I certify that on (date)I havepassed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required trainin tise a Ience described in�10 CMR 15.017. Date Signature Q:\SHPTICVERCPORM.DOC Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 17 Avalon Circle - Property Address . 7 Barnard Rd Nominee Trust Owner Owner's Name information is `v required for every Osterville Ma 02655 4-28-15 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms s 1 on the computer, use only the tab 1. Inspector: key to move your cursor-do not Matthew F. Gllfoy use the return Name of Inspector key. B&B Excavation Company Name 14 Teaberry Lane Company Address Sandwich Ma. 02644 State Zip p Code (508)477-0653 S113640 Telephone Number License Number. B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® y Passes ❑ Conditional) Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 4-28-15 Insp or'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 use at that time.This inspection does not address how the system will perform in the futur under the same or different conditions of use. Ld l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page f 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 17 Avalon Circle yV Property Address 7 Barnard Rd Nominee Trust Owner Owner's Name information is required for every Osterville Ma 02655 4-28-15 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 1.5.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally.Passes: . ❑ One or more system components as described in the "Conditional 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 over20 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. El Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 f Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 17 Avalon Circle Property Address 7 Barnard Rd Nominee Trust Owner Owner's Name information is required for every Osterville Ma 02655 4-28-15 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not,operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally passes (cont.): ❑ Observation of sewage backup or 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): ❑ broken pipe(s) are replaced" ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑. N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh (\ t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 17 Avalon Circle Property Address 7 Barnard Rd Nominee Trust Owner Owner's Name information is required for every Osterville Ma 02655 4-28-15 page. CitylTown State Zip Code Date of Inspection. B. Certification (cont.) I 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 El ® clogged SAS or cesspool El ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 17 Avalon Circle v Property Address 7 Barnard Rd Nominee Trust Owner Owner's Name information is required for every Osterville Ma 02655 4-28-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) I 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. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The- system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or'"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ 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 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 I - - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 17 Avalon Circle Property Address 7 Barnard Rd Nominee Trust Owner Owner's Name information is Osterville Ma 02655 4-28-15 required for every page. City(rown 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 l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1.7 Avalon Circle Property Address 7 Barnard Rd Nominee Trust Owner Owner's Name information is required for every Osterville Ma 02655 4-28-15 page. Cityrrown State Zip Code... Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection 0 Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d see below 9 ( Y 9 (gP ))� Detail 2013- 11 000gallons 2014-9 000gallons Sump pump? ❑ Yes ® No Last date of occupancy: Jan-2015 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 I Commonwealth of Massachusetts . Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 17 Avalon Circle Property Address 7 Barnard Rd Nominee Trust Owner Owner's Name information is required for every Osterville Ma 02655 4-28-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/user Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes 0 No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box,,soil absorption system ❑ Single cesspool ❑ 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 17 Avalon Circle Property Address 7 Barnard Rd Nominee Trust Owner Owner's Name information is required for every Osterville Ma 02655 4-28-15 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): 1,8„ Depth below grade: feet Material of construction: ® cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in good working order no sign of leakage. Septic Tank (locate on site plan): 1 Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No 1000 gallon Dimensions: 6„ Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 17 Avalon Circle Property Address 7 Barnard Rd Nominee Trust Owner Owner's Name information is required for every Osterville Ma 02655 4-28-15 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 2011 W Scum thickness 6„ Distance from top of scum to top of outlet tee or baffle 14" Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? measured I Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appeared to be in working order,Tees present no sign of back- up.Liquid level equal with outlet invert. 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 17 Avalon Circle Property Address 7 Barnard Rd Nominee Trust Owner Owner's Name information is required for every Osterville Ma 02655 4-28-15 page. Cityrrown 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.): - G (tank must be pumped at time of inspection) locate on site plan): Tight or Holding Tank(ta p p p ) ( p ) 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 Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 17 Avalon Circle Property Address 7 Barnard Rd Nominee Trust Owner Owner's Name information is required for every Osterville Ma 02655 4-28-15 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.): At time of inspection d-box appears to be in working order no sign of carryover. 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 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 17 Avalon Circle Property Address 7 Barnard Rd Nominee Trust Owner Owner's Name information is Osterville Ma 02655 4-28-15 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 6'x6' ❑ 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.): At time of inspection leaching appears to be in working order with no sign of hydraulic failure. Pit was dry at time of inspection with a stain line 1'5" below 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 17 Avalon Circle Property Address 7 Barnard Rd Nominee Trust Owner Owner's Name information is required for every Osteryille Ma 02655 4-28-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/1,3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 17 Avalon Circle Property Address 7 Barnard Rd Nominee Trust Owner Owner's Name - information is Osteryille Ma 02655 4-28-15 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 71 VolMo / Q2a� �noUS�: A z 3 n3- 14z, Q)3 - 5 Z, l t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 I - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 17 Avalon Circle Property Address 7 Barnard Rd Nominee Trust Owner Owner's Name information is required for every Osterville Ma 02655 4-28-15 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope Z Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: >20 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: pate ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Previous inspection report ❑ Checked with local excavators, installers- (attach documentation) ® Accessed USGS database -explain: You must describe how you established,the high ground water elevation: Previous inspection report where USGS topo maps were used Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts M Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 17 Avalon Circle Property Address 7 Barnard Rd Nominee Trust Owner Owner's Name information is required for every Osterville Ma 02655 4-28-15 page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater . ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i i t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 17 Avalon Circle Property Address Philomena Reed Owner Owner's Name information is Osterville MA 5/28/10 required for every - 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. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to'move your cursor-do not Carmen E Shay use the return Name of Inspector key'. Shay Environmental Services, Inc. Gw Company Name 185 Ashumet Road Company Address �rwn Mashpee MA 02649 City/Town State Zip Code 508-539-7966 3080 Telephone Number License Number 14 B. Certification >4 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 insp�e8tion was performed based on my training and experience in the proper function and maintenance#on s sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15N�40 of,,-, Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs FurtherEvaluation by the Local Approving Authority J _ 5/28/10 Inspect 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. l c� 17 Avalon Circle,Osterville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal ystem•Page 1 of 15 i t Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 17 Avalon Circle Property Address Philomena Reed Owner Owner's Name information is required for every Osterville MA 5/28/10 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A), :System,Passes: . ® 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: leach pit has 3' Liquid-4.5' stain line noted 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. 8 Answer yes, no or not determined (Y, N, ND) in the ❑ 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. ND Explain: ❑ 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 17 Avalon Circle,Osterville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments e 17 Avalon Circle Property Address Philomena Reed Owner Owner's Name information is required for every Osterville MA 5/28/10 page. Cityrrown State Zip Code Date of Inspection B. Certification (cost.) B) System Conditionally Passes (cont.): ❑, 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): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 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. 17 Avalon Circle,Osterville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 17 Avalon Circle Property Address Philomena Reed Owner Owner's Name information is required for every Osterville MA 5/28/10 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 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 1h day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 17 Avalon Circle,Osterville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 17 Avalon Circle Property Address Philomena Reed Owner Owner's Name information is required for every Osterville MA 5/28/10 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes - No- El ®' Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 17 Avalon Circle,Osterville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 I I commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 17 Avalon Circle Property Address Philomena Reed Owner Owner's Name information is required for every Osteryille MA 5/28/10 page. 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)] 17 Avalon Circle,Osterville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 17 Avalon Circle Property Address Philomena Reed Owner Owner's Name information is required for every Osterville MA 5/28/10 page. City/Town State Zip Code Date of Inspection 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 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: Unknown Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 17 Avalon Circle,Osterville-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 17 Avalon Circle Property Address Philomena Reed Owner Owner's Name information is required for every Osterville MA 5/28/10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records Source of information: Board of Health Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ 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 l/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. } El Other(describe): Approximate age of all components, date installed (if known) and source of information: 1979 - BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No 17 Avalon Circle,Osterville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 17 Avalon Circle Property Address Philomena Reed Owner Owner's Name information is Osterville MA 5/28/10 required for every _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): No evidence of leaks, plumbing properly vented Septic Tank (locate on site plan): Depth below grade: 1 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: 5x 5' x 8' - 1000 gallon Sludge depth: 2 Distance from top of sludge to bottom of outlet tee or baffle 18 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 14" How were dimensions determined? Measured 17 Avalon Circle,Osterville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 17 Avalon Circle Property Address Philomena Reed Owner Owner's Name information is required for every Osterville MA 5/28/10 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.): Tank in good condition., inlet baffle in good condition, outlet Tee in good condition. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or.Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): 17 Avalon Circle,Osterville-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 17 Avalon Circle Property.Address Philomena Reed Owner Owner's Name information is required for every Osterville MA 5/28/10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) 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 Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert D-Box Present 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.): one outlet to leach pit. Some minor solids carryover noted Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 17 Avalon Circle,Osterville•03/08 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 17 Avalon Circle Property Address Philomena Reed Owner Owner's Name information is required for every Osterville MA 5/28/10 page. City/Town State Zip Code Date of.Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan;excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1-6'diam x 6' D ❑ 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.): SAS fuctioning properly, 3 liquid in pit, 4.5' stain line noted 17 Avalon Circle,Oslerville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts - W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 17 Avalon Circle Property Address Philomena Reed Owner Owner's Name information is required for every Osterville MA 5/28/10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow Yes, ® No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): 17 Avalon Circle,Osterville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 17 Avalon Circle ---- Property Address Philomena Reed __-- Owner Owner's Name information is Osterville MA 5/28/10 required for every ---- --- - -- - — __ page. Cify/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 17 Avalon Circle,Oslerville•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts uwTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 17 Avalon Circle Property Address Philomena Reed Owner Owner's Name information is required for every Osterville MA 5/28/10 page. City/Town State Zip Code Date of Inspection I D. System Information (cont.) Site Exam: ® Check Slope . ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 20 feet.. 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 plain 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: Inspector has performed perc tests in neighborhood-refer to Topo Maps 17 Avalon Circle,Osterville•03/08 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 15 of 15 No................_1...+ -� FEs...... ..s............. ` THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............OF....`... .4" -ta li .:..-..--------------.---.-------------. Applirafion b'"r Di-spniial Works Tonstrnrtinn ramit Application is hereby made for a Permit to Construct ( r Repair ( ) an Individual Sewage Disposal Sys ..................................... -••---. ...... - fa...C! ���'yz�' ...... /�ocationt. ddress ` or Lot o�- ��--• -1.:..: 'F........ ------------ ............................• �® G� � � '4 :�..... w r ess ....... Installer f A dress d Type of Building Size Lot... -----Sq. feet aDwelling—No. of Bedrooms................�.................___....Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P4 Other fixtures ------•----•--••--------••-•-•-- . . -• W Design Flow......... _ -__' .... ... ........gallons per person per day. Total daily flow__.......: _ 3.C�._._._................gallons. WSeptic Tank—Liquid capacitylk"rC'..gallons Length------.�_.... Width....,6......... Diameter................ Depth................ x Disposal Trench—N - ---------- ------• Width..?---------------. Total Length.................... Total leaching area...................sq. ft. / --- Seepage Pit No....... -_._____-- Diameter..... ...:....... Depth below inlet.... ............. Total leaching area..................sq. ft. Z Other Distribution box Dosing tank '~ Percolation Test Results Performed by.......14 1............. Date........?�//7 .____.... a Test Pit No. 1....�.. :.minutes per inch Depth of Test Pit..___! __....... Depth to ground water.._....'....__. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ .............. . .......................................... �G -Description of Soil..... = y--------------------- .-------- -------------- ----•----• ---•-•••-•-•-----------------•--•••-••-•-•---••----••--•-•-•--------•--------•--------•--••---•-••----•-•--•-•-•-----••----•---------•--•-•-------•-...-•••-•-•-•....---........._........---------= -•-•- U Nature 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 A I"Li p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Si ned.l... . C� 6'" - - �� 41 / Date Application Approved By...... -• �, /.G _................... (� z 7-_7 ........ Date Application Disapproved for the following reasons-----------------------•---------•----------------•------•-----•---------------..........--•--•-•----......---- ..............................................-•------•--------••---•-----•---•-•---•--•-------•--....--------••--••---•-••---••-------•••••---•-•••----•-•••--•••-•••-----••--•---•--•--••------------ Date PermitNo......................................................... Issued....................................................... Date No......... I FIMs..........y_........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .---.....OF...301,k i.aA .. ApplirFation for Disposal Works Tonstrurtinn Vrrutit Application is hereby made for a Permit to Construct ( r -Repair ( ) an Individual Sewage Disposal Sys at- ' 3 0 V ........... ....................•-•---.----...... y -•---•----- _. .......... .. 0w r....... A . .............I.......... ....... o....... - .... .- Locatio ddress �/ �� • or Lot ... a ............... — � ... . ...^•.... COX:=Yi!.l i�c es.. r' � Instaer ' A �.. lit Type of Building $ Size Lot__I_��__adpD......Sq. feet U Dwelling—No. of Bedrooms..........................................._Expansion Attic ( ) Garbage Grinder ( ) aOthe Other—Type of Building ............................ No; of persons____._______________:__.____ Showers ( ) — Cafeteriar fixtures - ; ----= _.-••--------•------- -------••---- -•- ....... ............. W Design Flow._:_____ _ _ �7..__.___gallons per"p son per day. Total daily,, fipw.___...._,, _,_ __ .............gallons. W Septic Tank—Liquid capycatv,tQ .. _gallons Length...... �'..... Width__..--------- Diameter................ Depth................ Disposals Tre ich N Width _________________ Total Length Total leaching area.................... ft. x . Seepage,PIt<.TVo...... §�.Diameter,.___a___...__.___ Depth below`inlet____ __�;t Totat� thing area_" .............sq. ft. Z Other Diirib tion box (' ) Dosing tank ( ) �{ g,� '-' Percolation Test, Results Performed by .... fit.-: _ a _..... Date- �/..7 ..� $ { F-,a Test Pit No. 1....r�__�_minutes er inch Depth of,Test Pit____________________ Depth to'gr4nd water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit..................__ Depth to ground water......................... .•. . ; jI_ Description of Soil.... -.X- .---A a---- ..............• ................... .s W u .. IV � �; •------------------------ - ___........................................................ __ ._......_ _.____._......_....._ ............................................._ .......... U Nature of Repairs or Alterations—Answer when applicable......... -----------------------•--___________..._..__._.__..._._.:.___..__________.....__. ----•-------- ------- --•-•------•--•-- Agreement: -•- --•---•--........---- --------------•- , r . The undersigned agrees to install the aforele�6 ed Indivld-b)l Sewage Disposal System in accordance with f ;. the provisions of TIT1,71,,5 of the State Sanitary"Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. x1. .--.:._ Sned � :.... Date Application Approved By..... r." �r .--• . a............................ Date Application Disapproved for the following r'easons:--••---•----•-••--••=-------•---•--•---•--•---•••...•--•------...--•-----=--•--•----••--•.............•---•--- ......••----•-•---•-••••••••--•-••-•-----••--•-------••--•--•-•-..._.....-•----•-----••----•••••-•-•---....••--------------•••.........-................................................................. Date PermitNo.... .............................. Issued:.....................................•-----......--. Date THE CO,MMO.NWEALTH OF.,MASSACHUSETTS' _'BOARD OF HEALTH �tP°ti�Yl.. OF.. if irFatr of Toutpli antr THIS S ^CERT FY, T Itim idtial Sewage Disp s Sy tem constructed (�or Repaired ( ) � ":......... ... Iasta11 v has been installed in accordance with the provisions of T 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No ................ dated_-o.'..A.7- :.-7'9.-............... kTHE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. OF DATE.........{,, -'.,�. :: '.j fr..............6.....---...•;. Inspector..._ ._...-•-- :... ------------ THE COMMONWEALTiH'dF MASSACHUSETTS BOARD HEALTH 4ef .fit ............................. FEE........,i No os 1 oak (911MI ` iYri err i Permission/is hereby granted......-- -- ................ •-- •----•--•---•; •-- .. ................................ to Construct � ) or Repair ( ) an Individual ual Sewage Disposal. ystem at No........ 0...... CA.J,d --... Street as shown on the application for Disposal Works Construction P it No _________ _______ Dated__ : :.:....:-...... •-r 1 _- ------ ' +_.__ _ Board of t,w DATE. -•------ ...... �---• •-, .�3;:" FORM 1255 H0168S & WARREN. INC.. PUBLISHERS X h r I THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) m ^�c� I DATA 'U�=lGr� 17Q,T A r ;• 1 U��LL LAM 1 Lam( - 3 TS» j LA►►-�! F Low _ i l o 3 = 3 d &%P.D. EPT"1 C TA-J K = 33o,r ( G 'o i 4-9 56.P.D. �� ! uS�- t ooc� 6aL.. S:>15PCKA.L PIT - uSE loco GdL. �,.vaL.L l�eEa. = �So s.�. 15 „ • � �f'�5� � I, i 1 - ,`1 h j, D TOTAL. �ESIGa1 ' d2S G.P.D. 1 - ° ToTA J•- Ti,d 1 L2`( FLj-)W = 330 v PD. r� �� � ' p • ._ c�r1�oLL�T1b�l CZnTE : � 'w 2�rcI:N• orz LASS. ' �o P, 2� ,� � L-� Ot> T>~5T Tor 17•+0 T.goo tc-•� Poe Iuv.• _ J^ I000 Imo. A f -Box (j&4 SE4-nC l o M . Ipoo SS iwv. GaL. 4Lo o qL'Z- i :LEA.:N A p,T a• V,/11-0 Ir-'�••� r'•W44►JED CSQT tr t ED p LET" PL /_a1�1 - LoCATIOtJ TC T�!A T T i 4 GL v.'w-L.1 N L. 5 w a�u P 1==1=�= ►.I C. fcaAvkPLI-IS `� u� :-[_`f 1r1;/�C I` �'C�J I�I_`tit c-uTy �� l'N{� •- � �__L_ -�t--.fV :..� ,� ...�- • _' , g/s.';.Tc� ;r Y c 1�-J`_2GGlS tt���D t-J11v.1G �UZv�_Yol�`� (� C?cntil (-; a_1UT LA•;Ct� Uti r�.J O>Tci`u►C_Lt_ _ C'-,C.i� jig i• 1^iv.�/ti� �1f_ ,�%T (_II.1�`;� At.�-1 •LO CAT ION SWAGE PERMIT NO. , a0 )-a i VILLAGE INSTA LLER'S NAME & ADDRESS G U I L D E R OR OWN ER DATE PERMIT ISSUED s, DATE COMPLIANCE ISSUED i "1 �` i � �� �. ��� �� �� �� � +1 � LOCUS DATA - - - -r= `1 28 A V � ALON CIRCLE �pN °�R• �� CURRENT OWNER SEAN P. GEARY �y W T— W -t 46— -�-- Al _ LOCUS r � PLAN REFERENCE LCP 34608-B-1 / -C�1 =-�...�_ — c� S85' 3'10" E�' W �o r DEED REFERENCE CTF 206641 // �/ i _ 100.00' I — _ — —I —48 �a o -�- _ — HYDRANT ZONING DISTRICT RC / GP i/ ! I ----� _ _49 FLOOD ZONE „X„ D�� 36.5' �`6/ o L O T 3�� -I — - 50 " LOCUS MAP -ASSESSORS MAP 145 `�6 15,000f S.F. NOT TO SCALE. I DRIVEWAY I PARCEL 061 51 _ 18-0121 OVERLAY DISTRICT ZONE II LOT-AREA 15,000± S.F. LOT 31 15.1 I j — --52 i 0 3 tHOF Q #17 . SITE & SEWAGE 3 BEDROOM EXISTING DWELLING GARAGE o U�� EDAA, RD REPAIR PLAN STONE 0 EXISTING 1,000 GALLON o to No.28980 SEPTIC TANK TO REMAIN as \ A VA L ON CIRCL E \ PATIO N N / I 1 28.0 PD'� OS OXED OSTER VI LLE, MA Z / \ IO BENCHMARK OF DATE: NOV. 12, 2018 / Co ER / � �/ // '\ I � CONCRETEE STOOP ELEVATION 53.00 OWNER/APPLICANT: / / O; O SEAN GEARY / / I D.T.H. #1 6i / D.T.H. #2 I 25.8' 3'°x25 S S.A.S. 17 AVALON CIRCLE 0 / r OSTERVILLE, p LEACHHI MA 02655 / r I GALLON LENG CHAMBERS ' S EXISTING LEACHING PIT & SHEET 1 OF 2 D-BOX TO BE PUMPED, I I 13 I _ LOT 29 CRUSHED AND .ABANDONED IN ACCORDANCE WITH TITLE 5. / PREPARED BY: / I I I EAS SURVEY, INC. I >' / P. O. BOX 1729 / SHED p 20 30 40 SANDWICH , MA 02563 N 85-33-101, W 100•00, o to to CONCRETE BOUND CELL (508) 527-3600 LOT 37 FOUND & HELD GRAPHIC SCALE: EAS.SURVEY®YAHOO.COM 1 INCH = 20 FEET SYSTEM DESIGN RAISE COVERS TO WITHIN 6" OF FINISH GRADE EXISTING DESIGN FLOW TCF = 52.84 FINISH GRADE RAISE RISER TO WITHIN 3 BEDROOMS AT 110 GPB/D 33-2 GPD GRADE 51.1 ELEV. $1.4 ELEV. 51.3 FINISH GRADE 16" OF FINISH GRADE ELEV. 51.2 ELEVATION 51.5 REQUIRED SEPTIC TANK ///ate �� PEASTONE OR ___330 x_2 GAL. EXISTING 4" PVC 24'®S=0.036 TOP ELEV 48.60 FILTER CLOTH SEPTIC TANK PROVIDED = _1.500_GAL. • SCH 40 "--�- 4" PVC SCH 40 8' ®S= 0.02 0 0 0, o o 00000 t INV.= 49.44 INV.= 2 MIN-3 MAX o SIZE OF LEACHING FACILITY REQUIRED 49.00 10"TEE 14"TEE INV.= 7INV.=47.93 00000 0 0 00000 M :#" 48.800 0 0 )on-on 0 0 DESIGN PERC RATE ___<_�___-MIN./INCH INSTALL 00 00, o o O LONG TERM APPL. RATE-2-1-4-GPD/S.F. GAS BAFFLE „ 4'-1" LIQUID LEVEL TWO 5-0"x8-6 x3'-0 CHAMBERS " TO 1�" DOUBLE 330 _ 0.74 SF/GPD = _446 S.F. MIN. REQ. INV.=47.60 o w WASHED STONE SIZE OF LEACHING SYSTEM PROVIDED: DATUM: S.A.S. (13.0' x 25.0') a V 45.60 USING H-20 CONCRETE LEACHING CHAMBERS N q WITH 4' OF STONE ALL AROUND VERTICAL DATUM: EXISTING 1,000 GALLON ELEV. 40.4 BOTTOM (13.0' x 25.0') = 325 S.F. MSL± / BARNSTABLE GIS SEPTIC TANK TO REMAIN BENCH MARK USED: .F SIDE WALL (13.0' + 25.0') 2x2 = 152 S CORNER OF CONCRETE STOOP 477 S.F. ELEVATION 53.00 CONSTRUCTION NOTES: 477 S.F.x 0.74 G/SF = 353 GPD 18-0121 353 GPD PROV > 330 GPD REQ. = 23 GPD RES. 1. CONTRACTORS / INSTALLERS SHALL VERIFY GRADES AND 00000 0 0 00000 ELEVATIONS AND SITE CONDITIONS PRIOR TO COMMENCING 0 O ol 0 0 0 0 NO (GARBAGE DISPOSAL / GRINDER ALLOWED) SITE Bc SEWAGE WORK ON THE SITE. 00000 0 0 00000 REPAIR PLAN 2. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE I S TO OBTAIN SUCH DETERMINATION FROMWAPPROPR APPLICANT --4.0' 5.0' ---1--4.0'--� P-15818 ,(1� 3. VEHICULAR TRAFFIC, PARKING OF VEHICLES AND PLACING jJ` MATERIALS OVER THE SEPTIC TANK, DISTRIBUTION BOX AND j 13.0' D.T.H. #1 D.T.H. #2 A VAL ON CIRCLE S.A.S. AREA IS PROHIBITED GROUDATEND ELEV. 51.5 GROUND ELEV. 50.9 GENERAL NOTES: NO GROUNDWATER NO GROUNDWATER IN 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. I CERTIFY THAT I AM CURRENTLY APPROVED BY THE TITLE V AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS ! DEPARTMENT OF ENVIRONMENTAL PROTECTION OF MY SOIL 0/E/A 0/E/A TION TO CONDUCT MA FOR SUBSURFACE DISPOSAL OF SEWERAGE. SOIL EVALUATIONS AND THAT THE RESULTS 0 S TE R VI L L E � EVALUATION ARE ACCURATE AND IN ACCORDANCE WITH 310 LOAMY SAND. LOAMY SAND 2. AT LEAST ONE ACCESS POINT OVER TANK TEES SHALL BE I CMR 15.10 T OUG 15,107 1OYR 5/1 10YR 5/1 DATE: NOV. 12, 2018 ACCESSIBLE WITHIN 3" OF FINISH GRADE, WITH ANY REMAINING 6. 10" ACCESS PORTS BROUGHT TO WITHIN 12" OF FINISH GRADE. B B 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE -- - - -- -�� --- CAPABLE OF WITHSTANDING H-10 LOADING UNLESS � EDW A. STON CE IED SOIL EVALUATOR LOAMY SAND LOAMY SAND OWNER/APPLICANT: OTHERWISE SPECIFIED. 7.5YR 5/6 7.5YR 5/6 S E A N G E A R Y 4. THE EXCAVATION CONTRACTOR SHALL VERIFY THE LOCATION OF EL. = 49.3 26 EL. = 48.6 28 OF ALL UTILITIES PRIOR TO ANY EXCAVATION. y�Fp�-TM INDICATES DEEP 17 A VA L 0 N CIRCLE 5. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE DTH #1 OR WITHIN 6" OF GRADE SHALL BE MORTARED IN PLACE. D p TEST HOLE 48" O S TE R VI L L E, MA 02655 6. FINISH GRADE SHALL HAVE A MINIMUM OF 0.02 FEET PER F E ,JR N FOOT OVER THE S.A.S. AND DISTRIBUTION BOX. INDICATES 7. SEPTIC TANK SANITARY TEE'S SHALL BE CONSTRUCTED OF P-1 " PERC TEST 48 C C SCHEDULE 40 PVC AND SHALL EXTEND A MINIMUM OF 6" ABOVE /g MED/COARSE MED/COARSE SHEET 2 OF 2 THE FLOW LINE AND SHALL BE ON THE CENTERLINE AND S4NiTARO NO MOTTLING SAND SAND LOCATED DIRECTLY UNDER THE CLEAN OUT MANHOLES. 2.5Y 7/4 2.5Y 7/4 8. THE INLET PIPE INVERT ELEVATION SHALL BE NO LESS THAN (� NO WEEPING - 2 INCHES NOR MORE THAN 3 INCHES ABOVE THE INVERT ` PREPARED BY: ELEVATION OF THE OUTLET PIPE. C�, woo- 126" INDICATES ADJ. GROUNDWATER NO G.WATER NO G.WATER MoabE A S SURVEY, INC. 9. THE SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9 INCHES NO OBS. GROUNDWATER EL. = 41.0 126' EL. = 40.4 126 10. THE OUTLET SANITARY TEE SHALL BE EQUIPPED WITH A GAS BAFFLE, 4 INCHES IN DIAMETER AND CONSTRUCTED OF 4" PVC B.O.H. P. 0. B 0 X 1729 11. ALL PIPES SHALL BE SCHEDULE 40 PVC SEWER PIPE AND NO OBSERVED GROUNDWATER DON DESMARAIS SHALL BE SLOPED 1/4 INCH PER FOOT MIN. EXCEPT FOR THE SOIL EVALUATOR FIRST TWO FEET OUT OF THE DISTRIBUTION BOX WHICH SHALL DEPTH TO BOTTOM OF HOLE 10.5' ED. STONE SANDWICH , MA 02563 BE LEVEL VARIANCES REQUESTED BACKHOE OPERATOR. 12. CHANGES OR REVISIONS TO SEPTIC DESIGN REQUIRE NOTIFICATION JOEY'S SEPTIC TO EAS SURVEY INC. FOR B.O.H. AND DESIGN ENGINEERS REVIEW NONE SOIL TYPE: -_ CELL (508) 527-3600 AND APPROVAL. PERC RATE: <2 MIN. PER INCH EAS.SURVEY©YAHOO.COM 13. MAGNETIC TAPE ON ALL COMPONENTS. LOADING RATE: 0.74 GAL/SF/MIN