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HomeMy WebLinkAbout0039 BLOSSOM AVENUE UNIT BLDG A UNIT 1A - Health 39 Blossom Ave -, .MAi".'St f Osterville, :Osterville<Villa e_Condos' ' A= 117 053;-,'OOA e _ o a 4210113 BGR 10% : P a Commonwealth of Massachusetts Ti . Title 5 Official Inspection For Subsurface Sewage Disposal System Form -Not for Voluntary Assessments li a 39 Blossom Avenue Property Address Clock Works Condominium -Building A Owner w information is Owner's Name required for every Osterville M» page. CitylTown MA 02655 State 7/26/2017o Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms m en ay not be altered in any way. Please see completeness checklist at the end of the form. Important;when filling out forms A. General Information on the computer, use only the tab • - key to move your ,1 Inspector: cursor-do not use the return James Ford key. Name of Inspector T Ford Septic Services, LLC +� Company Name P.O. Box 49 .Company Address Osterville City/Town MA 02655 508-862-9400 State Zip Code Telephone Number S12482 License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address information reported below is true, accurate and complete as of the time of the inspection.arid that the was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP a p on. The inspection Title 5 (310 CMR 15.000).The system:approved system inspector pursuant to Section 15.340 of ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Eva uation by the Local Approving Authority Inspe is Signature 7/26/17 Date The tem inspec or 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 has a design flow of 10,000 gpd or greater, the inspector and the system owner shall y or 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 conat that time. This inspection does not address how the system will perform in thef ruture uof us nderthe same or different conditions of use. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 LO )d VS ` Commonwealth of Massachusetts • 4 t Totl • e 5 Official Ins pection echo Subsurface Sewage Disposal System For m - Not for Form ses Voluntary Assessments ^A-a 39 Blossom Ave nue Pro ert Ad Property dress Owner Cloc k Works Condominium - Building A ' information is Owners Name required for every Osterville MA 02655 page. CityrTown 7/26/2017 State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E./always complete all of Section D A) System Passes: ® .I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. indicated below. Any failure criteria not evaluated are 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 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): 15ins•3/13 .. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Subsurface Sewage Disposal System Form -Not for o Form Assessments As•` 39 Blossom Avenue Property Address Owner Clock Works Condominium -Buildin A information is owner's Name required for every Osterville MA page. City/I own 02655 7/26/2017 State Zip Code Date of Inspection B. Certification (cont.) - ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if Pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water le vel in box to broken or obstructed pipe(s) or due to a broken, settled or uneven distribudtioni box Systemuwill 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: El 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 15ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �„ 39 Blossom Avenue Property Address Clock Works Condominium - BuildingA Owner Owners Name information is required for every Osterville MA 02655 7/26/2017 page. City/Town State Zip Code Date of Inspection .B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank y p 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: I D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of.the following for all inspections: Yes No El ® Backup of sewage 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 'h day flow l5ins-3113 - Title 5 Official Inspection Form:Subsurface Sewage Disposaf,System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments `A.a •'•r 39 Blossom Avenue Property Address Clock Works Condominium - BuildingA Owner Owner's Name information is required for every Osterville. MA 02655 page. City/I own State 7/26/2017. B. Certification. (cont.) Zip Code Date of Inspection 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 co and chain of custody must be attached to this form.] copy°f the analysis ❑ ® 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. I5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form 7 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M a 39 Blossom Avenue Property Address Owner Clock Works Condominium -Buildin A ' information is Owners Name required for every Osterville MA 02655 page. Cityf I own 7/26/2017 C. Checklist State Zip Code Date of Inspection 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 but.plans of the system❑ il Y obtained an �d 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 8 (design): Number of bedrooms (actual): 8 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 880 l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 39 Blossom Avenue Property Address Clock Works Condominium - BuildingA Owner Owner's Name information is required for every Osterville MA 02655 7/26/2017 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: unknown Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection . ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: unavailable Sump pump? ❑ Yes ® No Last date of occupancy: currently 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: (Sins-3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Subsurface Sewage Disposal System Form -Not for o Form Assessments �M 39 Blossom Avenue Property Address Clock Works Condominium- Buildin A Owner ' _information is Owners Name required for every .Osterville MA 02655 page. Citylrown 7/26/2017 State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records:­ Source Source of information: pumped year) 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 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. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments '�.,e,•'y 39 Blossom Avenue Property Address Clock Works Condominium - Building A Owner Owners Name information is required for every Osterville MA 02655 7/26/2017 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: stem installed - 10/2/2002-per info Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron 0 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition-of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 6feet 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: 2000 gal.H-20 Sludge depth: l5ins•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 �A- 39 Blossom v A enue Property Address Clock Works Condominium_-,Building A Owner Owners Name information is required for every Osterville MA 02655 7/26/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 2 Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tees were present. There was no sign of leakage The inlet steel cover was to grade. Grease Trap (locate on site plan): . Depth below grade: n/a feet Material of construction: El concrete ❑ metal ❑ fiberglass ❑ polyethylene El 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 15in9 3/13. 'Title 5 Official Inspection Form:Subsurface Sewage Disposal Syslem-Page 10 of 17- Commonwealth of Massachusetts v Title 5 Official Inspection Form aS Subsurface Sewage Disposal System Form •Not for VoluntaryAssessments sessments 39 Blossom Avenue Property Address Clock Works Condominium - Building A Owner Name information is Owner's required for every Osterville MA 02655 7/26/2017 page. City/Town State Zi Code p Date of inspection- D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection locate on( site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass 9 El polyethylene El other(explain): N/a 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 Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �,. 39 Blossom Avenue Property Address Clock Works Condominium - BuildingA Owner Owner's Name information is required for every Osterville MA 02655 7/26/2017 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` even 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.): The D-box was under the asphalt. Recommend riser and steel cover be installed. 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.): I 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: l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts w v Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 39 Blossom Avenue Property Address Clock Works Condominium - Building A Owner Owners Name information is required for every Osterville MA 02655 7/26/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits ' number: . ® leaching chambers .number: 8-500 gal.chambers ❑ leaching galleries number: El 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.): The chambers were dry and clean.There was no sign of failure. A camera was used I Cessp ools s (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 (Sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection dorm Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a,•'•F 39 Blossom Avenue Property Address Owner Clock Works Condominium - Building A information is 6 Heys Name , required for every Osterville MA 02655 7/26/2017 page. City/Town State Zi Code P 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,): N/a t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 �• Commonwealth of Massachusetts H y Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Blossom Avenue Property Address Clock Works Condominium - building A Owner Owner's Name information is required for every Osterville MA 02655 7/26/2017 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 . P 15ins•3/13 Title 5 Offidal Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 commonwealth of Massachusetts H - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 39 Blossom Avenue Property Address Clock Works Condominium - Building A Owner dw—ner's Name information is required for every Osterville MA 62655 7/26/2017 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water El Check cellar ❑ Shallow wells Estimated depth to high ground water: 25' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: • Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health- explain: Using Topo and water contours map ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high.ground water elevation: see above Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M a 39 Blossom Avenue Property Address Clock Works Condominium.- BuildingA Owner Owner's Name information is required for every Csterville MA 02655 ' 7/26/2017 page: City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file 151ns•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Commonwealth of Massachusetts 6S3 -Ij 04 A H Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments- 39 Blossom Avenue 1-4 Property Address Clock Works Condominium - Building B Owner. Owner's Name information is ✓ required for every Osterville MA 02655 7/26/2017 page. Cityrrown State Zip Code Dat9of 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 S/. c f filling out forms �C � on the computer, use only the tab 1. Inspector: key to move your cursor-do not James Ford use the return Name of Inspector key. Ford Septic Services, LLC IF owCompany Name P.O. Box 49 Company Address Osterville MA 02655 City/Town State Zip Code 508-862-9400 S12482 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Eva aption by the Local Approving Authority 7/26/17 Inspector' Signature Date The sys inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 LDS � Commonwealth of Massachusetts Title 5 Official Inspection p on Form Subsurface Sewage g Disposal System Form Not for VoluntaryAssessments sse ssments ;M A •`'• 39 Blossom Avenue Property Address Clock Works Condominium - BuildingB Owner Owner'sName information is required for every Osterville MA 02655 7/26/2017 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: B)' System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system,.upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): (Sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Blossom Avenue Property Address Clock Works Condominium - BuildingB Owner Owner's Name information is required for every Osterville MA 02655 7/26/2017 page. City/Town State Zip Code. Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if Pumps/alarms are repaired. B) System Conditionally Passes (cont,): ❑ Observation of sewage backup or break out or high static water level 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): I ❑ 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 NN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 39 Blossom Avenue Property Address Clock Works Condominium - Building B Owner Owner's Name information is required for every Osterville -MA 02655 7/26/2017 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑.The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ .The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or."No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1h day flow l5ins•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 a••'' 39 Blossom Avenue Property Address Clock Works Condominium - Building Owner information is Owner s Name required for every Osterville MA 02655 7/26/2017 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® 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. ❑ N 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. I5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 39 Blossom Avenue Property Address Clock Works Condominium - Building$ Owner Owner's Name information is required for every Osterville MA 02655 7/26/2017 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? ❑ N 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? ❑ Z 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 12 12 (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 1320 l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Fora a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Blossom Avenue Property Address Clock Works Condominium - BuildingB Owner information is Owner's Name required for every Osterville MA 02655 7/26/2017 page. City/Town State Zio Code Date of Inspection D. System Information Description: Number of current residents: unknown Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑. Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: unavailable Sump pump? ❑ Yes ® No Last date of occupancy: current) 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? El Yes ❑ No Industrial waste holding tank present? El Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w„a 39 Blossom Avenue Property Address Clock Works Condominium - Building B Owner Owners Name information is required for every Osterville MA 02655 7/26/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: pumped yearly Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? i 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•3/13 - Tille 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments • 39 Blossom Avenue Property Address Clock Works Condominium - BuildingB Owner Name information is Owner's required for every Osterville MA 02655 7/26/2017 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: system installed - 11/8/2002-per info Were sewage odors detected when arriving at the site? El Yes ® No Building Sewer(locate on site plan): 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.): Septic tank (locate on site plan): Depth below grade: 6" feet Material of construction: ® concrete ❑ metal ❑fiberglass 9 ❑ 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: 4000 gal.H-20 Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM a •'r 39 Blossom Avenue Property Address Clock Works Condominium -BuildingB Owner Owner's Name information is required for every Osterville MA 02655 page. Cityrrown 7/26/2017 State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 2 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 How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tees were present. There was no sign of leakage. Both steel covers were to grade. i Grease Trap (locate on site plan): Depth below grade: n/a feet Material of construction: ❑ concrete El metal El 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form I` Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �,a •' . 39 Blossom Avenue Property Address Owner Clock Works Condominium - Building B information is Owner's Name required for every Clsterville MA 02655 7/26/2017 page. C ityLTown State Zi Code P Date of Inspection D. System Information (cont.) Comments (on pumping recommendations inlet .and outlet tee liquid levels as related to outlet ' or baffle condition, structural Integrity, 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 9 El polyethylene El other(explain): N/a Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: El Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No i, 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments e 39 Blossom Avenue Property Address Clock Works Condominium - Building B Owner Owner's Name information is required for every. Osterville MA 02655 7/26/2017 page. Cityrrown 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 even 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.): The D-box was under the asphalt. Recommend riser and steel cover be installed. f 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.): i 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: l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 39 Blossom Avenue Property Address Clock Works Condominium - Buildin B Owner Owner's Name information is required for every Osterville MA 02655 7/26/2017 page. ' CitylTown State Zip Code Date of Inspection D. System Information (cont.) Type. ❑ leaching pits number: ® leaching chambers number: 14-500 gal. chambers Elleaching 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.): The chambers were dry and clean. There was no sign of failure. A camera was used. 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 El 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 �,••'` 39 Blossom Avenue Property Address Clock Works Condominium - Building B Owner Owner's Name information is required for every Osterville MA 02655 7/26/2017 page. City/Town State Zi Code p Date of Inspection D. System Information (cons.) 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.): N/a l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection For Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Blossom Avenue Property Address Clock Works Condominium - BuildingB Owner Owner's Name information is required for every Osterville MA 02655 7/26/2017 page. Cityrrown State Zi Code P 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 As Cq/ Can _i' qtAK t5ins-3/13 Title 5 Official Inspection Form:Subsurface sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts u d Title 5 ,Official Inspection Form f Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °�•, 39 Blossom Avenue Property Address Clock Works Condominium - Building B Owner Owner's Name information is required for.every Osterville MA 02655 7/26/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 25' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans,on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS), ® Checked with local Board of Health-explain: Using Topo and water contours map ❑ Checked with local excavators, installers -(attach documentation) El Accessed USGS database -explain: You must describe how you established the high ground water elevation: see above s Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts • _ v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M A,•''t 39 Blossom Avenue Property Address Clock Works Condominium- Building B Owner Owner's Name information is required for every Osterville MA 02655 7/26/2017 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Commonwealth of Mas.s3.chusetts W Title 5 Officiai Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � 39 Blossom Avenue Property Address Clock.Works Condominium -Building A' Owner Owner's Name information is required for every Osterville MA 02655 10/22/13 page. City/Town ' State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector. key to move your I n�I/I cursor-do not j S V use the return James Ford key. Name of Inspector rab Company Name P.O. Box 49 - Company Address , Osterville MA City/Town 02 i State Zip Cod Code 508-862-9400 S12482 Telephone Number y, 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 &DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The`system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Nee4Furtheration,by the Local Approving Authority 11/7/13 Inspect 'sDate The s stall submit a copy of this inspection report to the Approving Authority(Board of Heal 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. Th e original Iglnal should be sent to the s and copies system owner p es sent to the buyei, if applicable, and the approving authority. t ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspecti6n does not address how the system will perform in the future under the same or different con(i;Mons of use. a I I l5ins•3/13 r -Title 5 Official InspectioVorm surface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Offici0 j Inspection Form Subsurface Sewage DispoOl'System Form -Not for Voluntary Assessments a 39 Blossom Avenue Property Address Clock Works Condominium - S�ilding A Owner Owner's Name information is required for every Osterville MA 02655 10/22/13 page. City/Town State ZipCode Date of Inspection B. Certification (cont Inspection Summary: Check;;A,B,C,D or E/always complete all of Section D q. A) System Passes: a j ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in-3.10 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments:------------ fl f ; 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 Y completion P of t the Board p he replacement or repair, as approved by of He alth, 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 fiver 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 passinspection 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 f❑ ND (Explain below): „ t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 i Commonwealth of Massachusetts Title 5 Official Pns pection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Blossom Avenue Property Address Clock Works Condominium - B "Id-n A Owner Owner's Name information is required for every Osterville MA 02655 10/22/13 page. City/Town State Zip Code Date of Inspection B. Certification (Cont.) El Pump Chamber pumps/alarms not operational.,System will pass with Board of Health approval if Pumps/alarms are rep6ired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed.pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with;approval of Board of Health): ❑ broken pipe(s)�'a.re,replaced ❑ Y ❑ N ❑ ND (Explain below): 1 ❑ obstruction,is refthoved ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): l ❑ The system required pumping more than 4 times'a year due to broken or obstructed . system will pass inspection if(with approval of the Board of Health): Plpe(s). The ❑ broken pipe(s) die replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): it 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 orprivys 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 '! i Commonwealth of Mas Oachusetts W Title 5 Official' Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Blossom Avenue Property Address I i Owner Clock Works Condominium - Building A Owner's Name ' information is required for every Osterville page. Cityfrown MA 02655. 10/22/13 State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a 6ptic 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. H ❑ The system has ia 1, ptic 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 wi thin supply well. ` ri 50 feet of a private water ❑ The system has a septic tank and SAS and the SAS Is less than 10 0 feet but 50 feet or more from a private water supply well". Method used to determii ne distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal conform 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. i i 3. Other: 6� D) System Failure Criteria Applicable to All Systems: r You must indicate "Yes" or"No"to each of the following for all inspections: Yes No . a ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Disch��ge or ponding of effluent to the surface of the ground or surface waters due to.an overloaded or clogged SAS or cesspool ❑ ® Static liquidlevel in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquiddepth in cesspool is less than 6" below invert or available volume is less than Y2,day flow t5ins-3/13 h Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 .r ti Commonwealth of Maslachusetts f. Title 5 Offici&[� Inspection Form Subsurface Sewage Disposail System Form - Not for Voluntary Assessments °` •'• 39 Blossom Avenue Property Address ,' Clock Works Condominium - bu'llding A Owner Owner's Name information is required for every Osterville MA 02655 10/22/13 page. Clty/Town f 7 State Zip Code Date of Inspection B. Certification (cont.) Yes No ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below ground high g g and water elevation. Any�ortion of cesspool or privy' ❑ ® P p y 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 sup ply ppl well with no acc eptable ceptable 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- 10,000`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 systein.`owner should contact the Board of Health to determine what will be neceysary to correct the failure. f E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpdto.15,000 gpd. For large systems, you mu§f indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the sys't6m 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=,fIWPA)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 �.10 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 .! Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5of 17 (" r z Commonwealth of Massachusetts - 1 Inspection Form Title 5 Offici a Subsurface Sewage Dis os�al System P y. m Form -Not for Voluntary Assessments 39 Blossom Avenue �M Property Address Clock Works Condominium>-�tiildin A Owner Owner's Name a information is W i required for every OStervllle MA 02655 page. City/Town 10/22/13 State Zip Code Date of Inspection C. Checklist I, 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 t e system received normal flows in the previous two week period? ❑ ® Have barge volumes of water been introduced to the system recently or as part of this in6pe6tion? ® ❑ Were asbuilt plans of the system obtained and examined?(If they were not availaol`,note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was tte.isite inspected for signs of break out? Nt ® ❑ Were all system components,'excluding the SAS, located on site? i, z ❑ 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 si eland location of the Soil Absorption System (SAS) on the site has been d :teIrmined 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)] bid t D. System Information Residential Flow Conditions: ` Number of bedrooms (design): Number of bedrooms (actual): $ DESIGN flow based on 310CMR 15.203 (for example: 110 gpd x#of bedrooms): 880 I. i.. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System 9 p y tem•Page 6 of 17 1 : ,i ji Commonwealth of Massachusetts W Title 5 Officials inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M�,•°°p 39 Blossom Avenue Property Address C Clock Works Condominium -Building A Owner Owner's Name a information is required for every Osterville Y' i MA 02655 page. City/Town 10/22/13 State Zip Code Date of Inspection D. System Informati®n Description: 'a Number of current residents:` : n/a Does residence have a ga1bage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected' ' ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: unavailable Sump pump? 4 ❑ Yes ® No Last date of occupancy: currently Date Commercial/Industrial Flgvv,,Conditions: Type of Establishment: Design flow(based on 310 AMR 15.203): i Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? s ❑ Yes ❑ No 5 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 y Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 l �i t Commonwealth of Mass'! achusetts W Title 5 Official Inspection For Subsurface Sewage Disposal :System Form -Not for Volunt ary Assessments °�M A 39 Blossom Avenue Property Address Clock Works Condominium - 8bildi Owner information is Owner's Name t required for every Osterville (" MA 02655 10/22/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use Date 4 Other(describe below): General Information Pumping Records: 1 Source of information: pumped every year for maintenance Was system pumped as pqirt'of the inspection? ® Yes ❑ No If yes, volume pumped: Ij gallons How was quantity pumped determined? Reason for pumping: maintenance 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) El Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 8 of 17 Commonwealth of Massachusetts Title 5 Offici ( Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments III c 39 Blossom Avenue Property Address Clock Works Condominium. -Builjinq A Owner Owner's Name information is required for every Osterville MA 02655 10/22/13 page. Clty/Town State Zi Code P Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: installed - 10/2/02-per info j, Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on;site, plan): ll ;y Depth below grade: feet Material of construction: ❑ cast iron ® 401 PVC El other(explain): Distance from private water supply well or suction line: g ' feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site,iplan): Depth below grade: ;!. ., 6" p r. feet Material of construction: q ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: +:i {. years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ElNo Dimensions: 2000 gals. Sludge depth: 2" I M t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Mas�a:chusetts W Title 5 Official` Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 39 Blossom Avenue 'I ' M ven Property Address l Clock Works Condominium - Buildin A Owner Owner's Name information is required for every Osterville MA 02655 10/22/13 page. Cit ylTown � State ZipCode Date of Inspection D. System Information (cont.) Septic Tank(cont.) t. . Distance from top of sludge to bottom of outlet tee or baffle . y Scum thickness '` 2" Distance from top of scum Ito top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions dete`rn'ined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tees were present. There was no sign of leakage The inlet cover was to grade r Grease Trap (locate on site plan): Depth below grade: i - feet Material of construction: ❑ concrete ❑ metal',. ❑ fiberglass ❑ polyethylene ❑ other(explain): N/a a4 4 R , Dimensions: Scum thickness s Distance from top of scum to top of outlet tee or baffle Distance from bottom of scumlto bottom of outlet tee or baffle Date of last pumping: ' Date (Sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 t'' 1 Commonwealth of am _ Mass a c'huset ts Insp ecti 0 n Form 5Oficrl Subsurface Sewa ge e Dis posal sposal System Form -No t Voluntary Asses sments sm Ih ent s •`' 39 Blossom Avenue Property Address Clock Works Condominium =a3tlldin A Owner Owner's Name g information is required for every. Osterville MA 02655 page. City/Town 10/22/13 State Zip Code. Date of Inspection D. System Information (coat.) Comments (on dumping 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 ❑fiber lass g ❑ polyethylene ❑ other(explain): N/a i Dimensions: Capacity: t gallons Design Flow: gallons per day Alarm present: 1,' ' El Yes ❑ No j. Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: g Date Comments (condition of alarm*.and float switches, etc.): Attach copy of current t Pumping contract(required). Is copy attached? El Yes' ❑ No t5ins-3113 y( Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 r. Y Commonwealth of MasPachusetts W Title 5 Official, Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 39 Blossom Avenue Property Address Owner Clock Works Condominium Building A Owner's.'Name information is required for every Osteryille MA 02655 10/22/13 page. City/Town :T State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above'outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into o out of box, etc.): The D- box was under thus halt. Recommend riser and steel cover be installed. ----------------- t. Pump Chamber(locate on:site plan): Pumps in working order: El Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition "f pump chamber, condition of pumps and appurtenances, etc.): N/a { it ` * 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: i Y l5ins•3/13 it i Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 t i Commonwealth of Massachusetts • W Title 5 Offici - Inspection For Subsurface Sewage Disposal System Form - No t for Voluntary Assessments �,, ,••'�r 39 Blossom Avenue Property Address Owner Owner's Clock Works Condominium -'BuildingA ' information is Name required for every Osterville MA 02655 10/22/13 page. City/Town State Zi Code P Date of Inspection D. System Information (cont.) it Type: ❑ leaching pits number: ® leaching chambers number: $- 500 gal. chambers ❑ leaching galleries number: 0 leaching trenches p number, length: El 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.): ; The chambers were dr .There was no signs of failure. A camera was used for the inspection. S; i F� Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration I" N/a 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 El Yes ❑ No t5ins•3/13 � �'' t Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official !ns ection For Subsurface Sewage Disposal'Sytem Form Not for Voluntarym Assessments ill 39 Blossom Avenue Property Address Clock Works Condominium - Building A a Owner information is Owner's Name required for every Csterville MA 02655 page. City/Town State 10/22/13 Zip Code Date of Inspection D. System Informal tio (Cont.) Comments (note conditionof soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.): it Privy(locate on site plan): G Materials of construction: Dimensions Depth of solids Comments (note condition'of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/a A �t �r 1 it !, j. t5ins-3/13 r' Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 i k' t: Commonwealth of Massachusetts W Title 5 Official Inspection Form orm Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 39 Blossom Avenue Property Address Clock Works Condominium - 3_uildi information is Owner Owner's Name required for every Osterville MA 02655 10/22/13 page. City/Town State Zi Code P 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 Eldrawing attached separately 11 1 G . ; l' t5ins•3/13 ' Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official) Inspection Form a Subsurface Sewage Di g sposal System Form Not for VoluntaryAsses III is 39 Blossom Avenue t Property Address � -, Clock Works Condominium -Building A Owner information is owner's Name required for every Osterville MA 02655 10/22/13 page. City/Town State ZipCode Date of Inspection D. System Information (Cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ti is h x . ❑. Shallow wells G'$; Estimated depth to high groundwater. 25' feet Please indicate all methods used to.determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date,of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: Using topo andiwater contours maps ❑ Checked with local excavators, installers -(attach documentation) it ❑ Accessed USGS:database -explain: i You must describe how you dstablished the high ground water elevation: see above F Before filing this InspectionYReport, please see Report Completeness Checklist on next page. t5ins-3/13 'Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 a ! r Commonwealth of Mas�dchusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Blossom Avenue Property Address Clock Works Condominium =Building A Owner Owner's Name information is required for every Osteryille MA 02655 page. Clty/Town 10/22/13 State Zip Code Date of Inspection E. Report Completeness Checklist Z Inspection Summary:, B, C, D, or E checked o ® 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 j 5 Ij I i g i t5ins-3/13 i Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 t e i'r s Commonwealth of Massachusetts x; Title 5 Officials Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments i M 39 Blossom Avenue Property Address ° Clock Works Condominium -BuildingB Owner Owner's Name information is a required for every Osterville MA 02655 10/22/13 pager CitylTown State Zip Code Date of Inspection I Y Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist.at the end of the form. ' Important:When filling out forms A. General Information' on the computer, use only the tab Inspector: key to move your I V cursor- not James Ford l 1 use the return urn ►►►...JJJ key. Name of Inspector rab Company Name P.O. Box 49 Company Address Osterville MA City/Town : . 02655 State Zip Code 508-862-9400 S12482 Telephone Number License Number I r 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 aDEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails E El Needs Further Eve u tion by the Local Approving Authority r - - s 11/7/13 Insp or's Signature Date The sy tem inspector shall submit a copy of this inspection report to the Approving Authority(Board of H 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. d l5ins-3/13 Title 5 Official Inspectio or Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Mas:'achusetts Title 5 e Officia�lJ ris ction Form orm Subsurface Sewage Disposal System Form -Not for.Voluntary Assessments •'�• 39 Blossom Avenue Property Address Clock Works Condominium ' Build' B Owner Owner's Name information is required for every Osterville MA 02655 ----own 10/22/13 page. 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 ica CMR or in indicated below. 310 CMR 15.304 exist. Any failure criteria not evaluated are .,,. Comments: l { i B) System Conditionally Passes: , One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The;system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined,' please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. t *A metal septic tank will pa s`inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that tre tank is less than 20 years old is available. -❑ Y ❑ N ❑ ND (Explain below): 0 1 t5ins-3/13 a' Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 i Commonwealth of Massachusetts Title 5 Officiail' inspection F®rn1 Subsurface Sewage Disposal System Form Not for Voluntary Assessments 39 Blossom Avenue Property Address Clock Works Condominium -Buildin B I Owner. Owner's Name information is > required for every: Osterville MA 02655 10/22/13 page. City/Town �. State -ZIP Code P Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if Pumps/alarms are repaired. B) System Conditionally,Passes (cont.): ❑ Observation of sewage backup or break out or high static water level 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): f, . El broken pipes)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): i , ❑ 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): ly 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 environ'inent: ❑ 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 . e t5ins 3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 , Commonwealth of Massachusetts Title 5 Official; Insnecton For Subsurface Sewage Disposal System Form Not for Voluntary A i <+ y Assessments �M 39 Blossom Avenue ii Property Address Clock Works Condominium -Building B Owner- Owner's Name informatiorris required for every Osterville ' MA 02655 10/22/13 page. City/Town State Zp Code Date of Inspection B. Certification (cont ) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environmenf: ❑ 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. El The system has a se;ptic 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, provi°oed that no other failure criteria are triggered. A copy of the analysis must be attached to this form. d , 3. Other: F 11 ' D) System Failure criteria Appllicable to All Systems: 4 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 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 lajquid 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 '/zi day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 ii .. a t Commonwealth of Massachusetts W Title 5 Official lns ection F p orm Subsurface Sewage Disposal System Form- Not for Voluntary Assessments `M 39 Blossom Avenue Property Address X Clock Works Condominium - Build4n B Owner Owner's'Name information is required for every Osterville MA 02655 page. City/Town 1.0/22/13 State Zip Code Date of Inspection B. Certification (Cont.j Yes No ❑ ® Regdir�d 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 groundwater elevation. E ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any pgrtion 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- 10,00019pd• ❑ Z 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 Qdicate 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 I.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 Sectiorj`Dabove 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 3,10 CMR 15.304.The system owner should contact the appropriate regional office of the Departmdnt. t5ins•3/13 l Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 l Commonwealth of Mas achusetts Title 5 Official"; Ins Inspection T _ , ,.. p Form aS Subsurface Sewage Disposal System Form -Not for Voluntary Assessments `M •`'r 39 Blossom Avenue 1i `Property Address Clock Works Condominium -Qui,ldin B Owner Owner's information is ri required for every Osterville ( MA 02655 10/22/13 page. City/Town u . State Zip Code Date of Inspection C. Checklist Check if,the following have,.,bedn done. You must indicate"yes"or"no"as to each of the following: Yes No ® El 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? ❑ ® .V Have Iprje volumes of water been introduced to the system recently or as part of this ins,pe'ction? ® ❑ Were as built plans of the system obtained and examined? (If they were not availab.leinote as N/A) ® Was thle tscility 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? F: ® ❑ Were tP1e'Septic tank manholes uncovered, opened, and the interior of the tank inspected'for the condition of the baffles or tees, material of construction, dimensioris, depth of liquid, depth of sludge and depth of scum? Was thofacility 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: ® ❑ Existingiinformation. 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 desi n 12 ( g ) Number of bedrooms (actual): 12 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): t5ins•3113 I' q: Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 �i I 3 Commonwealth of Massachusetts Title 5 OfficidE, inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M ,••'•y 39 Blossom Avenue , Property Address • Clock Works Condominium Buildin., B Owner Owner's Name information is required for every Osterville _page. CitylTown MA 02655 10/22/13 �; State. Zip Code Date of Inspection D. System Informatioln Description: I Number of current residents:'; n/a Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) III. ❑ Yes ® No Laundry system inspected' ❑ Yes ® No Seasonal use? 4 El Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: unavailable Sump pump? P ❑ Yes ® No r Last date of occupancy: a currently Date Commercial/Industrial Flow:Conditions: Type of Establishment: I' Design flow(based on 310 CMR 15.203): l o Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank.pesent? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? El Yes ❑ No a , Water meter readings, if avalable: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 7 of 17 q; f Commonwealth of Massachusetts W Title 5 Official, Inspection Fora Subsurface Sewage Dispos System Form Not for Voluntary Assessments � . wM 39 Blossom Avenue Property Address { Clock Works Condominium - Bu;ijdin B Owner r: information is Owner's Name ; required for every Osterville MA 02655 10/22/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use li Date Other(describe below): i General Information Pumping Records: Source of information: ; y, pumped every year for maintenance Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined?. Reason for pumping: maintenance Type of System: ® Septic tank,distribution box, soil absorption system tt, Single cesspool EJ 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 o`.f the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 e I . Commonwealth of Massa'chusett s Title 5 Official} ins ection For Subsurface Sewage Disposal System Form -Not for Voluntary m ., ry Assessments 39 Blossom Avenue + ., Property Address Clock-Works Condominium - 1§6 Iding B i Owner Owner's Name information is required for every ,Cisterville I r MA 02655 10722/13 page. City/Town State Zi Code Date of in P - D. System Informatiolr� (Cont.) r ; Approximate age of all components, date installed (if known)and source of information: installed - 11/8/02- er Info Were sewage odors detected when arriving at the site? ❑ Yes ® ' No Building Sewer(locate on'site plan): Depth below grade: feet Material of construction: ❑ cast iron 40lVC ❑ other(explain): Distance from private water,supply well or suction line:. ( feet Comments (on condition of:joirits, venting, evidence of leakage, etc.): Septic Tank(locate'on site2plan): Depth below grade: ', 6" {.: feet Material of construction: ® concrete ❑ m�1tal ❑fiberglass ❑ polyethylene ❑ other(explain) fl If tank is metal, list age: r , years Is age confirmed by a Ceinificate of Compliance?(attach a copy of certificate) ❑ Yes , .. ❑ No Dimensions: 4000 gals. Sludge depth: i 2" t5ins•3113 fTitle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of MAS4 phusetts W Title 5 Official inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 39 Blossom Avenue Property Address I Owner Clock Work s uildin B Condominium -B .- Owner's Name information is required for every Osteryille page. City/Town S 02655 10/22/13 tate Zip Code Date of Inspection . D. System Informati®In (cont.) Septic Tank(cont.) ,1 y Distance from top of sludge to bottom of outlet tee or baffle Scum thickness , :, 3" Distance from top of scum t0 t6p of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determihed? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tees were present. Th `re was no sign of leakage. The both steel covers were to grade. Grease Trap (locate on'site,plan): Depth below grade. i feet Material of construction:. 0-concrete ❑ me9al," El fiberglass fiber�; ; 9 ❑ polyethylene ❑ other(explain): N/a Dimensions: j. 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 l5ins•3/13 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official` ins ection F a p Form Subsurface Sewage Disposal Syetem Form -Not for Voluntary Assessments 39 Blossom Avenue Property Address Clock Works Condominium -BuAdfn B Owner Owner's Name information is required for every Osterville MA 02655 10/22/13 page. City/Town 1 State Zip Code Date of Inspection ' D. System Informati6o' (Cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlef invert, evidence of leakage, etc.): i Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ me I . ❑fiberglass 9 N/a El polyethylene ❑ other(explain): • Dimensions: Capacity: I gallons Design Flow: gallons per day Alarm.present: El Yes ❑ No Alarm level: Alias in working order: ❑ Yes ❑ No Date of last pumping:- } Date Comments (condition'of alarm and float switches, etc.): t E! I *.Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 p. , Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments_ 39 Blossom Avenue Property Address Clock Works Condominium - BuildingB Owner Owner's Name information is required for every Osterville MA 02655 10/22/13 page. CitylTown State ZipCode Date of Inspection D. System Information (cont.) Distribution Box(if prese tImust be opened)(locate on site plan): Depth of liquid level abovebutlet 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.): The D- boxes were under the;asphalt. Recommend riser and steel covers be installed is r • t ; Pump Chamber(Iodate on'site plan): t Pumps in working order: ❑ Yes ❑ No Alarms in working order: El Yes ❑ Noy Comments (note condition pf pump chamber, condition of pumps and appurtenances, etc.): N/a f J * 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: . _j r + t5ins•3/13 f: ! Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Officiallnspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 39 Blossom Avenue Property Address .Clock Works Condominium -Building B Owner Owner's Name information is required for every Osterville MA - 02655 10/22/13 page. City/Town State Zi Code ` P Date of Inspection D. System Information.(cont.) 1. Type. - leaching pitg number: ® leaching chambers number: 14-500 gal. chambers ❑ leaching galleries number. I ; ❑ 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.): The chambers were dry.There was no signs of failure A camera was used for the inspection T t. Cesspools (cesspool must lie.pumped as part of inspection) (locate on site plan): Number and configuration N/a 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 l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 i Commonwealth of Massichusetts Title 5 Officiei; Inspection For Subsurface Sewage Disposal,System Form - Not for Voluntary Assessments �M A •'�a 39 Blossom Avenue Property Address Clock Works Condominium B�uildinq B Owner Owner's Name information is required for every Osterville MA 02655 10/22/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition ofsoil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 1 µ . R; Privy(locate on site plan) 4i {i Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):' N/a t, r t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts. Title 5 Official Inspectio - n Form orm } Subsurface Sewage Disposal'System Form -Not for Voluntary Assessments 39 Blossom Avenue Property Address Clock Works Condominium -Building B Owner Owner's Name ji, information is required for every Osterville MA 02655 10/22/13 page. Cityfrown 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 P. t5ins•3/13 t Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Ins F _ pection Form Subsurface Sewage Disposal;System Form - Not for Voluntary Assessments ;M ,•` 39 Blossom Avenues Property Address r Clock Works.Condominium -Build' B Owner Owner's Name information is required for every Osterville MA 02655 10/22/13 page. City/Town State Zip Code Date of Inspection D. System Information.(cont.) _ Site Exam: ti t• �:: 5 ❑ Check Slope ❑ Surface water Check cellar ❑ Shallow wells _. Estimated depth to high ground water: 25' t. : feet Please indicate all methods;used to determine the high ground water elevation: f' ❑ Obtained from system design plans on record If checked, date lof design plan reviewed: Date Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health --explain: Using topo and water contours maps ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS'"database-explain: You must describe how you:established the high ground water elevation: see above . } Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ina•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts' Title 5 Official" Insp ection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r °M 39 Blossom Avenue Property Address ' Clock Works Condominium - lipilding B Owner Owners Name information is required for every OSteN MA 02655 10/22/13llle � ,�?' page. City/Town 7 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 f ,u ® System Information-Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file ii a. i ? Y' 1 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 y 31Hi�7. EFMR§`�—`ELL, � � 3 0 2003 COMMONWEALTH OF MASSACHUSETTS F BgRNSTggI E T + p Z EXECUTIVE OFFICE OF ENVIRONMENTAL d DEPARTMENT OF ENVIRONMENTAL PROTECTION AqM 5�0 350 MAIN STREET & WEST YARMOUTH,MA 508-775-2800 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION MAP 117 PAR 58 Property Address: 171 PINE LANE-CLOCKWORK CONDOS II-#3 OSTERVILLE,MA 02655 Owner's Name: POOL,DICK Owner's Address: 171 PINE LANE OSTERVILLE,MA 02655 Date of Inspection JULY I,2003 Name of Inspector:(please print) JAMES D. SEARS Company Name: A&B Canco Mailing Address: 350 Main Street West Yannouth,MA 02673 Telephone Number: 508-775-2800 CERTIFICATION STATEMENT I certify that I have'personally inspected the sewage disposal system at this address and that the infonnation reported below is true,accurate and complete as of the time of the inspection. The inspection was perfonned based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes i Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: ']- 3—o j 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 tot he buyer,if applicable,and the approving authority. Notes and Comments SYSTEM IS FOR UNITS 1, 2 AND 3 ****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. Title 5 Inspection Form 6/15/2000 1 Page 2 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 171 PINE LANE—CLOCKWORK CONDOS Il-#3 OSTERVILLE,MA 02655 Owner: POOL,DICK Date of Inspection: JULY I,2003 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 CM 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: N/A 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. 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 extiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with 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 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: Title 5 Inspection Form 6/15/2000 2 Page 3 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 171 PINE LANE—CLOCKWORK CONDOS II-#3 OSTERVILLE,MA 02655 Owner: POOL,DICK Date of Inspection: JULY 1,2003 C. Further Evaluation is Required 6y the Board of Health: N/A 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 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 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 i le than 1 s less a 00 feet but 50 feet or more from Y r • • a private water supply well**. Method used to detennine distance **This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Title 5 Inspection Form 6/15/2000 3 Page 4 of 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 171 PINE LANE—CLOCKWORK CONDOS II-#3 OSTERVILLE,MA 02655 Owner: POOL,DICK Date of Inspection: JULY 1,2003 D. System Failure Criteria applicable to all systems: N/A 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 pits is less than 6"below invert or available volume is less than %2 day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone 1 of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) NO (Yes/No)The system fails. I have detennined that one or more of the above failure criteria exist as described in 310 CM 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: N/A To be considered a large system the system must service a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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 is 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. Title 5 Inspection Form 6/15/2000 4 ' Page 5 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 171 PINE LANE—CLOCKWORK CONDOS II-#3 OSTERVILLE,MA 02655 Owner: POOL,DICK Date of Inspection: JULY 1,2003 Check if the following have been done. You must indicate"yes"or"no"as to each of the following Yes No ✓ Pumping infonnation 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 nonnal 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 infonnation on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System SAS has been determined based on: P Y (SAS) • Yes No ✓ Existing infonnation. 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 CM 15.302(3)(b)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 1 I } OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 171 PINE LANE—CLOCKWORK CONDOS It-#3 OSTERVILLE,MA 02655 Owner: POOL,DICK Date of Inspection: JULY 1,2003 FLOW CONDITIONS RESIDENTIAL—CONDOMINIUMS Number of Bedrooms(design): 9 Number of bedrooms(actual): 9 DESIGN flow based on 310 CMR 15.203 (for example: 1 10 gpd x#of bedrooms: 990 Number of current residents: N/A Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): YES Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): N/A Sump pump(yes or no) NO Last date of occupancy: PRESENT COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CM 15.203): Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: "`OTHER(describe): ` GENERAL INFORMATION Pumping Records Source of information: N/A ,Was system pumped as part of the inspection(yes or no):.• NO e; 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) Tight tank Attach copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: AROUND 1986 Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 171 PINE LANE—CLOCKWORK CONDOS II-#3 OSTERVILLE,MA 02655 Owner: POOL, DICK Date of Inspection: JULY 1,2003 BUILDING SEWER(locate on site plan): N/A Depth below grade: Materials of construction: Cast iron _' 40 PVC _ other(explain) Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): ✓ Depth below grade: 18" Material of construction: ✓ concrete metal fiberglass polyethylene _ other(explain) If tank is metal list age: Is age continned by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 2,500 GALLON PRE CAST Sludge depth: 3" Distance from top of sludge to the bottom of outlet tee or baffle: 35" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 19" How were dimensions determined: ASBUILT,TAPE&PAST REPORT Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): TANK AT WORKING LEVEL.THREE INLET TEES,ONE OUTLET TEE. BOTH COVERS 2' STEEL AT GRADE NO SIGN OF OVERLOADING OR LEAKAGE. GREASE TRAP(located on site plan) N/A Depth below grade: Material of construction: concrete metal fiberglass _ polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 Page 8 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 171 PINE LANE—CLOCKWORK CONDOS II-#3 OSTERVILLE,MA 02655 Owner: POOL,DICK Date of Inspection: JULY 1,2003 TIGHT or HOLDING TANK: N/A (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/day Alarm present(yes or no) Alarn level: Alarm in working order(yes or no): Date of last pumping Comments(condition of alann and float switches,etc.): 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.,): DISTRIBUTION BOX IS 2'x2',3' BELOW GRADE.T STEEL COVER,4"BELOW GRADE.ONE LINE IN, TWO LINES OUT. BOX IS CLEAN AND SOLID.NO SIGN OF OVERLOADING OR SOLID CARRY OVER. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15/2000 8 Page 9 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 171 PINE LANE—CLOCKWORK CONDOS II-#3 OSTERVILLE,MA 02655 Owner: POOL, DICK Date of Inspection: JULY 1,2003 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: 2 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.) LEACHING IS TWO 1,000 GALLON PRE CST PITS. BOTH HAVE Y STEEL COVERS AT GRADE. V WATER IN PITS. CESSPOOLS: N/A (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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.): PRIVY: N/A (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.) Title 5 Inspection Form 6/15/2000 9 Page 9 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 171 PINE LANE—CLOCKWORK CONDOS 11 -#3 OSTER.VILLE,MA 02655 Owner: POOL, DICK Date of Inspection: JULY 1,2003 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchn;arks. Locate all wells within 100 feet. Locate where public water supply enters the building. V� ;r 7' 1 { rF " f ( �1 is I Title 5 Inspection Form 6/15/2000 10 � S Page I I of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 171 PINE LANE—CLOCKWORK CONDOS 11 -43 OSTERVILLE,MA 02655 Owner: POOL, DICK Date of Inspection: JULY I,2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to groundwater 20+ feet Please indicate(check)all methods used to detenninc the high around water elevation: Obtained from system design Plans on record-If checked.date of design plan reviewed: Observation site('abutting propertylobservation 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: AREA HIGH. LOTS HIGH. NO SIGN OF WATER PROBLEM. ii Title 5 Inspection Form 6/15/2000 11 C(udv kr k Cv�r�81 S TOWN OF BARNSTABLE r � LOCATION 9-14rd 11 i� SEWAGE # 74 VILLAGE 6,510-V Ifs ASSESSOR'S MAP & LOT Ll7'as? INSTALLER'S NAME&PHONE NO. a ays�l &Vc-Dw9 C65,v 5Q4 c s3`'Pa I SEPTIC TANK CAPACITY ? o00 v a LEACHING FACILITY: (type) Too C) i (size) A g ` X 0- NO. OF BEDROOMS S BUILDER OR OWNER 9 - L �" ' PERMIT DATE: .:1 ( •-G f COMPLIANCE DATE: u 2 02- Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility �" Feet Private Water Supply Well and Leaching Facility (If any wells exist � on site or within 200 feet of leaching facility) '� y Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 fee of leaching cili ) Feet Furnished by L..t _is,M.�.� 3-cl J No. � `• - FEE C®MMONW L11['OF MASSACHUSETTS, � Board of Health, 7hR?4,,)S OA 5 L E, , MA. APPLICATION FOP DISPOSAL SYSTEM CONSTRUCTION PERMIT IT Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) -AComplete System 0 Individual Components Location — � / ``snrYN Z Owner's Name Map/Parcel# Q ®,5"f��101L Address ®S Lot# 5 Telephone# Al — 156'3 Installer's Name NN Designer's Name Address N. ALmboTw 4w)j, W.FkNug4 Address Telephone# S4 -395 i Telephone# y — —9(0 Type of Building �3v s\dC CA 04n�n�C`\C61\ `S Lot Size Q2lc�l sq.ft. Dwelling-No.of Bedrooms 1Q _ �. 11 i '�t M4 Garbage grinder Other-Type of Building /VQfle No.of persons Showers (I Cafeteria (iq Other Fixtures t. hl�l©A"ii}e�'{k\'1ed\ (Z)it1I . Design Flow (min.required) gpd Calculated design flow Design flow provided gpd Plan: Date r�� o�\ Number of sheets Revision Date Title tti-RnDoeaA 'D \ It Description of Soil(s) �Yk t �-+ Soil Evaluator Form No. I 1 0� Name of Soil Evaluator��Q��r3 PAY Date of Evaluation �J DESCRIPTION OF REPAIRS OR ALTERATIONS cbed The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further ws not to�ce e system operation until a Certificate of mpliance has been issued by the Board of Health. Si ned .pia.. Date Inspections I,— ,x. 71or -Is 1A1 No )�00, FEE 7 -C �7C, OMMNWIA 44- -MAS Board of Heal A L CATION FOP-DISPOSAL-SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( Repair Upgrade( Abandon( ' LJ-Complete System ❑Individual Components Location n IJEOwner's Name U Map/Parcel# Map I 1:i :Blork- 53 Address( —6\6sSoo-, L.CAV 5 Lot# Telephone#Z —6api 8— Z Installer's Name Designer's Name Address N, FA u.)Y, W Ff4l-mwl Address,34 % LOM 1�io,3i ,;relephonc# Telephone#, ,Type of Building Q2(o Lot Size f Co 9 1 sq.ft. Dwelling-No.of Bedrooms Pip ex Garbage grinder Opt Other-Type of Building No.of persons Co Showers (v<Cafeteria (k�� Other Fixtures'— L A\w�-Nimz,,� h'6-sign Flo I w(min.required) '820 gpd Calculated design flow O Design flow provided gpd a -- 7 Plan: Date \ \ Number of sheets Revision Date Title Description of Soil(s) Soil Evaluato.r.Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS 1?,q QZ An a4c c\--)ed pacs v2p c.bs r AneA v 1 tAj ft�?' 'W- 1.2 b I The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and ,4 further s to not to Aace ffie system in operation until a Certificate of Compliance has been issued by the Board of Health. J� Signed q Date �7 3,6d- Inspections s. a— No. FEE COMMONWEALTH Of MASSAC14USETTS Board of Health, C-N �A AM. CERTIFICATE Of COMPLIANCE Description of Work: Ll Individual Component(s) J Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed Repaired Upgraded Abandoned by: at tz, has been installed in accordance with the provisions of 310 CNM 15.00 (Title 5) and the approved design plans/as-built plans relating to application No..?Lx) J 7f dated 1.7 1 —. Approved Design Flow (gpd) Installer Designer: Inspector: Date: ,2 k1d-2 The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. Wl - 76 FEE SD COMMONWEALTH OF MASSACHUSETTS Board of Health, r AM. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to Construct,( Re,er� Upgrade Abandon an individual sewage disposal system at /101A YN A A as described in the application for Disposal System Construction Permit No. 20 P 7 dated- Wak) Provided: Construction.shall be completed within three yeaes of the date of this permit. All local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date Board of Health D,.-J /1 ! i&A, { �rrtICr k. (v'td s TOWN OF BARNSTABLE C- LOCATION' Bv�( i'n t SEWAGE # UU I (�S�ehi/i I G ASSESSOR'S MAP & LOTI I-05 3 VILLAGE INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY coo LEACHING FACILITY: (type) a (size) X �' NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: 1 - 1 ..o f COMPLIANCE DATE Za2iT-01- separation Distance Between the: Feet Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist ,t Feet on site or within 200 feet of leaching facility) 1� Edge of Wetland and Leaching Facility.(If any wetlands exist �� Feet within 300 fee of leaching cili ) Furnished by d `F� I 4 t ! TOWN OF BARNSTABL� � Col LOCATION SEWAGE # 60 VILLAGE Q�b 0; I LP ASSESSOR'S MAP & LOT�� Gt INSTALLER'S NAME&PHONE NO. �ua,� �3-a>✓rc ��=..5�/ _` _�/ SEPTIC TANK CAPACITY 4,de,0 rQyl' LEACHING FACILITY: (type) w ,x -' NO. OF BEDROOMS BUILDER OR OWNER -6 ct gztgg- PERMITDATE: I f ' r COMPLIANCE DATE: I ' - £; iA,. Separation Distance Between the: r ' Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and,Leaching Facility '(If any wells exist x' /' on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) �� Feet Furnished,by a .' ti IoSSa K4 AsBuilt Page 1 of 1 TOWN OFL BARNySTABLP ��,, C�OCF,l/ a-K, Gen�'Ol LOCATION �i—r— �dSSc�to ��,� �6�,,.. g SEWAGE# Z 6o j -7 '' VILLAGE n t�t2i`t1 J�jP JASSESSOR'S MAP&LOT /lS �Cti INSTALLER'S NAME&PHONE NO. A0P I L3'1 Yi iC s S�a5- 4 QIR-A ft. SEPTIC TANK CAPACITY LW1210 G .. LEACHING FACILITY: (type) LE AW (size)4 A /6 NO.OF BEDROOMS BUILDER OR OWNER C/ ckwk ks Cc,o1aJ PERMTTDATE: I a ! -o! COMPLIANCE DATE: I Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) N N Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by:l,- e ►d 1 S SI�ST�y Wal 31 � 9 1 i r• 31 o S S a vn1 I� http://issgl2/intranet/propdata/prebuilt.aspx?mappar=11705300B&seq=1 10/29/2018 No. 2u V 7C t `i, _ 2. FEE V COMMONWEALTH, E - OF Board of Health, �f A�ui��ZE MA. APPLICATION FOP, ➢ ISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repaix Upgrade( ) Abandon( ) - Complete System ❑Individual Components Location BnAding, - M ossery, Owner's Name .( '- Map/Parcel# MW w+ Rn_,,� 53 nfir Address t M Lot# .v1 ,3 .. Telephone# _ D Installer's Name Designer's Name ak �t Address L Address Telephone# aAt02 (o Telephone# _ 9 ®ZJ��Qo Type of Building IS Lot Size a(� (6qj sq.ft. Dwelling-No.of Bedrooms v` Garbage grinder ( Other-Type of Building K 1,�_l e- No.of persons��Showers (v�, afeteria (V Other Fixtures i)A Design Flow (min.required) ` elQ gpd Calculated design flow Design flow provided 3 gpd Plan: Date 1 �i-AN nX Number of sheets Revision Date �- Title %\ e 3�p Description of Soil(s) $ t Soil Evaluator Form No. Name of Soil Evaluator VDate of Evaluation 1 em DESCRIPTION OF REPAIRS OR ALTERATIONST1 A- C C 1 The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further aerees o not top place th ystem in operation until a Certificate of ompliance has been issued by the Board of Health. Signed ` Date T OG �— Inspections a. / C� IJ'yrfY.q+n1.IRb J U/r No. � �1.."'' I FEE y, r Board of Health, MA. APPLICATION FOP DISPOSAL SYSTEM CONSTRUCTION PERMIT . , plication for rPermrt to ConstructO Repair Upgrade( Abandon( -Complete System ❑Individual Components Location �1 t �'b 0 Owner's Name Q E r Map/Parcel# 0 f �JILL Address ,'jT � M Lot# _ Telephone# Installer's Name N N Designer's Name ��N A c g � �� C V� '• Address beC �-L �A Address 0 Telephone# 0Z Telephone# _ 9 o253b Type of Building Lot Size LLIL sq.ft.� Dwelling-No.of Bedrooms Garbage grinder { � Other-Type of Building No.of p' (i-)' (y>'e ersons��Showes 'rs Cafeteria Other Fixtures 1.P��J A"CD'�.`1 -C�t�p,{Z ►n k . L.e L, t`c�.A Design Flow (min. required)` ' e gpd Calculated design flow 2)QD Design flow provided _gpd IN Plan: Date o�i(7� Number of sheets Revision Date �R Title �. - ' Descrip tion of Soil(s) -- X Soil Evaluator,Form:No. ( Name of Soil Evaluator ( 4e--dY1FfIJ J4)9VDate of Evaluation ) Y DESCRIPTION OF REPAIRS OR ALTERATIONS v i The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE'5,and 5 further grees't not t place system in operation until a Certificate of ompliance has been issued by the Board of Healt: Signed r Date G G Inspections tf r^� No.. FEE COMMONWEALTH OF MASSAC14USETTS Board of Health, , �� �� �s�n MA. CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired �(f',Upgraded ( ),Abandoned ( ) by: at f has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. - _ dated Approved DesigniFlow 3?L(gpd) r Installer Designer: Inspector: Date: 0� e Ta: The issuance of this permit shall not be construed as a guarantee that the system will function as designed.,, � No. 9121 � - ;26 1 FEECOMMONWEALTH Of MASSACHUSETTS c Board of Health, MA. ➢ISPOSAL SYSTEM STEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( Upgrade( Abandon( ) an indi�idual sewage disposal system .9 at I �� 11i /)V / A1) ik (/_ �/1 as described in the application for df posal,System Construction Permit No. —) 1, dated Provided: Construction shall be completed within three years of the date of this p� lm permit. All All local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date t 2 Board of Health��., JY A4 _ i r W-20-01 13 : 52 BARNSTABLE HEALTH DEPT = 5087906304 P . 012 S25r01 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. _ PERCOLATION TEST AiND SOIL EVALUATION EXEMPTION FORM J hereby certify that he engineered pian signe d by me dated QA_, concerning the property located at � pyusSOM LCK k- meets all of the following cnterla. • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is ciassi:ied as.CLASS I and the percolation rate is less than or equal to b .Tun utes per !rich. The applicant may use histoncal data to conclude Phis fact or may conduct preliminary tests at the si,e without a health agent present. • There is no increase in flow and/or change in use proposed There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than Fourteen ,14) feet above the maximum adjusted goundwater table elevation. (Adjust the oun(lwater cable using the Fnmptor method when applicable) Please complete the following: ,a.) Top of Ground Surface Elevation (.using GIS information) 1 a B) &W. Llevat:on��_ ad For high C)tTFF, N CE. BETWEEN -1 and B �D SiGNED ktskA DATE: Based upon the above .nformauon, a reoair permit wil! be issued For bedrooms j \n n bedrooms maximum. cc..i..nal b dr�oms are authorized in the future without en;ineered sephc syste^-t plans. _ C:hc_lih!r[dcr,percczmp 1 I Permit Number: Date: Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location: floss , Ler� ©�p�V,11e Lot No. Owner: :[k �• dN� Address: Contractor:. C�1Q� `�� Address: Notes: t STEP 1 Measure depth to water table to nearest 1/10 ft. ...................... �Q GiS bC-G� J ......................... Date la b1 3, month/day/year STEP 2 Using Water-Level Range Zone [ and Index Well Map locate 1~.' site and determine: OAppropriate index well.................................................... NIlW2� �B�, Water-level range zone ...................................:................. f STEP 3 Using monthly report "Current I Water Resources Conditions" determine current depth to water level for index well ........................... �,� mo th/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 2B) determine water-level adjustment ................ ................. STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water level at site (STEP 1) ........... Figure 13.--Reproducible computation form. i 15 FORM 11- - SOIL' EVALUATOR FORK Page 1 of No.: Date: 11/15/01 COMMONWEALTH OF MASSACHUSETTS Sandwich , Massachusetts Performed By: Carmen E. Shay Date: 11/15/01 Witnessed By: Waiver— Per Barnstable BOH Location Address or #39 Blossom Lane, Owners Name: For Clockworks One Osterville,MA Address: 39 Blossom Lane,Osterville,MA Lot# Map 117 Lot 053-OOA New Construction : Repair: X Telephone Number: 508-477-0894 OFFICE REVIEW: Published Soil Survey Available: No Yes Year Published: Publication Scale: Soil Map Unit: Drainage Class: Soil Limitations: Surficial Geologic Report Available: No❑ Yes❑ Year Published: Publication Scale: Geologic Material: (Map Unit): Landform: Glacial Outwash Flood Insurance Rate Map: Above 500 Year Flood Boundary: No ❑ Yes X❑ Within 500 Year Flood Boundary: No ❑ Yes ❑ Within 100 Year Flood Boundary: No 57 Yes ❑ Wetland Area: None Observed National Wetland Inventory Map (map Unit): Wetlands Consercancy Program Map (map unit): Current Water Resource Conditions (USGS): Month Range: Above Normal El Normal ] Below Normal ❑ Other References Reviewed: USGS Topographic Map 3 DEP APPROVED FORM 12/7/95 FORM 11 -. SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No.: #39 Blossom Lane, Osterville, MA On -Site Review Deep Hole Number: #1 Date: 11/15/01 Time: 9:00 PM Weather: Sunny,Warm, 65OF Location (identify on site plan): Refer to Sketch Landform: Outwash Plane Position on Landscape (sketch on back): Refer to Sketch Distances From: Open Water Body N/A feet Drainage Way N/A feet Possible Wet Area N/A feet Property Line 25' feet Drinking Water Well N/A feet Other N/A feet DEEP OBSERVATION HOLE LOG Depth From Soil Soil Soil Soil Other Surface Horizon Texture Color Mottling Structure, Stones, (inches) (USDA) (Munsel) Boulders, Consistency, % Gravel 0" - 12" A Sandy 10 YR 3/2 None Friable Loam BW Friable 12" - 34" 10 YR 5/6 None <5% Gravel Sandy C1 Loam 34" - 168" 2.5 Y 7/4 None Med-Coarse Sand, Sand 5% gravel/cobbles, Loose Parent Material (Geologic): Glacial Outwash Depth to Bedrock: N/A Depth to Groundwater: Standing Water in the Hole: None Weeping From Face: N/A Estimated Seasonal High Water Table 168"Assumed DEP APPROVED FORM 12/7/95 FORM 12 - PERCOLATION TEST , ' Location Address or Lot No.: #39 Blossom Lane, MA COMMONWEALTH OF MASSACHUSETTS Osterville , Massachusetts Percolation Test Date: 11/16/00 Time: 9:45 AM Observation Hole #: #1 #2 Depth of Perc 36"-54" Start Pre-soak 9:45 End Pre-soak 9:51 Time at 12" Will Not Hold 24 Gallon Presoak Same Time at 9 Time at 6" Time (9-6") Rate Min./inch < 2MP1 Assumed @ 54 " Same * Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Performed By: Carmen E. Shay Witnessed By: Waiver per BOH Comments: Would Not Hold 24 Gallon Presoak - <2 MPI Assumed Al 36" Site Passed X Site Failed DEP APPROVED FORM 12/7/95 FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No.: #39 Blossom Lane, Osterville, MA Determination of Seasonal High Water Table Method Used: ❑ Depth observed standing in Observation Hole: inches Depth weeping from side of Observation Hole: 168" inches (assumed) El Depth to Soil Mottles: inches ❑ Groundwater Adjustment: None feet Index Well Number: Reading Date: Index Well Level: Adjustment Factor: Adjusted Groundwater Level: N/A DEPTH OF NATURALLY OCCURING PERVIOUS MATERIAL: Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system: Yes CERTIFICATION: I Certify That on September 17, 2000, (date), I have passed the soil evaluators examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature: Date: . t FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No.: #39 Blossom Lane, Osterville, MA On -Site Review Deep Hole Number: #2 Date: 11/16/01 Time: 9:00 PM Weather: Sunny,Warm,65OF Location (identify on site plan): Refer to Sketch Landform: Outwash Plane Position on Landscape (sketch on back): Refer to Sketch Distances From: Open Water Body N/A feet Drainage Way N/A feet Possible Wet Area N/A feet Property Line 26' feet Drinking Water Well N/A feet Other N/A feet DEEP OBSERVATION HOLE LOG Depth From Soil Soil Soil Soil Other Surface Horizon Texture Color Mottling Structure, Stones, (inches) (USDA) (Munsel) Boulders, Consistency, % Gravel 0" - 12" A Sandy 10 YR 3/2 None Friable Loam BW Friable 12" - 32" 10 YR 5/6 None <5% Gravel Sandy C1 Loam 34" - 16.8" 2.5 Y 7/4 None Med-Coarse Sand, - Sand 5% gravel/cobbles,Loose Parent Material (Geologic): Glacial Outwash Depth to Bedrock: N/A Depth to Groundwater: Standing Water in the Hole: None Weeping From Face: N/A Estimated Seasonal High Water Table 168"Assumed DEP APPROVED FORM 12/7/95 I � SKETCH OF PERC TEST & DEEP HOLE LOCATION Property Address: #39 Blossom Lane Barnstable,MA Owner: For Clockworks Condos Date of Perc Test: 11/15/01 Building B 12 Bedrooms B 1 0 s s 0 L Test a Hole n #1 Building A e 8 Bedrooms Test Hole#2 COMMONWE S — EXIsCUTIVE OF-17 !, OI 'NVIItONMh,N'I'Ai, ArI ALIt.S , I 0.1)hl.'AR'i'Mi:N'1.' O[� iNV1.itONMIN'I'AI, EC'�'I g x v t e � k`� ONE WINTER ,)TIZEET, BOSTON MA 02,1(1f1 (617)'2.h2-�iLi,_ 356 MAIN STREET WEST YARMOUTI-I, MA QC � �V�' T'RUD M COXF _ O Srctet.n 508-775-2800 T ARGEO 1'AUL GI,I.I,UG('I w 1 �ynoF r�(/J�VIU B. S`I'RUIIS V !'onlnii.sinner ve 1 S. Co .rt or SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION 9 PART A',., ., CERTIFICATION MAP 117 PAR ' 58 - £ PROPERTY ADDRESS: 171'PINE LANE, OSTERVILLE ADDRESS OF OWNER: DATE OF INSPECTION: SEPTEMBER 13, 1999 DICK POOL NAME OF INSPECTOR : JAMES D. SEARS CLOCKWORK CONDOS II T I am a DEP approved system inspector pursuant to Section 15.340 of Title 5.9310 CMR 15.000) ` COMPANY NAME: A&B Canco z MAILING ADDRESS: 350 Main Street,West Yarmouth,MA 02673 TELEPHONE NUMBER: _(508)775-2800 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: PASSES " X CONDITIONALLY PASSES NEEDS;FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY FAILS, INSPECTORS SIGNATURE: DATE: SEPTEMBR 16, 1999 'The system Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within thirty(30) days of cornpleting this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the .system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies"sent to the buyer,if applicable and the approving authority. NOTES AND COMMENTS: a REPORT 1 OF 2. SYSTEM IS FOR UNIT NO.S 1,2 AND 3 SITE OVER ALL PASSES,INSPECTION OF SYSTEM IS BASED ON CONDITION OF SYSTEM AT THE TIME OF THE INSPECTION.THERE IS NO GUARANTEE ON THE LIFE OF THE SYSTEM. revised 9/2/98 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM' PART A CERTIVICATION'(continued), Property,Address: 171 PINE LANE, OSTERVILLE a Owner: DICK POOL, CLOCKWORK CONDOS II Date of Inspection: SEPTEMBER 13 1999 y � INSPECTION SUMMARY Check A, B, C, ofD: A] SYSTEM PASSES: N/A y.4 have not found any information which indicates that the system violates any of the failure criteria as defined in 31,0 CMR . 15.303. Any failure criteria not evaluated are indicated below.. ' COMMENTS: B SYSTEM CONDITIONALLY PASSES: X One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The • -. System,upon'completion of the replacement or repair,as approved by the Board of Health will pass. Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate Of Compliance(attached)indicating that the tank was installed within twenty(20) years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank is failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. `X Sewage breakout in the distribution box is due to broken distribution obx. The system will pass inspection if (with approval of the Board of Health). % broken pipe(s)are replaced obstruction is removed X distribution box is replaced The system required pumping more than four times a year due to broken orobstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): _ broken pipe(s)are replaced " obstruction is removed I revised 9/2/98 2 w ° SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) w ' Property Address: 171 PINE LANE, OSTERVILLE Owner:. DICK POOL, CLOCKWORK CONDOS II" Date of Inspection: SEPTEMBER 13, 1999 C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: N/A a e Conditions exist which require further evaluation by the Board of Health in order to determine if the-system is failing to . ;. protect the public health,safety and the environment" SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303 (1)(b)THT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY - AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water ~ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY) v DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND 'SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within a ._ 100 feet of a surface water supply or tributary to a surface water supply. R •` The system has a septic tank and soil absorption system and the SAS is within a Zone „ 1 of a public water supply well. Y - The system has a septic tank and soil absorption system and the SAS is within 50 feet 4 of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen and is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3).. OTHER revised 9/2/98 a. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . ` PART A y. o CERTIFICATION(continued) Property Address: 171 PINE LANE, OSTERVILLE r Owner:, DICK POOL, CLOCKWORK CONDOS II. r Date of Inspection: SEPTEMBER;13, 1999 D]SYSTEM FAILS: N/A You must indicate either"Yes"or"No" to each of the following: i -I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to Determine what will be necessary to correct the failure. Yes No du to an overloaded ed or clogged Backupof sewage into facility or system component a gg 9 Y Y p .,-SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an over- "'loaded 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%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 Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of surface water supply or tributary to a surface water supply. • Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: N/A You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No ' 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 mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 91698 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART B ^ CHECKLIST ". Property Address: 17.1 PINE LANE, OSTERVILLE Owner: DICK POOL, CLOCKWORK CONDOS II Date of Inspection:. •SEPTEMBER-13, 1999 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes .. No N X Pum'ping information was provided by the owner,occupant,or Board of Health. X e' None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive a non-sanitary ry or Industrial ustrial waste flow. X The site was inspected for signs of breakout. X All system components,including the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site t Has been determined based on: X Existing information.Ex. Plan at B.O.H. X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)[t 5.302(3)(b)] X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal System. revised 9/2/98 5 • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C - SYSTEM INFORMATION ` Property Address: P 171 PINE LANE, OSTERVILLE Owner: DICK POOL, CLOCKWORK CONDOS If - Date of Inspection: SEP,TEMBER 13, 1999 FLOW CONDITIONS y 3 RESIDENTIAL: - Design flow: 990 g.p.d./bedroom for S.A.S. Number of bedrooms(design) . 9, Number of bedrooms(actual):,, 9 ' Total DESIGN flow Number of current residents: - 7 Garbage grinder(yes or no) NO Laundry(separate system) (yes or no): NO" If yes,'separate inspection required Laundry system inspected(yes or no): YES Seasonal use(yes or no) YES Water meter readings;if available(last two(2)year usage(gpd): N/A Sump Pump(yes or no): y Last date of occupancy: +. COMMERCIAL/INDUSTRIAL`. " -Type of establishment: Design flow: Gpd(Based on 16.203) Basis of design flow Grease trap present:(yes or no): Industrial Waste Holding Tank present:(yes or no) Non-sanitary waste discharged to the Title 5 system:(yes or no) Water meter readings,if available: - Last date of occupancy:, OTHER:(Describe) Last date of occupancy: GENERAL . INFORMATION , PUMPING RECORDS and source of information: W N/A System pumped as part of inspection:(yes or no) NO If yes,volume pumped: Gallons Reason for pumping TYPE OF SYSTEM ; X Septic tank/distribution box/soil absorption system i Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract. Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed (if known)and source of information: 1986 Sewage odors detected when arriving at the site:(yes or no) NO revised 9/2/98 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM < PART C -SYSTEM INFORMATION (continued) Property Address: 171 PINE LANE,OSTERVILLE ' Owner: DICK POOL, CLOCKWORK CONDOS II Date of Inspection: SEPTEMBER 13, 1999 ` '� .. BUILDING SEWER: N/A x ' (Locate on site plan) Depth below grade Material of construction cast iron _ 40 PVC othei(explain) ` Distance from private water supply well or suction line. Diameter Comments:(condition of joints,venting,evidence of leakage,etc.) r SEPTIC TANK: X (Locate on site plan) Depth below grade: 181, `Material of construction X concrete _ metal _ Fiberglass Polyethylene _ other(explain) If tank is metal,list age Is age confirmed by Certificate of Compliance (Yes/No) Dimensions: 2,500 GALLON. Sludge depth:, 8" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 19'. How dimensions were determined TAPE AND PLAN Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) TANK AT WORKING LEVEL,3 INLET TEES,ONE OUTLET TEE.BOTH COVERS T STEEL AT GRADE.TANK SHOULD BE PUMPED.. GREASE TRAP: N/A (locate on site plan) a Depth below grade: Material of construction _ concrete _ metal = Fiberglass Polyethylene other(explain) Dimensions: - Scum thickness:' Distance from top of scum to top of outlet the or baffle: Distance from bottom of scum to bottom of outlet tee or baffle:, Date of last pumping: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) revised 9/2/98 7 rt' SUBSURFACE SEWAGE DISPOSAL_ SYSTEM INSPECTION FORM ' ` PART C r SYSTEM INFORMATION (continued) Property Address: 171 PINE LANE, OSTERVILLE Owner: DICK POOL, CLOCKWORK CONDOS II Date of Inspection: SEPTEMBER 13, 1999 TIGHT OR HOLDING TANK, N/A Tank must be pumped prior to or at time of ins ection a ( P P P P _ .) (Locate on site plan) . r Depth below grade: y Material of construction Concrete _ Metal _ Fiberglass Polyethylene other(explain) Dimensions: , Capacity: = Gallons Design flow:, gallons/day Alarm present t , Alarm level: Alarm in working order Yes` No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) : DISTRIBUTION,BOX: X (locate on site plan) Depth of liquid level above outlet invert: 0 Comments: T (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc,) D-BOX IS 2'X2',T BELOW GRADE,2'STEEL COVER 4"BELOW GRADE.ONE LINE IN,TWO LINES OUT.WALLS OF BOX ARE GONE.BOX NEEDS TO BE REPLACED. PUMP CHAMBER: N/A (locate on site plan) _ Pumps in working order:(Yes or No) Alarms in working order(Yes or No)' Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) revised 9/2/98 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C w , SYSTEM INFORMATION (continued) r Property Address: 171 PINE LANE, OSTERVILLE - .. Owner:,, DICK POOL, CLOCKWORK CONDOS II Date of Inspection: SEPTEMBER'13, 1999. , SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if.possible;excavation not required,but may be approximated by non-intrusive methods) - ' If not located, explain: T Type ' Leaching pits,number: 2 it .� ,. Leaching chambers,number: „ Leaching galleries,number. Leaching trenches,number,length: ; - Leaching fields,number,dimensions: Overflow cesspool,number, Alternative system: Name of Technology: ; Comments:. (note condition of soil signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) 'TWO(2)1,000 GALLON PRE CAST PITS.BOTH COVERS 2'STEEL AT GRADE ONE(1)PIT 3'WATER ONE(1)8"WATER -NOTE:D-BOX UNEVEN AND BROKEN,MORE WATER GOING INTO ONE PIT. CESSPOOLS:'N/A (locate on site plan) ` y r Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer. Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: Inflow(cesspool must be pumped as part of inspection) Comments:: (note condition of soil,signs of hydraulic failure,,level of ponding,condition of vegetation,etc.) PRIVY: N/A (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.) revised 9/2/98 9` ' j , , - . .. a :. • .. .. 1. _ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM, �+ PART G ' SYSTEM INFORMATION(continued) Property Address: 171_PINE LANE, OSTERVILLE M tl Owner, DICK POOL„CLOCKWORK CONDOS Date of,lnspection:-. SEPTEMBER 13, 1999 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locale all wells within 1 00'(locale where public water supply comes into house); " w.... I ✓NI� JN�� w y _--_- ppp l revised 9/2l98 101 ;o- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM' t PART C , SYSTEM INFORMATION(continued); ^ :R w Property Address: ^ r Owner: s r "�. Date of Inspection: ^ NRCS ` Report name ` Soil Type Typical depth to groundwater USGS Date website visited m Observation Wells checked Ground water depth: Shallow Moderate Deep SITE EXAM -Slope { .. . . Surface water, Check Cellar . Shallow wells Estimated Depth to groundwater ' Feet ^ Please indicate all the methods used to determine High Groundwater Elevation: . Obtained from Design Plans on record s Observation of Site(Abutting property,observation hole,basement sump eta.) ;5 Determine it from local conditions x.• Check with local Board of health Check FEMA Maps ` Check pumping records Check local excavators;installers Use USGS Data -Describe in your own words how you established the High Groundwater Elevation.(Must be completed) revised 9/2/98 TOWN OF BARNSTABLE LOCATION 1 OPI N Z )-f SEWAGE # 9 6 VILLAGE S T ASSESSOR'S MAP & LOT INSTALLER'S NAME Cz PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY �D 13 O X S x r a Aot C £J LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER C Lock i,d fk e ov-Do S DATE PERMIT ISSUED: In D f DATE COMPLIANCE SSUED• "aZ VARIANCE GRANTED: Yes No m O O O O 1�Qd/� No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Migpozal 6peum Construction Vermit Application for a Permit to Construct( )Repair(V)Upgrade( )Abandon( ) ❑Complete System * Individual'Com Po nents Location Address or Lot No. f e�I//Q/ 4IV ®s f Owner's Name,Address and Tel.No. Assessor's Map/Parcel C LOclr I.Va1P4- C°©N a®S +� /71_. a0/,Vf 4Rr eS� Installer's Name,Address,and Tel.No. -�POD Designer's Name,Address and Tel.No. f�- 6 (!'/3IVC O s'o o9/,#/AI 77- w, y#k Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other r/' Type of Building f BA1,0a No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when ap licable) O Gt ®L64 C £_P 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 Certifi- cate of Compliance has been isspid by this Board of Health.()qg . Signed Date - Application Approved by Date Application Disapproved for Re fol wing reasons Permit No. - Date Issued n . •....\' ., . .. , -.:ems. r. No. :Fee <J / r THE COMMONWEALTH-OF MASSACHUSETTS Entered in computer: t/ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS t YeS ZIpplication for jigponl *pgtem Congtructioh Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ElComplete System 4IIndividualComponents .;.J; Location Address or Lot No. 4-0 (' ` Owner's Name,Address and Tel.No. : Assessor's Map/Parcel } p Installer's Name,Address,and Tel.No. 09 Designer's Name,Address and Tel.No. ,Ay i6 C,4#VC Q 3 S,4? .ovool4v ar Aw- ylgtY ?� tl Type of Building:: Dwelling No.of Bedrooms Lot Size - sq. ft. Garbage Grinder( ) Other 6e'. Type of Building 0,94140 No. of Persons Showers( Cafeteria( ) Other Fixtures Y Design Flow gallons per day. Calculated daily flow gallons. t Plan Date Number of sheets Revision Date Title .- Size'of Septic Tank . Type of S.A.S. Description of Soil Natxi e'of Repairs or Alterations(Answer when applicable) /F r Woo C ,r-41 /71 h I f G f tl 1/� 1 /l f t !"Y 11/: a f✓ l 1V L,, P'ate'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 Certifi- cate of Compliance has been is rid by this Board of Health. ® � �• Signed Date. Application'Approved by Date Application Disapproved for`He fol wing reasons 1. Permit No. � ,��/ro - Date Issued THE COMMONWEALTH OF MASSACHUSETTS 1 f �i I1 ► , - -� BARNSTABLE, MASSACHUSETTS Certificate of Compliance tm � THIS IS TO CERTIF -Y,that the On site Sewage Dts osal System Constructed( )Repaired (y)Upgraded( ) Abandoned( )b pr r A (900* A�',•ts 3 - ,,�.� at 19 401 V Z �AO 0.5 fir- has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 1- t 61 dated Installer j Designer _ .,, The issuance of this permit shal t be co strued as a guarantee that the system will function as desi ne•.c F Date 1-� �� Inspector1/i �1 g��l , � 6 ' j , No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS M*05al *pgtem Congtruction permit Permission is hereby granted gto Construct( )Repair(.Y)Upgrade( )Abandon( ) System located at E and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of�this permit. Date: - / 9 Approved by PROPERTY ADDRESS:aQ_B.l.Qs_s_QIILAya__ST.1 i_t_i_a Clock Works koo Condo ' s -_Osterville.Mass_____-_-- 02655 -- ----------------- On the above date, I inspected the septic system at the above address. This system consists of the following: 1 -g000 gallon septic tank. 2. 1-Distribution box. 3. 1001 Leach trench. / Has 100 ' Leaching trench exspansion. Based on my inspection, I certify the following conditions: 1 . This is a title five septic system. ( 78 Code ) 2. The septic system is in proper working order at the present time . SIGNATURE: G� N a m •-- Company:_J_P_Macomber_&-Son Inc . .- Box 66 Address R' -------------------- xy _0263211 .. 69,9 Phone: 508-775-3338 t ' THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tan ks-Cesspools-Leachfields Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 .775.3338 775-6412 �J Commonwealth of Massachusetts C.J Executive Office of Environmental Affairs Department of P. Environmental Protection William F.Weld oowmor �. t Trudy ' a.u.�.yC EOoxIae David U.§UU11 ti Cvnuntu onal SUBSURFACE SEWAGE•DISPOSAL SYSTEM INSPECTION FORM PART A Clockworks Condos . CERTIFICATION Unit # .2 Address of owner: NCUA Property Address: 30 Blossom Ave Osterville ,Ma. (If different) 4807, Spieewood Springs i Date of Inspection: 2/6/95 Austin Texas 78759 Name of Inspector: �Tos�pY �. Macomber Jr. Com any Name, Address and Telep one m e . J.�.Macomber & Son Inc. Box 66 Centerville,Mass . 02632 508-775-3338 CERTIFICATION STATEMENT personally inspected the sewage disposal system at this address and that the information reported below is true, accurate inspection was performed based on my training and experience in the proper function a I certify that I have nd and complete as a the time of inspection. The maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ fails � Date: 7-9 `y Inspector's Signature: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty r and0)days lhe system complet ng thsubmit is inspection. If the system is a shared system or has a design flow or 10,000 gpd or greater, the the report to the appropriate regional office of the Department of Environmental Protection, The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: Al SYSTEM PASSES: Q•S I have not found any information which indicates that the system violates any of the failure criteria as defined in'310 CMR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: 10 11)_ One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) AD The septic tank is metal, cracked,.'structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will'pass inspection if the existing septic tank is replaced with a conforming septic tank as �U approved by the Board of Health. 1 (revised 8115195) On•Winter Street 0 Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone (617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 30 Blossom Ave Osterville ,Mass . Clockworks Condo Is Unit # 2 Owner: NCUA Date of Inspection: 12/6/95 s e] SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high'static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C] FURTHER EVALUATION 15 REQUIRED BY THE BOARD OF HEALTH: _d16 Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water '( Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system nas a JeuUe Wilk d11U )U:I 11U:-U(p11U0 $YitelYl allu ii `tiithin 100 fee', to a surface %rater supply c.u:bu:a:j tc a surface water supply. 1 Q The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil_absorption system and.is within 50 feet of a private water supply well. 1 The system has a,septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. D) SYSTEM FAILS: At I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. �Q Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. p� Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. (revised 6/iw ss) 2 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: �O B1osoom Ave. Osterville,Mass. Clockworks Condo ' s Unit # 2 Owner: NCUA Date of Inspection:12/6/9 5 o DJ SYSTEM FAILS(continued): 0 �Q Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid.depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Q Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped y� /%ny portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. AD Any portion of a cesspool or privy is within a Zone I of,a public well. AO Any portion of a cesspool or privy is within 50 feet of a private water supply well. .D Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: ,AIL . The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a -public water supply well` The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00, Please consult the local regional office of the Department for further information. (revised 8/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST o Property Address: 30 Blossom Ave Ostervil le ,Mass . Clockworks Condo ' S -Unit # 2 Owner: NCUA Date of Inspection: . 2/6/9 5 Check if the following have been done:„ Pumping information was requested of the owner, occupant, and Board of Health. ,None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as pan of this inspection. _V/As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. iThe system does not receive non-sanitary or industrial waste flow ZThe site was inspected for signs of breakout. ' ZAII system components,.e luding the Soil Absorption System, have been located on the site. Y The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. /The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. the facility ov.ne; (and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. Recommendations 1 . Distribution box is badly erroded and should be replaced. (revised 6/15/9$) 4 II SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 30 Blossom Ave Osterville,Mass. Clockworks Condo ' s Unit # 2 Owner: NCUA Date of Inspection: 2/6/95 @FLOW CONDITIONS RESIDENTIAL: Design flow• DO_gallons perdlYY Number of bedrooms: Number of current residents: c Garbage grinder (yes or no):? Laundry connected to system (yes or no).� Seasonal use (yes or no):A)D Water meter readings, if available: 50-25a& 1 Njt S Aye /J�4Y� e j't'�� s Last date of occupancy:(A1f 04CAIV)r COMMERCIAUINDUSTRIAL: Type of establishment: 1014 — Design flow: AA allons/day Grease trap present: (yes or no)NA Industrial Waste Holding Tank present: (yes or no) n-sanitary waste discharged to the Title 5 system: (yes or no)'V9 ater meter readings, if available: A)!� Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as pan of inspection: (yes or no)A If yes, volume pumped __gallons Reason for pumping: A41 SYSTEM TYPE Septic tank/distribution box/soil absorption system AIV Single cesspool 90 Overflow cesspool �� Privy Shared system (yes or no) (if yes, attach previous in pection records, if any) Other(explain) �Q Uu lT'S Tt� T T /c. S1 ur d hODyYI APPROXIMATE AGE of all components, date installed (if known) and source of information: gage odors detected when arriving at the site: (yes or no) (revised 8/15/95) 5 1 0 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 30 Blossom Ave Osterville ,Mass. Clockworks Condors Unit #2 Owner: NCUA Date of Inspection:12 6/9 5 SEPTIC TANK: lyV y4A�4k 1,44N, ' (locate on site plan) Depth below grade:l(r4ftr. Material of construction: Zoncrete _metal _FRP other(explain) Dimensions: U 1al Sludge depth: Distance from top o;sludge to bottom of outlet tee or baffle:%:& Scum thickness: V Distance from top of scum to top of outlet tee or baffle: d Distance from bottom of scum to bottom of outlet tee or baffle:_ Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Garbage disiposal present SeDtiC tank shottlr3 be pumnpd _ annually,Tank is struntursl 1 Round Wi th nn PIT; (fiz. nf leak ge GREASE TRAP:& (locate on site plan) Depth below grade: Material of construction:A4concrete _metal _FRP_other(explain) Dimensions: Scum thickness. hilt Distance from top of scum to top of outlet tee or baffle: Distance from bottom M Fcon) I,� h0[IOm OI OUtIP! fee or battle' Comments: (recommendation for pumping, cond ton of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, e!c.i (revised 8/15/95) 6 SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 30 Blossom Ave Osterville,Mass . .Clockworks Condo t s Unit 2 Owner: NCUA Date of Inspection:) 2/6/95 TIGHT OR HOLDING TANK:a (locate on site plan) ` Depth below grade:,AA- Material of construction: oncrete _metal _FP,P —other(explain) Dimensions: Ahf Capacity: 64_gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: ? (locate on site plan) Depth of liquid level above outlet invert:—A)b Comments: mote ii level and c.'dencc of solidi ca.r%over, evidence of leakage into or out of box, etc.) T)i•st.ri biiti on box i , badly- errod .d and should d he replaced before soil intrusion he$ins PUMP CHAMBER:9R (locate on site plan) Pumps in working order.(yes or no) 0A Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) AMy�. (revised 8/15/95) 7 ' SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) aperty Address:30 Blossom Ave Osterville ,Mass . Clockworks Condts Unit # 2 wner: NCUA to of Inspection: 12/6/9 5 - IL ABSORPTION SYSTEM (SAS): ,%zg&W+ TreNC4 i cate on site plan, if possible; excavation not required, but may-be approximated by non-intrusive methods) of determined to be present, explain: pe: leaching pits, number: leaching chamber;, number: leaching galler;es, number: leaching trenches, number,length: 1 —W,L leaching fields, number, dimensions: CS overflow cesspool, number. mments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) it is sand OOLS: `( cate on site plan) mber and configuration: AA pth-top of liquid to inlet invert: 9tby pth of solids layer: pth of scum layer: mensions of Cesspool: serials of construction: ication of groundwater: _ inflow (cesspool must be pumped as part of inspection) A9A mments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) IVY:�Q sate on site plan) serials of construction: Dimensions: AM pth of solids:_ mments: (note condition of soil, signs of hydraulic failure, level of pondin& condition of vegetation, etc.) V evised 6/15/95) B SUBSURFACE.SEWAGE DISPOSAL1YSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 30 Blossom Ave Osterville ,Mass .. Clockworks Condo Is Unit # 2 Owner: N. C.U.A. Date of Inspection: 12/6/9 5 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks,or benchmarks locate all wells within 100' Town water. Li Qf, ' r 4A. �% • - -(, Z. . T DEPTH TO GROLINDWATER Depth to groundwater: 20+ feet method of determination or approximation: Installed septic system across tAe".street. No water arnnnntarP.d q.t 1 L I (revised 8/15/95) 9 i VA Ickv Are Q.4 0 4 ir .rt4. vtA10 -ee` i c/I,RHV* _ t2'. M.t+ n , 5 9 L. i _ y�•q 4 S 14 •S I cat M.►+. - M — a' KI 1ONE W q FLOW `= too. O S'•}94 L�� - tot i '• 8U1 LID 1 IV (Z> �} V ty ITS z BED ROOMS j 2 Ibez; R{P c P-t s. Prr ARE A Z�.45 S Q. IP'T f csnei-! Oyu ) Q. `IF' t N� 44 l03•� Ion •-p fJ' loss i � o� •o a2 1 9S t n•rnn*•n.-nrrs—re-ssr:szr.•nrsr--r.r...—.r.:-.•ss--r_rr.-rrs�rs r-�z r.—rzr..='- ..p TOWN OF Barnstable BOARD OF HEALTH l S(II)SURFACF SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION `� �:•••rrs-T•:-::t-rttr.^.--nr.-n•r.:rr:—s.•—.r-rrrrr•r—:.—'=.a-r-�s--r++.•sr-r=—rsrrre:rrs:�srrmrrrersr.xtatsenr.-emreerc:s•zsrrrrrrr•.rr-rr•r.--:r -TYPE OR PRINT CI.EARLl'- PROPERTY INSPECTED STREET ADDRESS 30 Blossom Ave Osterville,_Maz-s:C-1-o-e-kwo�rks Condo' s Unit ASSESSORS MAP, BLOCK AN4 PARCEL # y OWNER' s NAME N. C.U.A. PART D - CERTIFICATION -r NAME OF INSPECTOR Joseph P. Macomber Jr- . COMPANY NAME J.P.Macomber & Son Inc. COMPANY ADDRESS Box 66 Centerville ,Mass . 02632 Street Town or City State LIP COMPANY TELEPHONE (508 ) 775- - 3338 FAX ( 508 ) 790 - 1518 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate, and complete as of the time of :inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one: XXXXX System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* The inspection which ' I have conducted has found that the system fails to protect the public health and the environment in accordance with Title 5 , 3.10 CMR 15 . 303 , and as specifically noted on PART C - FAILURE . CRITERIA of this inspection form . ,r z PgA Inspector Signature Date 12/7/95 One copy of this certification must be provided to the OWNER, the BUYER (where applicable ) and the DOARD OF HEALTH. * If the inspection FAILED, th'e owner or operator shall up'grade ' the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 3.10 CDIR 15 . 305 . S�j'1[ 3r�1 THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required and is hereby -authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. _June 8, 1995 Acting Director of the ' ' ion of Water Pollution Control No.._ ��.:....,1 d Fss. . ........ THE COMMONWEALTH OF MASSACHUSETTS t. BOAR® OF HEALTH OF............... ..................................................... pphra#iun for RopmFai - urki Tonstrur#iun,� rrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst at: 1� a -.--- ----------._._. , tj:.Addr.e - Lot � r f :� ? �................. ..•----••. .... E..! ..._...... ner -------- ---------------------------------•------------- ---7 ------Sef/,------ ........�w......� Installer Address a dType of Building �// Size Lot............................Sq. feet Dwelling—No. of Bedrooms......1_....................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Other fixtures .................................. W Design Flow..........................3A11?-----gallons per person per day. Total dai�y flow.........................._.................gallons. WSeptic Tank—Liquid"capacity ...galloiis Length._.,./........ Width...6_:_..__. Diameter________________ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..._:�............ Diameter......1!V...... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+' ••••-•----•---•--•--•-•---•-•---•-•-•----•-----•---•-•-•....................•......................................................................... 0 Description of Soil........................................................................................................................................................................ x v ---- W -•---•-------------------------•-----------•-----•------•••--•-----•-•---------------•-•••••--•-•••-------•----•------------•-----•--••----•----------•-•••••••-•-•-•-•--•-•-•-•-••--•-•-...._.......-- UNature 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 TITLE:, 5 of the State Sanitar de— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has een is ue by tl���t5pard health. Signed......... ..................................... i�....... �. �f Date J Application Approved By.... ...................................... .....__...-- Date Application Disapproved for the following reason :-•-•--------••-----------•-----••-•---••-------•-------•---••-•--•---•--•-••................••••-............--- ..................•••-••-••---••------•••---•--••••-•--•----•--•-•-•-•-•-------••-•..........•••-----•-------•-••--•••--••-•-•--••-•------•-•---•••-•-•-•••-•-•----••---••---•••-----•••-----•-•......._ Date PermitNo......................................................... Issued....................................................... Date ;q,w£. _. / a ND.. asr. .�" FES r ,,.r r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH q ------ - -- -- ---' OF.... w Appliration for Disposal Works Tonstrurtion rruti# t Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal Y S st .at / 4.....KV-1 '.>.._�:,Ale....-•••-•..... ..... ............. ... --••--V ..---.....--••-- •. . ....: c � c " eta 4 ocation-Add r r /o 0 ! f caner p �d s ................................ Installer Address Type of Building ?. Size Lot.................... :__..Sq. feet �-, Dwelling—No. of Bedrooms,:..-.-/.:... ...........................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Buildin a ; YP g- --------•--------------------No. ---of-persons ---------------•---------�----Showers ( ')=— Cafeteria Other .fixtures . ) DesignFlow..:.... d Rb_..__ allons per.person erson per day. Total da' w----------------------------- W '�------------� -- g P P P Y• �Y � - --•--------- --gallons. Sep tic Tank—Liquid capacit __.gallons Length_,-/---__._.. Width. ':�z.... Diameter................ Depth.........-...... xDisposal Trench—No..................... Width............ ..._.. Total Length.................... Total.leaching area....................sq. ft. Seepage Pit No.-__--&------------- Diameter.....././...... Depth below inlet-:_--.............. Total leaching area...................sq. ft., Z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by...••....•-•--•--••-•----------•••................ ------- -................ Date-----...------....-----•-••----------.. Test Pit No. 1----------------minutes per inch Depth of Test Pit.....................,Depth to ground water........................ 4= Nest Pit No. 2................minutes per inch Depth of Test Pit-................__'=Depth to ground water.... =-----••-------------------------------- .--......................................................... Descriptionof Soil........................... ............. : .....•--------•----------- --------•------•----- c -------•--•-•---------•-•---•-•-------------•-•--••-------••----••---•••-••-----••-----•-••-•---•--•----------•--•---•----------------•------------ UW ---------------------•-•--'•• ------•-••---•-•••----••••---•----------••--•--•-••--....-•---` •--------------------------- .................... Nature of Repairs or Alterations—Answer when applicable....................... ..................... ......... ............_...._............. -------------------------•---•---------....------------•--•----------------------..........-•-----•----•--------------------------.-------------------------------•--•-------------•-•---....._...---- Agreement: The undersigned agrees to install the afore'described Individual Sewage Disposal System in accordance with the provisions of TITLL 5 of the State Sanitar de—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has t is ue by thetoard,4 Health. Signed. Date Application Approved BY ....................................... ......... •-------- ' Date Application Disapproved for the following reason...-•-•-•••••--•------•--••••------•----•-•••--•-----•----••-••--•--•......------•---•---••• ......-----••------- ..-•-----------------------------------•--...---•-----•--•--------•••----•• g k °^Ae*, Date I . , } Permit No........................................-----•- --...11Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH n' ............................:.............OF..:..'..........................................................................{... Zrdiftratr of Tnmph aurr I. THIS 7S TO CERTIFY, That.the Individual Sewage Disposal System constructed ( ) or Repaired ( ) bye 'N ----------•--•----•-----•-----------------------•-----.................•-----...---. yr t m -_ �Installer has been in�'Es tilled in accordance with the provisions of T!TIE- 5 oaf The State unitary Code as desc ibed in the application for Disposal Works Construction-Permit No....... _____✓ 11�._._... e�,t . ;�....... ...... ....................... ' THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE Thfkr, ..SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.....:....-=t....------------------.....----------..........--------------•--•---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �d No. ..... �_........__ .............i. ..................................................•-•........ FEE. �i,��rlar��a1` �ark� �lQa�� z�r�irrri .eruti# Permission is hereby granted---------------- lf'it .-_-----_ ti--------------------------••-------------.....-------••-•-----............------ to Construct ( Repair (' an Individ at No pal S wage Dispos �1 t ........ c .. •---- ...., .-........................... Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... r Board of Health DATE...............•--.-•_= f f •��• v - FORM 1255 A. M.jAULKIN, INC., BOSTON -� i h, l'O C A T 10N :5 3t TE W-Z G E PERqlT ISO. Aj-e f� 1�t1 lAG E I N S T A LLER'S NAME i ADDRESS 3 U I L 0 E R OR 0-W III ER- DATE PERMIT t.S_S-II E D p ,ZA DAT E COM-PLIAN-C-E , -ISSUED 17 ,1 } ko$ ,� No... l G/� �C a c C�/E.K CO A) b C) Fes$..... ..... LCI & 1A THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H EALTH �.C�IviJ: ................OF..... LV./Y t .(� ApplirFatiun for Diupla i al Works Tonstrnrtiun ramit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individuq�g/ 1isposal Syste�a�.r5.� ....�.1.! .l L ...... ! ! !. ��"7 �4 S7 •^ o¢a ion-Address or t N W .AU staller .........•..•-•_'�_9 tl•1".""" .- Address �, `X��s-.....f� JC_��v � d Type of Building �l�L.,Tj � Pit-L.:°-� Size Lot.2.6,_617 ----Sq. feet Dwelling—No. of Bedrooms........... 0........................Expansion Attic (�a) Garbage Grinder Other—Type of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures W Design Flow...................G7.6 ___=_____._.------gallons per person Rer, day. Total daily flow._...------------� �.0__......____._..gallons. WSeptic Tank—Liquid capacity gallons L'ngth-_�.�.-:W.. Width..6-__1. r D__- Diameter................ ,Depth_ -�_. x Disposal Trench—No....._i............. Width_......._...... Total Len gth...L C�.........Total leaching area__�.` _ -:sq. ft. Seepage Pit No................ Diameter........ De tli below inlet.................... Total leaching area.................. ft. Other Distribution box Dosin k z �i gr� � a Percolation Test Results Performed by._...13. . .... ____.. _ Cf�.. 'iL Date..l _� -.. __ F.a Test Pit No. 1.�.Z..minutes per inch Depth of Test Pit _� __.____._ Depth to ground water.CS�y-4 fi, Test Pit No. 2................minutes per inch Depth of Test Pit...tl�........ Depth to ground water.0_V:fr '... -7—1 P4 ------------------------------ ------•••--- ............................•- Description of Soil.....M_Lu.yd....... .1) vr. r•-- ------- -------------------------------------------------------------------------------------------------------------•----•------------------- 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 TITI„-. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificatielof Compliance.has.been issued by tin board of health. Si ned e _ Application Approved By.---.•.. ------•- �. .........--•.• 1� 1 /:�J ------ e. 1Sate Application Disapproved for the following reasons------------------------- •-............��. ------------..= --------------------------------------- - .............................•---•----••......_.....---------..............--•--••-•-••--•••--------••-•- ---------------------- Date PermitNo......................................................... Issued....................................................... v----- Date -- --� f' Fss.... :l ..... THE COMMONWEALTH OF MASSACHUSETTS BOARDS Off` HEALTH .. ....r...A�.I -.................OF.....1 � J d 5 -e... ------------....----•-...................... App irFation for Disposal Works Tonstrurtiott erutit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal Syst at: 7 ;,-A, O�fzT_,u itte -Location-Address or Lot No. ............. .... .....»............---..............---.......................................... •......--•--•---••--••-•----•---•--•••-•------•.................................................-- Owner /4::yr Aer„��.� Address .............11--•---......................._.....-- _ �.-... .... ..........---............_.................._--....---.._._...-..._------.---•-••-•--•--------- Installer Address Q Type of Building U1..rj I L—( Size Lot. - .......'? -.......Sq. feet Dwelling—No. of Bedrooms............................................' Expansion Attic �)o Garbage Grinder Ij '4 Other—T e of Building No. of persons... ........................ Showers — Cafeteria � Other fixtures - - ! ------ --------------------------------------------•---------------- W Design Flow.......................................:gallons per person per d,4y. 'Dotal:6^daily fl . ow.:...',.%�.., n.................gallons. WSeptic Tank—Liquid capacity�.1`^ gallons I.�ength..V- S... Width. - -.-. Diameter............... Depth.'�...+ x Disposal Trench—No.................... Width....:7:._........ Total Length__!K V......... Total leaching,area_1�4.��....sq. ft. Seepage Pit No.................... Diameter.................... De th below inlet.................... Total leaching area........... ft. Z r Other Distribution box Dosin � � Percolation Test Resu is Performed by......z� . . t+J...Lyr c::: ..¢-�`�.2. Date_i�__y_ aTest Pit No. 16....�_.minutes per inch Depth of Test Pit( .�-�......_.. Depth to ground water-C:?v e,f-..�Z .. rX4 Test Pit No. 2................minutes per inch Depth of Test Pitj. —......._.. Depth to ground water GV`-'.Y"'... 1 i� ------------- .o Description of Soil:.:: t ................................................................................................................ .........................................................=-----------------••----------•------ W -------------------------------------------------------------- •--------- •--------------------------- vNature of Repairs or Alterations—Answer when applicable..................................................................:............................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the ,provisions of'TT` 1, 5 of the State Sanitary,Code—The undersigned further agrees not to place the system in operation until a Certiacate of Compliance has been issued by t e board of health. Si ned ! .�1 �` ! --------•---------•-•-•••••........_. " to Application Approved By.....: -- ICZ.:- . .... .......................... -- 4a.t� .... Application Disapproved for the following reasons:............................................................................................................... ...........:...........•-•--•--------•---••---------------------------------•----•------------------•-----•••••••--------•-•---•-••-•-•--------•----•--•------•-----•--•------•-•---- Date PermitNo......................................................... Issued_.,..................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH O ...... ~A ,- .........1................................ Trrtifiratr of Tompliattrr I TO CERTIFY That the Individual Sewage Disposal System constructed or Repaired THIS S ( ( ) d g P �' by... ---------------------------------------------------------------------------------------------------------------------- Inst ler at ..C)� -----------------------------•-------------------------•------- ------ -- ---- has been installed in accordance with the provisions of TI T LF 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No---- ,ti+�- ,.! ................ dated...--------------------------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 1 DATE............................................ /_ ...... --•-••-•-• Inspector----•---------1 . 1 'f THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............................. FEE... Disposal, Works TOnstrurtivit Uprrutit Permission is hereby granted. -----•----------------------------•-..........................--•-•--- to Construct ( or Repair ( ) an Individual;S,wage Disposal System y� . a :, Street as shown on the application for Disposal Works Construction Permit No--------------------- Dated.......................................... - f' -----------------------•......----------....� L// of Health DATE..---•------------•..................p>..�1/_....._....----•--- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS No p / THE COMMONWEALTH OF MASSACHUSETTS ` BOARD OF HEALTH .G..4U ................0F.....�v/�l.`-P s. --------------•-----------------•------.-. Appliration for Disposal Wqks Tonotrnrtion ramit Application is hereby made for a Permit to.Construct (" or'lkepair ( ) an Indi idual Se we/Dis osaSystel �. .............t:.�.. E......::l. ...... .�� ....... A.5.j�bX"...1.'.:!-k.....�-J... -?119 -Dr"` --'z oca ion-Address o Lot No --4----� 1 c .............. r A r p a --.......!< i V... 1���''. caner l . _ L.F�J �r C �`�l• \ �� '`—� ......... _ ........ Installer Address U Type of Building 0t j_T-1 PPAFAlL`f ' `_` Size Lot... 31 b ...Sq eet Dwelling—No. of Bedrooms.............��t 1b ..............__......Expansion Attic Garbage Grinder Other—T e of Building No. of persons............................ Showers — Cafeteria Other fixture..•-•-••---••--•-•------------•-• W Design Flow..................cam ...............gallons per person per day. Total daily flow...._... `�.�.�3__......:_.__._._.. ns. H �.Qo W Septic Tank—Liquid capacity- fJfiG?.gallons Length��_� f_... Width,{sa... ....... Di eter............... ept ....__-.c�.__. x Disposal Trench—No..................... Width-----,.._.._........ Total Length...._._. ......To al ch ng area... . ............sq. ft. Seepage Pit No......4.......... Diameter....... ......... Depth below inlet____. ._.._.. _.. T al ea ing J-Z_..sq. ft. z Other Distribution box (�e5 Dosing-tank ~4 Percolation Test Resul,s Performed by,... t .. ate......t�S.� .�Q��........... 1 1-4 Test Pit No. 1................minutes per inch Depth of Test it....l _....... . Dept t ound Vater_U__..__._Y-I-Z, L14 Test Pit No. 2................minutes per inch De th o Test Pit....... ... ..... Dept t , roun water........................ . ---- ---- -----•------------------- ------•--------.------ - -•---- O :.... ... _.. Description of Soil . 1 ._ . _ . . x45 . ........................... c., - ---------- --------- - - --------- Uw -------------------------- ............................... - -- -- -------- ----------------------- ------------ Nature of Repairs or Alterations: Answe when a plicab --------------------- ------------ --------------------- --- ---- -.Z...................... -------------------- ------ --•------------------ - - Agreement: The undersigned agrees to sta he aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of th ate Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by e board of health. Signe ......4--- ---------------------•-•-............ lr ........ Date Application Approved ojlC`� �------------ Date Application Disapproved for the following reasons:............................................................................................ .............. --------•-----------•------•-•-------------------------------•---•----------------------------------•----------------------------------.------------------------------------------------------.......... Date PermitNo........................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH iota ................OF.... .. . . .... ............................................ Trdifirn#r of Tontnlianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed' (�or Repaired ( ) bY-----......ti------� ¢-=-------------------------------------------------------: ..._....---------...------------------......----...........----------------------------._..._ ' Installer has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.R/:::_:�/2.................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................................................-.................. Inspector..................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH y. `....................OF..... ` . 3 a� .... FEE..:at t............. Dionosal�Works Tonotrttr#ion rranit Permission is hereby granted------.. .....................-•------------------------------••-----•-------•••--•....----....._....._.... to Construe �. or Rep it ( ) an Iud} idua�Sewage Disposal System Street as shown on the application for Disposal Works Constructions Permit No...................... Dated.......................................... Board of Health DATE,................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS o A rr- No.. /.:--�L •.. i �' ('GvCr'fLtlJ/i// F.0 ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f OF � SGt = Apphration for Disposal Miariks Tnnotrn.rtirrn rrmit Application is hereby made for a Permit to' 'QRnstruct ) or Repair ( > an Individual Sewage Disposal Syst a J � _ /4 � L). .-8 .. Location-Address or Lot No. Owner " Address W •.�- `�r ...................................................................•--•`•••--'•--•-•-----•---=t= ---•.....-••-••---•------'----•-•----•-•..._..----•-•-••--•�---_..�......._...........-- Installer Address Type ofoBuilding IA V LTI PNq►L. Size Lot__.____....�................Sq. feet '4 Dwelling—No. of Bedrooms............1_(e�..............:. =__..Expansion Attic kb) Garbage Grinder (K. _) aOther—Type of Building ............................ No. of persons......_..:;;_-_............. Showers ( ) — Cafeteria ( ) Otherfixtures -•------------------•----------•--------•-•--------••------------------_--•----------•-------------- W Design Flow.................v5 ..............x.gallons per person per day. Total daily,,flow-_-_, .....................gallons. gallons g.A 1 -�I � _S � Septic Tank—Liquid capac>ty; .ga s Lengt _______________ Width _.._._._.._. Diameter................ Depth._._. _ .... v W — .r rye.` Disposal Trench :�o. „__�:.............. Width...._.._._.__.,._.. Total Length............ Total leaching area.................... ft. Seepage Pit No.... ----------- Diameter Diameter...... _......... De th below inlet.... '........... Total leaching area_9.3 . ..sq. ft. Z Other Distribution box (ye)5 Dosing tank i ~' Percolation Test Resu sJ Performed by... __,__ ._.h -_ _ _.. _........._. �� a � �' Date_-_.--------�•���---------- � Test Pit No. 1.4............minutes per inch Depth of Test tPit____��.......... Depth to ground water.F..�_.-------'f_..... .� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_..................... n ---------• -----•............. -•------••---•---------•-----•-- 01 Description of Soil_ _rr ,_!.L1 ______ �_..___�1 ._....`? ,D txy ---••-•--------------------•-------------------_______-•---------------------------•---• -------•---•---------------------------------•------ -•-•----------••-------•--•---------------- W UNature of Repairs or Alterations—Answer when applicable............................................................................................... 3 f , ______________________________________________________1_.__._.____._.___._._.__.,_......._.._._.......................___......._._..........__......_....._....................._.__............_...... Agreement: Rr Tile undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of A.—I 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. A lication Approved B , .. . : ..... d, � .�......_.._. PP PP By Application Disapproved for the following reasons:.................................................................................... --------------- ----------•-----------------•---------.....--•----•------------•-•------.....------------..._..---------------------•--•-----•-----•----•-------•----•-------------•••-•-•----------••-•-•••-----•-_.... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1. ................0F...... ....... (9rdif iratr of TumpliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( 11011or Repaired ( ) by............... ------ .......................................................................................................................................................... ` d � Installer at............... ---------------- ------------------••--••-•----•-•-----••--------------------------. --..._has been installed in accordance with the provision s of TITLE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.._*1°•_.V41.................. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.........................................•-•--•-............-•-•-------••------• Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . ! .................................... D �.. - No.... �t! .. FEE.......:.. •......... Disposal Works Tonstriu-tion 1hrmit Permission is hereby granted..........tC. ..... ---.._--- to Construct ty'gr Repair ( ) an Indivi ual §ewage Disposal System atNo....... ....................... Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... •- -- --------------•--...------...............-•-_..... DATE................................................................................ oard of Health FORM 1255 HOBBS & WARREN, INC., PUBLISHERS <"-TL`t Lvi. L��/iN� Room el1S re JA 4 �)2 p�w,rJc, (LOOM IG1TN�1 aD�Yo 'a LC-3 O J��T -A 4 JTV I I 3��ooM t�'2 OF F i cE/,Dc Nt L. f3 AT�-1 P2aPc�5�o r3E:OQOprt1 5'ooz�ri�tiY, 4-�3 fJoT �`o SLn,�E i� - - r _ 'A1 Vol 1 Too . DS'VV SOWAS- wl;yv tt ti -�,. !K �`. �� 4 x �� .,1"6 a y 4_y- -� #'4 { =•"sE a , t i TOWN OF BARNSTABL j I 0 U �a if�70JSEWAGE # 6fl - �� LOCATION � 6 o c1?---��-,=r6��.r—•,�-- --►- VII.LAGE r,-tai`u� 1/,P /ASSESSOR'S MAP & LOT S INSTALLER'S vAME&PHONE NO.N0ued SEPTIC TANK CAPACITY ra,V . - LEACHING FACII.ITY: (type) O-+D DGq/� t � a (size) 16 NO.OF BEDROOMS u BUILDER OR'OWNER (,� c eu i �S (fig0 16 A 0 "� PERMIT DATE: , / "d ( COMPLIANCE DATE: a Separation Distance Between the: Maximum Adjusted Groundwater-Table.and Bottom of Leaching Facility Feet;:..; Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) . N.1� Feet_ Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of beaching facility) Feet_ Furnished by� .- (3��-� i3 S�Stevty t i-e e ..�.— _ _n 3;A�- ' c , f L — e 7 a L0 CAT 10N 5415— ) EWAGE�PERVIT 00• V 1 L L AGE 57 . le I N S T A LlE S,_ N M�E/ A ADIRESS i U I L D E III,::..OR OWWER "a su GfP xn - DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �� c.. a Qa .t TOWN OF BARNSTABLE 1 I2-_ 053_.8Z) C3 LOCATION PA)r7' 5� SEWAGE # VILLAGE �V f ASSESSOR'S MAP&LOT/0- IN L-HR''- NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILnT: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by l UVIF s 6 �3 3q y LOCATio SEWAGE PERMIT NO. 1� L- VIL LAG E.' �- r � o�sUr-► �4crin � �.�� INSTALLER'S NAME i ADDRESS BUILDER . OR,�, O.WNER 0AT. E PERMIT ISSUED OAT E COMPLIANCE ISSWED �O/� k3 z� SWOSS.ar. -Nq v. .�fds�r► /-fie 30� 3 ���� LOCATION SEWAGE- PERMIT NO. VILLAGE � Y ,_,S, 4- 0 S� INSTALLER'S MAME ADDRESS S U I L 0 E R OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED % tea 1 { I V I� , Z-. �S Fis............._............ _. C� THE COAgPv10NWEALTH OF MA�SACHUSETTS BoAR® F HEAL .......... .................... ..........OF....................................... W.................... Appliration for llhipasal Morks C untitrurtiun p �� Application is hereby made for a Permit to Construct ( or Repair ( ) an Individ ewage s osal P � P System at / .. ...... � .. -------- � Addre or Lot No.. 12 . ........... .. , Owner a ----------------------------------------------A- ---•----------------------------------••- ------.-.--- � Installer Address - UType of Building �� Size Lot_._�7__39.__�7.._..Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a W p, Other—Type of Building .Cm�?'�2CJ....... No. of persons..........1................ Showers Cafeteria ( ) a' Other fixtures, .°�- W Design Flow..................... .............gallons per person per day. Total daily flow....1`�..�-�..().......................gallons. WSeptic Tank—Liquid capaF ityAAMgallons Length................ Width................ Diameter................ Depth....._.......... x Disposal Trench—No. .................... Width ............ Total Length.............,:... Total leaching area.._.................sq. ft. Seepage Pit No.............v, .. Diameter.._..1.�,f......... Depth below inlet_.3.6........... Total leaching area. � .sq. ft. Other Distribution box ( Dosin tank ( Percolation Test Results Performed by.. P. ��I���I W.�. . �°'' �(�f�Date.... ... ...........................� ,aa Test Pit No. 1._��inutes per inch Depth of Test Pit__/3.A ..j__.. Depth to ground water......:................. Test Pit No. 2..�=�niinutesper inch Depth of Test P�.� ..� Depthto ground water....` ��. O Wx Description..o.f�Soil DS1�1)?iMl_l f---.�.t7-.-_'-._j rrsl � ®� .0..._� ---- 5 ........... ...1 ............... ------------------------•--- ...... VNature. f Repairs or Alterations—Answer when applicable....__ r ... ... _41emn _. . ...................................... ............................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of THTLEE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ben issued by the boar f 11 'th. q Signed. D e Application Approved By............ ..... --- Date Application Disapproved for the following reasons------------------------------------•---....-----------------•-•----.....--•-•------------------••-•------....._ --------------------•--.....----------------------------------------------------------.........----------...-------------•----------------------. ................................................... Date PermitNo......................................................... Issued_...............................................--...... Dale No......................... FRic............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD,-OF HEALT _..............OF...{f7/�L.... --........ .. ......................... Appliration for Diipoiaal Mirkii Tanstrnrtion Permit Application is hereby made for a Permit to Construct (, or Repair ( ) an Individual Sewage Disposal System at: r; ........ ._•• ..••--.......---•---- ..... ................... ... ---•--. , Lpc ti bn-Add, or Lot No � c. _....... ..... .. ........ ........... W ''Owner ----•-----------------••-•-----.Address -- - - ------------------------------------------ ------------ ........................... Installer Address t�7-_o� Type of Building �z Size Lot_1.. 9._!.-...Sq. feet Dwelling—No. of Bedrooms o..... .........................Expansion Attic ( ) Garbage Grinder ( ) a, Other—Type of Building . ?a ' C1......._ No. of persons........_r_._d__..._....._ Showers Cafeteria ( ) QI Other fixt<11 ure_ . ----------- ..-------------------------------------••----------- ---------• -------------- .-•---------- W Design Flow..................... ............J.....gallons per person per day. Total daily flow.._&/C.0....................... . G:�L-V � Septic Tank—Liquid capac>ty:�:....:....gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No. ................... Width- ....... Total Length.....;....�,r.... Total leaching area....................sq. ft. Seepage Pit No............ � Diameter.....�.r ......._ Depth below inlet_.:_1.42_..__..._... Total leaching area.!�2._1..sq. ft, • Z Other Distribution box (''') Dosing_ tank ( ) Percolation Test Resu'ts�; Performed by.4�czt•:•e!._.. _ u' f�'�l ! Date -f...: .:..... : ........ a Test Pit No. 1..--____0--.minutes per inch Depth of Test Pit. - _. ______ Depth to ground water.__..._.."_----- Test Pit No. 22____� y:/minutre�s per inch Depth of Test Pitl f�_le_... Depth to,ground water "'"_ .. !_...�.. f 'C- rl .•al'f;�j._"_`. .�_ ...-_... :'..`_...... ............................................................ ........ O Description of Soll 7..... .U..I ;...L)� _ �� .... :. ........•• -••••-........-•---••-••••_.. f r t- } {JJ.. / / C,�iC°'_?;, ! I ��, ° .i!'r ..: L.J,,'so/ f "'t,� ��t�/ �Jt?�-�1. �fp/ts�l,•1-............. U ••-•-•-••••.••... •-- - -----------------------------------------------------------------•- ...•....................................... VNature of Repairs or Alterations—Answer when applicable............................................................................................... -----------•-------------------•----------.........----•----•------......._.._...-----............-•--------...----------------------------------------------•-----------------.............•-•-•-•••_•. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of:T:'T-S 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 boar of I f th. Si ned.° _� _ •.:. _......�''---•--....•-- Application Approved B ......._ �-- _. !'__._ ._. ........................... PP PP Y � �`Date Application Disapproved for the following reasons:................................................................................................................ ..........................-•--•-•----- •----.......----•---.......................................................................................................................... ................. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ ...........OF... ti: :e'?.1 .................................. 01rrtifiratr of TompliFanr THIS IS TO CURT FY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) b L t r.'. l..G f�. _,�?......................... i taller at... has been installed in accordance n with the provisions of rp �' ` The State Sanitary Code as described in the application for Disposal Works Construction Permit 1 .. . . _. ___.5..4•T......... dated_............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................=......=......... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD,-OF HEALTH /.'....Wit. ..."':........OF... .......................... .1 .... ...--•---•. ...��..$:....... FEE....r7 ............ i ro aal ork� o iitr ion ermit Y granted.... c ii'r Permission is hereby = -- -: `_.. �' to Construct (/-) or Repair ( ) an I di 'dual Sewage Disposal at No.f. : ;__ _ n.f�1_ '. ' }l �' L/ _�'_l -f L,'i ....---.....•-•.----•-•---------•--- ....................................... Street as shown on the application for Disposal Works Construction Permit No-/�- '_�._._-- --- Dated.......................................... oard of Health DATE ................................................L FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS Is fai h r I� Al .�� '0 3ns s v 3 :) NVIldW03 3ira aInSS1 IIINa3d 3 1 V 0 �I a 80 +. 3alln n3 ago �a t �;S3Na® � 4 3�tl M .S, 31.1 :v1SN1 *ON ll0d� 3d 35VM3S NOIIV301 wr THE COMMONWEALTH OF MASSACHUSETTS ' BOARD OF !-i EA�T I-I • ---....OF......... .. 2 c�4 ............. AppiirFation for Uiip.a i ai orko T ion ramit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: ._.....v....---•--/�'�:is'u__:5�-.°.---�....�.._'�.... C................................................ � ------ o ton-Address Lo No. O ner -_ _ -----•-------•••-•-•-Address Installer Address Type of Building �— Size Lot... J�_ ..Sq. feet Dwelling—No. of Bedrooms_______________............................Expansion Attic ) Garbage Grinder ( ) per, Other—Type of Building ---- No. of persons------- " `' --- Showers (0) — Cafeteria ( ) Other fixtures ------------------------------- - W Design Flow.......�_r_�_<1`...............................gallons per person per day. Total daily flow........... :.....................gallons. WSeptic Tank—Liquid*capacityl __gallons Length................ Width................ Diameter---------------- Depth................ Disposal Trench—No- -------------------- Width.................... Total Length...............r,,_ Total leaching area....................sq. ft. Seepage Pit No----------- Diameter..../.�K.f...... Depth below inlet....I&........ Total leaching area.-759_3.�sq. ft. Z Other Distribution box ( 'I- Dosin tank ( ) a Percolation Test Results Performed by..���_.__��.►��Q_ ____________�...__...__�-�L Date._..__._.__ _____. ______...-. Test Pit No. 1.....__..�.minutes per inch Depth of Test Pit-_-_fA.._._... Depth to ground water........................ Gz, Test Pit No. 2.4:'9L-._minutes per inch Depth of Test Pit.---?.v'?h......... Depth to ground water........................ a �� y�...............r - - ??•---_----77.... O De cription of Soil....1-- �� - l - �0 '` ''c 'ski c�C� - _• _ __-_____ _•.......................: _ O �i-- ill �••--••• . - -- UNature 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 iIT:IL 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 bo d o 1 lth. c� p JSign.ed �1J.-�-E�`- ...................... x V D Application Approved By--------- � � L � Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- -•-------------------------------------------------------------------------------•-------.....-----------I...........................................................-................................... Date PermitNo.......................................................... Issued....................................................... Date JY Y THE COMMONWEALTH OF MASSACHUSETTS BOARD OF �-i E .. 1 •. ':`.: .........0F........ ....4 ................................................... r Aptiration' fur Dispaiiai Works Toustrn.rtinn antic Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: j o / _ev_ , �C,S; All �`f%,�rl�I T C.. mot. .� �Lo a�.on-Address R No. .----.. ......�`.............. 1 :�.... 1 ,E � ........ .....-•---------..............-••••--••-••---- / wl�"f•. Owner Address ...............••--•--------•----------•------------- ...................................•......................................................---^--- Installer Address l Type of Building Size Lot.-_':`................. .....Sq. feet U Dwelling—No. of Bedrooms............................... .....Expansion Attic ( ) Garbage Grinder ( ) r: Other—Type of Building .r.f.:.................. No. of persons...... .. ----- Showers O — Cafeteria ( ) Other fixtures ---------------------•---------- -. . W Design Flow____...::.:'________________________________gallons per person per day. Total daily flow._._.....................__•................gallons. 9 Septic Tank—Li uid ca acit 2CC-•gallons Length................ Width................ Diameter................ Depth................ W Disposal Trench—No.................... Width............._...... Total Length..... Total leaching area sq. ft. x - Seepage Pit No....__._._=''.:_...... Diameter._.. .. _..._. Depth below inlet__..` '._......-. Total leaching area_! s.._'.sq. ft. Z Other Distribution box Dosing tank ( ) J , / ,F '-' Percolation Test Results Performed by_LO.A)....6-r_`��`.............._'��-....��''/L Datel.�_:�_%....._�............. Test Pit No. 1..`_•2=minutes per inch Depth of Test Pit..... _-��..... Depth to ground water........................ Gz, Test Pit No. 2Z___.. --_-.minutes per inch Depth of Test Pit.... a........... Depth to ground water........................ tx ............�.F�- ...---• D Description of Soil f .. J' :, r `'' a l_i' e .U ...........................................................7............................................................... ---....... •---------------- --•------------ -- . ............................... - / f ` - _..._._ - - - •------• ..... . . ............................... ........ --..........•-•-----------------------------------•----•------••-- 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 TiTI: 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�4he board o •1 ealth. �s Si en e� --- --=---` . cr: !L__.-:. ... •.............. ....... `�'..:� . Application Approved BY................ ...... . .....•. 50V. _ Date •- APplieation Disapproved for the following reasons:................................................................................................................ -------------- ------------------- -........ ---------------------------- •-- ---------- Date PermitNo.-•-•-••--••---•-••........-•............................ Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT ........:•......:<i- .-...........OF.�. ..:xt/....'................. : Tertifira#r of umplianrr THIS IS TO CERT FY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) y -��---Ls ,. _ at �%iCrir,f?:y 7TV enf" e/�'✓ i`• �t-!� — has been installed in accordance with the provisions of TIT r, ` State Sanitary Code as described in the application for Disposal Works Construction Permit No--- ......... dated-..--------------------------------------------- THE ISSUA E OF THIS CERTIFICATE SHALL NOT BE CONSTRUED,,AS A GUARANTEE THAT THE SYSTEM WILL //U�.Trl SATISFACTORY. DATE......,��..<--.1 .....-•...................................• . Inspector.... • --•--- ............................................................. THE COMMONWEALTH OF MASSACHUSETTS `- BOARD,OF HE A THr ' rf... .. .'... OF. c-rG Lr�fr� It �4r�l . .................... FEE........................ Disposal Works (Innotr #ion rrmit Permission is hereby granted..... ............................. _ to Construct. (X)_or Repair ( ) an Indiyidual.Se age Disposal Stem _. / "' ''• C - -----..._� Z'u--. ... u�i •-.f at No.. lit/ Street as shown on the application for Disposal Works Construct' - it o........... �Health_ ...................................... .............•----•••----....._••--•-••---- oard . FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS No.. - / F�s...1� ........... r THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .............OF.........T�..A........./.STAT3L-� � Appliratilan for BiipniFal Works Tontrurtion ramit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage, Disposal System at: _ /3/cly• `Z - laba 0,- ®i�4/©m/e>� n� ... � 1 _ 1/�s -3 ...Q crvi//e-_d ais. Location.Address o � f No. ..Czl!�lll t/i.. lr �.. /._ ..7f Addres.rrxt?%s� Owne � a Installer Address dType of Building Size Lot... .....Sq. feet " V Dwelling—No. of Bedrooms..........Z�2...........................Expansion Attic ( ) Garbage Grinder ( Other—Type of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures -------------------------------•-- W Design Flow....................�5......._..20®0_gallons per person per day. Total daily flow............................................gallons. W2 Septic Tank—Liquid capacity/50n.galIons Length__ :.. Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------_0........ Diameter...../ P:. _. Depth below inlet..... = ':_. Total leaching area,t-'✓J!.Vsq. ft. Z Other Distribution box (✓j Dosing tank ( ) a Percolation Test Results Performed Date.......���3�8�............ h a Test Pit No. 1__.<.2....minutes per inch Depth of Test Pit.... Depth to ground water-----t/on 5--._-: 4i Test Pit No....�-A....minutes per inch Depth of Test Pit-----/.44`.... Depth to ground water....Nd?�.... 04 •-------------------------------•--------............................--•............................-----•-•-----••---.... ..... .....____------... O Description of Soil.................d �"--- a/P vac .__,lam--.___ :'_�4✓A,9bi�,; �'"-/ _"._11�� r-f... x W ---------------------------------•-----------------------------------------------------.----...------•------------------------------------•---------------•--------•-•--•---•-------•--......------•-- UNature 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 ITLL 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. / Sig ed-------------------------------------------------------•----------------------------•- ---- -_ .....---•-- t ff Ito Application Approved By r.C - ��'�` /�.C ':�/'Y - ----------- Application Application Disappro, or following reasons-...............................------------------------------------------------•-----•----- -----•---:......_.. ..............•----------......' . ----•----•------- Date PermitNo......................................................... Issued........................................................ Date tNo..g...:...... . .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH dV............OF......... I�.9, Appliration for Disposal Works Tonirurtiun Famit Application is hereby made for a Permit to Construct ( v�or Repair ( ) an Individual Sewage Disposal . System at: I-/C • 2 - A),o 45¢cGr-V� �' � Q.... /� ..... Loc do -Address t No. 7.1 Owep ner' Address _c2 'C�!/� 1. G' /y Qi7 /.5_� /f ,1 �:........................ .. Installer Address d Type,of Building Size Lot.... z z _----Sq. feet Dwelling—No. of Bedrooms.........................................................................Expansion Attic ( ) Garbage Grinder Other—T e of Building - No. of persons............................ Showers — Cafeteria a' Other fixtures -------------------------------------------•-. W Design Flow.................._..:�--'�_•....20._.gallons per person per day. Total daily flow................�����............gallons. W2 Septic Tank—Liquid capacity i�aagallons Length...�%7�E_..Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........... Diameter.._.. .-`!.. Depth below inlet.....2. ".. Total leaching area.¢..X1 7sq. ft. z Other Distribution box Dosing tank ( ) `-' Percolation Test Results Performed by.- /rYJ, ?:w rt/i /<•-s..�'h csc: //�c-: Date.......`���• rAl' ---- a Test Pit No. 1...."<.2....minutes per inch Depth of Test Pit.....f Depth to ground water........................ c%.. Li, Test Pit No.3... ...minutes per inch Depth of Test Pit...... Depth to ground water.....��!��_... ---------------------f---.-----•----------..--.---.-.-•------------ O Description of Soil ®�~ ?' %cam ,/_ l "................................u,66e �/,..0,0_- /44..__. ....c x W ••-••••---•----. .................................................................................................................................................................................... UNature 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 TITLE 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. �� Sig ed................................................................................,...-• •• .......:.._.. f Date Application Approved BY--�--�---'ll _.1�,."------•-------•--------•--•--------------•----•--•--------•-------•- -•J��:��{��1�-='-----....--- Date Application Disappr tie or the following reasons---------------------------------------•-•---------........------............................................... -------------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF..................................................................................... rdifiratr of Tout rliatta TTH I 0, ERTIFYY ��i -he Individual Sewage Disposal System constructed ,( or Repaired ( ) by..... �" !Zh.!'.r... Installer r .. . h h '" T r f h State ani r Cod a scri in h has been installed in accordance with the provisions of L, >o The St t S to y C s di(scribed the application for Disposal Works Construction Permit N _�.-_._ _._ ---------------•---- dated` - ;/��--- ��--�'=---------------•---- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUA ANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................'OF..................................................................................... �i��r�a i , or , T�antruan rrmit Permission ' ereby ranted -�n�' to Con t or pair anual Sewage Disposal System at No - • -- - - --./ Street n as shown on the application for Disposal Works Construction Permit No............ ated/. / -................ ................................... "'= ' •-------------------------------------•--------------------- oard of alth -DATE...............................................................................- d FORM 1255 HOBBS &WARREN. INC.. PUBLISHERS 4 No..V�E��° _ .,„.i Fizz_..,.?�..e.............. THE COMMONWEALTH OF MASSACHUSETTS �- BOARD F ..............O F..... M ApplirFation for DiupmFal Works Tomitrurtion ramit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at .............. Aj 4 1�= _41- ��t� .. --_---. �" ��- .. ,�f y -- -- Addres or Lo 0 8 On Address Installer Address U Type of Building Size Lot... _ ._Sq. feet .-, Dwelling—No. of Bedrooms. ........`.�...�..�............................Expansion A-ttic ( ) Garbage Grinder ( ) Other—T e of Building a —Type g - .t .... No. of ersons.........�............... Showers — Cafeteria ---------------------------•---••P (� ( ) d Other fixtures .._._....- -- ----------•------------------------- -----------------'---------.........---------........--•---- w Design Flow..... J`___.__gallons per person per day. Total daily flow-_-_._;��0.......................gallons. WSeptic Tank—Liquid capacity1 gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. Width_._._;.._.._.___.. Total Length............... Total leaching area:...................sq. ft. • �... Seepage Pit No.......6 --------- Diameter... _. ..... Depth below inlet_..��...______ Total leaching area.7Z22 .sq. ft. Z Other Distribution box Dosing tank�, ) Percolation Test Results� Performed by._ sv___C ! �1 -I� 13�.� 1 1_ � Date.9 ..._ i _ ....... 1.4 Test Pit No. 1__'.�-.__.___.minutes per inch Depth. of Test Pit__�S` _ .... Depth to ground water.._ �_---. 44 Test Pit No. 2........Pl..minutes per inch Depth of Test Pit_. ........ Depth to ground water........................ ._. .. ..;.y- , . . .. � ..._.......... ----._.. . . .............7 . L.lODes ription of Soil...�l.._ / T - -- w �S.C�.t_scf_ C�_' .C��1 _t 5 ' �-tJ -1 � 0.................. J y 1 - U Nature of Repairs oar-Altierationes—Answer when apphcagble..-----------------------------i......._............._._.�......_._........_......-`.... ...d.J.E416 -^ .....'•eAp?.,L'L*-........(v....roll/?.�isA.ea.e._.....�-ea9�'i.G`s- :�...------ Agreement: The undersigned agrees to instalf the aforedescribed Individual Sewage Disposal System in accordance with the provisions of AIml,i-. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b en issued by the boar f e lth. Signed.. ... ....... ....C... �^�----....---------•- A Application Approved B y.��� f` '= e PP PP y--•.•••-- / .. ,i1 Date Application Disapproved for the following reasons------------------•------------------------------------------•-•----•------------•-----•••-•-••----............._ ...........................•--------•-------•------•-----•------------.....---••--•--.....-•-•-----•-----••••-•----------•-•-•••••---=•----•---•-----------•-•---•-••--••-----•----•••••••-•.....•----- Date PermitNo......................................................... Issued....................................................... Date No......................... - Fnz...... U .............. .,a THE COMMONWEALTH OF{.MASSACHUSETTS fy.�� f ` _......f..'�... ........................OF..... �.." i`.,.z............................................................... App iratiun for Bioposal Vorkg Tome ruriion ".until Application is hereby made for a Permit to Construct ( ,or Repair ( ) an Individual Sewage Disposal System at: ...1 1 .. .t.�..<. "` ��<ec -------------- _�� t .Ui�f ..... .. ..... �- ...... --- r oca'i Address or Lot/�Io. ......................„„......... ....... ..... ................... .:..iG ........ ifAddress - .... ......................................•-------•-------...........------------............-••_..... Installer Address U Type of Building Size Lot... `.. ,.. 7 7.Sq. feet Dwelling—No. of Bedrooms_,...................... .•.._.....Expansion Attic ( ) Garbage Grinder ( ) p�.I Other—Type of Building ... No. of persons...........?�............... Showers (,F) — Cafeteria ( ) Q' Other fixtures •----------------------••-•--......-•--•-•--- Design Flow...... .A '....gallons per person per day. Total daily flow.......S.S.(...:�-0.......................gallons. w P Y acit ._ca2G 9SeP q tic Tank—Liquid ._. gllons Length th................ Width................ Diameter---------------- Depth................ Disposal Trench—No. .................... Width... ............ Total Length.................... Total leaching area----...............sq. ft. Seepage Pit No..................... Diameter..../. ........ Depth below inlet...::` ........ Total leaching area. Pe._PKsq. ft. Other Distribution box (_ ) Dosing tank )f '......�r f r-!z'=....� �..?._Git_....... Date. ......�.leg�....._. a Percolation Test Resu`is� Performed by. .�_ ........._ Test Pit No. 1...............minutes er inch Depth of Test Pit__f%�� _... Depth to ground water... --___. Test Pit No. 2...._....!�..4.-..minutes.per inch Depth of Test Pit..?.y/......... Depth to ground water........................ x r------------ ----- -- � . --------...7;... O De ription of Soil ''�. _..f.....�`� / <'` �( .rJf a �^! '�� � / = v "U t <�_ )_e_ ,S`��Jf. . /��`•...f�- � .�./fA/ .�-/ !"i 1:--- <7` ��<rs ; ~tom 4J J�<.4 �. '> (7`r_ ,<r / _._fir A_)P fr_/�/!/!'/'% =1Cas�l.._�"z"FR-! ............. W _ 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 TITS:;. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is ued by th boar f lth. Signed - g ! / / D e. Application Approved By.......... ....... •................. s , Date Application Disapproved for the following reasons:-------•-----------------•-••--•-----------------------------------------------------------------••-•........_ •-----------•--•------••-----------•-••-•••••-•-•------•-•••----•---•---••-----••••..........•-------•--•--••-••------•-----•-•---•----------•••--------------------•-----••--•--••--•-•------•....-•••- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD/Of HEAL H .....................:.•...................OF.......`.._ ....:2r'............................................................ 05rrfifiratr of Toutplittnrr Tg-IS IS T.0 CE TIF Y, That the Individual Sewage Disposal System constructed ( or Repaired ( ) b . J) A `~" -------------------------------•-----•--------................................-•---......---------•--.........--------------•--------- A Installer t at._r6 ��M f1 >t}I, _ car' f '2 Life' ` 1 4L 1`" s ----------------•-••---• r has been installed in accordance with the provisions of TI > of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._ CQl__.:�_ �...___.._..... dated_............................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WIL UN ION SATISFACTORY. • DATE.. .. 1�........4e.._2:......................................... Inspector-- ----- =f1 --------------------•----------•-------•-------------•-••-- THE COMMONWEALTH OF MASSACHUSETTS BOARD -OF HE_LT-H 8/ SBL. FEE... .d......--•--- No... ............... Disposal lVorkii ,Tono#rudion anti# Permission is hereby granted-..! ................'� z:::_.. ` s��, ....................................... to Constr-u t (1�e") or Repair ( ) aMdividu -Sewage-Disposal System. / - / �.r' Street as shown on the application for Disposal Works Construction Permit No..................... DpAed.......................................... »„ / � • ' ---------------------------•-----•- DATE.... .................................. B Health FORM 1255 HOBBS & WARREN, INC., PUBLISHERS 1 ' LOCATION SEWAGE PERMIT NO. j V I L L A G.EAxle., i n 5 i INSTA LLER'S NAIVE i AD.DItE`S'S B U I L D E R OR OWN ER DATE PERMIT ISSvED DATE COMPLIANCE ISSUED3 LV i d _- LOCATION! SEWAGE PERMIT . NO, U -L 1 1NST ALL E.R'S NAME i A'D-DRESS Fi s c � BUILDER OR; OWNER � �5- L iltc �L PATE PERMIT ISSUED - RATE C0INPLIANCE ISSUED 1� k3 x ILI J ?q3) 7)e/5 Six s /VO ..No................ ...' v J 7 y6 Fizz........................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................. ----......OF..........................................:-............_.._.............................. App iration for Di-spnsttl Workii Tonitrurtion rrntit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: /el-©C7 5. o3 ram.¢vrL G . ... s ..0&..✓..!4 ,.�Nl. .._ ...............•--- ..........�...._.............------------------------------------------ Location-Address or Lot No. ....L,F�3E4�......4s�!/..:�:L�:s......C.�..O7a.6!�14'....-.. ,1� �T... �.... Y.e �lltl�. ........ Owner Address -------------------------------- Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.............. .....Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building .. No. of persons............................ Showers — Cafeteria a Other fixtures ..----------•------------------- - W Design Flow..................J6_.................gallons per person per day. Total daily flow...............4e ..............gallons. WSeptic Tank—Liquid capacity0 allons Length---£7V.. Width---OOP.. Diameter................ Depth................ x Disposal Trench—No. ................... Width.................... Total Length.................... Total leaching area....................sq. ft. 1 -Aa.. Depth below inlet....... g 4�G29q. ft. Seepage Pit No._.._..,�___..._.. Diameter._. ._._._... .......... Total leaching area.... . Z Other Distribution box (>✓f Dosing tank ( ) Percolation Test Results Performed by.....1wez--W.,*+Aw.Ick...................... Date...... ......... aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water...------........... Test Pit No. 2.........f.....minutes per inch Depth of Test Pit____________________ Depth to ground water......... . ..... a' ............................ ••--•-•----•-------•-----------•------•.......•-----------------------------•--------•-------...•------•--•-••-•-•4.....--.•••-- O Descri tion of Soil.......... Al----------------- -- --•------------- x - ... ._.....�.�- ..__ ---------------- W UNature 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 TIT E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be iss e y the board of health. .. ` Signed -• •••... e..' "_.. l / ! -• .......................... .4 Date Application Approved By........ _ t.. ......,, �%%�s ` ` - . .......... Date Application Disapproved for the following reasons-------------------------------•------------------------------------------------•---------------••-----.--------- --•................................•--•.....••-•••••----••••--•---------•-------------...._..•----••----- ........................ Date PermitNo...............................•------------------------- Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH lx ............O F..... ............................................. TLrrtifirFatr of TompliFanrr THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( � or Repaired ( ) by-------------------X--d------- • Installer at........ s+s....Y/._...•••-_® .......................... e._...-•-...7,.8.:>,Q`-------------------------------•---•----•----.•...--•---------------. has been installed in accordance with the provisions of TITL. 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit �Tc�!__.���_�_Y�..?Y.�_ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO�IRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......................................•--------------------------------•---.---- Inspector----------------------------------------------------------.......------...........-- yk 3 s 7 >1/6 No........................ Fss.............................. THE COMMONWEALTH OF MASSACHUSETTS y BOARD OF HEALTH .............. ................OF........................................ Appliration for Uhipoii al Works Tonutrnrtion amit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: /3L,G7C� 5 Location-Address or Lot No. ' Owner A dress a Insstatall/�c......y? l. . er .............•---..............---. ...... --------------------------------------------- Addreessss.-- ------------------------------------------- � �• Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms.............. .Ex anion Attic Garbage Grinder aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) @ Other fixtures .----•--•----------------------------------------------•-....•••-•-••••••--•••-•...--------.......••-•-•--•------•-..................----•-......_... W Design Flow...................6;�..................gallons per person per day. Total daily flow-------------- 6-: ,46 <.J_...............gallons. . 04 Septic Tank—Liquid capacitye.,_- ogallons Length•_�,�_Q_. Width._y.T',6;.• Diameter................ Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.-•.-__Z.......... Diameter.......4_:,.�.:•Depth below inlet.......7.:...._.. Total leaching area..... . _ q. s tt. Z Other Distribution box Dosing tank ~" Percolation Test Results Performed by...._ __ .... ........................... Date...._._. ..,1 aTest Pit No. 1................minutes per inch Depth of Test it._.___._............ Depth to ground wa er-___..._.._._..•...•_ . 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---- .._. Desc i tion of Soil....._...... ._. _ f__.... _-,¢-• ` . 9' %t!'..... .� j } 7 ,i......-t c.../moo ")� .' <. - 2c.�a,t.tom_ UNature 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 TITLE; 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 qj;health.; ned................................ ........ D _.... Application Approved By........ i---•--•--•-•- :. =:/�,./ .-/� /r -/d- try a --•-----•--------------•----••--------•- Date Application Disapproved for the following reasons----------------•---•----•----------•----•-•------...------•------•-----•---.....----------••......•--•-...---•-- -•------...--••-••---------•-••••-•--••-•••-•--........•----••.............•-•••----....--••---••-........_......--•••-...••-----••-•---•--••--•--••••------•--•••-•-•-...---•••.••---•.....---••-.---•- Date PermitNo.......................................................... Issued......................................................• Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .:;7-Z."�...............OF........ /- Trrtifiratr of Tnntplitanre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (j) or Repaired ( ) by------------------- ---•--•-------------------- __ _ Installer at......- .........0- --$;�X--------------------•------ 6 -? '----------------------•------------------- has been installed in accordance with the provisions of I LE `)of The State Sanitary Code as described in the application for Disposal Works Construction Permit N�'/.__���- `tjj �`!� dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ? DATE......................................................•--•-•--••------•-••..-•-- Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH J ............ .. OF....... ,. rl� .............................................. /�/lJ " d > �U` ''............. �G-.. FEE........................ No..........:�� _!•--• yr, Ropos al Vorkv Toast inn rrntit Permission is hereby /granted------. � --- 7 to Construct ( for Repair ( ) an Individual Sewage Disposal System atNo.. ... --------------- ------- fj'.......................................................... (�=7 - Stree Gj- as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... �i DATE... �..--�-••-•--�--••--*------r�---�--f................................. �5and of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS J �- No...... _ Fxs. ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH rV... %..............OF.........9,cev.u... > ............... Applira$ion -for ihtipoiittl Norks Tonfitrurtion Vamit Application is hereby made for a Permit to Construct (' ) or Repair ('J-)"an Individual Sewage Disposal System at: ------- ----- =- .-....... -•---- �----------------------------------------------------------- Lo ion-Ac r s or Lot No. -- ------- ------ O er . Address ...................... ........•------•----- ... Ins ]ler Address Q Type of Building Size Lot-----------------------------Sq. feet U Dwelling—No. of Bedroo Attic ( ) Garbage Grinder Other Type of Building_?_ o. �xpansion sons_________________________-_ Showers ( ) — Cafeteria ( ) Q' Other fixtures,..-_ W Design Flow__ ______________________1 tllons per person per day. Total daily flow-------------------------------------------- W Septic Tank�Liquid capacity_�G'�-vg'�lIons Length................ Width................ Diameter-----------_--_ Depth----- ._---.•---. Disposal Trench—No. .................... Width...._......_._...___ Total Length Total leaching area--------------------s . ft. x P g g q Seepage. Pit No--------------------- Diameter.................... Depth below inlet-------------------- Total leaching area.......--------.-.sq. ft. Z Other. Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Date--------------------------------------- Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water..------.-------_-----. (_, Test Pit No. 2................minutes per inc Depth of Test Pit.................... Depth to ground water........................ a ---------------------- ------ 0 Description of Soil--------------------------- t----------------------------------------------------------------------------------------------------- x U -----•-•-----•-•--•-•-•--•----------------------------------- ------------------------------------•-----.---•-_----.-•-•----•------------------------- �- --------------------------- -- Nature of Repairs Alter t —Answer when applicable..._______.: /" �--..-- f�.`--O__. _..__.. ... ••----••---------- ------------------------------------------------------------------------------------7 -...-----....... Agreement The undersigned agrees to install the afored ribed In 'dua e age Disposal System in accordance with the provisions of Article XI of the State Sanitary ode— T un sign further agrees not to place the system in operation until a Certificate of Compliance has been ' sued y th oard of healt . \ J� Signed. . . • -- -------------------------------------------------- - ----- ---------- Application Approved By------ --- - --= :•• �tJ �... ate .�L.. Application Disapproved for the following reasons--------------------------------------------- -------------------------------------------- .................... --•-•---•--•-----•------•------------------------------------•-•----------•---•--•----•------•------•--............---....•---.-•--••--•-----..._..----------------------•-.........---•--------..•---- Date Permit No......................................................... Issued-•---�P -� 7 Date THE COMMONWEALTH OF MASSACHUSETTS BOARD QF HEALTH , pphration -for Uiii usal Works Tatuitrurtion Punift Application is hereby made' or a Permit to Construct (' er epair ( an Individual Sewage Disposal Systemat1_ _ ___•--.... ••--- . _C_ a-•---•- -- --F------•-�----•--- ----•--- _�_----•--______............................................. L on-A ress or Lot No. ......•••. .... -- . . ..........!-......••.. .... --. . ..... ................................................................•---............................. O er Address a --~-------- - - ---------- ------ .............................. =------...._....._......-=---------------------------------------------------- : Ins aller Address Q Type of Building Size Lot----------------------------Sq. feet V Dwelling—No. of Bedroo ...-__:fj` xpansion Attic ( ) Garbage Grinder ( ) `1 Other x="f e of Buildin �'�( _ o. of ersons____________________________ Showers — Cafeteria a' Other fixtures _._ W Design Flow_ ___________•________ � Mons per person per day. Total daily flow.....:..:_.___.__..___._....__..._._.-_.__-gallons. WSeptic Tank Liquid capacity__-____gallons Length................ Width................ Diameter___-_-_-__-____ Depth- "______"_-.". x Disposal Trench—No..................... Wi ------------ Total Length.................... Total leaching area....................sq. ft. Seepage Pit Now•--------------------- Diameter,--_-___-___--______ Depth below inlet.................... Total leaching area------------------sq. ft. z Other Distribution box i Dosing.tank ( ) aPercolation Test Results Performed by---=-------------------------------------------------------------------- Date----•---------------------------------- Test Pit- Ito: 1 _____________minutes per inch" Depth of Test Pit-------------------- Depth to ground water_--______-_____-_-__- (y, Test Pit No. 2................minutes per inc Depth of Test Pit_-_:.____--_--__-__. Depth to ground water-------------------- ------------------------------ - Descriptionof Soil - /►U F•-------•----•----•-------------------------:---------------•--•-------_-----••-•_------------------- : x ................•-----------•--------------•------._._....:_.....-•----••---------•-•-------•-------•-•-•--•----•-•---•.... -----•--.......................................................... 0 Nature of Repairs Alter, s------------------- Answer'when applicable.-.- _. __ _._..____________________ -----�..�._ ____--� ------,e....... ._ ------------------------:-----•----------7•--".....__....••.........--•---. •. -_-- Agreement: The undersigned agrees to install the afored cribed In 'du e. age Disposal System in accordance with the provisions of Article XI of the State Sanitary- ode—T u• sign.` further agrees not to place the system in operation until a Certificate of Compliance has been ' sued •y th, oar healt . igned------- --- ' `���... Date Application Approved BY = 1 to--- Application Disapproved for the following.reasons:...:...........••----•--••------,--•- ............................................................... Date . PermitNo. ....... Issued-................................--•-•--•--------•---- Date THE COMMONWEALTH OF MASSACHUSETTS i BOARD O HEALT ....- G_ ..........OF......:..........................:...............-.........4........-.:..:........- i Trrtifirate of f�om li�tnrle T. 9 TO CERTI , .That the�ividual Sewage Disposal System constructed ( )7. or Repaired by - - = - --- : nstaller /�df "� } t has been installed in accordance with the provisions of Article XI of,,The State Sanitary Code '_ desc 'b d�ii the application:for Disposal Works"Construction Permit No---------------- _ _ ..__.___. dated_-"____s_ � - .._......... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUN C'TION''SATISFACTORY. DATE.................................................................................. Inspector..................................................................................... y THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH 1 / No..... . EEE ............. rl, Tom rtion rrrmit Permissioti-A hereby grante ---- ---0�--'-------_------------- . .._.._ ......................................... ._., to Cons t�t,,f( or Re ( ) al I �uajSew�age Disposa s m at No. .t�Yi--�--....--'�------------------------•--------- ----"- f�="��'!^� -_- ---- ------- _ treet as shown on the application for-Disposal Works Construction P N.. .........o._._... .:'. __-?ff Board of Heal h --......... ................ -•_-•-•- --- •'....... DATE.. ------------------- FORM 1255 HO BS & WA REN. INC.. PUBLISHERS ,. � � .. =. =_=�-.mot.= � ' • ---, ,� � �_ cv Gam"'"Y _ _ � � �� / �J-Zr"D � Cc-r.�- _ . �/ �r ,�- 'f C � / ! /1 �� r �: r No.9 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................OF... ?4c!r».5 ....................................................... Appliration for Uhgp ii al Works Tomitrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: .... �� ..1-'. O►Sat�t...s t.. 6e�-c,1t..................... ..........""•"--"-""-----"•------•""............_.....----- Location-Address r Lot No. ................................... --"------............-""" .1d ,[t_._ �44sa.tK_.s�:..__ b �!�x 1��. W Owner Address f Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No: of Bedzo ms...........................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons____________________________ Showers — Cafeteria Q' Other fixtures "___________________•-••---•-••- WDesign Flow............................................gallons per person per day. Total daily flow------------................................gallons. WSeptic Tank—Liquid'capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No_ ____________________ Width.................... Total Length..................... Total leaching area....................sq. ft. Seepage Pit No----_---------_--- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ ..a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water----------------_----. Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a __________--••-•____________________________________________________________________________________________________________________________________________ ODescription of Soil-""":""""""""""""""""""""-""""""-""""""""""""""""""""""""""""""""""""""""""...-""""""---""-"""--"--""""""-"-"-"""""-"-""----""""---------------------------------------- x U .__-------•----•-••••--•______________________________________________________________________________________________________________••-•-------------_-________._____________._______________________.. W UNature of Repairs gr Alterations—Answer when applicable ?ib -.A".0--59 4r,icLs�..1S.�1!�2L'm� ............ 0 Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI.L- 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 byyt the eboard of health. Signed__. -"-...... Application Approved By./ --_ ----- a O Date Application Disapproved for the following reasons:................................................................................................................ QQ' Date Permit No..s.J. " Issued Date a .d- v. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliratiun for Diipuual Workii Tunutrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal System at: I, H 1- , r' : 11� .......... - ......:.........:......... .............. .........._..... - ............--------. .......... - ..... FF Location-Address or Lot No. 11 .......... . !•-•�-=-=------.. :.r Address :-••-.Owner -.._..-•----•-•-----------•--•.......... . ..�/..-- •• -•----•=•-—�---•/•-- � -/--•------• ------/-)--.......--•-•------- Installer Address 1 UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers a YP g ---------------------------- P ( ) — Cafeteria ( ) Q' Other fixtures ------------------------------------------•-.. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date---------------------------------------- Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water....................... ri, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 •••••-••--•-••--•••••••-••••-•-•----••-•----•••----••--•-•..............•--•........•-•--._.._............................................................... 0 Description of Soil..........................................................................••-••---••-•-•--•--•••-••-•-•--•--•-•-•-••-•-••-•--•-••••••--•---••...--••-••---•-•-•........ "4 U -••--••••••--••.....•-••---••-•••••.......-•--•••--••-----•••---•-••------•--...••------••-•----••••••-••-••-•-•--••......--•-•----•----••--........................................................... W U Nature of Repairs or Alterations—Answer when applicable=_ _ f:.. . ...:'L_f% �.z+ _ �' I --r---l Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I T 11 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. Signed . '..1 k == -- rr: , , ;l 4 -6-z' ....................... Application Approved By_. _. �% �j D-�--- Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- -----••---•-----•-•-•••-•--•--•---•-......•---------•-••......--•--•--•••...•-•--------------------•-•-•-•---------•--------••- -----------------------------------------------------...._.._. � Date Permit No.1.�._ .....`.........�k.� ... Issued... Date i THE COMMONWEALTH OF MASSACHUSETTS l•'�` lA;, BOARD OF HEALTH ........................:................OF....t.................... ...n..................................................... 01rrtifiratr of Tampliatta THZ IS 50 C RTI Y, That they} al Sewage Disposal System constructed ( ) or Repaired by......... Q .. ..._. 1 J1. (.V-_. --- ----.......................................... ---------........---------....-•-----•----•------- ,�^ !l 4 at.._..-•-...•.---•••--L .1.;..-' �_a..a Cl `) _ has been installed in accordance with the provisions of T 5 of The State Sanitary Coe s scribed in the application for Disposal Works Construction Permit �'o.-� Q�(�1� . dated �- -g-��-------•-------. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUA A TEE THAT THE SYSTEM WILL rFUNCTION SATISFACTORY. DATE.----••---••--•-•+�..:..�.!�. ................................ Inspector..................... + THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................................. ,- No.. . FEE...^ .............. Dispuu IV rk T n ' n run Permission is herebyrante ._._. --. .__._4_..D' _..../-, /-' - ----------------------------------------------- g 1 L� to Construct ( or Repair ) an Individual Sewage Di osal sCt, b at No...... �- ��...... 1-�.Q �..........r �/- /C ! � _ ............. lStreet �- as shown on the application for Disposal Works Construction P r N ..... _ ated.. ._Q.........:............ DATE............. lX_ 28?/--------------------•-----•------- Board o He lth FORM 1255 HOBBS & WARREN, INC., PUBLISHERS I1.__ ••.�.,• ca -. 4;- dA A) I a�CO3Sow Locu> A✓�_ + — i /v14/,v sT,ec r u ; e'OAG , N rn :.JTTL d L O CCU 5 MA P LA !� V °i G47cs//y'A3ft/ i I i /1 -4,0.zo Yv 1 I + e 5 07- /6' /O t:� /G�9 GG�_ /P I - M /r,`;w►'I' f I I I FYuD. # /G U i0' I ti . its ___.T,F•ii2.Sc? , \ � ,f„� ( � (' � 'ri%�L.:. � � _. 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M.LI 55. rNI 1 wuklwr,i 6 CA L 5 � /' - eo, �A TW � .3�fr'T, �3, /D3/ No. IPA a c` 9vv. z9187 v'fCOA ~• SU rf `,'rS�C�'ALF�+,�il'~ , !J" I I AI \ , 1� 1�r.r K ` ( I L K�L,.r .,.�5�C. 141C. rY�rtl c iKY�� PEE'0,A E 5./01VA!_ EftI L A.V,C? .9U e V. 14 � � `'1�,�,.,.u'��n�,nY��.,.,•t�?'`}�'"�M�' "i�Vv�/v��t,,nr�'''�v,,.,.r�'ti.r�'"`2-,,,^1`*�-v,����n� �. j � LoT 56 a s�� PHASE r i T'1 7 � 1 t � � 0 N EX I I ' �-- KT I u G V iJ FJZT Z-+.A-' I I a� �. VIJ IDS -5 cA4ITS I Z P I es P L DOZ E .V = Z7.3 S A MA OF ` r F1Ev - E XI�TI►iG SEPTIC- ° j (-n-P) i SYST£r�l f 1 vu I-rs 3 � 4 O M I-{ i I r PLA. 1 CO$BLE I PLR-4<►Nkr a- I I pow ,' —2Z.0 --- 39.I5 -,1 -�-- —Q--- - pu:E LUAU-I TPIE N E -P''`' ---------- x zi, 1201�1 �' x2' S' DEEP o° -UTIL. . Po LE �9 hIAT� 3 131E N MARS /V HYDRA.T TACK I3o Lr # 31 Z 1 �x111"I�IG B�II.�It�lGr I — 56FTIC_ `T STEi'�l i�i=51 C�N 1 L�k1 CSTIh'IATE , SEb MS K110 <:�,/c? 5E('TIC- TAW -4-16 6- ALI"Y x 1.15 1 YS s CEO G4AI T+,�T �LE LoC3 T N 1 I G, �L_ p�IL rAfa� Ti=sT R�Y W. M. HAZ.N I c-K 1 Z�V L.EAcr1 I� A AA ' U 5 E ES -e n- WITNS 2— CiI FflOFlp I SVB �z" Soles Zoo sIM ,aeEA zziz` .z PATE Iz-I- £31 r-Ep _ PEeL )?ATE Z M I N/I fa. I s TbM 2�"Z� .D� ` `{ � t� Zb� 4-6" 24.3 TaTAL CAFACIY`(_ 69-4- 61 b ME'r, COTUIT SANS �'' PEA sTq.li= F T� " y ., I ��N, -- /4 -I z WaSI-J�f� STa.� UF6FAPE 1 144" 140' ELl:-Y 7�T OF LAWD IfJ: QSTEPNI LlF- , M A . I.bT1=S \t3. 7 I 23.33 23.I(o - 7/— � 1�EPAfZF-D rnr-1. D/LTvM ASSUMEb F12,0Y1 �/b� 5 eE-rE�EvZ. WATER UNc5T-o i5E Lo--ArET t�TTIM� CoI.IsT c�Tloy, I— � b �X v ��'Nt�dN11NIL)MS23.G1 Z3.36IF kiTHIN 1d OF SETTIC_ L.E.f►GI-iIqGi Ar�, Fz L- "T- E�W 18.O-50 As To SE La M1�1. 1F WATF-� AHv �WEC- L1HES Isoo GAL �`£X EL-Gy = to-']-8S ScAl I = log ML,sr Gw!gs gaTl-t ICI PEs To rFe I 5f> Lr-3 FuE:stou:-:- cus6 . serri c TANK, 2 Z� �. -HTLE Y VAO AHCES QUEST�p OW LEAGtI rtIZEf-L;H C7Z ,Z SAL E ) SEAT ION. 15,03 A. t5EPt ILTA► r- TO FE S3 FCC�" Gt---LLue wA LL- (v.a ICJ A QCE or- S') B. LEACH J-r-kNcti -fa (3E LczfGTED 1-7 1✓K4M c E L LA F- WALL tH OF ���Y" (VALl AWo:E c7F 3 J. � G ARNE �a\ G . L_ E-I Ci�ENGH Tn ItE1� Z' FP�1"I F l� '7Y t-1 IJ� ARNE H. / eivl� (� H. O GALA NI lc��r7 e (` 7tr7e errncl CY,�I�J AI.1G� Q g ). N0. 30792 I �o \ems AfCISTER CIurL E►�1GINa✓E2S �Fss/aNALE���' ` ��'1 Lkk�. LAI_Gb S8'3da # ` TYPICAL PROF IL E SITE PLAN 1 NOT TO SCALE " I SCALE — / " = 20' FL.EL 4B•5 OLD G /B STD. L T. WG T C.1. MH COVER 47- o - �,•. )n "' I FAY/STl�t/� "C. 4'�B/T. FIBER PIPE- TIGHT JOINTS 4 1. PIPE , FLOW QUTLET LEVEL LO L/N E TO FIRST JOIN w I DWELLING 4/ v 1'O /4 O C.I. TEE • ,/ C./. TEE b PNA�E 1 ` 14a.G7 STANDARD PRECAST 4 CONCRETE` GALLON -6'?. TD - _ SEPTIC TANK D/S TR/BU T/ON BOX 5 B2 .0 9' 50" W B" TO BE INSTALLED ON /p do4.97' LEVEL , STABLE BASE. SEPTIC TANK TO BE INSTALLED ON LEVEL , STABLE BASE qo • __ , ` ___ 2"- //B` TO 1/2' WASHED PEA STONE LEACHING PIT V y� Q I ALL AROUND FREE OF IRONS, FINES BASE TO BE LEVEL AND DUST IN PLACE \l a I BRICK 8 MORTAR COURES 3/4" TO I-1/2" WASHED CRUSHED ! Sao tV v e I AS REOU/RED TO BRING STONE ALL AROUND FREE OF i �• / Q Q I COVER TO GRADE ZAND /FRMH AME OVER IRONS, FINES AND DUST /N PLACE IW Q N - -- - — -- --- }}tj 474 4 NL£r ---_-- _ _ _ _ LEACHING P17 SECTION 8 FLOW L INClNE T+ PIPE' I. CONCRETE TO BE 4000 PSI 28 DAYS , 2. REINFORCED WITH 6" x 6" NO. 6 GA. W.W.M. d e Q RP_e ',4.3T i � Coves /�` L _ � ', 3. 2' AND 4' SECTIONS ARE AVAILABLE FOR GREATER 1L`PTK T'A�/K 1 DEPTH REQUIREMENTS. 7' 1-zo LvioD. 1 Q' / Q OPENING W/TH 4-//B" 4. NUMBER OF PITS REQUIRED W -� OUTER DIAMETER 8 NOTE: EXCAVATE TO ELEVATION -32 7 OR LOWER AS /-3/4" INS/DE DIAMETER 3 REQUIRED TO REMOVE ALL LOAM AND CLAY BENEATH - /DNA 5E A �I I PIT. REPLACE EXCAVATED MATERIAL WITH CLEAN ¢ ,E3 I GRAVFI TO DESIGNED GRADE 351.5oW C6 � I 6,-6" .� =Q" 7 I FL.EL I EY157 AND. I 4,_0., 4 -o" /¢ � 48.5� � I � a►I MIN. EFFECTIVE DIAMETER -- -I (NOT TO EXCEED 3 TIMES EFFECT/VE DEPTH/ WATER TABL E RA T � I SOIL AND F'ERC. DATA GENERAL NOTES 4 ��/T� .s /�� I NO HEAVY EQUIPMENT TO RUN OVER SYSTEM ` - PERC. RATE : � 2 MIN. /IN . - ! SEPTIC TANK, DISTRIBUTION BOX , LEACHING PITS TO BE STANDARD FC.EL 4G•5 ¢,BR l I w/Y) />9 K e21__k l C- f r o, � TEST BY: � A3�oc Inc. r!.P 6f �/u � PRECAST REINFORCED CONCRETE UNITS. sTD..a1l' r G- © /3�/� ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE • L�St-ti �v WITNESSED BY: —_ _ �� �� -- - ------ TO REVISED TITLE 5 OF THE STATE ENVIRONMENTAL CODE 1 TEST PIT GR. EL. 47. 5 DATE ' jTZ3�B/ MINIMUM REQUIREMENTS FOR THE SUBSUFACE DISPOSAL OF SANITARY SEWAGE EFFECTIVE I JULY 1977. TEST PIT NO.4- TEST PIT NO, L E,Sa, ems✓ - — _ 0" 0" ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE � J \ f• N-Lo [.ctia T?A Sc'>iL 7'oP .��L "11 i Ploy 4 c��ks G. - BOARD OF HEALTH. _ 5G/F�3 �O�L 20 ! 4� ,a�,,v ` - 30' -- ---- __ -- SILTY �,gclo AT COMPLETION OF CONSTRUCTION , PRIOR TO BACKFILLING, THE I N-so �ooy- J tq p IF -- ---- - _' BOARD OF HEALTH SHALL BE NOTIFIED FOR INSPECTION. Eo � yU� PITCH ALL SEWER LINES 1/4" / FT. UNLESS INDICATED OTHERWISE. 2-C.l9Asiv> ,. 144 - _ DESIGN DATA •�j T /� ✓ �� ` Q BEDROOMS ¢ DISPOSAL EST. TOTAL DAILY EFF. 4O GALS. LEGEND -.. SEPTIC TANK /.50o GAL SIDEWALL AREA 2•.S GAL./S0, FT BOTTOM AREA / d GAL./SQ. T. SEWAGE DISPOSAL SKSTE/r�O XOD EXISTING GRADE LEACHING REQUIRED 274'•Ja SQ.FT. � ACTUAL LEACHING AREA 4B9.99 SO.FT. FOR 13L,96 leR5/A/ 4 ZONE: 63 -A o ©o FINISHED GRADE f DOMESTIC WATER SOURCE: Torvw M/�4TE�Q 0. 0 o INVERT ELEVATION 6 . 7TE V14,4 E k124L 49 ,�E'�47 T_&fa r ---- - — PROPERTY LINE ��`�yfffd d�T�,�✓/LL.E,PLAN. REFERENCE Gd7" .5.5 SG f �5'9 ,�ssE3�a,¢.� MAR � � / � ^� � -- ---- MEAN NIGH WATER ? i� wit*"". ",,� a �; SCALE' AS INDICATED GATE a N1ittWlGN H No. 29U7 vi r.V BENCH MARK DATUM %L:= r u�2, v.�1—fro .��,Pv�y MARSH " " " No. 19771 � °AtiQ WM. M. WiARWI lK A ASSOCIATES' ' BOX 801 - IORTH rAl-moum . FL d t Zw,E rt /-�,+,oz. eo C" �'.9.i/, l �clo. ?.8eAG1d - G i✓`�4 f�.��✓�a ; �,�� ate +�� . 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[� L�C7 o Cxlo i`T 1 .0— No 0 I `� { 4� ----=- r- s � ;S ', ti//--�•.. _.. a1pp"rC rAAlK I 1 TP Aj Tf L`L. 4B.0 ` LE4Cf/. 4�✓t / `i ----- i I 5r C&C4 0 Cow axe c3 RrMrat --i._ c f p t. \. _ - .-__ r, y' `J oT 4 y3f LL ��j fP �.._ /'- �►�� •, o f�'c]Po.S Ep �Dlv.�T,�'✓C TiD�,t r R40A.W 1 N , PJ lG 41.c1/TS TG>rw Co lel 5�Nl l LlAolv. 45.75 F ! r i� .ri"(3; 04/rI/vim' r/NK ,o r T AL ap I I o,Eck. � , � ✓.EE SEWl.�CE .D/✓.�'G�3.�L P'Lr0.t1 FdrC'. { !�• � �L✓�G � - . ! �' /o0'/a \ ✓r'LaW�'f'2dF/LE'..5 GNO G£�(/S 'T"h:.Gt/ I L -- - -) �-- - - - --� i �, lAjDL G il1B3G/,C�fAc E ST.L'L/C TC/,k',�`5 i J FL L SO.S pQ 5t \ L 4C.4 T.EO/.t/©el V,-5 c3e19;V' oeK/iVCw -zc Alae," Tn �� Gt�Crt 'F9 ` RO __ `z "v 4G,O `1 ACA 7 P N6 .4.V�7 lJ f:`,4i r cf f tfLE F 1 `l ALL ,E'e�G�F jJ,E'<3f S�i�0 V 7 �' AO V4 ' y D!s r. \ /r Box ? 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WGT. C.I. MH COVER 49. o z. 4"'C.I. PIPE 4""BIT. FIBER PIPE TIGHT JOINTS OUTLET LEVEL FLOW L INE TO FIRST JD/N D*IEL LING , ra" - /4"' 45, C.I. TEE 45. C./. TEE 44./O STANDARD PRECAST a CONCRETEGALLON SEPTIC TANK DISTRIBUTION Bolt' ., TO BE INSTALLED ON LEVEL, STABLE BASE. ` SEPTIC TANK ik TO BE INSTAL L ED ON ' LEVEL , STABLE BASE a ,9 P""- I/8"' TO //,? WASHED PEA 3rONE LEACHING PIT ALL AROUND FREE OF IRONS, FINES BASE TD BE LEVEL AND DUST /N PLACE BRICX 8 MORTAR COURES 3/4," TO I-//,? " WASHED CRUSHED ' AS REOUIRED TO BRING STONE ALL AROUND FREE OF COVER TO GRADE. 24"C.I. MH COVER IRONS FINES AND DUST IN PLACE. AND FRAME " 4 f, LEACHING PIT SECTION INLET _ �B" FLOW LINE - - r--. _—` PIPE 1. CONCRETE TO BE 4000 PSI 28 DAYS --1-^„ 2. REINFORCED WITH 6" x 6" N0.6 GA. W.W.M. ('`' --L 3. 2' AND 4' SECTIONS ARE AVAILABLE FOR GREATER I DEPTH REQUIREMENTS. •Qf Q OPENING WITH 4-I/8"" 4. NUMBER OF PITS REQUIRED ''f � s OUTER DIAMETER 8 4 �11 l-3/4 INSIDE DIAMETER NOTE EXCAVATE TO ELEVATION FOR LOWER AS REQUIRED TO REMOVE ALL LOAM AND CLAY BENEATH PIT. REPLACE EXCAVATED MATERIAL WITH CLEAN # GRAVEL TO DESIGNED GRADE . 1 Al 4 0 4_4 MIN EFFECTIVE DIAMETER (NOT TO EXCEED 3 TIMES EFFEC T/VE DEPTH) 40 �.,.. WATER TABLE SOIL AND PERC. DATA GENERAL NOTES PERC. RATE 2 MIN. /IN . NO HEAVY EQUIPMENT TO RUN OVER SYSTEM. / SEPTIC TANK, DISTRIBUTION BOX , LEACHING PITS TO BE STANDARD TEST BY: jiS/,�EW�Gk �'VI�k�E Lw`s'�'w'�'eK�j PRECAST REINFORCED CONCRETE UNITS, WITNESSED BY _ �• Cif=F�E'•7 _'�� _.-_-_r_ _ ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE !- TO REVISED TITLE 5 OF THE STATE ENVIRONMENTAL CODE , TEST PIT GR. EL.: DATE MINIMUM REQUIREMENTS FOR THE SUBSUFACE DISPOSAL OF TEST PIT NO. E, TEST PIT NO J SANITARY SEWAGE EFFECTIVE I DULY 1977. 0" 0"_ ____.-_� ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH. AT COMPLETION OF CONSTRUCTION , PRIOR TO BACKFILLING, THE BOARD OF HEALTH SHALL BE NOTIFIED FOR INSPECTION. PITCH ALL SEWER LINES 1/4" / FT. UNLESS INDICATED SH.vl� �A,v.v OTHERWISE. /44 /44" DESIGN DATA BEDROOMS DISPOSAL EST. TOTAL DAILY EFF. egg GALS F�f�i�J�,cc '::�j SEPTIC TANK ;?000 — GAL SIDEWALL AREA 2. 57 GAL ISO- FT f� /�/j BOTTOM AREA /� 9._`GAL./SQ. FT. SEWAGE D ['�/ DISPOSAL ✓ / STE/Y/ LEACHING REQUIRED-4S/. -/9_SO.FT. ACTUAL LEACHING AREA FT FOR G/.T ✓I:-'e'jo,ue �L G'Gr. �o�TES't!/G L C�GNJt�C1/u/►? c�`D•t! S c f<0 SCALE: AS INDICATED DATE _. .8 f f## 3 WM. M. WARWICK & ASSOCIATES BOX 801 - NORTH FALMOUTH INASSACHUSE r TS 02556 x TYPICAL PROPILE � . NOT TO SCALE : 18"STD. LT. WGT C./. MH COVER 4"C I. PIPE 4"BIT. FIBER PIPE TIGHT JOINTS FLOW L/NE OUTLET LEVEL O--- - --- - O O TO I ST JOINT M DWELLING 4T J fi Io„ 14' �¢G.93 - C.1. TEE 4� G3 L47`!o C. TEE •BO STANDARD PRECAST 4 CONCRETE2Q°aGAL LON -" SEPTIC TANK DISTRIBUTION BOX 8 TO BE INS TA L ED ON SEPTIC TANK LEVEL , STABLE BASE. • I - TO BE INSTALLED ON LEVEL , STABLE BASE 2"- I/8`" TO 112" WASHED PEA STONE L EACHING PI T ALL AROUND FREE OF IRONS, FINES BASE TO 8E LEVEL AND DUST IN PLACE BRICKS MORTAR COURES 314" TO I-1/2" WASHED CRUSHED AS REOU/RED TO BRING STONE ALL AROUND FREE OF COVER TO GRADE. 24"C.I. MH COVER IRONS, FINES AND DUST /N PLACE. A NO FRA ME 4" 4 -� INLET 8'1 FLOW LINE— — LEACHING PIT SECTION— PIPE - __ PIPE �- - I. CONCRETE TO BE 4000 PSI 28 DAYS 2. REINFORCED WITH 6" x 6" NO. 6 GA. W.W.M. 3. 2' AND 4' SECTIONS ARE AVAILABLE FOR GREATER DEPTH REQUIREMENTS. OPENING WITH 4-118" 4. NUMBER OF PITS REQUIRED 2 OUTER D1AmErE­R /-3/4'"INSIDE O/AM 01A BETER NOTE: EXCAVATE TO ELEVATION 1714-OR LOWER AS REQUIRED TO REMOVE ALL LOAM AND CLAY BENEATH PIT. REPLACE EXCAVATED MATERIAL WITH CLEAN GRAVEL TO DESIGNED GRADE i 41_0„ 4 '-o 6 6 L -O - - M/N. _ EFFECTIVE DIAMETER (NO T TO EXCEED 3 T144ES EFFEC T/VE DEPTH J WATER TABLE SOIL AND FERC. DATA GENERAL NOTES PERC. RATE . t 2 MIN. /IN . NO HEAVY EQUIPMENT TO RUN OVER SYSTEM, TEST BY: WA�2[Vic,f k/i�,�i�-,Q���C wj� @w,c1< SEPTIC TANK, DISTRIBUTION BOX , LEACHING PITS TO BE STANDARD _ w4,—_ PRECAST REINFORCED CONCRETE UNITS. WITNESSED BY: 'e CiF'FO�GO ,13,(3N _�- ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE TO REVISED TITLE 5 OF THE STATE ENVIRONMENTAL CODE , TEST PIT GR. EL. `� Z DATE __ /? 6'� MINIMUM REQUIREMENTS FOR THE SUBSUFACE DISPOSAL OF TEST PIT NO. -- TEST PIT NO. 2 SANITARY SEWAGE EFFECTIVE I JULY 1977. 0 ,?ti.e OF a 14. 0 - ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH. AT COMPLETION OF CONSTRUCTION , PRIOR TO BACKFILLING, THE MAD. CaT�/�T �X�NfE BOARD OF HEALTH SHALL BE NOTIFIED FOR INSPECTION. �R.C1O PITCH ALL SEWER LINES 1/4" / FT. UNLESS INDICATED OTHERWISE. /44 Ale G,eAiv W,47':�=,e DESIGN DATA BEDROOMS _ �_. DISPOSAL- ,vo,{/,E' EST TOTAL DAILY EFF. SEPTIC TANK GAL SIDEWALL AREA GAL./SQ. FT BOTTOM AREA j O-_GAL./SQ. FT SEWAGE DISPOSAL S//STL c M LEACHING REQUIRED 4 T..,�_.1L_ S0 F ACTUAL LEACHING AREA ___ __SO FT FOR 42, <"3 - Y i a3 7-ZF e V11-LSE w4l l T.4,Ql-16 1 P7,q.:5..:5 SCALE: AS INDICATED DATE WM M WARWICK 8 ASSOCIArE5 BOX 801 - NORTH FALMOUTH 4 M4 SSA CHUSE T To 02556 T YPICAL PROFIL E NOT TO SCALE _,. .. 18"STD. L T. WG T C.I. MH COVER 4"C.l PIPE 4"'BJT FIBER P/PE TIGHT /O/N TS OUTLET LEVEL .. jLI-071 -FLOW L INN �_ �- TO FIRST JOINT -- - - -^ - DWELLING T^ i n o o 4G /4L C.I. TEE 4 C.1. TEE L l_ STANDARD PRECAST 4 CONCRE TEZ�oGAL LON SEPTIC TANK Des TRieu TIoN aox i ` {B, TO BE INSTAL L ED ON LEVEL , STABLE BASE. I i SEPTIC TANK TO BE INSTALLED ON i I LEVEL , STABLE BASE j 2"- 118 TO 112 WASHED PEA STONE LEACHING PIT ALL AROUND FREE OF IRONS, FINES BASE TO AI LEVEL AND DUST IN PLACE BRICKS MORTAR CORING 314"" TO ! 112'" WASHED CRUSHED AS REQUIRED TO BRING STONE ALL AROUND FREE OF AND FRAA ME COVER TO GRADE 24��C./. COVER IRONS, FINES AND DUST /N Pt ACE — i_ ____�_ T 81 —FLOW LINE LEACHING PIT SEC TION--- JNL ET - PIPE 1. CONCRETE TO BE 4000 PSI 28 DAYS 2. REINFORCED WITH 6'' x 6" NO. 6 GA. W.W.M. 3. 2' AND 4' SECTIONS ARE AVAILABLE FOR GREATER + - DEPTH REQUIREMENTS. + 2 OPENING WITH 4-//8" 4. NUMBER OF PITS REQUIRED OUTER DIAMETER 8 h NOTE: EXCAVATE TO ELEVATION .-;WQOR LOWER AS 1-314' INSIDE DIAMETER 3„ REQUIRED TO REMOVE ALL LOAM AND CLAY BENEATH PIT. REPLACE EXCAVATE[ MATERIAL WITH CLEAN GRAVEL TO DESIGNED GRADE . 6, 6", I 4 , 0 4 -p r-- - --- - - ---{� - - - - -- -- M/N. EFFECTIVE DIAME7 (NOT TO EXCEED 3 TIMES EFFECTIVE DEPTH) I - --�-< WA TER TA BL F_ SOS/L A ND FER C. DATA GENERA L NO TES PERC. RATE • MIN. /IN . NO HEAVY EQUIPMENT TO RUN OVER SYSTEM SEPTIC TANK, E ISTRIBUTION BOX , LEACHING PITS TO BE STANDARD TEST BY: W�4.eH/�Ck _£ W/GdC�E rQ�SpM t"✓�E'W/C� PRECAST REINFORCED CONCRETE UNITS. WITNESSED BY �• ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE s � � TO REVISED TITLE 5 OF THE STATE ENVIRONMENTAL CODE , TEST PIT GR. EL.. ¢8 5 DATE MINIMUM REQUIREMENTS FOR THE SJBSUFACE DISPOSAL OF TEST PIT NO. 1 NYSE LOGY TEST PIT NO. 2 SANITARY SEWAGE EFFECTIVE I JULY 1977. 0" - 0 -- � ANY CHANGES -f0 THIS PLAN MUST BE APPROVED BY THE gyp" BOARD OF HEALTH. ! AT COMPLETION OF CONSTRUCTION , PRIOR TO BACKFILLiNG, THE O. G'©T�iT 9E BOARD OF HEALTH SHALL BE NOTIFIED FOR INSPECTION. 3R.t/O PITCH ALL SEWER LINES 1/4" / FT. UNLESS INDICATED OTHERWISE. 144 .vo -- DESIGN DA TA BEDROOMS DISPOSAL— EST TOTAL DAILY EFFG' ._GALS SEPTIC TANK ZOG'a GAL . SIDEWAL L AREA GAL./SO. FT BOTTOM AREA __-GAL /SQ. FT LEACHING REQUIRED ____4L/ SQ FT SEAIAGE D15POSAL SYSTEM ACTUAL LEACHING AREA 4,94. 0 SQ.FT. FOR T,e 740 45TE.Q►�/L G C'a�c/t�o.r�f.�//L/ 5 f � s SCALE : AS INDICATED Da7E /Z WM M WARWICK 3 ASSOCIATES BOX 801 - NORrH FALMOUTH M,, SS.4CHU3E r T;-- 02556 FYPICAL PROFILE Aior rO SCAL , 14. Is"sm L r wGr. C.l. ASH COVER 1 (2 949c � ..,_ ..�..._._..... -• tit...:.._ - ',..._-- __-�--`' _. 4"G I PIPE 4"BI r. FIBER PIPE TIGHT xm rs * . avr4ET LEVEL FLOW L/NE �O FIRST JCJ41N ,, • ' ,. _ '," DJWLLING 4� IQ" 14 9 O O E:I. ME C.G TEE .¢G.G3 STANDARD PRECAST g� -1.¢ 4 2. coNCRETE GALLON sEPrlc TANK DISTRIBUTION BOX TO BE INSTAL L ED ON LEVEL, STABLE BASE. SEPTIC TANK TO BE INSTALLED ON LEVEL , STABLE BASE 2 1/8" TO 112" WASHED PEA STONE L EACHING PI T ALL AROUND FREE OF IRONS, FINES BASE TO BE LEVEL AND ous T IN PLACE BRICKS MORTAR COURES 314" TO I-112" WASHED CRUSHED AS REQUIRED rO BRING STONE ALL AROUNO FREE OF COVER TD GRADE. 24"C.I. MH COVER IRONS, FINES AND DUST IN PLACE. AND FRAME 4" - LEACHING PIT SECTION— INLET B' FLOW L INE -- - - - - PIPE - _ 1. CONCRETE TO BE 4000 PSI 28 DAYS - 2. REINFORCED WITH 6" x 6" NO. 6 GA. W.W.M. --fib 3. 2' AND 4' SECTIONS ARE AVAILABLE FOR GREATER I DEPTH ,REQUIREMENTS. � © OPENING WITH 4-11$" 4. NUMBER OF PITS REQUIRED 2- ..r £7"[lTER DIAMETER 8. NOTE. EXCAVATE TO TO- ELEVATION A90 OR LOWER AS I-314rr INSIDG DIAMCMIi .. . . . REQUIRED TO REMOVE ALL LOAM AND CLAY BENEATH PIT. REPLACE EXCAVATED MATERIAL WITH CLEAN GRAVEL TO DESIGNED GRADE . jt TO„ 4-- MIN. EFFEC rI VE DIAMETER li ()vOT TO EXCEED 3 TIMES EFFECTIVE DEPTHI _ /4 - •. . WATER T48LE SOIL AND PtRC. DATA GENERAL NOTES PERG. RATE : 2 MIN. /IN . NO HEAVY EQUIPMENT TO RUN OVER SYSTEM. SEPTIC TANK, DISTRIBUTION BOX , LEACHING PITS TO BE STANDARD TEST BY: E � ', rt//Y!•W.9�J✓iC� PRECAST REINFORCED CONCRETE UNITS WITNESSED BY. Y �• -�7� �©��___. __._� ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE / TO REVISED TITLE 5 OF THE STATE ENVIRONMENTAL CODE, TEST PIT GR EL.: 47 DATE' /Z,,C _ MINIMUM REQUIREMENTS FOR THE SUBSUFACE DISPOSAL OF TEST PIT NO.Ev TEST PIT NO t SANITARY SEWAGE EFFECTIVE I JULY 1977. " ---� ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE 147. APAID , �, /. vv� BOARD OF HEALTH. � ta" AT COMPLETION OF CONSTRUCTION , PRIOR TO BACKFILLING, THE BOARD OF HEALTH SHALL BE NOTIFIED FOR INSPECTION. To C,07- ,,7" PITCH ALL SEWER LINES 1/41e / FT UNLESS INDICATED RQA/O OTHERWISE. 144 DESIGN D4 FA BEDROOMS DISPOSAL EST. TOTAL DAILY EFF. t9RO GALS. SEPTIC TANK GAL. SIDEWALL AREA 2.5' GAL./SO FT BOTTOM AREA 1• 10 GAL./SQ. FT LEACHING REQUIRED- 4-4,11 IV..SO,FT, SEWAGE DISPOSAL SYSTE ' ACTUAL LEACHING AREA 4 ,G SQ.FT. FOR • ,, , �.'1-;a�'.•-:�- � ,�._�' ;� ;�,�_` •:� • _G,E'�.EL - .S,yi,EL L>S �v.�/�T"�'. l�tlC . AE S SCALE' AS INDICATED DATE WM, M. WARWICK 8 A 5SOCIA7E'S � ,�"J ` BOX 80/ - NORTH FALMOUTH a MA.SsACHUSE T 7-502556 1 {ir 7 t 4 q .- ATE _ �! \b GhT WA-GQ i T , •� � /�tG N Bk rT.N - \ p C 4 'z 1 Oa w o � ? fop ►,. t,x �tT O 9 r A x' a G •c--- -F ...- LOP " `its. 7 �U6 � F,ut Ll'7 1114 ,_ �rti> t v ►i► > # s�,4 �! .CpI t"�,., =. 'U� z— N 45 S Q �'? 't � ,� t sr.u.� ; sA„�a ` I sr,ha . r 8a 7 a/Z/PI ' I �,• poi 5 G Gp►,t.. IE + N = GHQ FT y- A °tom I>Nlt , FLOW - 20 x 1\ o ^ zzoco .PD. U S� ::i.C'X.,�.~'=� ���.- • `t'Pam.►y K. gi E ti,c �A N=t E L.C� u s E l W VIE 5 t t>E w ^. C3_t 4 a- Z to C7 Z C. )F Z.S 3 C C. 0 po-r-r v M /a it A►. - ( L x % o o)( t . 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N"/ FRAM C-� t, L f ho 0 - 10-7 5 to.6n loq• L M't la3.q 1t �M`' 103.E °' t, uov GAS_ c� 4 } 'G5 1 s 1 04 3/.d �\ to3.8> r. 1✓1 T �" k'NSH li a fSTG►t� T IL �sE C—T Q ,V P L A. tv Q C->cYM S IZ x 1 1 - 13'Lo c' °T�•D. x s o io = ► R �',,-� �c� o. ^ USCp, TS Wt'T 44, -I-O-T �,L 7> E s, C�, N I x z '` I(o'L7. G, P. Z-� C), '. ©g S c�-�-� ' A��. P ► ��. � T c�., ca� 4' P� �' . C....3� �t E:U u t.-�. 4 o M��.N'-- �ram '119 £�� tv ( Icl iO� 3 S E—V>`r.+ C "i"/N�t.,a Cr L IE-IBC_.,H T S 1 Co r1 L� r Axe �� � N�' � ;�AC, �'�� 1--i - Z.O � c: A..� r-a � . �;rttG�s`cta�'c.•D``P.ND SuRv�.Y oR.� Js-r Vr IP\4 +_•-'-E t- pl,IS s t f _ 14-7 41 + 100, Lad - 'pROP n SE.�• GR_�4- �'- \ � �. r 'r 4 'y o K A N U 1 " .1STING 4,000 GALL-ON H-20 SEPTIC TANK FOR BUILDING F1 LA N T F T EPT K_.� TYSTEV NOT TO SCALE SCALE: 1 "=20' RCOLATION TEST ......... Date of Percolation Test: NOVEMBER 15, 2001 Test Performed By. CARMEN E. SHAY C.S.E. 4*CPA Ill 0 Results Witnessed By. N/A - Waiver for Repair 13, Percoiat on Rate: <2 min./Inch LXa-,D LEVa Or IZA CLUBW COYM PLAC110111; 7' Test Hole Test Hole 1`ll rJ No. 1 No. 2 0 10-1 �v DEPTH _SOl _E_L_E_V_. 0 97.50 0 J�7 _ L SOILS .__ I - - 6- _FT_ 98.00 SANDY LOAM SANDY LOAM 0 OF TTWIDE WA 94.32 10 YR 3/2 10 YR 3/2 (40' X - C'-12" A, 0'-12' A, 6 NT PIPE A'l A? N SANDY LOAM SANDY LOAM 44 SCH 40 93,88 '110 2.5 -f 5/e 2-5 Y 3/0 CROSS SECTION TOP-SECTION ,_ 12•-32' 8, 94631 12"-34" B 95-1 2 1 6 HOLE X 11,111,1111101jr�"-7 93. 2 X A,y H­20 D-Box-\\ 2iS61 2.5 Y 7/4 Mod y Sand 7-5 7/4 94.10 94.20 1 ft ASPHALT 32"- 168' C, LT 50 34'- 168' C, L4 ��n E, 'r DRIVEWOAY 94.62 NT PIPE _X !9�5.�2 X :Z N E W 2000 GALLON H -20 SEPTIC TANK FOR BUILDING A SCH 40 PVC 5.72 NOT TO SCALE X 96.1 \ • A �-,---239-95 0 X X A .5 6' TOP (6' H-20) 94- ./b .72 12' 8, Or, F X X A#* _7 PLArr I - !_I� -�_ ASPHALT I -.1ilill---- i - - - . 7 • 0 Will FT 79d k DR AY 1 2 5' IM Or#= 95.4C 0 • 1 PLAM JOA .1L 12. X ASPHALT CA Perc f1 Perc #1 16'-6' •I,1.- ELEV.- 97.50 Perc Rate= <2mir./inch Perc Rate= <2min./inch 4`7 4' 41 DRIVEWAY t�.. 9 CW NOT Observed GW NOT Observed m @mum an Gillum 190 Exist. 4000 BUILDING "B" ,EXISTING GW Adj. None Required T-1 • _---So _-----N 2,000 1 I - GW Ad� - None Required Gol. Septic Tan H CONDOMINIUM UNITS #1,#2,#S,f4 & #5 J VF 12 BEDROOMS TOTAL (Per Assessors) 1!14,_NT PIPE 6# SCH 40 PVC \X k (FULL BASEMENT AREA) (CONCRETE SLAB AREA) ,9 4 EXISTING TOP-SECTION 96--_ CAPE COD CELLAR (CONCRETE SLAB AREA) PATIO AREA Co Ns cb Cb Design CgLcu I ons -- BUILDING "A" BUILDING "A" EXISTING Number of Bedrooms 6 Equivalent tc 880 Gal./Day 1011. 97.1 CONDOMINIUM UNITS 6,#7.#'88 & *4 9 ALL- OU TLET Pill Farr TW Garbage Grinder: No OMTVWUT04 SOX SHALL BE • -91 8 BEDROOMS TOTAL (Per Assessors) Capacity Required:880 Gal./Day Minimum ( Title V SET LENIEL FOR AT LEAST 2 FT. -V-,OONCRETE COVER to 7 Septic Tank 2 x 880 Gal./Day = 1,760 USE 2,000 GAL. Septic Tank. 6 3- OUTLET% "NOCKOUTS TOF ELEV. 100.00 Assumed SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch Bottom Area: 0.74 g ft al/sq. ft. x 864 sq. ft. = 639.36 gollons 17 INLET Sidewall Area: 0.74 gal/sq. . x 336 sq. ft. = 248.64 gallons OUTLET 7- 0 TEST 1112 Providing: = 888 gallons 0J ar ELEV.- .00 X L 45 75' Use: (8) EIGHT PRECAST 500-C UNITS, HAVING A 2' EFFECTIVE DEPTH, 15.5, 135' 98- 2 -48 TO BE USED WITH 3.5' OF WASHED STONE ON THE SIDES AND P_LA_N_-S E Q LI Q N _QRO55 SECTION 4' OF WASHED STONE ON THE ENDS __40 X 1 98 74 Design Calcu!ction� --. BUILDING "B" 6 HOLE 11- 20 DISTRIBUTION BOX TWO D-BOXES REQUIRED) 26 1 44 F BENCH MARK Number of Bedrooms- 12 Equivalent to 1320 Gal /Day S 82d TOP OF FOUNDATION NOT TO SCALE ELEV. = 100.00 (Ass MI) Garbage Grinder: No Leaching Capacity Required: 1320 Gal./Day Minimum Title V Septic lank 2 X IlJa:U Liao./Clay = 264rU USE EXIST 4,000 GAL Septic Tank. SOIL ABSORPTION AREA: Using percolation rate of <2 min./irch LEGEND Bottom Area PER GALLEf TRENCH: 0.74 gal/sq. ft. x 610 sq. ft 451.4 gadon� Sidewall Area PER GALLEY TRENCH: 0.74 gal/sq. ft. x 284 sq ft. 210.16 gallons PROPOSED CONTOUR Providing: = 661.56 gallons x 2 TRENCHES 132812 GALLONS DENOTES PROPOSED TWO TRENCHES SEPARATED AS SHOWN: SPOT GRADE 97- -97 EXISTING CONTOUR Use: (7) SEVEN PRECAST 500-C UNITS, HAVING A 2' EFFECTIVE DEPTH, DENOTES EXISTING TO BE USED WITH 2.5' OF WASHED STONE ON THE SIDES AND 104X DEEP TEST HOLE 2.5' OF WASHED STONE ON THE ENDS SPOT GRADE PERCOLATION TEST LOCATION NOTE:- PROPERTY LINE STOCKADE FENCE 1 EXISTING LEACH TRENCHES & D--BOX ARE LOCATED WHERE PROPOSED SAS SAS FCR BUILDING "B"HAS BEEN SITED _E: 0 20 40 50 TUT S M A P GENERAL NOTES 2. EXISTING LEACH TRENCHES & D-BOX TO BE PUMPED DRY ELEVATION OF TOP OF PROPOSED SAS TRENCHES ARE BELOW THE SLAB ELEVATION OF REMOVED TO FACILITATE THE INSTALLATION OF NEW SEPTIC SYSTEM FOR BUILDING "B" BASEMENT AND CAPE COD CELLAR OF BOTH BUILDINGS I Contractor is responsible for Digsofe notification and protection of all underground utilities and pipes. SCALE: 1 "=20' 3. NATURAL GAS LINES AND WATER LINES MUST RE-ROUTED 10 FACILITATE INSTALL OF SEPTIC SYSTEM. 2. The septic tank distnWion box shall be set level on 6' of 3741-1 1/2 *tons. .3. Backfill should be clean sand or gravel with no 4. FOUR Tki'[-_S TO BE REMOVED FOR SEPTIC SYSTEM INSTALLATION stones over 3" in size. PROFILE OF SEPTIC SYSTEM -- BUILDING A SECTION A -A 4. This system is subject to inspection during installation PROFILE VIEW OF LEACHING SYSTEM by CARMEN E. SHAY - Environmental 5. The contractor shall install this system in accordance NOTE: THE STRIPPED OUT SOIL CONTAINING LEACHATE with Title V of the Massachusetts state code, the approved plan 3- of 1/8- - f/.R- was%" P"Weavis 10' min. from FROM THE ;___XISTING SEPTIC SYSTEM TO BE DISPOSED and Local Regulations. Existing House house to septic 6. If, during installation the contractor encounters any Ave FWvl floor rev. be SchedMe 40 PVC w/Charcod Odor Flitter OF AS PER BOARD OF HEALTH SPECIFICATIONS. 2111loss soil conditions or site conditions that are different Top of Foundation ore". - 100.00 ulthl. 6 in. of flnished grade V-Ovde o"r SAS - Va From a.EV to I I/S \ t" "SITE from those shown on the soil log or in our design k 1101.00 7t. Septic tank oafere must *NOTE: ALL PIPES ARE TO BE 4" SCHE)ULE 40 P.V.C. VENT PIPE (0 Laost 24 inches Will) - Finish Grade Grade o%w Septic Tank - Elev. 99.30 L;rodo ow D-Som - 99.00 0630 to 07.7-5 -A installation must halt & immediate notification be made to CARMEN E. SHAY - Environmental S 0.02 a HOLE l+_20 I 7. No vehicle or heavy machinery shall drive over the DIST. sox 3' Moidrrurn Cam r:n 0 1= ED] Im NOTLV septic system unless noted as H-20 septic components. A- S-0,0 [D CZ] M ED 0EXIST. SEWER P �GAL THE PRPERTY -INES ARE APPROXIMATE AND 8. Install Tuf-rite gas baffles or equals on all outlet tee ends. F;M FULPMA IM UJI . SEPTIC TANK V C3 I= /-\ c:i co ARE COMPILE FROM A SURVEYED PLAN BY 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipipes.H-20 g 75' E 8 Units @ 8' 64' il-m C3 3 C3 ENTITIE1 "PLAN OF LAND IN OSTERVILLE. MA FOR TO REALTY TRUST" PLAN BOOK 369, PAGE 98 CONCRETE SLAA 1�e. 1 0 ­\ Q 4' --- 10. All solid piping, tees & fittings shall be 4" diameter Ob ip 1i A a, ill OOID CELLAR S U li 4.0' 4.o, I L DATED - NOVEMBER 30, 1982, 13Y BAXTER & NYE of OSTERVILLE, MA. MAIN STREET Schedule 40 NSF PVC pipes with water tight joints. FLOOR EUNIATION - 94,00 6 Ill 3/4--1 1/2- i 9 1 A- I --t: oorrWactod stone --172'-- AND IS 40T INTENDED TO BE A SURVEY PLOT PLAN 11. Municipal Water is Available- SY5JLM PROFILE 'a - - 8 Effective Length IT SHOU-D BE USED FOR NO PURPOSE OTHER THAN 3.5'- -3.5 Nat to Scale S 12'- THE SEPTIC SYSTEM INSTALLATION. SOIL ABS3RPTION SYSTEM (SAS) 6 ln.of 314'-1 1/2' compacted stone _J 500 - C LEACHING UNITS / WIGGINS PRECAST SCHEDULE OF COMPONENT DISTANCES Batt;M of Tee hg6L I ElexTAIJ&1,2 FOUNDA'TION ___SEPTIC TANK D-BOX- --im-LEACHING FACILITY Not to Scale R E V I cID I O N S P P D R : P R O P O S E D I \ LFARF F1_1SUBSURFACE SEWAGE DISPOSAL SYSTEM 1 , min. from PROFILE OF SEPTIC SYSTEM BUILDING B_ PROFILE VIEW OF LEACHING SYSTEM NO. DATE: DEFINITION OF F Top of Foundation Bev. - 100.00 tar* coveini, must be IX w/Charcoa( Odor Filter 'I. eill fle. - 1A. iresill" Existing House hou to sell tank 0 IrL of flinished grade *NOTE: ALL PIPES ARE TO BE 4* SCHEDULE 40 P.V.C. Leont 24 Inches tofl) CLOCKWORKS CONDOMINIUMS Irst floor still - 1101.00 =174SIP to if f11 " ft%%" Crusilil," &ft" -Finish Grade iN M Qrsde over. Septic Tor* - Om 111111,75 grade wer. D-Som WDO ow SO Varies From E1.EV 06,50 to 97.75 CLOCKWORK ONE 3 9 BLOSSOM AVENUE, OSTERVILLE, MA -RUSTEE S 0.02 3 HOLEWILLIAM COUSIN - I EXISTING MT. Box Maid". Car" PREPARED BY: EXIST. SEWER PIPE- N 4.000 GAL FROM FOLFGATMN IZ:3 M EZI 0 M SEPTIC TAW H-20 7V C:3 M 1:3 = C:1 C3 C3 UNIT #3 39 BLOSSOM AVFNUE on C3 43 CM 1:3 /-\ Q Q Q f-\ CZI son CARNEW E. SHAY Pill CONCRE! 9 i 1 E. FLOM E FLU F 93.60 7 0 7 Units @ 8' = 56' ENVIROAMENTAL SERVICES, INC. SYSTEM PROFILE 6 Ill 3/4'-1 Itr A 1 --- OSTERVILLE, VA 02655 0.. to scale co"Wacted Ill 1 2.5' 34 THATCHERS LANE Not 2.5' 10 Effective Length S A EAST FALMOUTH, MA 02536 NITAR\ SCHEDULE OF COMPONENT DISTANCES 0orrPocted at, Battarn of ita How I Ellirt.-IMM SOIL ABSORPTION SYSTEM (SAS) (508) - 428 - 7503 TEL/FAX : 508-548-0796 FOUNDATION SEPTIC TANK D-BOX LEACHIN(_ IJly 500 C LEACHING UNITS / WIGGINS PRECAST SCALE: 1 '=20' DRAWN BY: CES DATE. DEC. 12, 2001 Not to Scale PROJECT#SD-278 FILENAME: SD278PP.DWG SHEET 1 OF 1 H C) Lo^P4 107. t Rtin t Y0 NR E--P-, Z -Z' 5 LD F-T. 5A FINE 5A 04 IV Ex VA c) W^,'l-E re T14 &- BLALVI 4 L)N t T Y LL lPN e- BED o 104 A K V T El; Q I E GD EZ, A,(7,L- t 0, m IT CO 4c 7 0 I f72 IT r tal 4 UN -e 'e,C.ID iz,00"S \3 T,\-r t ST PL A G,,E (,0 50 T -Top c il w 37- LLr. I NV vr INV it , {NV.- Tl- 11 03-1 1 � V. Ic NIV, ......... C, V 101 ?. L V, As 14 IZ7 D E <S t4c) (7DP*,RJ5^%GF- A, 'v F FLOW C. C G P to lllsK Z I 'l 6 G Y, \ S 0 .4 C) 1> P I u Ve .is PL OT L o6\ 4-2 TOTAL UPS4 F5 051T N 'S T E- t eol ijc T H O M A 'S I NN,� E- INC, 4 ool, t Sr A k=00 ft 1"V Ix Al