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0010 CAPTAIN ALDEN'S LANE - Health
10 CAPTAIN ALDEN'S LANE,OSTERVILLE A= 1 'j III V^I I - i II I I if } p a No.20 R — 1 Fee'W 00 - a THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes. 21ppYication for ]Disposal *pstem Construction Permit Application for a Permit to Construct( ) Repair A) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. !O dapi vr, A S axj Owner's Name,Address, d Tel.No. 7'7��,7 - � 7l ��.cP�» 39. Assessor's Map/Parcel/y L?3 Ui/[° Installer's Name, ddress,and Tel.No.._5F-09-Y18-55:2 . De gner's N me,Address,and Tel.No. [ �oIOCn5 -�lrcun �" inee/s!j $���1cri•� l 0 M-6 )57 Type of Building: �d V ll Dwelling No.of Bedrooms ✓ Lot Size `S/(®� sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided ySS gpd Plan Date /�� �DhI/3= Number of sheets Revision Date Title �9� / Size of Septic Tank � i Type of S.A.S. _ Sw�� 14-00 L/Yl07KlPii S Description of Soil Nature of Repairs or Alterations(Answer when applicable) Prhpu'g— dgox 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 Environment a not to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt Si d Date e Application Approved by Date Application Disapproved b Date for the following reasons Permit No. 7p t Z^ /0 1 Date Issued Z Zo -2— _. _.. __ _-__ -._ _. _ -__- - - _ _.._ _ Pam__•. R �tT ._---_- ._ ...._ _. _ _— _... ... _ _ - ""'"�� r _ � .*ra '.. No. O i- Low .t Fee/ 00 . y. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN-OF3BARNSTABLE, MASSACHUSETTS application for misposal *stem Construction Permit Application for a Permit to Construct( ) Repair V Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 10 6 E4 LA, A f�, � tf XJ Owner's Name,Address,and Tel.No.")'I V- ,,, C G��P,�✓!Z1`��,��Ge.C i��A..e.:v'� /G'{�Gc f�J � -r s�tl�. Assessor's Map/Parcel/�-J(p g3 65� lvie t-V Installer's Name,Address,and Tel.No. —oS Y-1i Fi 1�SxC. Designer's Naine,,Address,and Tel.No. ( �o�o( <<ns; •, �nc VSi. c�strcSi .c��cc�n rn .inr%�f S3S�c.�o�5� 5 I/WAL-2fuAs AILI< Type of Building: 'i Dwelling No.of Bedrooms -3 Lot Size s�_ M sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ;Design Flow(min.required) 3 3 U gpd Design flow provided US S gpd Plan Date (_,[of, 1 !;. Number of sheets Revision Date Title / f B /D t s' / r Size of Septic Tank Fx4im, ype of S.A.S. - .`�0✓]�+.v 0 /-f �Jy �y e„ S Description of Soil �j Nature of Repairs or Alterations(Answer when applicable) /11S A 1p�41"'o— AV O 9e111604 4 ir► 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 Environm�entaaLGode a not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health,,-, ealth,/ f Si ned // Date '( i Application Approved by Date 411Z-4 Application Disapproved b. Date for the following reasons i Permit No. 7n S� Date Issued y(2 Z v) .- _------ C:>-------------CC-;-r-- .--- Z-:-- ---- --Tom_----.-_L7-_--- --__- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ✓5 Upgraded( ) Abandoned'( )by k, i at ( �A�QTiA!rJ At,-btNS (gk DXL ytde t� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.701- -/(X dated 2 3 Installer Designer #bedrooms Approved design flow Sb O gpd The issuance of this permit shall notbe construed as a guarantee that the system will function as d 'fined. Date / /I Inspector -- ------ - - - - - - - - - - ---------- No. Z Z ' Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS _. Disposal *pstem Construction Permit , Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at d CAPTA,N A LMM 5 WAM 2.1 a t.QE ^ i and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this perfnit. Date / 21 7 a Approved by -� I TOWN OF BARNSTABLE LOCATION 10 CA-, . P4AC4 tA),H SEWAGE# /� • /Q� VILLAGE d&7UWiJ1LJ_19_ ASSESSOR'S MAP&PARCEL /��$•��3 INSTALLER'S NAME&PHONE NO.3&nL:ro-La-r1-1 6Wg- SEPTIC TANK CAPACITY A /Q i r v LEACHING FACILITY:(type) (size) 33 .5 X, NO.OF BEDROOMS OWNER l G a PERMIT DATE: 4- 1:7-/�_ COMPLIANCE DATE: � l> b tx Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 40v� Cgy�r Lf�.w.�s �/D l<�� S, �, � . .�- .. 3�� S176� y�� MAY-08-2012 12:37 From:BORTOLOTTI CONST 5084289399 To:15087906304 P.112 FROM :down cape engimering Inc FAX NO. :aSM6298M May. 08 2M2 12:33PM P1 ✓ ��'i�4,, ���`l�tlli�iff D K"j' �id'�`'VT.i~� Qw r •y . - Ar � �ieovtas:��'. ad�+il,�►a-, ��DA�h6S��1z ;LP I Boa Pmhlk..TlesAtIr DIA.Rion �:�P�ll��f ��UF19iAA V�PJ��0171�ZDNa"J:d:d4hA" • ?i4E)A+Itufm Strra�t, FIIy��t�i�1,li9LA�OF�4i4}X Cl it a; aU8•ftF -n644 Fst�: 'wli3 �90 6304 • .L��I�B�� It}eye�;N;�p r1 i'ila;►4dt Ha.Ih�IDlil�tl _ Znt s Ja illaar t r �v 7 CA AA SA f� t n� t (. (doo :, ,�rSc o1,rEirCm:,t.1V 4.0.�JCI i t r�;�Wa i/ t:t�iod �n u�i� clrAam by -��3r•�•:ys) 1 �sPIS c'd',Yt t ibot IN,- JLpfl.Q syi"aw.J'CfCTC,T1Lkd A110-VU OMa 1T191i ltd SUNIaTTittlll'y acuurf Lur,� to (leiign, x'J,iC'11 Wuey•uOILIde nin,crr;FFPi,pved k;uA.n�,es 3+10) LUJ WaTai rt.lorati)rj Uf iha clia�zxb�,ttiuul•nr, �Incl/fir�aJrti!s tr�tik,_ i +'crhiFv t V tilt ;(Plja ;ryat= refp•cWn:1 ahuvo. wan iMtelled WitniajDr alga gCS (g-�- pt-,Ntr.r than lit° ltit+:sAl.relo:A;o.a:r,f'thr.S.A,$ 0r anY VCrdt.tti rt of Compuuant of tttc�tti4 warm)bw in aemrdpro with Stale A Local J;.r.,-,i alxun�. Mall tovi:�i;nx a ccidificd n-built 4y de gwr to follow. DANIEI.A OjAx,�A a (lziet ll�r'a tii ru�coj 01%AL fA Ne 4s,,ax a; IONA (�'+•;u(��°ier'a$ipnt{iirrw) , (,�'Ft;R Lk,3i,F,+'►tar's�id.�ii.p k�;xo) ,t_f1M, 1AN�."lip ' .� f.1 TXEW.VlpAn�.T Ara , � ,rr�tixr �r,;taav rl: 'avJ< T).. n.i i r.lfl.l�"•nr r/rFn•�*r•nr r l'cn lili CdtIOR rb�+Y1�-�6-+��.Y,IP+� MRY708-2012 12:37 From:BORTOLOTTI CONST 5084289399 To:15087906304 P.2/2 FROM :down cape engineering Ime FAX NO. :15083629NO May. 08 2012 12:33PM P2 �aMw�O une�` duWL mm w� l ° ► Joao TAM r oca� nu oIML. mr new, i a east aCaK Min a r A M NOT UMM SEPTIC A&BUILT PLAN PREPARM E(CLIJSNMY FOR M HFJLTH nor,, NOr FOR MV OTNER USE LOCATION : 10 CAPT.ALDIVIS WAV9 OSTERVILLE SCALE : 1' a .30' DATE : MAY 8, 2012 PREPARED FOR: REFERENCE : MAP 146 PAII<CEL 93 BORTQLO NST,/ Macs, , DANIEL A. �r en.aer-�eFt C)JAI,.A a sa�sa9aeec NO 40980 uem�anpe.aan• '4 W w� tit • ft Jim � °� lag d �`4 enprnee ���� andsurv�eyvr� �..r,�---- --•-y— ^--w--�— ----- ''Y,4A#Mft F AW� �AWYd --�— DATE REG. LAND SU .. aR TOWN OF BARNSTABLE LOCATION �Cilu-�/! keens &.n SEWAGE# VILLAGE 0SZA41" ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.�rat+d J GJ�•�c- L-�'+�'se G SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS D OWNER RO b C"I AS /f C C F' PERMITDATE: COMPLIANCE DATE: 9 as f 75 Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 Page 10 of I -� OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT_S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:10 Captain Alders Lana Ostetville,MA.02655 Owner:Robett Asiager Date of Inspection:8/22/2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. t3 e vd II� 1 J F 'I 1. r.n.c r.............rr,.....Rn cnrnn 10 /2 0 ff� U ta-r V Se JT_���e T honna, F. GeUeT, Direclo vc_A,'S, 11111bl c He0th Di-, 7etr1'In ,homas McKean, Director 200 Main Street,Hy 2mais,DLk 02601 Office: 508-862-4644 Fax: 508-790-6304 installer & Desrguer Certification Form Date: Sewage crn�nt;'1 C2ojd' 10g Assessor'si�IapTarceli �I64 ]Designer: 10VjV\ t (/l2eh Installer: �O��Cyll i t,DlLd�f�Dti A dldlregs: IJ 01 ey "Address- 0 L& On 17 /a— � „aLv� l a)�as issued a permit to install a (date) (installer) septic system.at / l�� .�6 I r\ w ke v W6LV based on a design drawn by (address) AA_n'oJ 1 t• l U .�.PLsda,ed �a (design -) - I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. -�— greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow.; . Ia OF MgSsq�yG DANIELA. s OJAI (Installer's Signature) CIVIL N � No.46502 r �0 GISTt �esigr�er's Signature) l (�' x 1�esigner's Sfam� Hero) PUASL RETURN O BAR14STABLE PUBLIC HEAL'rfl DIVISION. i.E TIFICAT`{ OF COMPLIANCE VV1-1L NO BL ISSUED U iTIL 130TH TEas FORM AND. AS-BUILT CARD ARE' R ECEWE ➢BY THE BARNSTABLE PUBLIC HE4 ALTH DIVISION. THAI- �YOU. Q:i iealtb/Septic/Design r Certification Fc„i 3-26-04.doc I 3- 500 GAL.CHAMBERS WITH 4! 0 STONE AROUND 0 �r O h a U GRAVEL 44 �Ok O DRIVE Z l n< kj HF� ° 10DO G TIC TANK - ° p0 f� GRAV, 1, • DECK EXIST.DWELL TOP FWDN. \ EL 59.5' DECK 4 Q 04 v LOT 2 SHEo IN THIS 15,tfi2 f SF AREA NOT SHOWN 1 °y8 f� 00, 15.50' a0%) SEPTIC AS-BUILT PLAN 12-084 PREPARED EXCLUSIVELY FOR THE HEALTH DEPT., NOT FOR ANY OTHER USE LOCATION 10 CAPT.ALDEN'S WAY, OSTERVILLE SCALE : 1" = 30' DATE : MAY 8, 2012 PREPARED FOR: REFERENCE : MAP 146 PARCEL 93 BORTOLOT ONST./ MacQ Mq� DANIEL rod A, off 508-362-4541 U OJALA N fax 5W 362-9WO p N0.40980 downcape.com ® v own cope eadineefind,filt. qOP SS a civil engineers land surveyors 939 Moin Street (Rio 6A) — YARMOUTHPORT MA 02675 DATE REG. LAND SURV OR I 02 •- o 60-flHacQuee Town of Barnstable 1DepartmQ'It Of Regulatory Services J u Public Health DiViSioll Tate BAMSTAHLt;, 4 1"AB& g 200 Main Street,Hyanuis MA 02601 Date Scheduled Time Fee Pd. Soil Suitability Assessmentfor Sewage Dispogal Pcrfonned By:' Witnessed By,: LOCATION & GENERAL J[NJC'O][B,MA7 ION Location Address /o c +�, al A,,j, v/� Owner's NanreY �ae(�t�o� � T ` Q P��ll Address Assessor's Map/Parcel: -J��1 9J erigiucer's Name; Ow-N—, NEW CONSTRUCT101`4 REPAIR Telephone ff Land Use' Slopes(9'0) �— ® Surface Slunes Distances,from: Open'Water Body It Possible We[Arep (L Drinking Water Well / ft Drainage Way A'10AI J R ProperLy Line 26) ft oilier t't SliETCH, (Street came,dimensions of lot,exact locations of I of c pore 51s, to ale mdands'fn pracinuly to Bales) L� ,. ry) r ate-' C-4 cj 0 Parent material(geologic)lc • g )_�� u/Q � Depth lU BedrOcls, � • Depth to Groundwater: Standing Water in Hole: Weeplug frill Pit PROO [1/eAXI: Estimated Seasonal High Oroundwater ][ E,T ERAIINA�`�'J[�JN FOR S14C ,r`ONA,]L HIGH V�'A.71'Elt TABLE, Used: Depth Observed standing in obs. hole: In, Deptla lu 5411 tzlc�lU.�i; _ lu, Depth to weeping,Prom side of obs.bolt: III. 0rLuidwmEr AdjuBlMet1l:,— Index Well ff Reading Date: Index Well level „ +„ AdJ,factor � AL,.Capcawut'er Eve.)�9 11TIRC+L LA T1[01NT 'BEST.: Date Observation / Holc# / Tlma to 9" _ Depth of Pere (Q 1'In'ip 4L 6" 1 , Start Pre-soak Time @ �V) _ Time(9"-0") End Pre-soak 10� RULE Min./Lncll Silt 5uilability Assessment: Site l'esseil 5ilg Failed: Additional Tosting Needed(YIN) Original: Public Flealth Division Observation Ilolf,Data To Be Completer)on Back--- --- "" 'If Pei-colatiom test is to be cojiducted wiLiiin 100' of wetland, you must furslt aotaiy We Barnstable Consep ation Division at least one (1) week prior to Ibegim..uaug. QASEPTtC\PEIZCPORM.DOC Depth from Soil]aarizon ��� Hole # r Surface(in.) Soil Texture Sdil Color (USDA).. Soil. Other (Mansell) Mottling�^ y g (Structure,Stones'; Boulders, Con tsta c a r, el �®Az21j /,(lye elk Depth from .Sell 140tlzon TION HOLE? LOG ]E][® �_ Ie # Surrace(in.) Soil Texture Soil Color (USDA) Soil ^— ) (Mansell) Mottling er (Structur0e,lStone., Boulders O- 1/ �'T C sis e c % 0 avel 40® .. lL��P ®11�,yJ1!.,A�U'���O Y HOLE L®C, Depth from Rail7-lorizon ,] olp, # Surface(in_) Soil Tcxture Sail Color, -"--- (USDA) Soil Other (Mansell) Mottling 69tructure,Stones,Boulders• ('ol i to cY.%Oravel) .......... — i — )DI]E]C]1D 0BSQ ll�ll�a7p 'Ir" 7�.T xx � .n p From V 1�JLJL11.1�1�q 11Q),I E .1LJo(; Soil Horizon Soil Texture �H ole Surface(in.) Soil Color Sall " (USDA) Other (Mansell Mattling (Structure,Statues', boulders, LI I,_w➢Insurance Rate myar Above 500 year.food boundary No ycs ' Within 500 year boundary No --. ' Yes.,...._...._ Within 100year flood boundary Na_ Y65_ ID)e tnu oar a>Ittnnily oecuau'ring rgicv>ious Material Does at least four feet of naturally occurring pervious material exist in al! area a s nbserved tiu pughout the area proposed for t;le soil absorptioiu system? 1 �f not, "That iS the deptll of naturally occuning 1A rvious marol'ial A certify that on L (date)T have passed the soil evaluator examination approti�ed by the Departrnent of Environmental.PIVCCtion and that the above analysis was performed by me consistent with Ole I-egtaired training, expertise and experience descriUcd in V0 CAdR.15.017. Signature , l7� "0 Date Q\SPPTlC\PERCP'0RM.DOC COMMONWEALTH OF MASSACHUSETTS Col z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS + d DEPARTMENT OF ENVIRONMENTAL PROTECTION �a � e V �M yve TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 10 Captain Aldens Lane 1 C_ Osterville,MA. 02655 w;=�€ � v:Owner's Name: Robert Asinger - Owner's Address: Same w. 1 E Date of Inspection: 8/22/2005 Name of Inspector: (please print) Brad J White as ' r-- Company Name: Windriver Enviromental Mailing Address: 107 N.Main Street Carver,MA 02330 Telephone Number: (508)-866-2576 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this-address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority F ' Inspector's Signature: Date: 8/22/2005 The system inspector shall submit a copy of Yctsion.inspection report to the Approving Authority(Board.of Health or DEP)within 30 days of completing this insp If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments System Passes. ****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 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 10 Captain Aldens Lane Osterville,MA.02655 Owner: Robert Asinger Date of Inspection: 8/22/2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System passes.Recommend regular service. 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 corripletion 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 exfrltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed 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: T;tl. 1� r .,.t;—17 -,„rii 1�0000 2 Page 3 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 10 Captain Aldens Lane Osterville,MA. 02655 Owner: Robert Asinger Date of Inspection: 8/22/2005 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria 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: T;tIA 3 l_ Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 10 Captain Aldens Lane Osterville,MA. 02655 Owner: Robert Asinger Date of Inspection: 8/22/2005 D. System Failure Criteria.applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool —X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool —X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than'h day flow —X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS, cesspool or privy is below high ground water elevation. _X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _X_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X— Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [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.] _NO_(Yes/No)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. 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 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. T;t1. c rno —ti—17—9i1,;i1nnn 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 10 Captain Aldens Lane Osterville,MA. 02655 Owner: Robert Asinger Date of Inspection: 8/22/2005 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No _X_ _ Pumping information was provided by the owner,occupant,or Board of Health _X_ Were any of the system components pumped out in the previous two weeks? _X_ _ Has the system received normal flows in the previous two week period? _X_ Have large volumes of water been introduced to the system recently or as part of this inspection? _X_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ _ Was the facility or dwelling inspected for signs of sewage back up'.) _X_ _ Was the site inspected for signs of break out'? _X_ _ Were all system components,excluding the SAS,located on site? _X_ _ 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? _X _ 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: Yes no _X_ _ Existing information.For example, a plan at the Board of Health. _X_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] E T;o. C Tn .,fi—17—All Gnnnn 5 f _ Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 10 Captain Aldens Lane Osterville,MA. 02655 Owner: Robert Asinger Date of Inspection: 8/22/2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440gpd Number of current residents: 3 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): NO 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: Current COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,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: Pumped after Inspection. Was system pumped as part of the inspection(yes or no):Yes If yes,volume pumped: 1,000 gallons--How was quantity pumped determined?Sight tube on truck Reason for pumping: Check for,groundwater infiltration. TYPE OF SYSTEM _X_Septic tank, distribution box,soil absorption system _ —Single cesspool Overflow cesspool _Privy No Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: System was installed approx 16ears per as built plan. Were sewage odors detected when arriving at the site(yes or no): NO Tid. G Tno —ti—T.'nr,v,411 ;/loon 6 l_ Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 Captain Aldens Lane �Osterville,MA. 02655 Owner: Robert Asinger Date of Inspection: 8/22/2005 BUILDING SEWER(locate on site plan) Depth below grade: 36" Materials of construction:_cast iron X 40 PVC_other(explain): Distance from private water supply well or suction line: N/A Comments(on condition of joints,venting,evidence of leakage,etc.):Building sewer is in good condition. SEPTIC TANK: X(locate on site plan) Depth below grade: 21" Material of construction:X concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 8' x 5'-8" 5'-2" Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 11" Distance from bottom of scum to bottom of outlet tee or baffle: 14" How were dimensions determined:Measured Continents(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Tank is at normal level.No evidence of being high.Tees in good condition. GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee 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.): TrtIA S Tna —f;n Pn F./I1 /0000 7 Page 8 of 11 OFFICIAL. INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 Captain Aldens Lane Osterville,MA. 02655 Owner: Robert Asinger Date of Inspection: 8/22/2005 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: X (if present must be opened)(locate on site plan)(40"below grade) Depth of liquid level above outlet invert: O Continents(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 level.No evidence of solids carryover.No evidence of leakage in or out of box.Distribution is level. PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): T 1A G Trio —fi—T7-Ail;nnnn 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 Captain Aldens Lane Osterville,MA. 02655 Owner: Robert Asinger Date of Inspection: 8/22/2005 SOIL ABSORPTION SYSTEM(SAS):X (locate on site plan,excavation not required) If SAS not located explain why: Type _x_leaching pits,number:_1_ 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.): Soil is dry.No evidence of hydraulic failure.Vegetation is normal.No ponding on the surface. CESSPOOLS:_(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): T;�iA r--f;-T,--..,All�,Mnnn 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C i SYSTEM INFORMATION(continued) Property Address: 10 Captain Aldens Lane Osterville,MA. 02655 Owner: Robert Asinger Date of Inspection: 8/22/2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. 0 0 13 F�aNI t i { V .i f V 04 e"T t 1 `7 } T41. C Tncnnntinn Rnr All 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 Captain Aldens Lane Osterville,MA. 02655 Owner: Robert Asinger Date of Inspection: 8/22/2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 7'+ feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: _X_Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation:No groundwater encountered @ 7.per local slope off across street. T41. G T„c„ f;--'P--m All C/')000 11 l BORTOLOTTI CONSTRUCTION, INC. SUBSURFACEI�SAGE D•ISPPnOSAL SYSTEM INSPECTION FORM N 4404 ' Address Of Property ply �1-2 N , Owner's NameL'��P� Date Of Inspection PART A MCKLIST 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 columes of water have not bee n introduced into the system recently or as part of this inspection. As-Built plans have been obtained and examined. Note if they are not avail- able with N/A. The facility or dwelling was inspected for signs of sewage back-up. The site was inspected for signs of breakout. All system components, excluding the SAS, have been located on the site. 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 SAS on the site has been determined based on exist- ing .information or approximated by non-intrusive methods. The .facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of SSDS. I� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential number of bedrooms number of current residents garbage grinder, yes or no e5 laundry connected to system, yes or no � seasonal use, yes or no ' If nonresidential, calculated flow: Water meter readings, if available: C U ryT h r Last date of occupancy GENERAL INFORMATION Pumping records and source of information: Cei9��OPc -Qo — /fc�meocvy�✓ &)b . System pumped as part of inspection, yes or no if yes, volume pumped Reason for pumping: Type of system I/ Septic tank/distribution box/soil absorption system Single Cesspool Overflow cesspool Privy Shared•tsystem (yes or no) (if yes, attach previous inspection records, if any) Other (explain.) Approximate age of all components. Date installed, if known. Source of information: p Sewage odors detected when arriving at the site, yes or no SU&SURFAGE:.SEWAGE DISPOSAL- SYSTEM INSPECTION FORM PART:`B' SYSTEM`II�RMATION'DO�flTIlWED EPT IC. TAW.. r/ (locate on Site;plan) depth below grader material of construction: ncrete metal FRP other explain sludge;depth 3 distance from top of ;sludge:.:to bottom of .outlet tee or baffle sGvm ,thickness. n ` d� tance from top of scum: to:-top of.:outlet tee or baffle distance from bottom of scum to bottom of outlet tee or baffle Cotmnents r Eton for pumping, condition`:of inlet and outlet tees or baffles, depth o liquid level in -relation to outlet invert, structural integrity, evidence of leakage, recommendations for repairs, etc. ) A car v�- c 17AJ' t� ��� d 2- sit e plan) depth of liquid level above outlet. invert (note level and`distribution;:is equal,. evidence of solids carryover, evidence ofleakage into orou of box,. recommendation fro repairs, etc. ) D O o e / PUMP CHAMBERt (locate on site plan) pumps.: in..working`.order,, yes or no Camehts t (note condition of pump chamber, condition of. pumps and appurtenances, recccmlendations for maintenance'or repairs, etc. ) I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART. B SYSTEM INFORMATION CONTINUED. SOIL ABSORPTION SYSTEM (SAS) : (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type leaching pits and number P"tcay�l_' Z'e 64 /i v leaching chambers and number leaching galleries and number. leaching trenches, number, length leaching fields, number, dimensions overflow. cesspool, number Comments: (note condition of scil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc.A L,9PE%�, tc�✓1 CESSPOOLS (Locate on site plan) : /41) 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, recommendations for maintenance or repairs, etc. ) PRIVY: /Y () — (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, recommendations for maintenance or repairs, etc. ) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION CONTINUED SKETCH OF SEWAGE DISPOSAL SYSTEM; include ties: to at least two permanent references landmarks or benchmarks locate .all wells within 100' i �kto� DEPTH TO. GROUNDWATER depth to groundwater method of determination or approximation: C©�`'���Q�`i®.rs ��,� �e r�r�i�Y�-.�'�l�r alvuh�wr ✓' sut v�,,l SUBSURFACE .SEWAGE.DISPOSAL.SYSI'EM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined'', explain why not. Backup of sewage into facility? Discharge or ponding of effluent to the surface of the ground or surface waters? L`/ Static liquid level in the distribution box above outlet invert? N/"- Liquid depth in cesspool, 6" below invert or available volume, 1/2 day flow? Required pumping 4 times or more in the last year? number of times pumped Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? Is_.any portion of the SAS, cesspool or privy, below the high groundwater elevation? Within 50 feet of a.surface water? Within 100 feet of a surface water supply or tributary to a surface water supply? /Y Within a Zone I of a public well? /V Within 50 feet of a private water supply well? Within 50.feet of a bordering vegetated wetland or salt marsh (cesspools and privies only, net the SAS)? 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, amonia nitrogen and nitrate nitrogen. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATIION Name of Inspector: Company Name / /� % �'(�D�S!I`!1 �/olJ� —D?C- Company Address 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: / V I have 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. I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15.303. The basis for this determinimation is. provided in the FAILURE (!RITERIA section of this form. Inspector's Signature Date Original to System Owner Copies to: Buyer (If applicable) Approving authority 7� THE COMMONWEALTH OF✓NiASSACHUSETTS BOAR® Off` ,HEALTH =Q1,t.).AJ..................OF..... ....................................... ApplirFation for Uh4pogal . orks Tonstrur#ion. Prrmit Application is hereby made fora Permit to Construct (11/) or Repair ( ) an Individual Sewage Disposal System at: .....J0.STEAr_ V J64e................... ........Z0. ........------..... ..:........_. Location-Ad ress or Lot N ............. = .. . -----------------.----------•-------- ._../ .... ------......................... W Address caner .................... Installer Address d Type of Building Size Lot.1_5,Z.?�........Sq. feet Dwelling—No. of Bedrooms___..---•-.--3..........................Expansion Attic ((o®) Garbage Grinder (N®) a , p, Other—Type of Building _...M_,l_J .__......._. No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ,,,,-------------------------------- -----------------•--------------------------•---------------- W Design Flow..-,//..O----_----------------_----- per XA per d�. Total daily flow.._...._S-6---_........_.___.._gallons. WSeptic Tank—Liquid capacity/_490...gallons Length 45.�6._".. Width_/,.l_4?"1 Diameter________________ Depth..5.'8_." x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.........f......... Diameter..__..'...... Depth below inlet......6........... Total leaching area..o'2 00..sq. ft. Z Other Distribution box Dosing tank ( ) '-' Percolation Test Results Performed by.__l 0V_,&-,D.....�.�_.._�O,t�f� �_�e. e_.. Date...A.00-----2.2f/f��.. aTest Pit No. 1...C_,;L---minutes per inch Depth of Test Pit-- ------- Depth to ground water.../V_ON- ...... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ra •----------------------------------•-------------------._... .....----------.............--.--------------------------------------------------------------- O Description of Soil------. 0.....Z.04..,c+ ....AJV.lJ--------5.V1 _TV&.--------- r..... v �.r9s�-.A N� A ' /�, /�1 �1T &410..--------•-------•---------•..................................... 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 iITLE 5 of the State Sanitary Code—T dersigne of to place the system in operation until a Certificate of Compliance has been is by e bo i_ iealth. gne ..... . .............................. ............. ..................... ----------------••--•--------•-- Date Application Approved By....—.• .._... ��rl � Date Application Disapproved for the following reasons:.............................................................................................................. -•----•-•-•-......--••----•-•------•.....................•--..-........................----•--------------•-•--••-----------•----•------••-•---------------------•- Date PermitNo......................................................... Issued_....................................................... Date No Tim THE COMMONWEALTH OF MASSACHUSETTS :...f BOARD OF HEALTH ...................0F.....RA.R.N.r..`...1;t../ Appliration for Elispniial i8orko Ton union Vamit Application is hereby made for a Permit to Construct (11"") or Repair (" ) an Individual Sewage Disposal System at 01. ...... •.:`_ �' ---''- .fit ..✓¢ ......................»» ..... .......... _................... ........ ........»....._........... .._. 0' --Location Address -- Lot N Address 000000)1 ............... ........ .......................................................... ................. .._........_.__.__._........----........... Installer Address dType of Building Size Lot_✓ a_ t .......Sq. feet N oms._._.___...Dwellng— o. of Expansion Attic (00) Garbage Grinder (NO) aOther—Type of Building ---- ............ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ......................................................? .+c.Ad+` = ----------- d•--••---•--•• Ions. W Design Flow-.,�-�:�...............................gallons per person per day. Total daily flow__..... ?._.... gal lJOA i Yl `Je IY Y d, WSeptic Tank—Ligmd capaclty.............gallons Length�...�!?...___ Width_''......__.... Diameter................ llepth._�..�.._.. x Disposal Trench—No. .................... Width.................... Total Length................. Total leaching area....................sq. ft. Seepage Pit No......../.._...... Diameter.... __'____-_- Depth below inlet.....!(!........... Total leaching area..r''-.._O ..sq. ft. Z Other Distribution box Dosing tank ( ) Percolation Test Results Performed =.1`�.....;!- -__ :� �!-?x ------ t... Date._.. 4 =_.. Test Pit No. 1..e..9....minutes per inch Depth of Test Pit �-*........ Depth to ground water.._! (i Test Pit No. 2................minutes per inch .Depth of Test Pit.................... Depth to ground water........................ a -•-•--•••----------••---•-•-•••--•....._...-•-•---•-•------------•----------------------•-...._.............................................................. D Description of Soil r� �.�,r.ar .�.nI^ Sri t��r�t------------��-�-''-'-"' ='.5.. ' f#...Al��l� V /�.Ai... ................... ......Z;.r!Vc-c�1 6 6r�--------...------.........-- -•-•---• •--.....-----------•---- 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 iIT1.L 5 of the State Sanitary Code—T dersigne t to place the system in operation until a Certificate of Compliance has been is by e bo ealth. r r Sine ; �� ate'7 Application Approved By..... .......... --•----- � �' :f .....-.Q------.............................. Date Application Disapproved f or th'e following reasons:_...--•------------------------ ......._-----•---:-.---=----------------------,-- -----•--- --•- ..............................•--...-•--------•••-----......----•--------------•------•--•----•----•-•...._...---•-•----•-------•••-------••. Date .Permit No....................• - :.---------•----------------•--- Issued.......................................................... rn` Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O EALTH ......... .......OF..... - �........ ..... .. 4!' ...... ... Trdifirate of Tomplianrr THIS IS TO CRI TIF hat the Individual Sewage Disposal System constructed ( w.}' epaired by---------- -- ....................... .......................-------------------•---------------- -------- --------.......__..._ ,;,,���/� Ins]"aller at.......I:; -....... -•-----•-----------ro.......-- ..S."�" ?! --- ,... has been installed in accordance with the ovisions of T r of The State Sanitary Code as described in the application for Disposal Works Construction Permit No. .____ __. `6 '�dated 7.........................7f— THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ' r Ins or_ .. . ....DATE.......: . ' ect .... ..... ....._..TK9 COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH ry 7 .. .............. No..•-•------G..?. :. FEE .. . ..."...... Disposat r %Douo r Uan rrnti Permission is hereby granted.............. --• •--- .•. ►=, P -----..... to Construca,,,}.wer°Repair ( ) an ndivldual w e Disposal System at No........ ..... wo- M - _. + "' Y Street as shown on the application for Disposal Works Construction Per i o.............�,____. ated... ..................................... 7/'2 •------- » Board of Health DATE.. -•••••�i.. .......... 'v FORM 1255 HOBBS & WARREN, INC., PUBLISHERS r r (LEA ESERVE �� PRJI MURP',bY- = _l'�i� � ;�': ��;� • V Lo pit PIT LD7 3 �' r �' 3fJ - /44 , MEur:J/ i i SA;'� D 9v S.445 NOCE FOdND. t d 53 / TEST ' 40 - /` NO UJA TER EN�:�JN?Ef�' L) j LOT a. r `± Gb - y , i .3 M/iV/tit U A,-1 r3 U/LD/NG S E•T6,�1 C,rC .e 6Q U i.e�ME!<J7� S'cALE F20/v T /r Si DE �L 72�4 Tz _ P20POSED .. � BE.D20oMS SE P T/C. _5 Y5 TEM CoN.5 T2:UG TLOA/ SHA LL GONF02M TO MA SS - IDES/G N FLOW � �O GAL�D,4 Y L E A C H 2,4 Tx" a M/A/.�//VC,/ ' 2E1�lSE '.� 7-/ -.7'?. G.?IFN5. �'�I/ ,�EQU/2G-D LE�ICN..�12 _4 •?� NEALTN '2��G/LA T/OHS �- T 0/-' G't iO MAn/HOLE Co✓E,a TO EX.TEnfD 'TO "2✓/OUS CO ciE� TO ,al2E V fAyT Wt TN/A�/ P OF F//�//S-//E-v C�IZ.40 ,c20i-1 /,�/F/LT2aTinf6 S T-OnJE �0 I �4,.Coi/E�7.5 /0/ - l D/ST ...� �. ��\ co✓� 2/o G,eAZIE 4 i 30X I \Z/W12/ lE OVER C45r/iZo/J - Y --- 3"M/N P/T M/n//MUJ�/ — 3"^41AJ : A• q/ATFZ r FLOW L/NE / gf .•��-�--(. D/A.70"M/n/ 2" Mnv r�/rc�i 4"/FaOT /4":: Ar FOOT �'`� .�i2 _Y_ �} r� Minl �4."/Fo.o r �oo" WA 5 H E CD _1_ L1� _ ✓ _ a26 / i . � STONE /NVEJZ 7- CA ., l� LI L L 0&/ _ 1,V✓E 2 T /iV VERB T C A .p 4 C/ T Y. 2 O vn/O ELEV• . - - S/E!�T/c TA�/•e /(�. 95 - /(,..C7 . �.� B c�Tro.N of 9 (. biIATGTdT/Gh/T) /A/VE,2T. C /O.O /N VE ZT /V Q GA. ,e8A6E G,2p/ JDE;� 6' ,�x / > LOCA T/ON 2 EFE 2�nIG E LOT 62 A -r,�` —PLAN Qc'?C�k.— AT/G TA/�/K j�/S7T�iBUT/ON f30X', EAG/-,� N� P/T TD .c3E: o� .�E?rn/FOT2CED co.vCrzGT� _ '' �'CONG2ETE ST2E/VG7� 3000 7as/ tij/n/. l"i V ! _ - EGE 20000 7-7- `�'�`,,.t 2 �1'20R /0 LOAD/NC7 #3 t L, : :,+. /. '?" a/7 "- 3 �w p2/VE yL//tY /v"0T TO E3E Z-0-A;..c`� O✓E,e s YS TE n�J u/vL 5 5 .f/- 20 .-I CERTIFY I HE FOUIVL'A7'r'ON. SFI; /N ON THIS PLAN � `�ti OF ,4�E.S/vn/ LOAD//vG /S us�z�. /5 LIXATFD ON THE GRDI�ND A 'S 5H,)i,J--IV �• AND {T UOES C='Ni i:'OF S�-7[3ACrC f?E�U!l?F.l`'1�Nf5 �,F ,THE ;,•-:?x,:'l�l (" .'�w ��;. =t c . •--------- SYSTEM PROFILE ALL SYSTEM COMPONENTS SHALL BE z MARKED WITH MAGNETIC TAPE OR NOTES COMPARABLE MEANS FOR FUTURE LOCATION. (NOT TO SCALE) PROVIDE MIN. 20" DIAM. WATERTIGHT ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE 1. DATUM IS APPROX. NGVD a \ TOP FOUND. EL. 59.5' FILTER FABRIC OVER STONE 2. MUNICIPAL WATER IS EXISTING MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 58.5' 3, MINIMUM PIPE PITCH TO BE 1/8°' PER FOOT. ocus PRECAST H-10 H-10 BLOCKS OR 4. DESIGN LOADING FOR CHAMBER RISERS (TYP.) PRECAST RISERS UNITS TO BE AASHO H-� 2'm 57 8' 4"OSCH40 PVC MORTAR ALL. H_10 Route 28 ;:..•,. PIPES LEVEL 1ST 2' �ENDSJ 4. COMPONENTS7' q' S. PIPE JOINTS TO BE MADE WATERTIGHT. o(NF') SIDES 55.67' 10" EXISTING 14" :y. °` o0000000° 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE o •�' ** TEE DO®� 0 ®0�® L�]®®� -��M0 '°°°°°°°° WITH 15.000 (TITLE 5.) TEE SEPTIC TANK 56.4f* °°°°°° °°°°°°°°° °° 6" MIN SUMP o >00000000 o®aoaaa000a . C7®a®®o�®oao ,00000000 GAS BAFFLE::: ° ° ° ° 00 ° ° a�a�a®aaa�o C�®ao�o�®aoo ° - °�o�o�°^°- 12" MIN. INT. DIM. N ;°0°0°0°0 ;°0°0°0°0 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND y o ®���®��M®C� �'FP®�Es0®DODO .0 NOT TO BE USED FOR LOT LINE STAKING OR ANY ° ° ° ° ° 5267 54.94 54.77 °°°°°°°° °°°°°°°° OTHER PURPOSE. 3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. H-20 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. a (3) UNITS REQUIRED Valley Bum s �'i�er ALL AROUND PRECAST STRUCTURES 9. COMPONENTS NOT TO BE BACKFILLED OR Ro 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 33.5, X 12.83, CONCEALED WITHOUT INSPECTION BY BOARD OF COMPACTION. (15.221 [21) 1p HEALTH AND PERMISSION OBTAINED FROM BOARD (A. OF HEALTH. .3 % SLOPE) ( 1 SLOPE) 10. CONTRACTOR SHALL BE RESPONSIBLE FOR FOUNDATION EXIST. SEPTIC TANK 34' D' BOX 12' LEACHING CALLING DIGSAFE (1-888-344-7233) AND LOCUS MAP FACILITY 48.0' BOTTOM TH-1 VERIFYING THE LOCATION OF ALL UNDERGROUND & NO GROUNDWATER FOUND OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF NOT TO SCALE *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT WORK. UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM WITH 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE 11. ANY UNSUITABLE MATERIAL ENCOUNTERED ASSESSORS MAP 146 PARCEL 93 CONDITIONS IF NOT SUITABLE SHALL BE REMOVED 5' BENEATH AND AROUND THE PROPOSED LEACHING FACILITY. 12. EXISTING LEACHING FACILITY SHALL BE PUMPED LEGENDAND REMOVED. 99- EXISTING CONTOUR X 99.1 EXIST. SPOT ELEV. / `L� �' PROP. VENT WITH CHARCOAL FILTER 99 PROPOSED CONTOUR / <`b CAND ONTRACTOR WITH CHI & PLACEMENT BY SYSTEM DESIGN. / CONSULTATION) 198.41 PROPOSED SPOT EL TH 1 d GARBAGE DISPOSER IS NOT ALLOWED TH 1 /�� TEST HOLE o c� EXISTING 3 BEDROOM DWELLING o �� DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD 2� SLOPE OF GROUND SEPTIC TANK: 330 GPD (2) = 660 UTILITY POLE \ / **RE-USE EXISTING 1000 GAL. SEPTIC TANK FIRE HYDRANT g BENCH MARK - CORNER OF 5 So CONC. BULKHEAD EL. = 59.7 NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAMIING LEACHING: I CO O GRAVEL DRIVE 1 SIDES:2 33.5 + 12.83 2 .74 = 137 GPD Z wiR\'yFq ��,, 0 BOTTOM 33.5 x 12.83 (.74) = 318 GPD TEST HOLE LOGS Q S 04 I �° TOTAL: 614 S.F. 455 GPD ENGINEER: ARNE H. OJALA, PE, SE y AV. WALK I DECK USE (3) 500 GAL. H-20 LEACHING CHAMBERS (ACME OR EQUAL) WITNESS: DON DESMARAIS, RS Z WITH 4' STONE ALL AROUND DATE: APRIL 13, 2012 Q I so PERC. RATE _ < 2 MIN/INCH I LO ; w\ 5a EXIST. DWELL. CLASS I SOILS P# 13608 Q I �� TOP FNDN. _ Z W EL. 59.5' ELEV. ELEV. Q I DECK » `� 58.5' 0" 4 58.5' M A 0 I � APPROVED DATE BOARD OF HEALTH A/B �' N FILL SL C� I TITLE 5 SITE PLAN OF 6„ 4» 10YR 2/1 I LOT 2 A/B E 15,162 t SF AREA SHED IN SHOWN 10 CAPTAIN ALDEN'S WAY SL MS OSTERVILLE $„ 10YR 2/1 6„ 10YR 6/1 E PREPARED FOR Ms a BORTOLOTTI CONSTRUCTION/ 10" 1OYR 6/1 1OYR 6/6 N1 MacQUEEN B 36" 55.5 APRIL 13, 2012 y SL �% REV. 4/25/12 (4 BR TO 3 BR DESIGN CALCS) `Q _ 46 54.67' MCS a�H OF MAssgcy �rt\A 01FWq,R fax 508-362-9880 C 2.5Y 7/4 15.50' fO / DANIELA. �� DANIEL �� I PERC MCS CJALA A • downcape.com ICD 4 0 CIVIL 0i N down coAe e# Ifteerift Inc. 126" 2.5Y 7/4 48.0' 120" 48.5' No. q N0.40980 s °��� -sTe��Q �, �°p S civil engineers Scale: 1 = 20 -Z�;/,.L �Os/ �' Nosu ° land surveyors NO GROUNDWATER ENCOUNTERED �� ' 939 Main Street ( Rte 6A) 2-084 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675