HomeMy WebLinkAbout0054 CINNAMON LANE - Health 54 Cinnamon,Lane ,
- _ - Osterville
A = 165 - 025
I
' Commonwealth of Massachusetts
Title 5 Official Inspection Form
0
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
u� 54 Cinnamon Lane �..
Property Address
Cornelia Reschke 4
Owner Owner's Name
information is
7;
required for every Osterville ,/ MA 02655 5-8-18 ,
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.
filling
out forms A. General Information �
filling out forms /30� `,�ttttunnn►r���,�
on the computer,
use only he tab OF
1. Inspector:
key to move your
cursor-do not James D.Sears =�: JA M ES :R,
use the return = _
key. Name of Inspector U: :�
Capewide Enterprises is V..
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�i Company Name --A
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153 Commercial Street ��''�,F...
s I N SP�G��``���`
�I Company Address
few Mashpee MA 02649
City/Town own State Zip Code
508477-8877 S 1623
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 Evaluation by the Local Approving Authority
5-10-18
spector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of
10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP. The original 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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 1 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
54 Cinnamon Lane
Property Address
Cornelia Reschke
Owner Owner's Name
information is required for every Osteryille -MA 02655 5-8-18
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:
® 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:
The system is a 1500 Gal. Tank D Box and 24 Chamber's.
B) System Conditionally Passes:
❑ .One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
54 Cinnamon Lane
Property Address
Cornelia Reschke
Owner Owner's Name
information is required for every Osterville MA 02655 5-8-18
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):
❑ 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17
f
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
54 Cinnamon Lane
Property Address
Cornelia Reschke
Owner Owner's Name
information is required for every Osterville MA 02655 5-8-18
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 aseptic 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 is less than 6" below invert or available volume is less
than %day flow s f#/iv
t5ins.doc•rev.6/16 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
54 Cinnamon Lane
Property Address
Cornelia Reschke
Owner Owner's Name
information is required for every Osterville MA 02655 5-8-18
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:
El ® 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
p Y
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.
t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
/M1e Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
54 Cinnamon Lane
Property Address
Cornelia Reschke
Owner Owner's Name
information is Osterville MA 02655 5-8-18
required for every .
page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no" as to each of the following:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
❑ ® Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
C Number of bedrooms (design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
l Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
54 Cinnamon Lane
Property Address
Cornelia Reschke
Owner Owner's Name
information is required for every Osterville MA 02655 5-8-18
page. Cityrrown State Zip Code Date of Inspection
D. System Information
Description:
1500 Gal. Tank D Box and 24 Chamber's
Number of current residents` 1
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)): 2016-24,000Gals
2017-74,000Gal's
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: Present
Date i
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.):
r
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:
15ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
F Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
54 Cinnamon Lane
Property Address
Cornelia Reschke
Owner Owner's Name
information is required for every Osterville MA 02655 5-8-18
page. Cityrrown 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: 2015
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.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Ala Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
54 Cinnamon Lane
Property Address
Cornelia Reschke
Owner Owner's Name
information is required for every Osterville WA 02655 5-8-18
`
page. City/Town State Zip Code Date of In
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
2009 Permit # 2009 369.
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
18,
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.):
Pipeing is 4" PVC SCH -40
Septic Tank(locate on site plan);
Depth below grade: 8„
feet ,
Material of construction:
concrete ❑,metal El fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age:„ years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1000 Gal. Precast H-10
lit
Sludge depth:
t5ins.doc-rev.6/16 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
Subsu a p Y
g
54 Cinnamon Lane
Property Address
Cornelia Reschke
Owner Owner's Name
information is required for every Osterville MA 02655 5-8-18
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.) .
29"
Distance from top of sludge to bottom of outlet tee or baffle
0"
Scum thickness
8"
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
18"
How were dimensions determined? Asbuilt Plan Tape Sludge Judge .
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. Tank and covers at 8" below grade. In and outlet tee's. No sign of leakage or
over loading
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
kk Scum thickness
I Distance from top of scum to top of outlet tee or baffle
ff Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Fora
<o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
54 Cinnamon Lane
Property Address
Cornelia Reschke
Owner Owner's Name
information is Osteryille MA 02655 5-8-18
required for every
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons per day
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.):
t I
"Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Fora
<II� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
54 Cinnamon Lane
Property Address
Cornelia Reschke
Owner Owner's Name
information is Osterville MA 02655 5-8-18
required for every
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
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.):
D Box is 16"x 16"-20" below grade. Box is clean and solid w/three line's out. No sign of over loading
or solid carry over.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments(note condition of pump chamber,.condition of pumps and appurtenances, etc.):,
* If pumps or alarms are not in working order,system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located,explain why:
t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
�a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
54 Cinnamon Lane
Property Address
Cornelia Reschke
Owner Owner's Name
information is required for every Osterville MA 02655 5-8-18
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number:
24
❑ 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 24 Chamber's. Ck D Box and camera out lines. No sign of over loading or solid carry
over. No sign of holding water.
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
i
Indication of groundwater inflow ❑ Yes ❑ No
t5ins.doc•rev.6/16 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
c Commonwealth of Massachusetts
Title 5 Official Inspection Fora'
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
ulv"F` 54 Cinnamon Lane
Property Address
Cornelia Reschke
Owner Owner's Name
information is Osterville MA 02655 5-8-18
required for every
page. Cityrrown State Zip Code Date of Inspection
D. System Information. (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
1
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
54 Cinnamon Lane
Property Address
Cornelia Reschke
Owner Owner's Name
information is Osterville MA 02655 5-8-18
required for every
page. Cityrrown 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
Pf
� R 3
13
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17
I
I
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
54 Cinnamon Lane
Property Address
Cornelia Reschke
Owner Owner's Name
information is Osterville MA 02655 5-8-18
required for every
page. City/Town State Zip Code Date of-Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
tuo 11'
Estimated depth t high ground water: 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: 8-19 -09
Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers- (attach documentation)
❑ Accessed USGS database -explain:
You must describe how you established the high ground water elevation:
T.H.'on Design plan 8- 19 -09 11' no G.W.. Bottom of chamber's around 3' below grade. Bottom of
chamber's at 8' above T.H. Depth.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
-N for Voluntary Assessments
e Subsurface Sewage Disposal System Form of
<� 9 p Y ry
,. 54 Cinnamon Lane
Property Address
Cornelia Reschke
Owner Owner's Name
information is required for every Osterville MA 02655 5-8-18
page. Cityrrown State Zip Code bate 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
4
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
f S_
Commonwealth of Massachusetts',;OA ,
Title 5 Official inspection Fora f
Subsurface.Sewage Disposal System Form -Not for Voluntary Assessments •. L �rC
r 54 Cinnamon Lane; Osterville
Property Address
Aries Lloyd Estate c/o Kim Cabral @ TD Banknorth ^-
Owner Owners Name
information is required for every 40 Main Street, Box 67, Orleans MA 02653 June 29,-2009 .
—
page. Citylrown State . Zip Code {Date of Inspection
inspection results musf be submitted on,th_ is form. Inspection forms may`not be altered.in any,
way.
r
Important:when A. General Information
filling out forms
on the computer, -
use only -
the tab 1. Inspector; CCF
key to move your
cursor-do not Troy Williams
use the return —
key. Name of Inspector
Troy Williams Septic Inspections
ray Company Name M
19 Hummel Drive
Company Address
South Dennis 3 MA 02660
City Town State Zip Code Y . ..
A508) 385-1300
Telephone Number — ;-r — License Number"µ
B. Certification
certify.that l have personally inspected the sewage disposal,system at this address and that the
information reported below is true, accurate and complete as of the time of 1he inspection Th'e.insoction I
was performed based on my training and experience in the proper function and maintenance'of orr,-"site .
sewage disposal systems. I am a DEP approved system inspector-pursuant $jdection�t5.340'f
Title 5(310 CMR 15.000).The system",
No
❑ Passes ❑ Conditionally Passes ® Fails
❑ Needs Further;Evaluation by the Local Approving.Authority
3.
June 29, 2009
Inspector's Signal re. Date
The system inspector shall submit a copy-of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system`is a`shared system or
has:a design'flow of 10,000 gpd,or greater, the,inspectorand the system owner shall submit the
report to the appropriate ,regional office of the DER The.original should be sent to the system owner:
and copies sent to the buyer, if applicable, and the approving authority.F
""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.
1 [Al
./oq
54 Cinnamon Lane,Osterville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System,Page 1 of 15
t
Commonwealth,of Massachusetts, N
Title 5-Official Ins•p,ection'�Form
Subsurface Sewage Disposal:Systelin Form Not for Voluntary Assessments
i
f
54 Cinnamon.Lane
, Osterville .
Property Address AS �
Aries Lloyd•Estate c/o Kim.Cabral (a�.TD Bank'north
Owner Owner's Name n z
information is '
required for every 40 Main.Street, Box.67, Orleans MA. ;.02653 une2g,'AiciVz-
page.e. City/Town States Zip Code Date of Inspection
B. Certification (cont.)-, • :
Inspection Summary^Check A,B,C D or.E./ah"its complete all of Section D
4,
A) System Passes
❑ I:have not found any information which Indicates that a the failure.criteria described
= °in'310 CMR 15.303 of in 310 CM 15.304 exist Any failure criteria not evaluated are e " .
_.
indicated below: $,k
Comments*"
N/A
B) Systei Conditionally Passes.
<, �.
❑, One or more,system components as'described In„the Conditional Pass'= sectionII, need to"be x
replaced of repaired. The system upon completion"of the>replacement or repair, as approved by
the Board of Health;will pass: -
a. �
::.Answer yes, no or not determined (Y N, ND) in,,the ❑for the.following state'ments:.lf`not
determined,"please'explain a.
4❑ The septic tank is metal and over i0.years old* or the septic tank(whether metal or.not) Is
structurally unsound,%exhlbitssubstantial infiltration;o"r exfiltratiorr or tank failure is imminent.
' System will pass inspection ifihe existing tank is-replaced uvith a complying`septic tank as
eappjoved by the Board of Health , x;.
r'
'*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 avalla610.a
ND Explain:. J.
w '
N/A _
❑ Observation of sewage backup or break out.or.high static water level in;the distribution box due
to„broken or,obstructed pipe(§)or•due to a broken, settled or uneven distribution box.>System will
pass inspection.if(with approval of.Board of Health): ;
b`
t`
'-broken pipe(s).are replaced
t ❑ obstruction is removed r
54 Cinnamon Lane,Osterviile•03/08: A; Title 6 Official Inspection Form Subsurface Sewage Disposal 5'ystem•Page 2:of 15
,
Commonwealth of,Massachusetts: k
Title 5 Official Ins e'Olpn Forrm'�a
p,
Subsurface Sewage Disposal'System Form-Not for:Voluntary'Assessments '
6 '
b may, 54 Cinnamon Lane, Osterville.
M
Property Address
Aries Lloyd Estate c/o Kim Cabral @ TDBanknorth�
Owner
Owne(s Name :'
information is . . 40 Main Street, Box 67 Orleans MA< 02653: June 29,•2009 a
required for every �--- -
page. Citylrown , State Zip Code Date of Inspection
B. Certification.(cont.)
B) System Conditionally Passes (coat).
0 distribution box is leveled or replaced'
ND Explain: '
N/A' h
❑ fThe 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): -
- 1 broken pipes)are replaced: t
4
obstruction is removed
,
ND Explain.-
N/A
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
w the,systein is failing to,protect public health ;'safe'ty or the environmen�`�'_
.1. System will pass unlessJBoard'of Health determines in accordance with,310 CMR
15.303(1)(b).that the systemas not functioning°in a manner which will protect public health,
safetyiand the environment:
Cesspool or privy-is within 50 feet of a surface.water
,
El
Cesspool or privy is within 50 feet of a bordering vegetated wetland ora salt marsh
2. System will,fail unless the Board of Health (and Public Water'Supplier; if any)_
determines that thesystem is functioning in.a,manner.that protects the public health,
` safety and environment:
The system has a septic tank and soil absorption syste►n'(SAS) and the SAS is within
1.00 feet,of.a"surface watersupply,or tributary to a`surface water supply.9,}
The system has,a septic tank and SAS and the SAS is within a Zone 1 of a public water
supp,IY:
The.system,has`a septic tank and.SAS and the SAS is within•50 feet of a private water
supply well.
r�
54 Cinnamon Lane,Osterville-03/08 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System ypage 3 of 15 '
4 ,
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
H 54 Cinnamon Lane„OsterviIle
Property Address r
Aries Lloyd Estate c/o Kim Cabral @ TD Banknorth
Owner Owner's Name
information i e
required for every 40 Main Street, Box 67, Orleans MA 02653- June 29, 2009
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cone.)
C) Further Evaluation is Required by the Board of Health (cont.):
❑ :The system'has a septic tank and SAS.and the SAS is less than 100 feet but 50 feet or.'
more from a private water supply well".
Method used'to determine distance .N/A
This system passes if the well water analysis; performed at�a DEP certified laboratory,for coliform
bacteria indicates absent and the presence of ammonia nitrogen and,nitrate nitrogen is equal to or
less than 5 ppm, provided that no other failurecriteria are triggered. A copy of the analysis must be
attached to this form.'
3..Other:
N/A
D) System Failure Criteria Applicable to All Systems:_
.
You.must indicate"Yes or",No"to each of the foilowing for all inspections:`
r
Yes No
El
Backup of sewage into facility or system_component due to overloaded or
® clogged SAS or cesspool
Discharge.orponding of effluent.to the surface of the ground or surface waters
due to an overloaded or.clogged SAS or cesspool
71 Static.liquid'level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool` -
Liquid depth in cesspool is less.than 6"below invert or available volume is less
than Y2 day flow
El
�. M.
Required pumping rtiore.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.
0 - �~ Any portion of cesspool or privy is within'100 feet of a surface water supply or
tributary to a.surface water supply.
.54 Cinnamon Lane,Osterville•03108.. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 ;
Commonwealth of Massachusetts '
Title .5 Officia Inspection Fora R
Subsurface Sewage Disposal System Form -.Not for Voluntary Assessments ' #,
54 Cinnamon Lane, Osterville
Property Address
Aries Lloyd Estate c/o Kim Cabral @ TD Banknorth
Owner Owner's Name 4.
information is required for every 40 Main'Street, Box 67; Orleans MA 02653 June`29, 2009
- - -
page. CityfTown State Zip Code Date of Inspection
i
B. Certification (cost.)
D) System Failure Criteria Applicable to All Systems,(cont.):
Yes No:
Any portion of a cesspool or privy is within a Zone 1 of a public well.
Any portionof a ces'spoo.l or 4privy 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 waterquality analysis. [This
system passes
.well water analysis,performed'ata DEP'certified.
laboratory,for fecal coliform bacteria indicates absent and the presence 4
of.ammonia nitrogen and nitrate nitrogen is.equal'to or less than 5 ppmi
;provided that no other failure criteria are triggered.A copy of the analysis
land chain of custody must be attached to this form.] .
® ' ' The system is a cesspool serving a.facility-with a design flow of 2000gpd-
El
10,000gpd.
® The system fails.I have determined.that one or more,of the above failure
criteria`existas 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. s
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 eitherT"yes" or"no"to each of the following,in additionto,the
questions in.Section D.
Yes No
the system is within 400:feet of"a surface drinking water supply.
:Q Z 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'
0' 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,sho_uld contact the.appropriate
regional office of the Department.
54 Cinnamon Lane,Osterville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-,Page 5 of 15
Commonwealth,&Massachusetts
Title 5 Official Ifrspection Form ., F v
Subsurface Sewage Disposal'SystemµForm-'Not for Voluntary Assessments
r 54 Cinnamon Lane, Osterville
Property Address
Aries Lloyd'Estate c/o Kim Cabral @ TO Banknorth ,,e ,�,.
Owner
Owner's Name.
information is
`e
required for eve 40 Main Street- 67,,Orleans MA_ ,;; 02653 '= June 29 2009
IY. — --
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 #•
® ;❑ PumpingFinformation was provided by the`owner,'occupant or,Board of Health
T ❑ �' 'Were an ofthe s stem components pumped"out in the previous two weeks?
® :Ha's the system received normal flows in the previous two week periods
y ,x
Have'IargeR volumes of water,been introduced to the system recently,or as part of
this inspections
Were`as built plans of the system obtained and4examined? (If they were note
:. available note'as N/A)'
® ❑ Was the facility or dwelling inspected for'signs of;sewage back ups 2
IM ❑ Was the site inspected for signs of break out?
® . ❑ Were all system components excluding the SAS; located dh site? _.
- ❑ '®` ,;Were the septic tank manholes uncoveretl :opened and the'interior of the tank .
inspected for.the,condition of the baffles or,tees material of construction, i
dimensions,depth of-liquid, deptii of sludge and;tlepth=of`sciim� °
: - . ,
r ;Was tie facility owner(and occupants if different from owner)'provided with
® ❑ _ information on the Plroper maintenance of ubsurface sewage disposal systems S.
z The size and,locatio`n of the Soil�Absorption'System (SAS)onthe sitehas
been determined based on.
- - •tee �.. .
❑N ®< ` ' Existing information For example'a plan at the Board of-Health Y°
s a.
w
e Determined in the field (if any'of the failure criteria related to Bart C is`at issue
® approximation of°distance is unacceptable)[310 CMR:15.302(5)] :a
-4.
- -. .. . •Z. 'tic. -x °� � �._
a • r
54 Cinnamon Lane,Osterville-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Wage B of 15
as
. ° y
n
• e
' r �
Commonwealth of Massachusetts
Title 5 Official In pection Forma
Subsurface Sewage Disposal System form -Not for Voluntary Assessments
'< 54 Cinnamon Lane, Osterville f
Property Address
/ i Cabral TD Banknorth Aries Lloyd Estate c o Kim
L _
Y @
Owner Owner's Name
information is required for every 40 Main Street,Box 67 Orleans ' _ MA 02653 June 29; 2009
page. CityfTown State Zip Code Date of Inspection
t
D. System Information '
Residential Flow;Conditions
Number of'bedrooms (design): 2 Number.of bedrooms(actual): 2
DESIGN flow based on 3.1.0 CMR 15.203'(Mr example: 110 gpd x#of bedrooms): 220 gpd
Number of current residents: .' 0
Does residence have a garbage,grinder? ❑ Yes ® No
Is laundry on a separate sewage'system? [if-yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ® ,Yes ❑ No
Seasonal'use? ® Yes ❑ No
Water meter readin gs,.if available (last ears usage d 07=9,000gals
9 ( Y 9 f9P )) 08=3,000gals
Sump pump? ❑ Yes'® No
e vacant aprx: 1 yr.'
Last date of occupancy: Date
Commercial/Industrial Flow Conditions.
Type of Establishment: N/A
N/A
Design flow(based on 310 CMR 1.5.203): , Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.); N/A
Grease trap present? 5. ❑ Yes M No
Industrial waste holding tank,present? ` ❑ .Yes ® No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes 0 No
N/A
Water meter,readings,,,if available: _ —>
Last date of occupancy/use: Date
m
Other(describe):
54 Cinnamon Lane,Osterville 03/08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 15
Commonwealth'of Massachusetts n
= Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M ye 54 Cinnamon Lane, Osterville !
Property Address
Aries Lloyd Estate c/o Kim Cabral @:TD Banknorth : -
Owner Owners Name
information is required for every 40 Main Street, Box 67, Orleans MA'_ _02653r June 29, 2009
page. CitylTown State Zip Code Date of Inspection
D.�'System Information (cont.).: x
General Information
Pumping Records:
Source of information: No pumping info was available.
L
Was.system pumped as part of the inspection? ❑-Yes .M No
If yes, volume pumped: NIA
' gallons.
How was quantity pumped:determined? ,
Reason for pumping: N/A
Type,of$yytem: ,
Septic`tank, distribution box,soil absorption system
r;
❑.: -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 ,t
maintenance,contract(to be obtairied from system owner)'and a=copy of latest,
M inspection of the l/A system.by system:operator under contract ' .
` Tight tank.'Attach a copy of the`DEP approval..
El Other(describe):
Approximate age of all components, date Installed (If known]and source of information:' k.
Cesspools,are original to home built approx. 45 years ago. f
-:.Were sewage odors detected when arriving at the site? ❑ Yes ® :No
54 Cinnamon Lane,Osterville a 03108 - Title 5 Official Inspection Form:Subsurface Sewage Disposal Syslerp Page$of 15
P, r
y _ 13
Commonwealth of Massachusetts , r
' f.
L
w Title 5 Officia'lr Inspection} Forrn
s Subsurface Sewage DisposalTSystem Form Not for Voluntary:Assessments 1:
M 54 Cinnamon Lane,`Osterville _
Pro r s Property ,
. P Y Add es
Aries Lloyd Estate clo,Kim'Cabr•al' ,TD Banknoith
Owner Owner's Name
information is : k.
required for every .40 Main Street,Box 67, Orleans MA '02653 June 29,2009
page. City/Town State Zip Code Date of Inspection,
D. System' Information (cost.)
Building Seiner(locate on`site plan).
r
` .
Depth below'grade, 18 +
feet
Material of construction:
[A cast iron ❑40_•PVC ®other(explain):
Orangeburg
N/A,
Distance from private water supply well or suction line:,` feet
Comments�(on condition of joints,:venting evidence of'leakage, etc:41
):
Lines were clear at the time of inspection:
n
• y,
Septic Tank(locate on site plan):-'
Depth below grade: N/A
feet
�t;
Material of construction:
❑ concrete: t ❑ metal ❑..fiberglass ❑ polyethylene ❑ other(explain)
N/A r
N/A � n`
If tank.,is metal list age:
years
Is age:confirmed by a Certificate of Comjliance? (attach a copy_of certificate) ❑ Yes ❑� No
_ ____ _ ______ _______________ _ -_ _-_--_____-_ ---__...___________L---___-
NIA f '
Dimensions:
Sludge depth: t N/A
Distance from top of sludge to bottom.of out let ftee or..baffle N/A
Scum thickness
N/A
Distance from top of scum-to-top of outlef tee or baffle , ,ti N/A --
.
Distance from bottom of�scum to bottom of outlet tee'or baffle — —
r How were dimensions,determined?
54 Cinnamon Lane,Osterville.03108 Title 50fficial Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15
Commonwealth of Massachusetts
w Title. 5 Official knspection. Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
f
M 54 Cinnamon Lane,Asterville
Property Address, -- - - - r
Aries Lloyd Estate c/o'Kim"Cabral STD Banknorth
Owner Owner's Name
information is 40 Main Street, Box 67,'Orlean`5 MA 02653 aJune29, 2009
required for every —
page. Citylrown- State: ; Zip Code Date of Inspection
D. System.Information.(cont ) °
Comments(on,pumping.recommendations, inlet and outlet tee or, affle condition structural integrity,
liquid levels as related to outlet invert evidence`of leakage etc)
Grease Trap(locate on site plan), -
G4 9 '
' Depth below grade: k N/A
feet
' Material of construction
f h
0 concrete:;- ❑ metals` fiberglass ❑ polyethylene other"(explain):
'N/A
Dimensions' - -
C N/A r y
Scum thickness - s
N/A,
Distance from top of scum to top of outlet tee or baffle w
Distance from bottom of scum to bottom of outlet tee or baffle'
S
Date of last pumping ` N/A
. '
Date s
•'",Comments(on pumping recommendations,"inlet and:outlet tee or baffle condition;.structural integrity, s
liquid levels as related to outlet invert evidence of leakage;'etc ). Y
:
N/A
Tight or Holding Tank (tank must be pumped at tlme.of Inspection);(locate on site plan): .
Depth below,grade: _-.f - -- -------
Material of"construction: d
❑"concrete ❑ metal 0 fiberglass 4 ❑ polyethylene . ., ❑other(explain) '
NIA.'
r.
t
54 Cinnamon Lane Osterville•03/08 'Title 5 Official Inspection Form:'Subsurface Sewage Disposal System-Page_10.of 15
Commonwealth of Massachusetts
W Title _5 Official Inspection Forth.
Subsurface.Sewage_Disposal:System Form`-Not for Voluntary Assessments
54 Cinnamon Lane, Osterville
Property Address --
Aries Lloyd Estate c/o Kim,Cabral @ TD Banknorth -
Owner Owner's Name -
information is . ry 40 Main.Street, Box 67, Orleans MA 02653 June 29, 2009 _
required for eve
page. City/Town State Zip Code' Date of Inspection
D. System. Information '(cont.)
' Tight or Holding Tank(cone.)
N/A
Dimensions:
Capacity: N/A
gallons
Design Flow: N/A
gallons per day. ,
Alarm present" • ❑ Yes . El No
Alarm level: N/A--
Alarm in working order: ❑``Yes ❑ No
Date of last pumping:
N/A
Date. r
Comments(condition of alarm and float switches etc.):.
N/A
Attach:copy of current pumping contract(required). Is copy attached? ❑ Yes ❑, No
Distribution Box(if(present must be'opened),(locate on site plan):
Depth of liquid level above outlet invert-
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.):, ,
N/A
r°
Pump Chamber(locate on,site plan)-.,.
• .Pumps in working order.-' El Yes ❑' No
Alarms in working order: ElYes ElNo
54 Cinnamon Lane,Osterville-03/08 ; Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page l l of 15.
Commonwealth of Massachusetts s
r Title 5 Official Inspection Fora
Subsurface Sewage Disposal System form Not for Voluntary Assessments
yr 54 Cinnamon Lane, Osterville
Property Address ;,r
Aries Lloyd Estate c/o Kirn Cabral @TD Banknorth
Owner Owner's Name
--
information is required for every 40 Main Street,,Box 67, Orleans MA 02653 June 29;2009 ;
page. CitylTown �b State Zip Code Date of Inspection
D. System Information (cont.j
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
N/A „
Soil Absorption System,(SAS) (locate on site plan, excavation,not required):
If SAS not located, explain why:
Note: Top of crown is missing 3 blocks and is patially caved in and unstable. Cesspool area should
not be walked on or near.Covering cesspool with plywood sheet would:be recommended. This also.
cause of failure of cesspools
Type;
❑ leaching pits number: �.
❑ leaching chambers number.
❑ leaching galleries number:
leaching trenches , number, length:
❑ Teaching fields, number, dimensions:'.
6,X5
® 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:):
Overflow cesspool was found dry on inspection with walls found.stained up too, and above inlet pipe. -
This is evidence of.cesspool being_ full and in hydraulc failure when home was occupied.Cesspool
had less than a minimum 1/2 day flow available at the time of inspection.
54 Cinnamon Lane,Osterville•03/09 Title 5 Official Inspection Form:Subsurface Sewage Disposal System ['age 12 of 15
Commonwealth of Massachusetts
Title 5 Official. Inspection. Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Mt 54 Cinnamon Lane, Osterville
Property Address
Aries Lloyd Estate c/o Kim Cabral @ TD Banknorth
Owner Owner's Name
information is 40 Main Street,Box 67, Orleans . . MA 02653, June 29, 2009
required for every -
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.) :.f$..
Cesspools(cesspool must be pumped as part,of inspection) (locate on site plan);
Number and configuration r 1 -Main cesspool
Depth-top of liquid to inlet invert 6,
Depth of solids layer
r Depth of scum layer . _ None
Dimensions of cesspool r ,-
,, ;"4 . Cesspool,block'
Materials of,constructlon
Indication.of groundwater inflow,- _ ❑ Yes ® No
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Root growth'was present in cesspool. Cesspool was found dry due to vacancy. Cast Iron,,outlet tee
-was present.,
Privy(locate on site plan):
Materials of construction: N/A _
Dimensions ` N/A
Depth.of solids N/A
Comments (note condition of soil, signs of hydraulic failurejevel of ponding, condition of vegetation,
etc.):
N/A,
54 Cinnamon Lane,Osterville-03/08 Title 5 Official Inspection Form.Subsurface Sewage Disposal System?,Page 130115
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
54 Cinnamon Lane: Osterville
Property Address '
Aries Lloyd Estate c/o Kim Cabral @ TD Banknorth'
Owner Owner's Name ;
information is required for every 40 Main Street, Box 67, Orleans MA 02653 `=_-June 29, 2009 >
_
page. City/Town State Zip Code Date of Inspection,
D. System Information.(cont.) i
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.
141
ful
54 Cinnamon Lane,osterville•03108 Title 5 Official Inspection'Form:Subsurface Sewage Disposal System,Page 14 of 15
• e -
Commonwealth of Massachusetts
Title 5 Official Inspection -I`orm i
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
yt 54 Cinnamon Lane, Osterville
Property Address
Aries Lloyd Estate c/o Kim Cabral @ TD Banknorth
Owner Owner's Name
information is 40 Main Street, Box 67, Orleans > MA 02653 June 29, 2009
required for every
page. Citytrown State Zip Code Date of Inspection.
D. System Information (cost:)
Site Exam:
® Check Slope.
❑ Surface water
® Check cellar • .
❑ Shallow wells
Estimated depth to high ground,water: 30'+
feet
_ f
Please indicate all methods used to determine the.high ground water elevation:
El Obtained from system design plans on record
If checked, date of design plan reviewed:
Date
® Observed site (abutting property/obse(vation hole within 150 feet of SAS)
❑, 'Checked with local Board of Health-explain:.
x ❑ Checked with.local excavators, installers-(attach documentation)
® „Accessed USGS database -explain:
MIW 29 Zone B 7.4' 1:7'adjustment
You must describe how you established the high ground water elevation:
Soil was sandy. Hand augered 3' below bottom of leaching with`no water_ found at 11.5'. Groundwater
adjustment in area at the time of inspection was 1.7'. Bottom,of leaching,at 8.5'was found not to be
at located in the high^gr6 ndwer'elevation at the time of inspection.
54 Cinnamon Lane,Osterville-03108 Tide 5 Official Inspection Force:Subsurface Sewage Disposal System Page.15 of 15
TOWN OF BARNSTABLE LOCATION S� -���"�o� ��� SEWAGE# 0 q9 — 36 /
"VILLAGE OT7- iz ✓, ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO. /1/0,e77tcti,v -Rok .14-
SEPTIC TANK CAPACITY /S0 D S-O - 3 9 4- 1'�-7 Ar�ti ua
LEACHING FACILITY:(type)%_�+J QU IE-w- 4t' (size) 32-
NO.OF BEDROOMS 3
OWNER A R 1 SAS CS G C O
PERMIT DATE: ////2-/Z o 01 COMPLIANCE DATE: li l 7 10 9
Separation Distance Between the: _
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 'J Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY (Z,.,1.•,o.J Q C'g -�'•••o
3 2�' 4g 0
1 6 " 2
0
3
TOWN OF BARNSTABLE
V
LOCATION S y G��,�, u u,r,t , L SEWAGE #
WMLAGE V III ASSESSOR'S MAP & LOT 16.5 6 29--M—
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS o2
BUILDER OR OWNER
PERMIT DATE: COMPLIANCE DATE: /`j b Y
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility a U+ 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 Wit-ti 6
/^' �K� 1
J
6
.�
D � �Y. � �_ � 3g
No. _ - Fee U
T THE COMMONWEALTH OF MiSSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS
pplicatior� for po�ai *pgtem �tCott.5truction Permit
Application for a Permit to Construct( Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 9L% C;,An o~ Lo e— Owner's Name,Address and Tel.No. A T1 1eL5 E. L`O y
Orsferv;l\e
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. ,e► t1 Designer's Name,Address and Tel.No.
2.0 Can a\Ew oo a Lo,\e SOY)3q$947 y Nv4A Cape- Ong i sin q
0"n;s ck A Z i 3 h `mot S-' .
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size 1Z�(2 sq. ft. Garbage Grinder( )
Other Type of Building$p(.'f 6ye I No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 1 O gallons per day. Calculated daily flow 3,3 O gallons.
Plan Date 811 5/n n Number of sheets Revision Date
Title ►tie S,`k Plan
Size of Septic Tank /_S00 G10104 Type of S.A.S. ; t-1
Description of Soil G - ImT 2 5 y GA
6
Nature of Repairs or Alterations(Answer when applicable) 1"r��� hR w (SV n G%I -rr P 6 c fart t. D-62
24 S+a--1&Q4CA Qvi c-k. 41 u,,Ir
Date last inspected:
Agreement:
The undersigned agrees to ensure the c struction and in
of the afore described on-site sewage disposal system
in accordance with the provisions o e f rronme 1 Code and not to place the system in operation until a Certifi-
cate of Compliance has been ' �ethi o a th.
Sign Date /4 D
Application Approved by Date /Z
Application Disapproved for tQ following reasons
Permit No. d — Date Issued U
No. �_... / R Y e Fee U
fi...
THE CO;MMQNWEALTH OF MASSA"`USETTS Entered in computer:
t Yes
'PUBLIC HEALTH DIVISION -,TOWN OF BARNSTABLES MASSACHUSETTS
pprication for pogar *pef enf Congtruction Permit
Application for a Permit to Construct( Repaii( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.SLA C,,nn D^OA Owner's Name,Address and Tel.No. ieS L`O y
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. NocDesigner's Name,Address and Tel.No. I
-LO CaAa\ewoocl Lone �So?)3g?9,y-7y DQVIA Cc3�pe- C—rny)A9-Qf;n9
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size 12/ 3 sq.ft. Garbage Grinder( )
Other Type of Building 5d.4 &9/y I No.of Persons Showers,(P ) Cafeteria( )
Other Fixtures
Design Flow 1 O gallons per day. Calculated daily flow 3,3(3 gallons.
Plan Date -R//_9/o Number of sheets l Revision Date
Title Tp ib S,'It Ma
Size of Septic Tank 1 Syo G,010 i Type of S.A.S. Dom'cic L1 V,�s "e 141y
Description of Soil L - d S' 2.5 Y G 4
Nature of Repairs or Alterations(Answer when applicable) Sr,,/,c a n k- D-61J N
2L4 S+a'AaoCc, QviGX q LYs fS
Date last inspected:
t
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions o ' e th ronmental Code and not to place the system in operation until a Certifi-
acate of Compliance has been' ed this oar o a th.
Sign Date l y O q
Application Approved by ih- Date �V 5
Application Disapproved fort following reasons
Permit No. Date Issued 1 la U
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( Repaired ( )Upgraded( )
Abandoned( )by
at CIA. CTn4 cA a y a= " An— Oe ZN has been constructe in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.�[jog- �61 dated 11112101
Installer ,i--nC Designer ( F0 b,,n p on
The issuance f this ermit shall not be cons ed as a guarantee that the syste `will uy tilon as�esig'}jd
Date — t)°I Inspector d
---------------------------------------
No. — Fee 40
i
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
wigpogal 6gtem ctCongtruction Permit
Permission is hereby granted to Construct( !?epair( )Upgrade( )Abandon( )
System located at_<1-! ,k�x� � ,. — t7cSA7,iv,11Q .,c
\. ,
and as described in the above Application for Disposal System Construction Pe51hlicant 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 tcltis
-Date: I I1 _ v Approved by
FROM :down cape engineering inc
// FAX NO. : 15083629880 Nov. 19 2009 09:45RN P2
i
q Thatuums F.PA MAM171
Q�eolnal-, ilDitttee$.®�r
Division
`••.a�� � 'Y'H.iaaota ans 1091a flc�e��o, .Il�nll'e;r�9:®n•
200 Maim Street,Vlfy,:amanix, .ip!➢A 02601
Office: 508-862-464/1 lim: 508-790-6304
.1lHfl9fl�lHiEIl"-d� ��ecu�oa:u fl-:ao-itfiiPla:��lR�nn. 6!^�n•�ut
.p aq.-e; I Il'O I0 Sewage IPerflull➢W maaflA1Pao•ed
�1 E HiisflsaHHeo: Os41
f
�addi•e,�s: l (39 / -lCc •� ALldresq: O C9,v»c.6
On Z / ud n. .-� V".a✓+� its issued a.r ei•mit to i.osta l a
(cYade) (installer)
septic system at�. � ("I Y1 h M_M0►1' .--. u�+^C based on 1.design d.rawai by.
(address) q
dated ! 0
T oeTtil.y thatL tl'o, yepl.ics sysltaii. referenced a.bovc was =tallcd subslklnLiLilly according 'to
the design, which ix)ay ii.uaude minor 8.ppr0v6d chan.gcti Such as l.aleraa:l. .reloca�ti.on of the
di.st;ributi.on box and/or septic tame..
_.___._... 1 coldly that the septic systeici redcrun.ced above waS itDstallcd rviLli nlajjur chatnges (i.e.
grcatcr than 10' lateral relocation of the ",AS or any vertical rclocatiula of any (;ompcmela
of ale, supli.c sysLoln) bid in aceOrdance with State & Local. Rug ulaliOTIS- T'lain. ,revi.si.Qja o.r ,
cerlified',LN-built by deli}fixer to follow.
DANIEi.A.x
u
OJAIA
(installer's Signature) Clvltm
No, 46502 47
�cSs/LC9
-- -
(T�er�i rsc_r's Signature) C. (Affix LDc signer's `Laarnp ere) --
TILEASE R.LiTURN TO BARi*TSTAB><,ic�'��u�B>l.C vo_EA1, 1A A)nvWAUN, r'JGRm-ril(CATG COIF
Q'O11MD-,AtANCT, i%o1U., Pda.D'll' $l;L ISSUED UN7 71, PQ TH. 'A7[IS FOXAM ANAL AS-Bi.IAfl.T CARD ARE .
][8D?;a_:!',M!.D)BY'R O litlaj14N5 t.4 Y,Y 1"U'JULIC'11 EA B.,1f H:DIVI SION. A f]f1�1�17(.3(rCD9J.
Q:Hoatth/Scptirl.Dc:sitnr;r hc;xiili�:Hi.;un:Furna'1-).G-On.doc;
-FROM :down cape engineering inc FAX NO. :15083629880 Nov. 19 2009 09:43AM P1
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L vl�ti����R°Y LA-M 119it.0'-S
"V'1tlaDon w F. Gee r.,Director
� R3R,iKNX�AJtBdd s
MASS. GDaa�pRu'c . .It;altht .Divisiion
111011naas McKcannn, Director
2001 Main Street,l•1(yavn ds, MA 02601
Office: 508-80-4644 Fux: 508-790-6304
Qune9ddull)<evn• z flegi u =��rde�d.an4na�� Form
D.nttr: � S"sewage nmt f/
Designer: lw"� 'e-
Address: q�9 �, �. Address:
Oil _ _ was issued a perinit to install.a
(date* (11 stall.er.)
r
septic system at 0-1.1 tl,✓\aMD Lased o9') a design drawn by
(ad(h-ess)
VJGI w Iited / p
(c`kehT�nier}
T certify that the wptic ystctu rcic-t:wnced shave war; instiilled siibstfj.nl:,i,,,d y according to
tLte desi-p, which im y include n-iinor approved changes such as lateral relocation of the
distribution box and/or septic tails.
I certify -that the sepW; syste11i reFer.ei wed above was installed with major changes (ix,
greater than 1 t) latE.t'a.I,rEI,OC7t).oJ.1 of the SAS or arty Vertical re10(;tAiun 0(•any ccmipcmei-A
of the septic systean) but in a.ccordanec with State & LocaI Regui::ltion,s: Plim .revision or
ceTIJ fied a.4-1)Uilt by designer to 1011ow.
of-Mgs.
g� UANIM-A,
0.1 Tit
- --- (Installer's Signature) CIVIL
N
No.4650' _
�•
C9-
L FAG\
` (Desif;mr s Signature) C (All Detii.gr►er s Staa�ap lerej
PLEASE RETURN TO 113AIMSTAIDLE ]F'U1CLIC HEALTH DIVIS10N. (:EJIZ'l EKICAA.'L fD.K
C70iA,PLlAi+C E_WiLL NOT A$D!! I.SSL E3.) 1.)MUL, BOTH '1111S,•FORM AND AS-BUILT CARD ARE
1R1F('ir,1VF,ID BY 'd'A.QI+ 1St113tti�"]C.4�1(il,� �'1fJUi)f.,XC:�]OCAI,'A'dd 1D.(iV1L�dd)N. '111A1Q1K YOU.
Q:llcalth/scptic/Designur CrrlilicNliuu Furrri 1-26-04.tiur.
Town of Barnstable
Departmcnt of regulatory Services
1 - Public Health Divisimi Date 9 �
' tulwerest,e,/
Maas / 200 Main Street,Hyannis MA 02601
Date Scheduled Time �( ��! Fee Pd.
Soil Suitability Assessmentfor Sebpage fisposal
Perfonned By: d6W,1 c ,�P 04v �/G Witnessed By:
l
_ LOCATION' & GENE,RAL IN,OR ATION
Location Addiess � � " Owner's Name
°y
IC Address
Assessor's Map/Parcel: 165' y' Engineer's Name r �O v,)►^
NEW CONSTRUCTION REPAIR Telephone if C J
c�-� Z r�
Land Use• It / Slopes(%) ��G � Surface Stones
Distances from: Open Water Body_ _ft Possible Wet Area ✓•�ft Drinking Water Well ` �ft
Drainage Way �1 A/ellft Property Line V ft Otlier
SYMTCH.,(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proxinuty to holes)
� Q . t
Eft A-.
-tit `�
� � NTs
106
Parent material(geologic) Ave Depth to Bedrock,
Depth to Groundwater: Standing Water in hole:wa Weeping 1'rairl Pit Fltce
Estimated'Seasonal High Groundwater
DETERN11iOTATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: ,In, Depth to Soil 1rt(Atlt 3: In.
Depth to weeping from s?de of obs.hole: In, Groundwater.Adjustment _,_1't.
Index Well# Reading Date: Index Well level Adi,factor r Adj.(7ruundwuter level
I'Ii;RCOI,ATION 7l' T Date
Observation
Hole H ! Tinie at 4"
Depth of/Pered Time at 6" l�
Start Pre-soak Time @ /l; b Time(9"-6") _f
End Pre-soak. At
Rate Min./Inch
Site Suitability Assessment: Site Passed ,�, Sit.G-Failed: Additional Testing Needed(YIN)
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100' of wetland,you crust first notify tile.
Barnstable Conservation Division at least one (1) week prior to beginning.
Q:\SEPTIC\PERCFORM.DOC
I DEEP.OBSERVATION HOL i LOG Depth from Soil Horizon Hole#
Soil Texture Sdil Color Soil
1 Surface(in.) (USDA) (M Other
unsell) Mottling (Structure,Stones,'Boulders.
Co sate c % ravel
.
0— r
I�E]CID OBSERVATION HOLE LOG
Depth from Soil Horizon Soil Texture Hale#G`"
Surface(in.) Soil Color Soil Other
(USDA) (Munsell) Mottling (Structure,Stones,Boulders.
0."^ /0 •Consistency,%Gravel
�os �z ,v 5 -
JM e ."
IV6 w
DEEP ORSERVA.TION HOLE LOG
Depth from Soil Horizon Hole#
Surface(in.) Soil Texture Soil Color
Mt Other
(USDA) Mottling
ottling (Structure,Stones,Boulders.
Co siste c O vel
----------
Depth from
DEEP OBSERVATION HOLE LOG IIOIe#
_
Soil Horizon Soil Texture
Surface(in.) Soil Color Soil Other
(USDA) (Munsell
Mottling (Structure,Stones;Boulders,
Consi ten ° a I
Flood Insurance state M :
Above 500 year flood boundary No_ Yes
Within 500 year boundary No Yes
Within 100 year flood boundary No Yes .
Depth of Naturally �ccurrin�pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas abserved throughout the
area proposed for the soil absorption system?
If not, what is the depth of naturally occurring pervious material?-
Certification Q
I certify that on 4eG / (date)I leave passed the soil evaluator examination approved by the
Department of Environmental.Protection and that the above analysis was performed by me consistent with
the required training,expertise and experience escribed in�10 CMR 15.017.
Signature Date__
Q:\S.EPTIC\PERCFORM.DOC
+*
24' VERIFY HEIGHTAND REQUIRED NUMBER OF RISERS N N
s� 2X12 PT JOISTS 0 16"O.0 � $
0
NOTCH POST TO ACOMADATE BEAM ^ z
(2)1/2"DIA THRU BOTL W/WASHER(TYP)
I III I I I I I I I I h 1
LUS SERIES HANGERS(TYP)
-j--i--7--T-; DIAMOND PIER DP-75/50" QQ
j II 1 I 1 I I 1 1 I I/ I
ABU SERIES POST BASE FASTENED TO Z
= == = ==- -' 6"X6"POST W/5/8"THREADED ROD 6"
-- -- -----------=--- -
(2)2X T �1?ir I,ir MIN IN EPDXY(TYP)? Q
n rl
III III I 1 m
5'-10 1/2" 5'-11" 5'-11 n III N
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JOIST HANGER IIiIi z4 iIi iIi ilili W
I�I (V l'7 u u III LUS SERIES HANGERS � O
---------------- _--_ __.---'-------- ------------- __. _�I 2X12 PT LEDGER FASTENED TO WALL W/3/8"LEDGER LOCKS Q16 O C Z Lu
` Sill {'-3" (2)2•x8"HEADER STAGGERED,2"IN FROM BOTTOM OR TOP OF THE DECK LEDGERS Z
AND BETWEEN 2"8 5"IN FROM THE ENDS W U it
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EXISTING CLOSET REMOVE DOORS AND FRAME Z W
II II _ c H
WC i i i o Z
BATHROOM ; I WINDOW= 101- HARVEY SLIMLINE.2432
DEN I i VERIFY ALL STRUCTURE IN
CEILING BEFORE REMOVAL OF
WALL.
BEDROOM
-MOUND STAIR i. ------
bo
___________________________� r• ------
_ 1 I
CARBOB ND
LALLY COLUM B i SMOKE
I, 6' 'I--'1 I+, EXT.LALLY COLUM BELOW -
� 1 I— 6'
I 1
(2)2^x8"HEADER`----- (2)z Xs"HEADER THIS IS WHERE THE
StS'tCK �xT C��Lt
FIRE PLACE I ' EXISTING POSTS ARE
�-- �01S-C v(3) ZX to BELOWTHATCARRY
BEDROOM L EXISTING OPENING i I _�sT $6LOvV THE-STEEL BEAM T
Off
oz- Id
OZ
LIVING RM
CLOSET KITCHEN
1 I
1
1
1 I
I ,
--------------j---------------
Y -
F
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1ST FLOOR' PLAN -
SCALE: 3/16"
f�
�I EXISTTNG
co
io
DEMO
r---------, t
U� L---------.J N Cn
EZ-77, FEW
DEMO o
m z
Y 03 04 REPLACE ALL EXISTING WINDOWS VOTH a o
ANDERSEN 400 SERIES ADH2644
C4 `7 8'-6" �I 3' " 6-3 3/4-1 Lu
0
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z
IT a
_
Sill F'-q-
ca
J LALLY COLUMN DN/UP TO POSTABOVE N
IF11'-5" VERIFY FIRE SEPARATION — — — — — — — — — w
uj
BATFIROO r j- LAUNDRY \ W
Lu
\ � z v
N 2'-6" ci
�' t i O O w
i O o
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L 0
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CARBOBAND LALLY COLUM / — — — — — — \ Z v re
----, I SMOKE ------------------ — — w
BO AND
I o ff¢¢ m
II I
LALLY COLUM BELOW
LALLY COLUM — — — — — — — —
r+ J
it
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W10X19
" 12' LALLY COLUM BELOW
EXISTING
FIRE \ /
- CREATE WINDOW WELL PLACE POSTABOVE 1
,
k
EXISTING ELECTRICAL PANEL.
AREA CAN NOT BE USED FOR STORAGE
v- - -
CLOSET LALLY COLUMN
I
t.
a
BASEMENT „a
SCALE: 1/4"
i
SYSTEM PROFILE MALL ED WM COM ONENNETIC TAPE SHALL
BE NOTES
OR
COM'ARABLE MEANS FOR FUTURE LOCATION.
PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) Iy 1. DATUM IS APPROX. NGVD (GIS SPOT)
ACCESS COVERS TO WITHIN 6" OF FIN. GRADE PROVIDE INSPECTION PORTS TO o �
TOP LOWER FNDN. C
TOP FOUND. EL 38.8' WITHIN 3 OF FINISH GRADE 2• MUNICIPAL WATER IS EXISTING
3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT.
MINIMUM .75' OF COVER OVER PRECAST 296 SLOPE REQUIRE �RS�YSTEM 38.0 Locus O
MIN. 8" DIAM. 4. DESIGN LOADING FOR ALL PROPOSED PRECAST �a
t. PRECAST H-10 7 UNITS TO BE AASHO H-4 I y c
RISERS (TYP.) �( FILTER FABRIC COVER
: 2'0 4"4SCH40 PVC
PIPES LEVEL 1 ST 2' OVER UNITS _� 35.0' 5. PIPE JOINTS TO BE MADE WATERTIGHT. b so. v
*36.9'
0
i. .* 10• 1500 GAL H-10 14" V 6. CONSTRUCTION DETAIL'S TO BE IN ACCORDANCE Sou h 7O
35.8 35.19 TEE SEPTIC TANK TEE 34.67 - NTH t
4.94 6" MIN. SUMP 310 CMR 15.000 (TITLE V.) 5
.0 0.00°0°0° 12" MIN. TNT. DIM. 0.67' m
GAS BAFFLE::' ,
I I I I I I - I I& 34.0 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND
F. 4' LIQ. LEVEL (ACME OR EQUAL) .- 34.88' 34.71' NOT TO BE USED FOR LOT LINE STAKING OR ANY
STANDARD QUICK 4 UNITS, OTHER PURPOSE.
J00 O O O O O•O O O O O O O••O.O O O O O O
•00000000000000000000000000000000000000000000000 "
�O O O O 000 O O O O O O O O�O�O O O O O.
o O O 0 O _ O OVERALL DIMENSIONS TO OUTSIDE OF UNITS: 32 x 8.5 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4 PVC. o
MIN. 6" CRUSHED STONE OR MECHANICAL (NO STONE PROPOSED)
9. COMPONENTS NOT TO BE BACKFILLED OR 0-
8,-
2 9: SLOPE) COMPACTION. (15.221 [21) 8.5' CONCEALED WITHOUT INSPECTION BY BOARD OF
( 1 % SLOPE) ( 1 96 SLOPE) HEALTH AND PERMISSION OBTAINED FROM BOARD
OF HEALTH.
FOUNDATION 30' 10. CONTRACTOR SHALL BE RESPONSIBLE FOR
FOUNDATION
10' SEPTIC TANK 6' D' BOX 6' LEACHING CALLING DIGSAFE (1-888-344-7233) AND
FACILITY VERIFYING THE LOCATION OF ALL UNDERGROUND & LOCUS MAP
BOT. TH 2 EL. 25.5 OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF
*THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL WORK. NOT TO SCALE
UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS
PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM 11. ANY UNSUITABLE MATERIAL ENCOUNTERED
SHALL BE REMOVED 5' BENEATH AND AROUND THE ASSESSORS MAP 165 PARCEL 25
VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE PROPOSED LEACHING FACILITY.
IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR
BY HEALTH INSPECTOR 12. EXISTING LEACHING FACILITY SHALL BE PUMPED LOCUS IS WITHIN AP DISTRICT/ESTUARINE
LEGEND AND REMOVED OR PUMPED AND FILLED WITH CLEAN PROTECTION DISTRICT
PAPERWORK AND HEARING' REDUCTION PROPOSALS APPROVED SAND.
99- EXISTING CONTOUR BY THE BOARD OF HEALTH REVISED DURING A PUBLIC
HEARING HELD ON AUG. 4; 2009
99.1 EXIST. SPOT ELEV. 2) FAILED SYSTEMS ONLY•. SEPTIC SYSTEM COMPONENT TO SYSTEM DESIGN.
99 PROPOSED CONTOUR FOUNDATION SETBACK, IF AN IMPERVIOUS LINER IS DESIGNED
99 AND INSTALLED (10' OR GREATER ALLOWED).
PROPOSED SPOT EL. GARBAGE DISPOSER IS NOT ALLOWED
TH1
TEST HOLE
41• DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 110 GPD
1
2� SLOPE OF GROUND I \��F 99.81x' x 39.49 USE A 330 GPD DESIGN FLOW
UTILITY POLE \�� \tiFyo SEPTIC TANK: 330 GPD (2) = 660
I \�T 40.77 USE A 1500 GAL. H-10 SEPTIC TANK
FIRE HYDRANT 0 x 38 5 '
G---_x�1 5 to NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING I �--�G o
LOT 45 38.91 LEACHING:
C
x
4.72 SF/LF x 4' LENGTH = 18.88 SF PER STD.
\
40.64 12,340t S.F. 2 x 39.54 ®4 QUICK 4 UNIT
TEST HOLE LOGS 37•98 x 3E. 8 x 9 330 GPD/0.74 GPD/SF = 446 SF LEACHING
I EXISTING 18. REQ'D
(SPLIT
ENGINEER: ARNE H. OJALA, PE, SE V I i 40. 9 41.84 LEVEL) 96 ' PROVIDE APPROX. 43' OF 40 MIL
DWELLING 10 LINER AT 5' OFF SAS IN AREA SHOWN. 446 SF/18.88 SF/UNIT = 23.6 UNITS
WITNESS: DAVID STANTON, IRS I I 41.50 C 0 r TOP AT EL 35.0', BOTTOM AT EL.
AUGUST 19, 2009 O 41.24 INV. OI17 36.9' cA 3 .35 31.0't
04 t5 THEREFORE, USE GRAVELLESS SYSTEM OF (24)
DATE: 41.29 1 3 STANDARD QUICK4 UNITS IN FIELD CONFIGURATION
< 2 MIN INCH I W IN "LOWER" TOP OF 3 ROWS OF 8 UNITS
PERC. RATE - Q' -N 6 w-_ OF FNDN. 7
41.21 FLAG.
CLASS I SOILS P# 12671 I PATIO ELEV. 38.8
/ 41.23 4 38.84!
j�39.12 W REMOVAL OF UNSUITABLE SOIL REQUIRED
Q 41
ELEV. ELEV. AROUND PORTION OF PERIMETER OF
Z� .23 10' .90 LEACHING FACILITY(HATCHED AREA). DOWN
INV. OUT 35.8' TO SUITABLE SOIL LAYER. REPLACE WITH
p" 4 36.5' 0" 36.0' I �9 `� RET• WAIL -0)
CLEAN MED. SAND. TO MEET SPECIFlCA110NS
A A I 4 8 M 28__ o
LS LS �38.41 .23,E = \ N
x 5.24 , MA
09 10YR 4/1 " 10YR 4/1 7 7 \� 3s.17 .29 - ; .90 APPROVED DATE BOARD OF HEALTH
10 �3�0 5 35.19 35.15 ,..
E E � � 7 PAVED 36 ®J • 6 35.24 TITLE 5 SITE PLAN
FS FS DRIVE 35:28 OF
1 ^'J ,36. 8
12„ 137.10c 10YR 5/2 12" 10YR 5/2 7.29 --5-
1- 37� _ I S
35 ---*35.11' TH 2 54 CINNAMON LANE
B B1s \ OSTERVILLE
LS LS 106 0 7' \ �c of��\ <<. PREPARED FOR
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43 43 � DANIELA. °yam o A. m ESTATE OF ARIES E. LLOYD
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