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HomeMy WebLinkAbout0062 CROSSWAY PLACE - Health fit Crossway Place Osterville P ti A = 165 070 P F 'I rob A • e w r Commonwealth of Massachusetts Title 5 Official Inspection Form.- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M svi 62 CROSSWAY PLACE . Property Address HALEY Owner Owner's Name information is required for OSTERVILLE MA 7-1-14 every page. City/rown :.. State` •Zip Code• Date of Inspection' Inspection results must be submitted on this form.'lnspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the ` computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not use the return Name of Inspector key. DOUGLAS A BROWN INC Company Name P.O. BOX 145 ,. Company Address CENTERVILLE ' MA 02632 Citylrown State 'Zip Code 5084204534 ' S14297 Telephone Number - License Number B. Certification .M 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. l am a DEP approved system inspector pursuant to Section 15.340♦°of, Title 5(310 CMR 16.000).The system: ® Passes ' * El Conditionally Passes ❑. Fails . ❑ Needs Further Evaluation by the Local Approving Authority 7-1-14 Inspectoes ature Y } Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use - at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-3/13 Title 5 Official Inspection F surface Sewage Disposal System Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments o �M sr 62 CROSSWAY PLACE Property Address n HALEY Owner Owner's Name information is required for OSTERVILLE MA, 7-1-14 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 5 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: SYSTEM MET ALL PASSING REQUIREMENTS AT TIME OF INSPECTION. THE OUTLET FILTER ON THE SEPTIC TANK WAS REMOVED AND CLEANED AT TIME OF INSPECTION AS WELL 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.' El Y ❑ N. ❑ ND(Explain below): „ t5ins•3/13 i • Title 5•fficial Inspection 0 p n Form:Subsurface Sewage Dis sal S stem Pare 2 of 17 Po Y 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments G M 62 CROSSWAY PLACE Property Address HALEY r Owner Owner's Name information is required for OSTERVILLE MA 7-1-14 , every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not'operational. System wil(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)' a C) Further Evaluation is Required by the Board of Health: El 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: Y ❑ 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 t5iris•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 t Commonwealth of Massachusetts` Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 62 CROSSWAY PLACE Property Address HALEY Owner Owner's Name information is required for OSTERVILLE MA 7-.1-14 every 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 ttie 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 , y supply well. z ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or, more from a private water supply well**. ` Method used to determine distance: **This system passes if the well-water analysis, performed at a DEP certified laboratory, for fecal ` coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal . . to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate."Yes"or"No"to each of the following for all inspections: 'Yes. 'No 4 r ® Backup of sewage into facility or system component due to overloaded or. clogged SAS or cesspool r Discharge or ponding of effluent to the surface of the ground or surface waters ` ❑ " 21, due to an overloaded or clogged SAS'or cesspool r. El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El - ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y day flow t5ins•3/13 , Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 . r Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 62 CROSSWAY PLACE _ Property Address , HALEY Owner Owner's Name information is required for OSTERVILLE MA 7-1-14 _ every page. Cityrrown 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. r ❑ Z. 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 n from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. 0 ® 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 4. 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. T i5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts; W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments, 62 CROSSWAY PLACE M . x Property Address • . HALEY Owner Owners Name " information is required for OSTERVILLE MA 7-1-14 - every page. Cityrrown 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? 0 ® Have largevolumes of water been introduced to the system recently or as part of. this inspection? ® F-1 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? ' 4 ® ❑ 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: r Number of bedrooms(design): 4 Number of bedrooms(actual): 4. DESIGN flow based on 310 CMR 15.203,(for example:-110 gpd x#of bedrooms): " 440 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 I ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM 62 CROSSWAY PLACE ' Property Address HALEY ; ) Owner Owner's Name information is OSTERVILLE MA -1-14 required for - every page. CitylTown State Zip Code Date of Inspection D. System Information Description: SYSTEM CONSISTS OF A 1500 GALLON SEPTIC TANK 1000 GALLON PUMP CHAMBER D- BOX AND 4 CULTEC 330 CHAMBERS WITH STONE AS PER AS-BUILT Number of current residents: 0 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? v ❑ Yes ® No Seasonal use?, ❑ Yes ® No Water meter readings, if available last 2 ears,usa e d SEE BELOW . 9 ( Y 9 (gP ))� Detail: . HOUSE HAS BEEN UNOCCUPIED FOR SOMETIME, MINIMUM WATER USAGE REPORTED Sump pump? El Yes ❑ No Last date of occupancy: Date Commercial/Industrial Flow Conditions: . - Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq:ft:, etc.): Grease trap present? ❑• Yes ❑ No Industrial waste holding tank present? ❑ Yes,-❑ No Non-sanitary waste,discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: :. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 62 CROSSWAY PLACE ; Property Address HALEY . Owner Owner's Name information is required for OSTERVILLE MA 7-1-14 every page. Citylrown 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: ' I 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 r ❑ Privy ❑ Shared system (yesor.no) (if yes, attach previous inspection records, if any)` a ❑ Innovative/Alternative technology. Attach a copy of the current operation and' maintenance contract(to be obtained from system owner) and a copy of latest ` inspection of the l/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ®- Other(describe): ` PUMP CHAMBER ALSO ` t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments - GSM , 62 CROSSWAY PLACE - Property Address HALEY Owner Owner's Name information is required for OSTERVILLE' MA 7-1-14 every page. City/Town State'. Zip Code : Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: INSTALLED IN 2000 PER AS-BUILT Were sewage odors detected when arriving at the site?. ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade:. _ feet Material of construction: El cast iron ❑40 PVC - ❑ other(explain): . Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): . Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass., ❑ polyethylene `:."'❑ other(explain).. If,tank is metal,list age: years Is age confirmed by a Certificate of Compliance?,(attach a copy of certificate) Q Yes ❑ No - Dimensions: 1500/1000 PC Sludge depth. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 f Commonwealth of Massachusetts ' - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 62 CROSSWAY PLACE Property Address HALEY , Owner Owner's Name ' information is required for OSTERVILLE MA 7-1-14 every page. Cityrrown State Zip Code Date of Inspection D. System Information(cunt.) Septic Tank(cont.) ! F Distance from top of sludge to bottom of outlet tee or baffle 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-. How were dimensions determined? Comments (on pumping recommendations; inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): , SEPTIC TANK HAS A ZABEL FILTER THAT WAS CLEANED,AT TIME OF INSPECTION HOME OWNER PUMPED REGULARLY. . Grease Trap(locate on site plan): A Depth below grade: feet . Material of construction: ❑ concrete ❑ metal ° . ❑ fiberglass ❑ polyethylene ❑ other(explain):- Dimensions: ; Scum thickness Distance from top of scum,to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle ' Date of last pumping: • Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments` M , 62 CROSSWAY PLACE a, Property Address , HALEY Owner Owner's Name '_ information is MA 7-1-14 required for OSTERVILLE ° 3 - every page. Cityrrown State Zip Code Date of Inspection D. System Informatiow(cont.) Comments(on pumping recommendations, inlet and outlet tee orbaffle 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 ofconstruction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: I Capacity: "' . , gallons. Design Flow: gallons per day r Alarm present: ❑ Yes ❑ No • 4 Alarm level: Alarm in working order: ❑ .Yes- ❑ No , Date of last pumping: ° Date Comments(condition of alarm.and.float switches, etc.):. *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes. ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 17 , Commonwealth of Massachusetts ; Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM , 62 CROSSWAY PLACE ` Property Address HALEY , Owner Owner's Name - information is required for OSTERVILLE• MA 7-1-14 s every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): o„ 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.): , ' , BOX LEVEL NO SIGNS OF FAILURE OR SOLID CARRY OVER- 'Pump Chamber(locate on site plan): - , - Pumps in working order' ® Yes ❑ No* Alarms in working order: x ®. Yes ❑. No* Comments(note condition of'pump chamber, condition of pumps and appurtenances, etc.): PUMPS AND ALARMS WERE RUN AT TIME OF INSPECTION * 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: NO OBSERVATION PORTS FOUND , ,> l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System!Page 12 of 17 R , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 62 CROSSWAY PLACE Property Address HALEY Owner Owner's Name information is required for OSTERVILLE MA 7-1-14 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) . Type: ❑ leaching pits ' number: r ' ® leaching chambers number: 4 CULTEC ❑ leaching galleries• number: ` ❑ leaching trenches number, length: ❑ leaching fields' number, dimensions: ❑ overflow cesspool number: ❑ j innovative/alternative system Type/name of technology: CULTEC CHAMBERS . Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil;condition of vegetation, etc.): PROBED AREA OF S"A.S.AND FOUND NO EVIDENCE OF FAILURE OR SATURATED SOILS, ' Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and'configuration ' Depth—top of liquid to inlet invert Depth of.solids layer Depth of scum layer " Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑:Yes ❑ 'No t5ms•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , M 6VBy`Bw 62 CROSSWAY PLACE Property Address HALEY r Owner Owner's Name information is required for OSTERVILLE MA 7-1-14 every page. CityrFown 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 j Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t t t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary,Assessments ' 62 CROSSWAY PLACE Property Address HALEY Owner Owner's Name information is required for OSTERVILLE MA 7-1-14 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 areabelow . ® drawing attached separately _ is * a .. `. _ •. • t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of.17 Commonwealth of Massachusetts r Title 5 Official Inspection Fora , . 3 Subsurface Sewage Disposal System Forme Not for Voluntary Assessments M 62 CROSSWAY PLACE Property Address HALEY • _ t Owner Owner's Name information is required for OSTERVILLE MA' 7-1-14 _ - every page. CityrFown State Zip Code, Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope M1f ® Surface water. ® Check cellar ; ® Shallow wells + Estimated depth to high ground water: GREATER THAN 5 a- feet Please indicate all methods used to determine the high ground water elevation: a ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date t ❑ 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:' ; e .. You must describe how you established the high ground water elevation; PROPERTY SITS HIGH ABOVE ADJACENT POND ` Before filing this Inspection Report, please see Report Completeness Checklist on'next page. • " t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 bIOZ/IZ/L I=basWOL0S9I= ddeuzLdsu-SuldsipWfpBuissassV/sn•alqt�suxegloumol•nnnnm//:dnq • Commonwealth of Massachusetts n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 62 CROSSWAY PLACE Property Address , HALEY » Owner Owner's Name , informatifor on is required OSTERVILLEt MA' 7-1-14 every page. Cityrrown State` Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information.—Estimated depth to high groundwater ® Sketch of Sewage Disposal Systemeither drawn on page 15 or attached in separate file r f. 1• n y' r fF'3 .. ♦, _ ' as . ' .,. ` , as f .. A .. ♦ a t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 o •ale », ri - a s a� i -s 5uissass ' z� •z , a� , ` . . , - p III. g � � Assessing As-Built Cards - Page'1 of 2 J TOWN OF BARNSTABLE LOCATION &a crt7�IAC - t SEWAGE 11 VILLAGE orner, ASSESSORS MAP&LOTI�DS INSTALLER'S NAME&PHONE NO. I SEPTIC TANK CAPACrrY IrTV S] — Ion Pmp GA4M4/ q LEACHING FACILITY:(type) 7' Culit, 33os (sue) /3'X 3s NO.OF BEDROOMS M1� BUILDER OR OWNER 1'1'!E �Orlv/1�4T i, ,• PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility g Fat Private Water Supply Well and Leaching Facility (If any wells exist ; on site or within 200 feet of leaching facility) Feet Edge of Wedand and Leaching Facility(If any wetlands exist ' within 300 feet of leachi g facility) Feet t Furnished byJ�—�ISnt�Con �FDV_J C. 3 r / eAwk a ss /y` , _ t t http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar--165070&seq=1 7/21/2014 . % Z(1�)2 RECEIVED COMMONWEALTH OF MASSACHUSETTS NOV 2 9 2004 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS O TOWN r BARNSTABLE DEPARTMENT OF ENVIRONMENTAL PROTECTION DEPT. fAAP I �` PARCEL. TITLE 5 LOT p OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY\ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 62 Crosswav Place Osterville MA 02 555 Owner's Name: Laurie Kioller Owner's Address: Date of Inspection: November 4 2004 Name of Inspector: (Please Print) James M. Ford Company Name: James K Ford AMailing Address: P.O.Box 49 Osterville MA 02655-0049 Telephone Number: (508)862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: Novezzzber 8 2004 The system inspector shaYsubmiaof this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I Page 2 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 62 Crosswav Place Osterville MA Owner: Laurie Kioller Date of Inspection: November 4 2004 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: 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. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or'break out or high static water level in the distribution box due to broken or' obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed 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: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 62 Crosswa Place Osterville MA Owner: _Laurie Kioller Date of Inspection: November 4:2001 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 CN M 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 tribuiary,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: 3 4 Page 4 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: _62 Crossway Place Osterville MA Owner: Laurie Kioller Date of Inspection: November 4 2001 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each'of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than %2 day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_ ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface, water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for 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 System: 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 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered'-' "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM' PART B CHECKLIST Property Address: _62 Crosswav Place Ostervdle M4 Owner: Laurie Kioller Date of Inspection: November 4 2004 ,Check if the following have been done: You must indicate" es"or"no"as to each of the followin 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 wafer 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: Yes No Existing information. For example,a plan at the Board of Health. V Determined in the field(if any of the failure criteria related to Part C is at issue approximation is unacceptable) [310 CMR 15.302(3)(b)]. of distance 5 Page 6 of 11 OFFICIAL INSPECTION FORM v NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: _62 Crosswav Place _ Osterville. MA Owner: Laurie Kioller Date of Inspection: November 4 2001 RESIDENTIAL FLOW CONDITIONS Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: S Does residence have a garbage grinder(yes or no): Yes Is laundry on a separate.sewage system(yes or no): n/a [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)): Unavailable Sump Pump(yes or no): No Last date of occupancy: _ Currently occupied 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): Pumping Records GENERAL INFORMATION Source of information:- Pumped in 2002-per owner Was system pumped as part of the inspection(yes or no): 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) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed on 5/5/00-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: _62 Crosswav Place Osterville MA Owner: Laurie Kioller Date of Inspection: November 4 2004 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 12" Material of construction: ✓ .concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): certificate) (attach a copy of Dimensions: 1500 gal. Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 10" Distance from bottom of scum to bottom of outlet tee or baffle: 13" How were dimensions determined: _Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were pLesent. The IL quid level was even with the outlet invert. There did not a ear to be an si ns o leaka e. A steel cover was to ade. GREASE TRAP: None (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.): 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: _62 CrosswavPlace Osterville MA - Owner: Laurie Kioller Date of Inspection: November 4 2004 TIGHT or HOLDING TANK: None (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: allons/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: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The D-box was level and clean. No solids were resent. There did not a ear to be an si ns o backu or allure from the leach field. PUMP CHAMBER: ✓ (locate on site plan) Pumps in working order(yes or no): . Yes Alarms in working order(yes or no) Yes Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): The liquid level was normal. I acled throu h the punip and the um was in working,order. i 8 Page 9 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 62 Crosswav Place Osterville MA Owner: Laurie Kioller Date of Inspection: November 4 2004 SOIL ABSORPTION SYSTEM('SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: ✓ leaching chambers,number: 4 Cultec 330s- 12'x 35' Per as built card) 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.): There did not yRyear to be an si ns o ailure. The bottom to grade CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) 1\umber 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: None (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,): 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 62 Crossway Place Osterville MA Owner: _Laurie Kioller Date of Inspection: November 4 2004 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. y C' 3 8 rA�'c L3 � Y8 a s8 fy 3 340 a 10 Page 11 of 11 w OFFICIAL'INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 62 CrosswavPlace _ Osterville. MA Owner: Laurie Kioller Date of Inspection: November 4 2004 SITE EXAM Slope Surface water Check cellar 'Shallow wells Estimated depth to ground water 40+/, feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours mans Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topoerapliic and water contours Wraps the maps were showing approximately 40'+/ to ground water at this site. The desi n lans are also showing 40'to ground water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed,written or implied,relating to the system, the inspection and/or this report. 11 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PRFF- I.ON CEIVED T 1 0 2002 OF BARNSTABLEEALTH CREPT. TITLE 5 OFFICIAL INSPECTION FORM _ NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 62 Crosswav Place i Osterville. MA 02655 Owner's Name: Mark Fortunhati Owner's Address: Date of Inspection: September 30,2002 Name of Inspector:(Please Print) James M. Ford Company Name: James M. Ford . Mailing Address: P.O. Box 49 Map: 165 Osterville,MA 026S5-0049 Parcel: 070 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected;the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Condi ' nally Passes Need F er Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: October 5, 2002. The system inspector shallu t.a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that. time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 62 Crossway Place Osterville,,MA Owner: Mark Fortunhati Date of Inspection: September 30, 2002 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: 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. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with . approval of Board of Health): broken pipe(s)are replaced obstruction is removed 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: 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 62 Crossway Place Osterville, AM Owner: Mark Fortunhati Date of Inspection: September 30, 2002 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: 3 Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 62 Crossway Place Osterville, AM Owner: Mark Fortunhad Date of Inspection: September 30, 2002 D. System Failure Criteria applicable to all systems: You must indicate either`yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/s day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. _ ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation.. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone l of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for 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 System: 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 '-es"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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 62 Crossway Place Osterville, AM Owner: Mark Fortunhati Date of Inspection: September 30, 2002 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 abased on: Yes No ✓ _ Existing information. For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR.15.302(3)(b)]. 5 Page 6 of I 1 , OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM_ INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 62 Crossway Place Osterville, MA Owner: Mark Fortunhati Date of Inspection: September 30, 2002 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 2 Does residence have a garbage grinder(yes or no): . Yes 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)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied 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: Never Pumped per owner-new system Was system pumped as part of the inspection(yes or no): 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) (ifyes,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: S/S/2000 .Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENT'S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 62 Crossway Place Osterville, AM Owner: Mark Fortunhad Date of Inspection: September 30, 2002 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: - cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: Approx. 12" Material of construction: ✓ concrete metal fiberglass L Uolyethylene _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: 1500 gal. Sludge depth: 0" Distance from top of sludge to bottom of outlet tee or baffle: 32" Scum thickness: I" Distance from top of scum to top of outlet tee or baffle: 10" Distance from bottom of scum to bottom of outlet tee or baffle: 13" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert. There were no signs of leakage. Cover was to grade. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: t 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.): 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: 62 Crossway Place Osterville, AM Owner: Mark Fortunhati Date of Inspection: September 30, 2002 TIGHT or HOLDING TANK: None (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: _ ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The D-box was level. Clean no solids present.No sign of backup or failure from leach field. PUMP CHAMBER: ✓ (locate on site plan) Pumps in working order(yes or no): Yes Alarms in working order(yes or no) Yes Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): The liquid level was normal. Pump and alarm working 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: 62 Crossway Place Osterville, MA Owner: Mark Fortunhati Date of Inspection: September 30, 2002 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: . ✓ leaching chambers,number: 4-Cultecs 330s 12 x 35'per as-built leaching galleries,number: leaching trenches,number,length: leaching fields,number;dimensions: overflow cesspool,number: Innovativelalternative system Typetname of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): The leach field was located but not dug up.No sign of failure in D-Box. Bottom to grade was approximately 4'. CESSPOOLS: None (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: None (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.): 9 f Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 62 Crossway Place Osterville, MA Owner: Mark Fbrtunhati Date of Inspection: September 30, 2002 Map: Parcel. 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. y C LA BAD a ss ty s 3G a `1r yp io 5, r Page 11 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 62 Crossway Place Osterville, AM Owner: Mark Fortunhati Date of Inspection: September 30, 2002 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate (check)all methods used to determine the high ground water elevation: ✓ Obtained from system design plans on record-If_ checked, date of design plan reviewed: 10199 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: The bottom of the leach field to grade was approximately 4: Using Barnstable Topographic Map and water contours map.Maps are showing app. 40'+1-to groundwater. Design plans also showing 40'to groundwater. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future.'There have been no warranties or guarantees,either expressed, written or implied, relating to the system, the inspection and/or this report. 11 TOWN OF BARNSTABLE !r° L +CATION C�a C rassw.oti PIA U- SEWAGE # OD VILFiAGE 0s`T"CrV. ASSESSOR'S MAP & LOTI(US INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1 5W S•r 0" PO AD LEACHING FACILITY: (type) 47+ CU40-4, 330's (size) I IG` X 3f NO.OF BEDROOMS 41 BUILDER OR OWNER fWrk &D—WIA411 PERMITDATE: COMPLIANCE DATE: 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 lea hi facility) Feet Furni shed by��1sn GG i o i 0 f .3 y e. 3 � g S a ss �y `� yo TOWN OF BARNSTABLE 15 oc F LOfa&TION CC SEWAGE # VILL AGE ( 5-7r �/ c �, (, ASSESSOR'S MAP & LOT §A5�,, IN-STALLER'S NAME&PHONE N0"2!. /Q Callf sr- s -tea 9 SEPTIC TANK CAPACITY SOD EA , /D0�aLm a C&d416�! LEACHING FACILITY: (type)C(-17CC 330E 4�— (size) /a �;C35 i NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: �7/"0?&00 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by u{�OY /. (t( 7 , ,� r sH�c7 i 1�(ST i�a u�oZ 1 � a o A Lf0' �s�C�(;i 16 , jW No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes �} PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS Q` 01 plication for Ziopozar *raem Construction Permit Application for a Permit to Construct( . )Repair(.k<upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.6a ?Jq C t—"03Ti Owner's Name,Address and Tel.No. Cyr a\Ter-_3r t: nC(f l Assessor's Map/Parcel / O �a CfbS Sw C`Y��C --O JT-- Installer's Name,Address,and Tel.t jo. Designer's Name,Address and Tel.No. 3rvCc k 7.1«T t�(T e_ S i'c cl,,f,,q 87 6 Ji. y ,9-5 -d..q PrA s -T - /3/ Type of Building: Dwelling No.of Bedrooms / Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow �Z//o gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 41,P !'Ant �- /S 0 O 601 S T��; /, 100 0 6,9 Cu cc -330 P "15 nme j4f ��� f1/J -73ftx 1rr tJ�1-e Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss d by this Bo d of He Signe ate /-J as 00 Application Approved by ate Application Disapproved for the following reasons Permit No. "'� Date Issued ---------- - -- - --------— _ -------- � a Y �✓ No. Fee THE COMMONWEALTH OF MA,SSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS. ZIppfication for Miopogaf 6p5tem Construction Vermtt Application for a Permit to Construct( . )Repair-(I-l'upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.16 a C/`0 3;w f1/ ? a r C-Q�)7i., Owner's Name,Address and Tel.No. Assessor's Map/Parcel �' C{�S &_ CC G J l Installe.�r',�ame,Ad ss,and`Tel. o. Designer's Name,Address and Tel.No. ✓/"U/C�-C IC-CCs 1/r Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow yC� gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when apR}icable) 0?6 rpnc i.ap v Gr?L_ 7 %f1i7 /1 do 0 6,9 l ✓-'v m1J C/�f�Yh�t'Q - ` //« -3.3 o c�. .17'1 .s T�n� jr— Date last inspected: Agreement: " The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of H Signe �/ ("'Date "Op Application Approved by - - V V1 1V t /Az- ate Application Disapproved for the following reasons Permit No Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certif irate of Compliance THIS IS TO CERTIFY that the.On-site Sewage Disposal System Constructed( )Repaired(�Upgraded( ) Abandoned( )by �`` ° `r l S t A,1 C 1-1 at - 5 s U,r t t'1 r3 cc 0 S C f` ha e constructed in accordance with the provisions of7itle 5 and the for Disposal System Construction PermitNo '- dated Installer s e `(0,,C C"k L+ _\c- Designer The issuance of this permit sh taall n e construed as a guarantee that the s t zn- 1 function as destgned� Date t � InspectorNo. ----------------- Fee "�/lrr-/� THE COMMONWEALTH OF MASSACHUSETTS ✓�✓ PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Oiopozar Opotem Com5trurtton 3permit ' Permission is hereby granted-to Construct( )Repair((/ )Upgrade( )Abandon(" ) System located at 6 C1 k- f"� J c ��� 7 i t« 5 tc� ,1 �c and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construdti,nanu t be completed within three years of the date of s pe PP t. Date: lY ©t./ Approved b ✓ ,, eY f J TOWN OF BARNSTABLE LL LOCATION X M53'�s�A�PJACC SEWAGE # a j VILLAGE Q i7e-iYr//b ASSESSOR'S MAP & LOT INSTALLER'S.NAME&PHONE NO.'R./ acallI s%c SEPTIC TANK CAPACITY _S00_ F} 000 LEACHING FACILITY: (type)C(,/7cc 33as rT_(size) ')(.a5 NO.OF BEDROOMS BUILDER OR OWNER �Cl� PERMITDATE: y o�&00 COMPLIANCE DATE: I Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility, Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility.) Feet Furcushed by f 9! i� ono r _J s� i i Y; 3„ �yC\ _ - -- .. f 9/26/2019 ShowAsbuilt(1700x2800) _ TOWN OFBARNSTABLE LOCATION V/ a CrOSM Ay MACE SEWAGE# VILLAGE 0rrtrv. ASSESSOR'S MAP&LOT&s INSTALLER'S NAME&PHONE NO. . SEPTIC TANK CAPACITY Ir!/V S?" - /on RL'V CkAmbc/ LEACHING FACILITY:(type) 'f" CV4jL, 330.5 (size) la X 3s- NO.OF BEDROOMS 41 BUILDER OR OWNER_MA/ Po;1nA4T'i ' PERMITDATE: COMPLIANCE DATE: 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 fcet of leaching facility) Fen Edge of Wetland and Leaching Facility(H any wetlands exist within 300 feet of leachii facifiry) Feet Furnishedby.z0$nt.Gl/Or1 FO C- LA \ s &e- a 59 /y ` 3 3tO I d y yo https:Hitsgldb.town.barnstable.ma.us:8431/Home/ShowAsbuilt?mp=165070&sq=1 1/1 arr- I '77hi is ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- architects interior designers builders 400 MAIN STREET ED CHATHAM !BEDROOM MASSACHUSETTS,02633 #3 TEL(508)241-1757 OFF1 CE 299 WHITES PATH MAS ............. SOzeee UTH OUTH YARMOUTH, BATH MASSACHUSEFS,02664 tel(508)362-8883 (508)760-2800 A— fox(508)760.5800 WWW,ERTARCHITECTS.COM MASTER BEDROOM MASTER #2 CLOSET ........................ DN a. IIIII!II • A— Llljl II I III III A— OPEN.—JUNG Jalme MAR R-Y ANNNE A UNEN 160a 62 CROSSWAY PATH 11 IF I'L11 -------------------------------------------------------------------------------- OSTERVILLE MA ------------------------------------------------------- PROPOSED UPPER - LEVEL PLAN SCALE 1/4"-I SlrAsIF rm SMAnaa s MApgL WORK TO Q E PERFORMED MA%---M IX51�n .......... AS PART OF ANOTHER PHASE. NEW Jj; LIVING a,E� OM NOT PHASE 1 , ........... —T. w-1= y nm m�Tm 1-t WNPOSE.ID(C17T �C I. --R, R �A nlo¢aF slum Nmi M�MCT%We -K. PROJECT#240815 Lb-AWRY w DATE ISSUED: -Pw wopml. -a- F-,-w i -7— REVISIONS: D., .......... a NEW: KITCHE�N 131 MASTER BEDROOM #1 iISLAND PERMIT SET BREAKFAAT1 "d PROGRESS SET PRICING SET [[......... IT l ..................... PROGRESS SET -1...........q�w,�- ....... ------------------ ?--y R.—.—N.1-- REGISTRATION WORKSHOP SCALE:1/41-I'-C' 4� #�e 17 --------------- 0 1 2 4 ell UNLESS OTHERNSE NOTED. SHEET NO. ... .......... mwi—zt TOTAL NUMBER OF SHEETS , M" IN SET: THIS SHEET INVALID PROPOSED MAIN LEVEL PLAN UNLESS ACCOMPANIED BY SCALE 1 11V .-a. A COMPLETE SET OF 11.21.2106 MEETING REVISIONS WORKING RAVINGS f - arrhl is ;I architects interior designers builders _ 400 MAIN STREET CHATHAM MASSACHUSETTS.02633 TEL)508)241-1757 . 299 WHITE'S PATH ro SOUTH YARMOUTH, ., - - .. MASSACHUSETIS,02664 . - -- tel SOB 3 2- 1 ) 6 8883 - - - 7 -I 508 60 2800 1 . _- _ ............. .fax(508)760-5800 + W W W.ERTARCHITECTS.COM JIM - .. MARY ' ANNE RYAN 62 CROSSWAY PATE; f-----------------1 - t I ' , . ..OST RVILLE MAI-. I I I I I ARE NOT TD K UsZO E X I S T I N G t .MAIN LEVEL PLAN p PEANITT RD LRLFS SFAMPFO LwsTucnw PURPQgS UN h 9QIm MRN AN OPoONAL ARCHITECTS • - SCALE 1/4 1'-0' STAYP ANO 9flIA v4 S h V P MON •ERMIT SET' �'Lb151RUCTpN SET. • ALL OF THE 0EA5.ARRAN-NTE OESONS.AND . - PUNS NpICATED TFAEOv OR REPRfSFNTED .__-_____________________________________________________________________________________________________________________________________________________________________________________________ ___________ tNER®Y,APE OWIFD flY AND.a..THE PROPEAtt OF FAT ARCMT my INC.NO PART TEREOP SHALL [1E IIRtN RY ANY PER T . OR CORPO- ANY PURPOSE E LEFT MIT SPEanG YRITIFN .. PElODS51ON OF TE flli aiT AR- 'PROJECT#: XXXXTT DATE ISSUED: - REVISIONS: PERMIT SET —.� PROGRESS SET PRICING SET PROGRESS SET .. REGISTRATION7-7 L SCALE.1/4' t' o' . i_c_____________________-____,.________________________ _ ._----_--___ ---------------—--------____-- UNLESS OTHERWISE NOTED. . SHEET NO EXISTING LOWER 'LEVEL PLAN EXISTING UPPER LEVEL PLAN.. SCALE 1/4- .. SCALE:1/4' i-0 .. EX - 1 . 1 - TOTAL NUMBER OF SHEETS IN SET: - THIS SHEET*INVALID* UNLESS ACCOMPANIED BY . .I .. A COMPLETE SET OF WORKING DRAWINGS f eL 12' FN�ED GRADE TEST HD LE ~ P S PEAS MI �\ , y 3 M \N 2„TONE \ \\ \ / "MA / \ \ \ M.• BAXTER & NYE INC. v� JF. j ... ' COVERS LOCATED TO WITHIN VENT 9/25/86 LOCUS F,i ` .5" s : Q• ••� ,.4' ELEV.= 41.2' 12" OF F.G. #P-6624 ��' ,.a °.' . f�• TOP OF BASEMENT FL00 F.G. PIT #2 F.G.- 42't _ c� G N 3/4" TO 1 1/2 " ' A . .\ �.�. ELEV. 48.0 •_�.�� I Q � LOAM DOUBLE 3' COVER LEVEL SCHEDULE 40 P LEACHING CHAMBERS M & WASHED STONE INV. = 40.0 �• MAIN EAU /� 1NV. 1500 GAL. IA T {2 2 FORCE DIST. V.C. SUB SOIL BAY 4 SECTION 39.8' SEPTIC TANK - INV. � 47.0' BOX INV., - 46.8 , INV. INV. - t:. ..:.:::: INV. - NO SCALE INV. -39.146.6 0 0 0 0 0 0 0 0 0 0 0 0 0 2 39.5' 39.3 { 0 0 0 0 0 0 0 0 0 0 0 o a -4' PERC TEST LOCUS MAP I C.B. 9 PUMP CHAMBER 0 0 0 0 0 0 0 0 0 0 0 0 0 SCALE 1 25,000 FND. .. ...............^. .. sEE PUMP Not>=s MEDIUM x ::::•:::� :•• v :. � BOTTOM..ELF/.= 44.5' SAN D ASSESSORS i ■ = catch basin 6" 'CRU':�IED STONE BASE PROFILE N ELEV. = 36.0' -12' NO WATER C.B. MAP 165 PARCEL 70 \ FND. M NO SCALE WATER LEVEL = 5.3' ZONES A.P. x�q4 47.5 2 S81°26'40.E NDTES� � C.B. RC BENCVA(C K 44.5 98,04' FND.OFF _..a, 1. THE CONTRACTOR IS TO SECURE ALL APPROPRIATE PERMITS. MINIMUMS TOP .B, x-4&8 2. THIS PARCEL IS NOT LOCATED IN THE FLOOD PLAIN. AREA = 43,560 S.F. EL. = 48.26L nr ' 401 3. REMOVE UNSUITABLE SOILS BENEATH PROPOSED SYSTEM, BACKFILL (� WITH CLEAN GRANULAR MATERIAL FILL TO BE GRADED AS FOLLOWS: NOT FRONTAGE - 20 ��,�� ,: � 4 .8 WIDTH` 100' �x 47.7 ��P•�`.>< ;r MORE THAN 15% RETAINED ON No. 4 SIEVE, NOT MORE THAN 90% RETAINED 47.3 . ON No. 50 SIEVE, OF FRACTION PASSING No. 4, 10% OR LESS TO PASS No. FRONT SETBACK = 20' #561/ .x 47 7 47.7 --%-47.3 SPIKE -"- -,., \ � � � Q � '� / 100 SIEVE. AND 5% OR LESS TO PASS No. 200 SIEVE,' SOIL TO BE APPROVED SIDE SETBACKS = 10' 4"""` FND.OFF 46 / f / BY ENGINEER FOR COMPLIANCE PRIOR TO PLACING ON SITE. 48. ^ 48.6 o \ 44.3 0 ' j J / / wf 4. LOCATION OF UTILITIES NOT SHOWN ON THIS PLAN, AT LEAST 72 HOURS REAR SETBACK = 10 48 8 N nc. wo% x 43.8 f / / g PRIOR TO ANY EXCAVATION FOR THIS PROJECT CONTRACTOR SHALL MAKE BUILDING HEIGHT = 30' C.B. I 4s.o 0 os 47.546.'8 \ �44,6 x 4 �> 1 j I THE REQUIRED NOTIFICATION TO DIG SAFE (1-888-344-7233) AND APPROPRIATE #2 FF V 8 T c S8 r ' ' WATER DISTRICT. TO DETERMINE UTILITY LOCATIONS: FND 0 ' ok one w 1 26 40�E r j wf 4 I oak 48.3 �' . 100, ' ' °'l �' J 5: SOIL SUITABILITY TO BE VERIFIED AT THE TIME OF INSTALLATION OF LEACHING FACILITY. .N P-6624 48.2 wQ shed 0 8:5 6: INVERTS TO BE FIELD ADJUSTED AS NEEDED TO ACCOMODATE EXISTING' PLUMBING. x 48.5 A x 43.5 x 44 x ) °, 8: ALL STRUCTURES BURIEDBE VENTED. x 7. LEACHING FACILITY TO 47.9 9.1 38, \ 48 s DEEPER THAN 4' OR SUBJECT TO VEHICLE TRAFFIC SHALL BE 48. 1 x 0. `' H-20 LOADING. / 4 co 43.3 7 9 A REQUEST FOR DETERMINATION OF APPLICABILITY MUST BE FILED AND ACTED UPON IT. 48.5 CO n i - �' �' c teA 4 •2 ( ' "' j 7•7 BY THE BARNSTABLE CONSERVATION COMMISION PRIOR TO START OF SEPTIC REPAIR. •r 0 20,48:1 / x 7co , 42.9 � qc`` §g ' x 43.2 x ^ate rc r -' ' wf#5 �s 49VEN x 42.3 �.' ^5 �,/ ! f �^�v► DESIGN DATA r Y \ / 42. 41.5 x <)�`48 � / r 4 y �' S`!Nr.l F PAMIL Y-- A REDROOMS 48.$ e 8.5 �. x 8.7 �� `\r� /` v N GARBAGE GRINDER m Q� 48 05 $ ��. J D�� / ' c rn NO GARa Q � 48.948.50� �, ui DAILY FLOW = 110 X 4 = 440 G.P.D. ii p� ,ha' o garden `° N 3 N N 1p• 8� � 2 h 48.9 °' o r 41 / / \ SEPTIC TANK 440 X 200q = 880 48.8 .0 48.8 ' ,C d ��c' /� / f 'f x 8.1 a`> N x 48.7�x 48. '48.7 0>�! . ' 9 , �r a, USE 1500 GAL. SEPTIC TANK 3. .. 16"0 maple 48.6 � � 0. �o � � � USE 1000 GAL. SEPTIC TANK FOR PUMP CHAMBER Uo 48 6 �• x o wf#6 \ �8' 8 48.7 garden / '`O 41.1 s P h x 1 4' wl ' 7.7 CULTEC LEACHING CHAMBER DESIGN 48.5 2 O 4 fawn 5 41.2 U P & LL `- 7.7 RWHARGER MR OR EQUIVALENT „ ti x 404 I c oq�k XI TI G C SS OOL�S ALL PIPES TO BE SCHEDULE 40 PVC PERFORATED 48.5 48' x \ �\ 5' USE 1 4" DISTRIBUTION LINE IN 4 RECHARGER UNITS \ 7.5 4 TOTAL UNITS 1 STARTER,1 END, & 2 INTERMEDIATES. IN A 12'X 35 WASHED STONE TRENCH AS SHOWN ' 41.3 \ ,, �,, i.4 x 40:7 \ f# 7 6 7.5' 6.25 6 25�4,4 on 48.0 48.1 x e ® -. �� 4,�1 LEACHING AREA REQUIRED e 5 .4 slate patio 40.3 44. wa -� ,� \ 1-1,5 WASHED STONE 440 G.P.D./.74 = 595 S.F. �. 48.6 s 44.7 44.8 50 4 x00 co v c,� r' r' �� o� o .:. .�.: i:.;: 2(35 + 12) X 2 = 188 S.F. SIDEWALL AREA 44.9 a 4 v�l•4:�i C7 0 49.0 x 9' �ti +� r� 0 W 6' s::::':: •. o 44.8 48: 1 \ ,... . :: ,. �i (12 X 35) = 420 S.F. BOTTOM AREA r ' VENT 608 S.F. TOTAL PROVIDED 45.0 /o�r8 7 x 6 x 3� x 3 7 , 35.00' $ o ` 75 �---- ---,� a 4.6 lawn 45.4 s n - f# 44.9 5.4, p�. PLAN OF LEACH TRENCH a X r . �, SEPTIC UPGRADE PLAN C.B. a 45.0 lOTW P"COL wf#9 v ` SCALE: 1" = 20' Iry CROSSWAY PLACE FND. OFF ,.o 44.5 44.8 34,384 sq.ft. WETLAND FLAQGED BY 8.2 /P�� OFPfgss IN . 0.79 acres NSR S.B. �9 /�_�� TEPHEN qcy� OSTERVILLE 35. 8125/99 FND.OFF rn wf#TO / �Lv ( ) x,34.5 x • -� 8.8 �- BARNSTABLE MASS . ge N .so<i s �'' q �o f �3 p9 �8 30 �, gF�tcr alp �¢/� >t k.q S" �' �► wok 9°39, x q5 v G1S7E Gar/ FOR C/Th, �.� went OpdE 13 �Slord COON�'.� \ c.6. 21, ` °'E �o WALTER, E. & MARJORIE H° BIANCIII TRS. TY ROq '�2.5 28,02' FND.OF 96.48 D OTN 8°43'S0'E '35.0 N88°49'10'E TENMa NOTES FOR PUMP SYSM : 1' = 20' 'DATE1 OCT, 12, 1999 SCALE I'gR�g6 FRANK P.L: & LYNNE S. MINARD �F L.C,C. 31743A 1) PUMP TO. BE SIZED BY PUMP SUPPLIER. BAXTER & NYE INC. 30.9 f - REGISTERED LAND SURVEYORS y 2) PUMP TO MEET GENERAL SPECIFICATIONS OF 310 CMR 15.231. CIVIL ENGINEERS ❑STERVILLE, MASS, 3) MAINTAIN CONSTANT PITCH FROM DISTRIBUTION BOX BACK T0' PUMP DEED REFERENCE: BOOK 5301 PAGE 179. PLAN REFERENCES: BOOK 155 PAGE 145, & L.C.C. 31743A: CHAMBER TO ALLOW FORCE MAIN TO DRAIN BETWEEN PUMPING. #99087A