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0088 EAST OSTERVILLE ROAD - Health (2)
88 kEast Osterville Road. sterville P. A — 122 656 r/ U O o U 0 D COMMONWEALTH OF MASSACHUSETTS u EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION t 'V TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION RECEIVED 88 East Osterville Rd MAY 2 4 2005 Property Address: Osterville TOWN OF BARNSTABLE Owners Name:,'r• ''SALANT HEALTH DEPT. Owner's Address: Date of Inspection:5/18/05 Ficis.,..L Oy Name of Inspector: (please print) Douglas A.Brown Company Name: Douglas A.Brown Septic Inspections Mailing Address:P.0 Box 145 Centerville,MA 02632 Telephone Number: 508-420-4534 CERTIFICATION STATEMENT 1 certify that.I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority, Fails Lnsgectar's Signature: Date: 5/18105 R 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. Notes and Comments 500 GALLON CHAMBERS OPENED AND ARE DRY AT THIS TIME ****This report only describes conditions at the time of inspection and under the conditions of use at that time_This inspection.does not address how the system will perform in the future under the same or different Conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Revised on 10/31/2000 I Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: / bt Owner's Name. 0-11, �- Owner's Address: Date of Inspection: 5/18/05 inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information winch indicates that any of the,failure criteria described in 3 10 CMR 15.303 or in 310 CN t 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 Pase'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 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 exBitration 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 inet-A septic Lark-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 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 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Prop" ?address: Owner's Name: Owner's Address: _ Date of Inspection: 5/18/05 C.Further Evaluation is Required by the Board of Health: Cvmditio%twat which require further evaluation by the Board of Health in order to determine if the sy stem 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 I 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: 'y Page 4 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART V CERTIFICATION (continued) Property Address: Os o Owner's Name: Owner's Address: Date of Inspection:5/18/05 D. System Failure Criteria applicable to all systems: You must indicate"yes or no to each of the following for all inspections: ves tale x Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than 112 day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X ?my portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, pQrforme4 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 desctibed in 3 10 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 %Pd- 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 nfl _ 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 public water supply well I€you l.z,aA.answered"ges"to any question in Section E the system is considered a significant threat,w answered yes'm,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 CNIR Page 5 of i l i OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: �9 ` ( lw Owner: 5calCan e Date of inspection: 5MN5 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No- X Pumping information was provided by the owner,occupant, or Board of Health X Were any of the system components pumped out in the previous two weeks ? X Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X Was the facility or dwelling inspected for signs of sewage back up? X Was the site inspected for signs of break out? X _ Were all system components,excluding,the SAS,located on site? X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _ X Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X Existing information. For example, a plan at the Board of Health. X Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3 ))(b)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:- t- �1 Owner's Name: .� �FYflET9�4�TSC99: ;gate of fuspo+ction. NI N05 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): -3 DESIGN How based on 3 1 0 CMR 15.203 (for example: 110 gpd x# of bedrooms): 330 'Humber of current residents: 0 Does residence have a garbage grinder(yes or no): no fs 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 OLI- S Water meter readings,if available(last 2 years usage(gpd)): 03 - Lf or0o0 Sump pump(yes or no): no Last date of occupancy: unknown COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seatslpersonslsgft,etc.): Grease trap present(yes or no):_ hidustrial waste holding tank present(yes or no).- Non-sanitary waste discharged to the Title 5 system(yes or no): — V ater meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: 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 X Septic tank,distribution box, soil absorption system _Sin&cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _InnovativelAlternative 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 Oft►er(describe): Approximate age of all components,date installed(if known)and source of information: 2fiflL Were sewage odors detected when arriving at the site (yes or no)? no Page 7 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: F—:- cs`t` Owner's Name: �tAy owner's&ddress: ;gate of laspeetion: 5113,105 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: X concrete metal_fiberglass _polyethylene other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no): _(attach a copy of certificate) Dimensions: 1000 gal Sludge depth: 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: OFF AS BUILT 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 appears sound baffles are in place GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction: _concrete metal_fiberglass—polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: . Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: f �5 t Le Owner's Name: �.— Owner's Address: Date of Inspection: 5/18/05 t . 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: eallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.):7 .2D-A lien e 1 tJ® PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFFORMATION(continued) Property Address: Owner's Name: Owner's Address: Date of Inspection: 5JJ 3,105 SO-U.ARSORPTION SYSTEM(SAS): _(locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits, number: X Teaching chambers,number: 2 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.): Chambers are dry at this time CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Page.10 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM,INFORMATION (continued) Property Address: '/�'d�l �+V Owner's Name: e,-u1Gv�{- Owner's Address: date of Iwrmtion: 5119/05 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. 31 r6 U 3 -47` 3 Soy ,13a,.cL i d C� Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM I INSPECTION FORM PART C SYSTEM I(( FO;R�MATION (continued) PrapQr Address: �g © ��'I`P -P Owner's Name: Owner's Address: Date of Inspection: SITE EXAM 1 Slope: I—eWe\ back(, V40 Surface water: Check cellar: Shallow wells Estimated depth to ground water 5+ 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: Obsen ed 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: Asbuilt card TOWN OF BARNSTABLEL .CATION SEWAGE #s'100.7' ✓ � V"�.LAGE Ile ASSESSOR'S MAP & LOT I . - INSTALLER'S NAME&PHONE NO. SEPTIC TANK.CAPACITY LEACHING FACILITY: (type) Soc GaL e.4a,,s4-5 (size) NO.OF BEDROOMS BUILDER O WNER 4 5 LL - PERMTTDATE /JAB COMPLIANCE DATE: 11- 1 -01 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) �- Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by p�8 /��` YG , F ��'' .. 1� �Uiob ��� y�� O � - - - - - � � 1 -. �ov � � so' i � � i( f No. 2.00 2-o53V Fee 6 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Application for Zi5poga1 bpgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade(" )Abandon( ) El Complete System LKdividual Components Location Address or Lot No. Ug jm5 ��f% wner's Name,Address and Tel.No. Assessor's Map/Parcel00,®56 Installer's Name,Address,and Tel.No. /v v ` Designer's Name,Address and Tel.No. 7 / 362-y5 Type of Building: c— Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building Ce No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow f�� gallons per day. Calculated daily flow K-340 gallons. Plan Date Z Number of sheets Revision Dye Title SJ /1 ® C/C /e Size of Septic Tank �3 Type of S.A.S. Z —rOD m Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 t ' Board eal . Signed Date Z Application Approved by Date Application Disapproved for the following reasons Permit No. `2 V0 2 —,S-3 0 Date Issued 1 6 No. ?_co 2— S' c Fee r t THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ��,/' Yes ' P;_UBLIC HEALTH.DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 2pplication for Migpogal *ps tem Congtruction permit ' Application for a Permit to Construct( )Repair( )Upgrade(v )Abandon( ) ❑Complete System ['I dividual Components Location Address or Lot No. r�y y- y� f,Jf ©wner's Name,/Address and Tel.No. Assessor's Map //e Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ���, i C���r; f�o1v�r 77/-9 1/9 Type of Building: /c-- Dwelling No.of Bedrooms , Lot Size `b,1 d� sq.ft. Garbage Grinder Other Type of Building _&51W1�OX1e& No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 3L� gallons. Plan Date d/`r (2 7 Number of sheets Revision Da e Title ✓r'/ /.!'/? © - 53� �a7' S _,�'l�/��P �' Size of Septic Tank 141:'Pel 9VII C %skiN3Type of S.A.S. 9� C miyv� Description-of Soil Nature of Repairs or Alterations(Answer when applicable) 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 t 's Board ealth. Signed Date. .t Application Approved by lop, Date Application Disapproved for the following reasons Permit No. 1 0Q "S 3 y Date Issued (I--------------------------------------- g 6 2 P THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTI that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded(+� Abandoned( )by G� 5 at g S l.// F' I^ has been construct d i accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. '2b0 Z-_S 3 o dated b — Installer Designer The issuanci of this,permit shall not be construed as a guarantee that the sysr�e will function as designed. Date 1 I 1 X�U Inspector tl- �. S ---------------------------------------- No. 2002 -53v Fee 3V ..- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migpogar 6pgtem Congtruction Permit Permission is hereby granted to Construct( )Repair( )Upgrad (✓)Abandon( ) System located at G`4� /' >YG'/'ri' r� ez 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:Construct on must be completed within three years of the date of this perm Date: (� 0 Approved by I t ` • r� . t ,r COMMONNVEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMIi;NTAL AFFAIRS A DEPARTMENT OF ENVIRONMENTAL PROTECTION 4 EEE 4 V - TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:. � dtnd Owner's Name: r Owner's Address: Q { 5 Cal Date of Inspection: 44, " Name of Inspector: (please rint) f _�I, Company Name. , �t ��r���/��� � � - Mailing Address: v C et,, Telephone Number: S(a$-• 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 tirne of the inspection.The inspection.was performed based on;ny training and experience in the proper function and maintenance of.on site sewage disposal systems. I ant a PEP approved system inspector pursuant to Section 15:340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes N s. urther Evaluation by the Local Approving Authority ils Inspector's Signature.: / Date: . = �0 The system inspeetor'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.systera 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 origuaal should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. . Notes.and Comments ****'Phis report only describes conditions at the time of inspection and under the conditions of use at(fiat 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 � r Page 2 of.1 l OFFICIAL INSPECTION FORM.—N T FOR`VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART A CERTIFICATION (continued) Property Address:15 Date of nspection. �✓,�f.�J Inspeetion Siimmary:. Check A,13,C D or E'/ALWA' S complete all of Section'D A. ystem Passes: lave riot iounel'airy urfc;i nation which<indicates hdt any of life Wore eriieria described'in 31d:CMR =' 15:303'or in 31-6 LIAR I5.304 exist:Any failure criteria n t evaluated are indicated'beiow. Comments: B. System Conditionally Passes: One or more system components as described in tlfe"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacemenl or repair;as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the or the following statements. If"not determined"please explain. The septic tank is metalw and over 20 years old* or lie septic tank(whether metal or not) is structurally unsound,exhibits.substantial infiltration or exfiltration or b�tank failure is imminent. System will pass inspection f the -existingtank.is replaced with a com l in' se tic tank as al roved b p p y g p pp y the Board ofl-Lealth. *A metal septic tank will pass inspection.if it is structural y 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 higli.static water level in the distribution box due to broken or obstructed.pipe(s)or due to a broken,settled or uneven ditribution box. System will pass inspection if(with . approval of Board of Health): . brokenpipe(s)are replaced obstruction is removJd distribution box is,ae b eled or replaced ND explain: The system rewired 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 rep aced obstruciion..is remove I . ND explain: ' Page 3 of I'l OFFICIAL INSPECTION FORM - NOT FOR,VOLUNTARY:ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATIOM(cot tinued). Property Address: A r Owner: Date or uspectiol& ,An C. Further.Evaluation is Required by the Board of Health: Conditions.exist which.require further evaluation-by the Board of Health in order to;detennine if the system is failing to protect public health, safety or the environment. ioes incrda MR15i. m 03balat the " system is not functibning`in a manner w' llich.will protect public health,safety'aud.41,ie envirolilnemf: Cesspool or privy,is.within 50 feet of a,surface water t Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt nnarsh 2. "Systeni will fail.unless the Board of Health(and Public Water Supplier,if any)determines that the system is.functioning in a.nianner that protects tile.publichealtlt,safety and envirou'liient: The syst6 n.has a septic tank and soil absorption'syster n(SAS)and tlne SAS is within 100 feet of a 'surface:water supply or.tributary.to a surface water supply. The,systenn has a septic tank and SAS and the SAS is witlnini 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 systein.has a septic tank and.SAS and the SAS is less than 100,feet but 5.0 feet or more from a private water supply well**.Method'used to deiernnine distance **This system passes if the well water analysis,performed at a DEP certified laboratory, for colifornn bacteria and volatile organic compounds indicates that the well is free from poilutioii from that facility and tire.presence of.ammonia niitrogen,and'nitrate nitrogen is;equal to or less tha7 5 ppin,provided that no other failure.criteria are triggered. A,copy of the.analysis niust be attached.to.this form. 3. Other: 2 3. � 1 Page 4 of I 1 OFFICIAL.INSPECTION FORM NOT FOR VOLUNTARY ASSESSMVNTS SUBSURFACE SEWAGE"DISPOSAL SYSTEM INSPECTION FORM PART A. CERTIFICATION(continued) Property Address: Owner: Q Date o nspectio •. D. System Failure Criteria applicable to all systems:. You must indicate"yes"or"no"toeacli of tlie•following for all inspections: Yes tic .,, c,, Backup of.sewage into facility or system component due to overloaded or clogged SAS or cesspool ischarge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or logged SAS or cesspool tatic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool v.,/Liquid depth in cesspool is.less than 6"below invert or available volume:is less than %2.day flow . equired;pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped _ V Any portion of the SAS,cesspool or privyl.is below high ground water elevation. ny 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- 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 ithat the well is free from pollution from that facility and t.he.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 musflJ6 attached to this form:] �r (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 file system fails:The systetn owner should contacHhe Board of 'Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a.large.'systeinahe 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 drinkingwater supply pP Y the system is within,200 feet of atributary 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. 4 g Page 5 of 1.1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE 01SPOSAL SYSTEM INSPLCTION'F.ORM PART B CI-1ECKL,IS1' Property Address: So &wt Owner: ff Date of Iiispectio �s�/(L/ ' Check if the following have bee►idone You must indicate"yes"or"iio"as to each of the.following: Yes No - ,> -f PWni�ing.i►,lotrnatioin.was provided by the owner, occupat,t,or.L'oa,d�f Ilealtltr, r_ r V Were,any of the system.components pumped out in the previous tvvo weeks? Has the system received normal flows in the previous two week,period — lave large.volumes.of water been introduced to the system recently or as.part of this inspection? t, _ Were as built plans of the system obtained and examined?(if they were not ayailabl.e note as.N/A) _ Was the facility.or dwelling inspected for-signs of sewage backup Was the site inspected for signs of break out? r Were all system components,excluding the SAS, located on site _ Were the septic tank uaanlioles uncovered,.ope►ned, and the interior of the tank.inspected for the condition of t/he baffles or tees, material of construction, dimensions,depth of.liquid, depth,of sludge-aind depth of scum 7 y _ Was.the facility owner(and occupants if different from owne.4pro.vided with information on the proper maintenance of subsurface sewage disposal.systems? on[lie site has been determ.ined based on: dlocation.ol`the Soil Abs,or.rtiou 5 sleur `SAS . The size an 1 Y (SAS) Yes no R _ Existing information. For example,a plan.at the aoard of Health. Determined in the field(if any of the failure criteria related-to Fart C.is at issue.approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] r 5 I Page 6 of 1 l ' OFT><C_IAL-INSPECTIONIVOIZAI`=NOT FOR VOLUNTARY ASSESSMENTS . su,.Bs)RA.C'T SE WAGE DISPO:.SAL SYSTEM-INSPrC`TION.l ORM PART C - SVY TIEMI INrO.RMATION Property Address: - 4 _ ;e?h �eo-ea r . A Owner: l Date o.f.,nspection: 41,�t� FLOW CONDITIONS RESIDENTIAL �. Number of bedrooms(design) Number of.bedrooms(actual):, DESIGN flow based on 310 CMR 15.203 (for example: 11:0'gpd x#of bedrooms): _ IfNumber of cnrrenf residents: Does'residence.'have.a garbage grinder(yes.'or no):� Is laundry on a separate sewage system (yes or no): ,�[if yes separate inspection required] Laundry system inspected(yes er no )� Seasonal use: (yes or no): Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no.: A Last date ofoccupancy COMMERCIAIJINDUSTRIA.t O Type of estal lisli'ment:.. Design flow.(based on 310 CMR.15.203): gp.i ' Basis of design.flow'(§eatslpersons%sgft,etc,): Grease trap present(yes or no): Ind►rstrial waste.holding tank present(yes or no):_ Non-sanitary waste discharged to the Title ,5 system(yes or no): Water meter readings, if available:- La.st date of occupancy/use: OTHER',(describe): GENERAL INFORMATION Pumping Records Sourceofinformation:•. Was system.pumped as Part of the' in pection(yes.or no): If yes, volume pumped: gallons--'I-low was quantity pumped determined? Reason'for.pumpingi . TYPE Or 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.Aiaach a copy of the current operation and maintenance contract(to be obtained from system owner') Tight tank _Attach a copy*of the DER approval —Otlier`(describe):ao atj,J �P/Jp, ;, � sa2 .S �c lIiJGG� A proximate age of all components, date installed(if known)and source of information: Were-sewage-odors-detected when arriving at the-site(yes'or noLA_ • Page 7 of l 1 OFFICIAL INSPECTION FORM=NOT FOR VOL.UNTARY ASSESSMENTS SUBSURFACE SEWAGE'DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM.INFORMATION(continued) Property'Address: A Owner: , Date o'nspectio / —,OC)� 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: Continents(on condition of joints,venting,evidence of leakage;etcrt): ;,, ' K: K SEPTIC TANK: locate on site ., plan) , Depth below grade: Material of construetion:.::�41cre.te_metal fiberglass Ipolyethylene —other(explain) If tank is metal list age:_ Is age confirmed by`a Certificate of Compliance(yes or uo):'_(attach a.copy of certificate) Dimensions: ? !V K Sludge depth:� —x Distance fi-onm top of sludge to bottom of outlet tee or baffle: Scum thickness: /ll Distance f-om'top of scum to top of outlet tee or baffle: •Distance,from bottom of scum to bottom of outlet tee or baffle: 1-low were dimensions determined: Comments(on pumping recomnren bons,inlet and outlet tee or baffle condition,structural integrity, liquid levels s related to outlet invert,evidence of leakage,etc.): e `cede GREASE TIZAI (locate on.site plan) Depth below grade: Material of construction:_concrete metal_fiberglass_polyethylene_other w (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance f-orn bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Continents(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 SUBSURI+ACE SEWAGE DISPOSAL SYSTEM INSPkcTION FORM PART C ,SYSTEM INl+ORMATION'(continued) Property Address: ' _ fJ Owner:- v Date o nspection. 7 / TIGHT or HOLDING TAN tank must be pumped at time of inspection)(loeate on site:plan) Depth below grade: t�taterial cf constructi:on: co: cre!e.. metal fiber lass ool ethvi-ne, otber(explain): Dimensions: _ Capacity: gallons Design Plow: 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 1307 ¢ 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.): PUMP CHAMBE ocate on site plan) Pumps in working order(yes.or no): ; k Alarms in working order(yes.or no):.. , Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): s Page.9 of 11 OFFICIAL INSPECTION.V ORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART C SYSTEM INFORMATION.(continued) Property Address: tett Owner:Date o nspection: t�/� SOIL ABSORPTION SYSTEM (SAS):._,Aocate on site plan,excavation not required) If SAS not located explain why: a..Sn.F•S,-,..6d _:44,. .; � Sr$... .,,;«- ,:.:-., �.E. c. '.: sc .3,;G+rr Y ` r.:.s+:' - Type eaching.pits,number: . Teaching chambers,number: . leaching galleries,number: leaching trenches, number, length: leaching fields;number, dimensions: overflow cesspool,number: in.novative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil;condition of vegetation, etc.): . 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 scurn layer: Dimensions of cesspool: _ Materials of construction: . . Indication of groundwater inflow(yes or no): t Comments(note condition of soil; signs of Ir draulic failure, level of porldirrg,ccondrtion 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.): 9 Page 10 of 11 OFF41CIAL INSPECTION FORM NOT FOR VOLUNTARVASSTSSMENTS SUBSURFACE SEWAGE DISP ,SAL SYSTI+JM INSPECTION FORM P1�n��?_' C. SYSTEM INFOtt IATION(continued) Property Address: Owner U Date of.Inspection. '�/Q/. SKETCH O,SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system includi g ties to at-least two permanent reference landmarks or be.nchniar" Locatc all wells 100 feet, Loc,ae i��"ere public water sjpply ertas the building. . 4 _ L 0 h 10 Page l I of 11 OFFICIAL INSPECT ION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUB.SURI'ACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C . SYSTEM INFORMATION(continued) Property Address: Owner: 202G/L_} Date of'1(nspection: 1�7 /;c�U/ SITE EXAM Slope- n. _Surface water Che ck cellar.Shallow wells { ♦ r .. .ti.2}.uYA:. ..; �l:..a...d. .'.::r. ....., .�,. Estin;ated depth to.ground water .L �: 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) Cliecked.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,grouud water elevation �I i ` 11 era a 7"�' S�Q• / 1 No.. Fmz./....a�..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD HEA T -..OF..... ..... Applirutluu -fur Uifiposal Workii Totui#.rurttuu Vrrmft Application is hereby'made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System a : � . •--•_--.. .......... •. ...................... ......................................... ocatio dress or I qt No. ..........j . .............................. .................. ... y O G Add W •. - •. --•--- --•--•--•-•- � �Installer Address UType of Building Size Lot_._._l�. ......... ..Sq. feet Dwelling—No. of Bedrooms..__.--------3---------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ......-,—°r'.`c- -----•----••---------------- -- ---------------------•-------•--._-.--- --------•------------------------ �` Design Flow____________________________________________gallons per person per day. Total daily flow.......... -.:®..d..................__gallons. W WSeptic T.,nk—Liquid capacit/_ gallons Length................ Width-.............. Diameter-----........... Depth..--_--_.----- x Disposal Trench—No- ____________________ idtl�..........._._ Total Length----------- -...... tal leaching area..-.--.._--_--__--sq. ft. Seepage Pit No.__ � ®"B=_ ...._...._. ow ' _____________ ___ otal leaching areaa.0__?.__sq. ft. Z Other Distribution box ( Dosing nk ) - C 4j • 7-12/ 77 W Percolation Test Results Performed by._--. G _ Date..:__ �_�!-_ ...... Test Pit No. 1----------------minutes per inch Depth of 'Pest Pit_---------......... Depth to ground water..__.------..-_.------ G14 Test Pit No. 2-----------------minutes per inch Depth of Test Pit____________________ Depth to ground water__.-.__.____-_._-.--.--. n ------------ •--_-------•---- O Description of Soil -f� Z.. l . . �?__ .`... 3 U ------------- --------------------------------------------------------------------------------.------------------------------------------------------------------------------------------------- -------------------------W U Nature of Repairs or Alterations—Answer when applicable...__________________--------------------------------------------------------_------------------ --------------------------------------------------------------------------------------------------------------------------•-----••-•-------•--------------•------------------------------------•----... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article aI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the oard of health. Sig -•--_.. _. .. --- --------- �.. Date Application Approved By--------------------------�'- - .---•. - - - - - - - --- -,------ .•. Date Application Disapproved for the following reasons------------------------------------- -----------------------------------------------------------•--------------- ----•---•--•--•--•.--•---------------••------•----------------•---.-------•------------.-----••------.---.. Date Permit No. Issued. .(-- -................................. Date �� - '---- — --------------------- --- z 1 � No ... 1. !FEE.............................. i c 41E COMMONWEALTH OF MASSA.CHUSETTS 1` .,. BOARD e F H VLTH O ....................... :XVIIiration -for Diipjaiia1. prk� . vtu rurtivn Verutit Application is hereby'made for a Permit t9 Construct ) or Repairs ( ) an Individual Sewage Disposal oe f __.____�______________ ___________ ___ .............................................O Loca n lAddr s (yam.yy yoya�No. ------------------- --•---- ------- ............................................................ ..........._..._........... .............................................................. Installer Address d Type of Building Size Lot............................Sq. feet U g— ___---------- Attic ( ) Garbage Grinder ( ) Dwelling No. of Bedrooms_________________ ___________ — Other—Type TYP e of Building _. No. of persons____________________________ Showers ( ) Cafeteria ( ) a -- -u--•- Other §xt6es ------------------------------------------------------ ------------------•----------------------------- ---------------------------------- Desi n Flow------------------------------- tllons per person per day. Total daily flow............................................gallons. Septic "l'.ulk—Liquid capacity-.--.-__-- _ r on i Len-h---------------- Width-.-- ----_.-_-- Diameter................ Depth---------.-.---. Disposal Trench INtdth__ ..._ T al Le Total leaching lrea_. s ft. x p f G �1.' �it �r x .—,.°o. g 3;. --a----- q Seepage Pit No-----------------� Diameter.. .... .......... Depth Belo inlet_- ________-__._-__ Total leaching area-------...........sq. ft. z Other Distribution box ( ) Dosing ank ( ) � - PC/ ► ;t f"" %`r ~" Percolation Test Results Performedjby.__.,6A __j-`--X e---------- -------- --------- Date. __` '-.�1- -----. � . Test Pit No. 1----------------n mutes pe nch Depth of lest ' it-.._.__-___-____-_-. Depth to ground water..__---.._----.--....... !X4 Test Pit No. 2----------------minutes p, inch Depth of Test Pit.................... Depth to ground water_-..-.-------__-_--_- f -•-- ..............................................O - Description of Soil .S '` �'- ------`... -'Z;-`- ---:. .. _.. 7 x . V --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- W V Nature of Repairs or Alterations—Answer when applicable.-.-_--------------=-------------------------......--------------------------------------------- . A -- -------------- Agreement: - The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agre s not to place the system in o eration until a Certificate of Com liance has lien issued t 'boar of ea Si •---- - - -•-- ------------------•---------- -•-'Date--"•-"-------- Application Approved BY------------------ -- .--- -• • - ------ .....--.X `---?2--- Date Application Disapproved for the following reasons_____________________________________________________________________ ----------------------- ------------- .................. --------------------------------------------------------------.................................................................................................................. Date PermitNo........................................................ Issued........................................................ Date THE COMMONWEALTH OF MASSA(,VUSETTS BO"ARD,- F HET (1:11p of irate of Tomphaurr THjL-S;-IS TO CERTIFY/That e, dividual Se age Disposal System constructed ( ) or Repaired ( ) / 6'}c by........ ' i L. ---- ------r= -- ---••--•-•••- nstall at.... 9'r/...................."•--•---- -•-•---"----------------•----------•--•----------------------------•------------------------•-----•-•"--------------•-•----------•--•------------------- has been installed in accordance with the provisions of VItic e XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.- _._...= _ '_ _____________ dated....... 1.-..7-7................ THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ..................... Ins pector--------•-••--------------• --_--- THE COMMONWEALTH OF MASSACHUSETTS BOARD �6 HEAL 8� O F................. ............................... No.......•--•-••••• FEE........................ Permission "sr eM seby granted-------- ---•- --------- ...s ro/� �; .... ._ .r to Construct l' or epair ) a Indi idual- ewa e spo. ys m � at No. ---- -- -------'—-... `` - _- ... - --. ...... Street- as shown on the application for Disposal Works Construc ' P o Dated-_-{ `�l "'7'!............ Board Health DATE............. ----------------------------------------------------------------- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS ' - DESIGN DATA -nb le Family - 3 Bedroom ti o Garbage Grinder � • Flo-,3 - 110 X 3 = 330 GPD ' y 330 X150% _ 495 GPD ��z�tic Tank = Ilse 1000GPD wsnosal Pit - 100OGal. 0 r v• �iciewall Area - 150 SF ; f/vt? " 1.50 X. 2.5 r 375 GPD V) iL * ottom Area - 50 Sf 50 GPD M 4� ! 1'3 �r al Design = 425 GPD "ota.l Daily Flow = 330 GPD , r'4'rc Test - 1 " in 2 Min or Less FL 114/v ' 4' 4� 4' PIPE - /�v v. 9 f, z l$,� t e•t J• 9.v.F� f 1, oco GA t 9T (s pE>zc, S C P ri G "+R Nt4 7/Z(,/77 J J PA r � f� / mo,-s-, LC> PL--A," Z (.'XCo t EAcN PiT G6RTt��( T"AT Tt4r- t=4UNDHTIGN e>"Otiv►.i -�•F..i A F �c►JC t-rEQ�as� GE /LPL�(S W ITF� 'f�-tic j1UE.i,t6.�E: LO T Awn SETV>ACV- WC-QU"ZG�vtG TS o� TNT 1,. G, 3 zz.25 U a IV O;= 06T ERV1 L.'I- i's4 Ti a 6uCVa,fc�eS TNiS dC�AW lS L1aT BASEto OsTe— Evu.LS, OW 4" o I�rCA►S�r tt,l4T2CJ,i✓CEtJ; SvQv' � Tttc- c TS 5t�owt.�a Ap9L._tc41%"-r ^Ptw Wvrmc DE`��:�» v str p To D e:T M IZA 04t= Lc>-r 4 c..l"CL-r am �. ....-._.___ TOP FNDN, AT EL. 54.7' SYSTEM PROFILE TEST HOLE LOGS ACCESS COVER TO WITHIN 6' OF FIN, GRADE (NOT TO SCALE) AH OJALA, PE / ACCESS COVER (WATERTIGHT) TO ENGINEER: / MINIMUM .75, OF COVER OVER PRECAST /� WITHIN 6' OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM 52.4' WITNESS: DONNA MIORANDi, RS ? �9�� sr 2' DOUBLE WASHED PEASTON DATE: 10 RUN PIPE LEVEL ,[22/Q? � �� �11 EL. 51.5' FOR FIRST 2' 3 MAX. PER(. RATE < 2 MIN/INCH EXIST. 1000 GALLON SEPTIC 50.36 CLASS I SOILS P# TANK (H- 10 ) GAS �� U67' [] [� [] [] O L C3 0 1-.] CARLISLE '• BAFFLE 1\ 49.84 0 49.53 0 171 0 0 a CO 0 0 1-1 $ 6 CRUSHED STONE OR MECHANICAL M ID 0 M 0 M CO 0 El �� 7i ELEV. mod' DEPTH OF FLOW = 4' COMPACTION. (15.221 f2b $ 2' 0 0 0 0 0 0 0 0 E] o" 47.53' 0-` 0&A 52 $ ��P LOCUS NP�pN TEE SIZES „ ( 2 % SLOPE) ( 1 % SLOPE) 3/4' TO 1 1/2' DOUBLE WASHED STONE LS INLET DEPTH = 10 4" 1OYR 2/1 OUTLET DEPTH = 14" E FOUNDATION--- EXIST. SEPTIC TANK 13' D' BOX 16, LEACHING FS LOCATION MAP NTS FACIL!TY 5" 1OYR 5/2 4.73' B ASSESSORS MAP 122 PARCEL 56 *CONFIRM EXISTING INVERT PRIOR TO LS INSTALLING ANY PORTION OF SYSTEM 30 10YR 5/6 50.3' 42'$, PERC ® C 501, MS 10YR 6/6 I 5oa 120 42.8' NO WATER ENCOUNTERED + sls 150.00' NOTES: + 52.5 - - - - - - 1. DATUM IS APPROXIMATED FROM QUAD + 52,8 SEPTIC DESIGN: (GARBAGE DISPOSER IS NOT ALLOWED > LOT 7 EXISTING I \ 53.5 + 53.2 DESIGN FLOW: 3_ BEDROOMS (1.2 GPD) = 330 GpD" ?, ► � +.IlrtPt.i �� TFP IF_. .. I 502 PAWED DRIVE 53.8 16,500f SQ. FT. _ USE A 330 GPD DESIGN FLOW 3. MINIMUM PIPE PITCH T❑ BE 1/8' PER FOOT. I \ I SEPTIC TANK: 330 GPD ( 2 > = 660 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H-10 -- 5. PIPE JOINTS TO BE MADE WATERTIGHT. y a + 2.4 USE A 1000 GALLON SEPTIC TANK (RE-USE EXIST) 6, CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. p I yG LEACHING: ENVIRONMENTAL CODE TITLE V. POOL s2.7 2(30 + 9.83} 2 (.74) = 118 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT SIDES: TO BE USED FOR ANY OTHER PURPOSE. BOTTOM: 30 x 9.83 (.74) = 218 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4' PVC. 0 9 COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT 7 4 O + 52.4 o TOTAL: 454 S.F. 336 GPD INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED D K o USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR FROM BOARD OF HEALTH. ` EXIST. DWELL. EQUAL) WITH 2.5' STONE AT SIDES, 4' AT ENDS AND 5' 10. PUMP & REMOVE (OR FILL W/CLEASAND) EXISTING LEACH PIT1 I tP TF 54.7' BETWEEN UNITS 11 , tZFMOu >; AKY vu'u vtAVXs, �-:ou.g w tTtj k*j 5' of- S•A•S. 02.4 23' .2 LGN TITLE 5 SITE PLAN 25' + + 52.1 OF 100.0 PROPOSED SPOT ELEVATION + 52.5 88 EAST OSTERVILLE ROAD + 53.3 + 100x0 EXISTING SPOT ELEVATION IN THE TOWN OF: BENCH MARK - CTR. OF 53.5 C.BASIN. EL. = 49.1 I H + 52.4 100 o PROPOSED CONTOUR ( O S TE R VI L L E ) B A R N S TA B L E .7 I 100 EXISTING CONTOUR PREPARED FOR: BORTOLOTTI CONSTRUCTION /WALL 150.00' I so. I + 52.9 20 0 20 40 60 4 9 0 J ? EXIST. SEPTIC TANK (RE-USE IF IN SUITABLE OPERATING CONDITION AND SUITABLE SIZE) BOARD OF HEALTH APPROVED DATE MA SCALE: 1' = 20' DATE: NOVEMBER 2, 2002 off 508-362-4541 fax 508 362-98M down cape engineering, inc, �o�� ARNE H �yGn ��`�r of. MAJcy OJALA ARNE H. VIL CIVIL ENGINEERS No. 4 0A�A No. 25348 e LAND SURVEYORS '�o� ISTE q .psi�? �P 939 Main st, yarmouth, ma 02675 2--34 AR OJALA, ;" .L.S. DATE �