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0044 EEL RIVER ROAD - Health
44 Eel River Road OsterviIle -P 116090 d n a ° } y `-� ��, j � �A � u e � ° �, � v - eS�'Ti ''v -��"--•"'`�.'�9 7 � .. ���r—i�[!"g -'�3' , ° ° r , q ° 0 e ➢ P e � ° a z o ^ ° ° c ° e ' ° TOWN OF BARNSTABLE LOCATION Sy EEL R;ucr RA.- SEWAGE# ZOZI - OSL VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY JSOO qca. LEACHING FACILITY:(type) S009oA 1 LIC CT-) (size) 13x ZS X 2 NO.OF BEDROOMS 3 OWNER Pouil PERMIT DATE: 3-1 -21 COMPLIANCE DATE: Z 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 l Al- 3y Az-' yo (33" Z3 3 C3 - Z3'S (34, C4 - Z4,��, c n O R F"rarA � f�77 ff �Co b No. CtiVI D Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Nplitation for Disposal *pstrm Construction 3pPrmit Application for a Permit to Construct( ) Repair(X) Llpgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No.LK rC ek Kwq c 9,00,6 Owner's Name,Address,and Tel.No. Not pwor to s O Stcc%;.ue,Assessor's Map/Parcel k t t. I q 0 44 e2` Q'NVCr Za. 0SA-tolkw Installer's Name,Address,and Tel.No. 3 S iuxco.-jdt�o N Designer's Name,Address,and Tel.No. F lahc{� tint/;rvrru,.}„ 314 aook-a, 130 Sa�d�i�c;h Sog• u47-o(,53 Pa 160x 331 Nato,01 MA 010!;' -e4•ggN• W, Type of Building: Dwelling No.of Bedrooms 3 Lot Size 36, '7 Sy sq.ft+( Garbage Grinder(po) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 34 S gpd Plan Date Number of sheets 2 Revision Date Title Size of Septic Tank 1 SO a kor% Type of S.A.S. �2 SOU llor� UG S Description of Soil eke 010 n3 Nature of Repairs or Alterations(Answer when applicable) ON 600 !o\16n JIT . 6 .6x O,nd ft) E-1-20 .SOO a o,\\o,. Lies. 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 Certificate of Compliance has been issued by this Board of Health. Signed Date Z 22 I Application Approved by Date Z Application Disapproved by Date for the following reasons Permit No. "� Date Issued 2 t �' 7 •, �k y�{b / t No. Fee _S ho P, THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:• t r l.. Yes PUBLIC HEALTH DIVISION TOWN-OF.BARNSTABLE, MASSACHUSETTS .0 i, 2pplitation for Bisposal �&pstrm Construction j9ermit Application for a Permit to Construct( ) Repair O d Upgrade( ) Abandon( ) ©Complete System ❑Individual Components Location Address or Lot No. t.,\ Kvq c Q,oa c\f Owner's Name,Address,and Tel.No. N,3t osor l,s Assessor'sMap/Parcel, IIt,,, `14 t4 � O,\JQr Installer's Name,Address,and Tel.No. cc,,>6-6 o,, Designer's Name Address and Tel.No. C1GVnt G '�'44 aoAc t-,o' andt.i,ih 4cki,�,a(j,, Pic, 0'7,cOy�- TJLI.Chclt4' Type of Building: Dwelling No.of Bedrooms 3 Lot Size �• rl :S ; 1 sq.ft.'/ Garbage Grinder(lyo) Other Type of Building. No.of Persons Showers( Cafeteria( ) Other Fixtures Design Flow(min.required) S's O gpd Design flow provided gpd Plan Date" 2 t Z t Number of sheets Z Revision Date Title -Size of Septic Tank (may.O C) ct n,�.n Type of S.A.S. (I.') Description of Soil Nature of Repairs orAlterations(Answer when applicable) fNo, ) 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 Certificate of s Compliance has been issued by this Board of Health. -, fi 5 Signed P:c" �t_ �`7Lc --� Date Z 1 Z2/?.I I Application Approved by = -..� _ �~, , Date r Application Disapproved by Date r C for the following reasons F. Permit No. ( (f O � Date Issued ��r� Tail 31,�Id r THE COMMONWEALTH OF MASSACHUSETTS ' BARNSTABLE,MASSACHUSETTS f Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by f� I �, t_Cn k x,�'v lnc. at ?i•ve c nark has been constructed in accordance l with the provisions of Title 5 and the for Disposal System Construction Permit No. ?..t1Lt "00dated J + Z Installer �•f7, r�Y (r�i�a�•,tsn 4ac .Designer V->LaNNarl,, #bedrooms 13 Approved design flow ?j 0 gpd The issuance of this permit shall not be construed as a guarantee that the systemwtll function askdestgned. t Date J ca Inspector. t ^� - - —_--.-_---- ,__ - - ._- No. '� � Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal .6pstem Construction 7"llermit Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( )' System located at L(j and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with LDtle 5 and the following local provisions or special conditions. r ovided:Construction must be completed within three years of'the date of this permit./� -� ate 3 / t F-L 1 Approved by Town of Barnstable .�"E' i.� Inspectional Services Y' ,Public Health Division • BnRtvsraBte. Thomas McKean,Director ? c ° 200 Main Street,Hyannis,MA 02601 } Office: 508-8624644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 3- ►0- Z Sewage Permit# ZoZ 1 -os6 Assessor's Map\Parcel. 11 L-90 Designer: X)omac F•l"=rAc :A Installer: ., �' �xca����1'o^, Address: Q o lox 331 Address: Jy Tc4ScrrW Iry �cj,r��;cl� irlra► Fo rc.51 doL lc M A On 3-i- 2 l (3 ExeaVoA i or, was issued a permit to install a (date) (installer) septic system at L4Q. EEL based on a design drawn by (address) (�,,,s F•lah�r� dated Z-18- Z 1 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. ,Strip out (if required) was inspected and the soils Were found satisfactory. X_I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. �� . I certify that the system referenced above was constructed in:¢ar�rc lla c I with the to rms of the RA approval letters (if applicable) ���` ~ 1 m4so. � AVID n o D. �. F(AHcFTy,3R. (I taller's Si )ZA N�• 211 Cj a I- 'T 1 k esigner's Signatur (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. WoMdeptMEALTHISEWER connecASEPTICMaigner Certification Form Rev&14-13.DOC ,t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M 44 Eel River Rd. r Property Address _j Quinn 0 Owner information Owner's Name i is required-for a.. every page. Osterville MA 02655 6/20/18 City(rown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information S/ 1. Inspector: Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 City/Town State Zip Code 508.272.6433 13010 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage-disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 6/20/18 Inspecto ignatu a Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, .if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the'system will perform in the future under the same or different conditions of use. t5ins.doc•rev.6146 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 44 Eel River Rd. Property Address Quinn; Owner information. Owner's Name is required for Ostervllle . every page. , MA 02655 6/20/18 Cityrrown State Zip Code Date of Inspection B. Certification (cont.): . Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any'of the failure criteria described in 310 CMR 15.303 or in 310 CMR,15.304 exist. Any failure criteria not evaluated are . indicated below: ; Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair, as approved by the Board of Health, will pass._ Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined,,.please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with•a complying septic tank as approved by the Board of Health.. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the:tank is less than 20 years old is available. ❑ Y ❑ N., ❑ ND{Explain below): , t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -,Not for Voluntary Assessments wM 44 Eel River Rd. Property Address Quinn Owner information Owner's Name is required for every page. Osterville MA 02655 6/20/18 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑, obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): r f C) Further Evaluation is Required by the Board o Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc•rev.6116 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 44 Eel River Rd. Property Address Quinn Owner information Owners Name is required for every page. Osterville MA 02655 6/20/18 CityTrown State Zip Code Date of Inspection B. Certification (cont 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: s D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® Static liquid level in the distribution box above outlet invert due to an overloaded El or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 44 Eel River Rd. Property Address Quinn Owner information Owner's Name is required for every page. Osterville MA 02655 6/20/18 City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ , ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] 1 ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑` ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M se''p 44 Eel River Rd. Property Address Quinn Owner information Owner's Name is required for Osterville MA 02655 .6/20/18 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ :,, Pumping information was provided by the owner, occupant, or Board of Health ❑ iE 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) . E ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins.doc-rev-6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 l 6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 44 Eel River Rd. Property Address Quinn Owner information Owner's Name is required for Osterville MA 02655 6/20/18 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Cesspool to overflow precast pit Number of current residents: 0 Does residence have a garbage grinder? ❑ Ye .�No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available (last 2 years usage(gpd)): Detail Sump pump? ❑ Yes ® No Last'date of occupancy: SeasonalDate 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 44 Eel River Rd. Property Address Quinn Owner information Owner's Name is required for - every page. Osteryille MA 02655 6/20/18 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: No recent pumping per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason.for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ® Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 44 Eel River Rd. Property Address Quinn - Owner information Owner's Name is required for every page. Osterville MA 02655 6/20/18 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Cesspool per age of home and overflow precast pit 1975 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 4, Depth below grade: feet Material of construction: ® cast iron ❑40 PVC ❑ other(explain): >10 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: . n/a feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) No septic tank If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins.doc•rev.6/16 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 44 Eel River Rd. Property Address Quinn Owner information Owner's Name is required for every page. Osterville MA 02655 6/20/18 Cityrrown State Zip Code Date of.lnspection D. System Information (cont.) Septic Tank(cont.) 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.): Grease Trap (locate on site plan): `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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 44 Eel River Rd. Property Address Quinn Owner information Owner's Name is required for every page., Osterville MA 02655 6/20/18 City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6/16 : Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments SVe,� 44 Eel River Rd. Property Address Quinn Owner information Owner's Name is required for every page. Osterville MA 02655 6/20/18 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert n/a i level ndistribution tl a ual n evidence of solids carryover, an Comments (note If f,ex s eve and to outlets equal, any ry y evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working,order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 44 Eel River Rd. Property Address Quinn Owner information Owner's Name is required for Osterville MA 02655 6/20/18 every page. Citylrown State Zip Code Date of Inspection D. System Information(cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology. Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 1000g precast leach pit, dry at this time, 34" cover raised to 2'of grade, stain line 4' below the invert, sidewalls above stain line are clean, no indication of past hydraulic failure, bottom of pit 12' below grade Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration cesspool to pit Depth—top of liquid to inlet invert dry at this time Depth of solids layer Depth of scum layer n/a Dimensions of cesspool 6x5 Materials of construction block Indication of groundwater inflow ❑ Yes ® No t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 44 Eel River Rd. Property Address t Quinn Owner information Owner's Name is required for every page. Osterville MA 02655 6/20/18 City/Town 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.): Soils are compact and dry Privy(locate on site plan): Materials of construction:_ Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc-rev.6/16 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 M , 44 Eel River Rd. Property Address Quinn Owner information Owner's Name is required for every page: Osterville MA 02655 6/20/18 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately - r n scKL-C-� t5ins.doc-rev.6/16 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 44 Eel River Rd. Property Address Quinn Owner information Owner's Name is required for every page. Osterville MA 02655 6/20/18 . Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: Check Slope ❑ Surface water = ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 15' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: n/a Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: Previous inspection GW 16' ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: Site is 18'msl and nearby wetland is 3'msl You must describe how you established the high ground water elevation: The estimate to GW is an estimate and has not been confirmed with a test pit. Per the estimate with the bottom of the pit at 12'the 4' seperation to groundwater has not been met Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M ,0y'et 44 Eel River Rd. Property Address Quinn Owner information• Owner's Name is required for every page. Osterville MA 02655 6/20/18 Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information=Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 CAL S T Z4-Z5 -\ COMMONWEALTH OF rMF' ASSA C W TS EXECUTIVE OFFIELO ' VWO'NMENTA L AFFAIRS c DEPARTMENT OF^EIVVIItU�NMK TAIL PROTECTION x.�..,, REP .. i ? FP RCEL, 14 2004 } LOT TOWN OF BARNSTABLE - ,I,I,I,LE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A \J CERTIFICATION _ . Property Address• Qc,, Owner's Name: Owrker's.Addre ;0 �a A., AJ Date of Inspection: ,� - 1 Name of Inspect (please print) Company NameZo Mailing Address: ,U" 0V Telephone Number: (� ' 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: _L/Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority �Fails _ o Inspector's.Signature: _ Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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 6/15/20.00 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS:: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: '4QVP Owner: Date of I ection: Inspection Summary: Check A,B,C;D or E./ALWAYS complete all-of Section D A. System Passes: I have not found an information which indicate th at hat an of the failure criteria described t O C y y � n�1 MR 15.303 or in 3.10 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 exEltration 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 irrthe 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 pipes)are replaced obstruction is removed ND explain: 2 Nee 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) y rYJJ l Prop ert Address: �x -7 , (�3 Owner: ® Date of pection: cr, , , �Y 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 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.l of a public water supply. _ The system has aseptic 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 *Thts,system passes if the well water analysis,performed at a DEP.certified laboratory, for.coliform .bacteria and volatile orjanic compounds indicates that the well ts.free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: t � Page 4 of 11 OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION;FORM PART A CERTIFICATION(continued) Property Address: c � Owner: Date of pection /, D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no",to each of the following for all inspections: Yes No/ _ i/ 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 1/ 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 groundwater elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary-to a surface l water supply. V . 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.] (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large.Systems: To-be considered a large system the system must serve a.facility with a design flow of 10,000 gpd.to 15,000 gpd• You must indicate either"yes," or"no"to each of the following`. (The following criteria apply to large systems in addition to the criteria.above) yes . no the system is within 400 feet of a surface drinking water supply the system is within 200 feet-of a tributary to a surface_drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D'above the large system has failed.The owner or operator of any large system.considered a significant threat.under Section E or failed.under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4 1 Paee 5 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: C t?� Owner: c Date of ection: c) Check if the following have been done.You must indicate "yes"or"no"as to each of the followinsi: T�N �. � �j + Pumping.information was provided by the owner;occupant, or Board of Health G�ere any of the system components pumped out in the previous two weeks? t/Has the system received normal flows in the previous two week period ? ve 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) —LZ/_ 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? f 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/ 0 i/ 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 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: ��.. OwnCr . . _ Date o✓. pection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(.design):- Number of bedrooms (actual): DESIGN flow based on 310 R 15.203 (for example: 11.0 gpd x#of bedrooms): w� Number of current residents:' Does residence have a garbage grinder(yes or no): . eQ Is laundry on a separate sewage'system-(y s or no)/�.'if yes separate inspection.required] . Laundry system inspected or no) I Seasonal use: (yes or no): C Water meter readings, if a( ' able (last 2 years usage(gpd)): O� �✓ � � � ��® Sump pump(yes or n y::: V , Last date of occupancy: COMMERCIAL/INDUSTRIAL/1,6- 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: Was system pumped as part of the inspe ion(y or 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) ]ZOther httank Attach a copy of the DEP ap,0proval J (describe): (/ � 1 2pproxi ate age of all components, date installed(if known)and source of information: Were sewage odors.detected when arriving at the site(yes or no 6 Page 7 of I OFFICIAL INSPECTION FORM—,NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued)- . Prope.rt .Address: L T � "' • • Owner: v Date of n pection: Q BUILDING SEWER(locate on site plan)///KJ Depth below.grade: Materials_of construction: cast iron 40 PVC other(explain): Distance from private water suppYiyw"eii'or"'suction'line ,t Comments (on condition of joints, venting, evidence of leakage, etc.): SEPTIC TAN locate on site plan) ��� Depth below tirade: 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):_(attach a copy of certificate) Dimensions: 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: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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,ofleakage, etc.): _.� .. 'ti ;., -► 7 Page 8 of I 1 OFFICIAL INSPECTION-FORM-NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION,(continued), Property Address ( c � Owner Date of sPection &ax J` 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: 4 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 BO *- , (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:. g 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 CHAMBEYU(locate on site plan) Pumps in working order(yes or no) Alarms in working order(yes or no); rw Comments(note condition of pump chamber,condition of pumps grid appurtenances, etc.): 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: Owner: Date o spection P J Y SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required) If SAS not located explain why: Type � ... _..... l/ leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches, number,length: leaching,fields,number, dimensions: overflow cesspool,number: __.inn ovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, , 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: /j Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): mments(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.): 0 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION.(continued) Property Address: + l Owner: Date o spection: � 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. �i �jq J C� k LAA Pit os aot . 10. Page 11 of]] OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C / p SYSTEM INFORMATION(con'tinued) . Property Address: Owner: Date of ection 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: 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:' TM �. _ s3� Permit Number: Date: Completed by: Site Location: L6J (�• //�s� �' ' O�'/��t'/� efo.L No.. `Owner: 14 e T 14 ddress: ,- Contractor:—X0,C&e4 Address• _ r STEP 1 Measure depth to water table 5 . / north/— ! I t-_ STEP 2 Using Water-Level Range Zone and Index Well A/lap locate site and determ.!ne: ..._..._ (� ApprCp!"late In.d'e;:V✓ell........................:.............:. I ,._ Water-level ranae co„n ................................ i S T E= S Using monu-!ly report `Cu r e.nt i I Water Resources Conditions" determine current t depth %1� VV I I I f water1@Ve! 7C; index ...................... .. ' - nonth/year S T tP 4 Using able of!h al r-Ievt?i Ad)usi-nnefits -ior Index well (S T+-P 2 1, current depth to water level for index well (STEP EP 3), and water-levei Zone (S T EP 2B determine?Naicr-12VeIaGIUStmepi ..............:................:....:..............:.............:........................ - 1 STEP 5 Estimate depth to high wazur by subtracting the water level adiustment (STEP 4) rrom measured deoth to water 7 level at site (STEP 1, J°7 ..... ........................................ ... M FC-]Ui Re iCObCiL 1e IC0An71.Sg1!Qil 1 Q['lll. ror- L�Iltm_ e/w �o Al lei _ �°% � ev _ .3 l ""' A :090 : 14 BORTOLOTTI CONSTRUCTION,INC. '� • "` 765 WAKEBY ROAD,MARSTONS MILLS,MA 02648•. 508-771-9399 508-429-8926 FAX: 508428-9399 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM S �' PART A ICATION dw Property Address: �` Date of Inspection: Inspector's Name: ' ees Name d Ad ess- : CERTIFICATION STAT ENT• I certify that I have personally inspected the sewage disposal system at this address and that the informa- tion reported'below is true,accurate and complete as of the time of inspection.The inspection was per- formed bayd on my training and experience in the proper function and maintenance of on-site sewage disposal stems. The System: " Passes Conditionally Pass t Needs Further. the Local'Aproving Authority Fails Inspector's Signature: Date: The System Inspector shall submit a copy of this inspection report to the Approving authority within thir- ty(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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. i INSPECTION slim, A R V A)SYS M PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated ''f below. , B)SYSTEM CONDITIONALLY PASSES; One or more system components need to be replaced or repaired. The system,upon comple- tion of the replacement or repair, passes inspection. . Indicate yes,nor,or not determined(Y,N,OR ND).Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.' The system will pass inspection if the existing sep- tic tank is replaced with a conforming septic tank as approved by The Board'of Health. Sewage backkup or breakout or high static water.level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. The. system will pass inspection if(with approval of The Board of Health): 'i.*�• yr:`iti ''�r w��'%�"� � t' �'�'T '�4 �X. xi'"'!A;c�"�.Y+x7 v- 7 ��paY�'3�',a. d�$`�' C i �,$tr �' �' :.f.,. i�V�rTk+-;ri l ..e-! "F�., yglS ,�} �i•' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Broken pipe(s)replaced tea.. Obstruction is removed Distribution Box is levelled or replaced The System required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of The Board of Health): Broken pipe(s)'are replaced - Obstruction is removed C)FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require fiuther evaluation by The Board of Health in order to determine if i fail' to protect the public health,safety and the environment. the stems 1)SYSTEM WELL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool-or privy:is within 50 Feet of a surface water. Cesspool or privy is within 50 Feet of a bordering vegetated wetland or a salt marsh. 2)SYSTEM WILLTAIL:UNLESS,THE BOARD OF HEALTH,(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE.)DETERMINES,THATTHE SYSTEM,IS FUNCTION- ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 Feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is with a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 Feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 Feet but 50 Feet or more from a private water supply well,unless a well water analysis for oolifornm bacteria and volatile organic compounds`'indicates that the well-is free from pollutionfiom the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less' i than 5 ppm. D)SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. ' i Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool: Discharge or ponding of efluent to the'surface of the ground or surface waters due'to an overloaded or clogged SAS or cesspool. •,Static liquidlevel,in the,distribution box aboye,outlet jnvert due to an overloaded or clog- . :.;,ged SAS or Cesspool• _ � �' Liquid depth in Cesspool is less than 6"below.invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year MOT due to clogged or obstructed pipe(s). :Number of times pumped -2- - - N i N 1., ti 1 �,y t • .. h E' ,, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM r . . . PART A CERTIFICATION (continued) Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 Feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within,SO Feet of a private water'suppiy well. Any portion of a cesspool or privy is less than 100 Feet but greater than 50 Feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: The following criteria apply to a large system in addition to We criteria above: The design flow of a system is 10,000 gpd or greater(Large System)and the system is a significant - threat to public health and safety,and the environment because-.one or:more of the following'` conditions.exist The system is`v�ntlun 400 Feet of a surface drinking water supply = H w The stem is within 200 FeeCof a tribute 'to a surface dnWn• wate'r'su`6 ;w SY ._ �y !I PP The system is`located in a nitrogen sensitive area Interim Wellhead Protection Area ; (IWPA)or a mapped Zone I1 of a public water supply well: The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B - CHECKLIST . Check if the following have been done: ,,k _Pumping information was requested of the owner,occupant,and Board of Health. one of the system components have been pumped for atleast two weeks and the system'has been receiving normal flow rates during that period. Large volumes of water have`not been strod iced into the system recently or as part of this inspection. As-built plans have been obtained and examined Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. Ole system does not receive non-sanitary or industrial waste flow. e site was inspected for sighs ofbreakout: Shesystem components,excluding the Soil Absorption System,have been-located on site. septic tank manholes were uncovered,opened,and the interior,of the septic tank was in- for condition of baffles or tees,material of construction,4mensions,depthof liquid, depth of sludge,depth of scum:' 1 The size and location of the Soil Absorption System on the site has been determined bused on' existing information or approximated by non-intrusive methods. -3- F' i ,4w���r'r•' n"n t •it}G r,,t kr i} s"'' i. ' N:n -w..ts ... .. .;,n,� s^ 4� ++s � a ,Q� '�f�;pr" {, �j * � * QI Sr.K '4N` � '� ..,' , J• ;,. rr .,, 7 8al''ni'P, �d '�5+,a5 ._ IM d 1. I �F 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST(continued) The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM,INSPECTION FORM PART C SYSTEM INFORMATION / FLOW CONDITIONS + DRM esign Flow: Ions Number of Bedrooms:3— Number of Current Residents, Garbage Grinder: Laundry Connected To System: Seasonal Use: Water Meter able: Last Date of Occupancy_ �•-�� -,f Establishment: Type 0 Design Flow: " •gallons/day Grease Trap Present: (yes or no Industrial Waste Holding Tank Present: Non-Sanitary Waste Discharged To The Title V System: Water Meter Readings,If Available: Last Date of Occupancy: OTHER: Describe) Last Date of Occupancy: j GENERAL INFORMATION PUMPING RECORDS and source of informsti,�n:7 System Pumped as part of inspection: ^ if yes,volum pain Reason for pumping: TYPE OF:SYSTEM: Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow esspool Privy Shared System(If yes,attach1p 'ous inspection records;if any)[ Other(explain): T:TMAGE-of all components date installed(if known)and source of information Sewage odors detected when arriving at the site: /Jd - -4- kS1;: ,SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM r PART,C ,k GENERAL INFORMATION (continued) r SEPTIC TANK: Depth below grader Material of Construction: concrete metal� •FRP_Other (expo) Dimisions: Sludge Depth: Scum Thickness: Distance from.top of sludge to bottom of outlet tee or baffle: _ - Distance from bottom of scum to bottom of outlet.tee or baffle:, - Comments (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) GREASE TRAP: Depth Below Grade: Material of Construction:_concrete_metal_FRP_Other, (explain) Dimensions: _ l 'Scum Thickness:'.- Distance from top of scum to top of outlet tee or battle:' Comments: (recommendation for pumping,condition of inlet and outlet tees.or baffles,depth of liquid' level in relation to outlet invert,structural integrity,evidence of leakage e'tc) TIGHT OR HOLDING TANK: Depth Below Grade: Material of Construction:_concrete_metal_FRP_Other(explain) > ' Dimensions: Capacity: gallons Design Flow: t;allons/day Alarm Level: Comments: (condition of inlet tee,condition of alarm and'Coat switches,etc.) DISTRIBUTION BOX: Q r Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) -PUMP CHAMBER: V'Nfthp is in workingorder" _ Comments:(note condition of pump chamber,condition of pumps and appurtenances,e'k.)' i ... as ,¢ *:i� Y•. +` rui"> i� +`'-' �- ::•.:a ,:`:s' "- - g , ;ca r v .�;. 'x t;. 'y� i ,;. x.'It s� k,-.,t'�s ., . .,d•-'�t '3' r+t�, , ��xkY SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) SOIL ABSORPTION SYSTEM(SAS): 1� (L,ocate on site plan,if possible;excavation not required,but may be approximated by non-Intrusive; methods) If not determined to be present,explain: Type: Leaching pits,number:1—Leaching chambers, number: leaching galleries,number: Leaching trenches,number,length: Leaching fields,number,dimensions: Overflow cesspool,number: Comments:(note condition of soil,signs of hydraulic failure leve of pond'n ndition of vegetation, e ' t CESSPOOLS:_l� Number and,configuration:/" ' !r Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of Cesspool;�a 14jy � Materials of constructionaC,6' Indication of groundwater: Inflow(cesspool must be pumped as part of inspection) Comments:(note condition of soi signs of by ulic fail a level of ponding,condition of vegetation, etc. / �� 1i Materials otconstruction: Dimensions: Depth of Solids• _ Comments:'(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) z SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) SKETCH OF SEWAGE DISPOSAL LS OSAL SYSTEM: Include ties to adeast two permanent references, landmarks or benchmarks. Locate all wells within 100 Feet. v to �. �7. - DEPTH TO GROUNDWATER.- Depth to gramtwater._ Feet 0fP Atrmination or App lion: r -7 .- .LOC T O _/ _ --_SEWAC�E PERMIT _U o.'- - .A►.A _�-ADD-R-E-SS D�►TE-P-ER-tv�1T L.S.SU-ED � i �� �� .. No......L- =' Fl�s.. Old ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD F H T OF......... ... .. . _ : . ..........- ......,................... Appliration -for Diq uittl Works C otuitrurtion Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at -----• _••-•--•-•...................................J..._...._.. 9.._..._.�..." __._................._..........._........_.___._._._..........._....__.._............................ > Location-Address or Lot No. = --------- ;e-- ----- -- -e ------------- - -' 6Ow r �f - ddre Installer Address / QType of Building Size Lot----- feet U Dwelling—No. of Bedrooms___ ____________________________________Expansion Attic ( ) Garbage Grinder ( ) PA Other—Type of Building ___________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Pa Other fixtures ------------------------------ - - W Design Flow...................._-----------------------gallons per person per day. Total daily .flow_._.._._.........___..._____._______..__...gallons. W4 Septic Tank—Liquid cahacity------------gallons Length---------------- Width-------------... Diameter-----...__:----- Depth-_____-__--. xDisposal Trench—No-____________________ Width.................... Total Length-------------------- Total leaching area-------------- .....sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet____-______-_-_--- Total leaching area-------.-------._.sq. ft. Z Other Distribution box ( ) Dosing tank ( ), Percolation Test Results Performed by------- ----------------------------------------------------------------- Date........................................ a Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water-._-___-_______._.... r1l Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water---------------._______- ---------------------------•--=-----.._...•--------.....----•--•-•--------...................------.......................................................... 0 Description of Soil-------------------------------------------------------------------------------I----------------------------------------------------------------------------------------- x -- ---------- --------- ------------------------------------------------------------------------------------------®-a ----- ------------------------------- U Nature of j epairs Alt rations—Answer when applicable.___-- _. _`_.-�_- ___ _________ __ _ _ ___.___--____-- 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 agrees not to place the system in operation until a Certificate of Compliance has bee i s d by the oardof a Sign - �f `S` ?�_ �l Date e Application Approved By---........_,/ - --- .5--�.7� i/ Date Application Disapproved for the following reasons--------------_--------------- ---------- -----------------------------.......:............................. ...........................••--•--•------------------------------------.=-----------•------------------------------------------------------•------------ -------•--------•------------------------------ Date PermitNo......................................................... Issued-----------------------------.......................... Date ---------- ------------------ ------------�- --------------------------- ---I 1 No....... ................... THE COMMONWEALTH OF MASSACHUSETTS 11 BOARD F E./1� ..........OF......... j...�t Applirtt#ion -for Di!ipoiitt1 Workii Tonofrnrtion Prrunit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: f j ,, ......• ...............................................................••.. ---- Location_Address or Lot No. 9 Own�r 7 - /t Addtes ............................ -tp/�(�'--_-.............. }........ v11f,/. .,C..i4I-!.t-/': ............ � Installer Address Type of Building Size Lot...__6!ts/�e.._____Sq. feet Dwelling—No. of Bedrooms----:%....................................Expansion Attic ( ) Garbage Grinder ( ) `q Other—Type of Building No. of persons_________________•.-___-_--. Showers — Cafeteria Otherfixtures ...................................................... W Design Flow...........................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity------------gallons Length................ Width................ Diameter---------------- Depth--------.------- xDisposal Trench—No_ --------------------- Width-------------------- Total Length...................- Total leaching area--_-----•_-..-.-----sq. ft. Seepage Pit No_____________________ Diameter-------------------- Depth below inlet.................... Total leaching area.-___-_._-__--..__sq. it. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date---------------------------------------- Test Pit No. I................minutes per inch Depth of Pest Pit-------------------- Depth to ground water..-.--_--.--.._-_-.----. (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-..---._________--__---- 0 Description of Soil........................................................................................................................................................................ I V •------------------------"•-------- ---•---------•--••-----•--'-------' '------'--"----••-"-------'----•------•--------------•-'-••••-•------'--•------•---'-....•---------------..........------ --- W ---------------------------------------------------------------------------------------------------------------------- -------------------------- -----••-• ....... /--------.._...............--- U Nature of Repairs o' Alt rations—Answer when applicable.....__[_-_`...,�. ----------------tea --- ------------------------------------------------------------------------------------ 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 agrees not to place the system in operation until a Certificate of Compliance has been ; issu/d by..the bo.a_rd of ealtlx Signe f /&� ._ ......... 3 r DeAPPlication Approved BY-...... •-• ....�.......... _ a Date Application Disapproved for the following reasons_________________________________ __ --------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------- ------------------ Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH :.. iY.'.h................OF....... A .A�c� .,..�� —17...................... Cner#ifirtt#e of 611411implittnre THIS IS/;Td'CE TIFY, Th t he Individual Sewage Disposal System constructed ( ) or Repaired by r�f' = ......... . � / / I / I stall r 14 ��� �� has been installed in accordance with the provisions of Article ai I of The Sy to Sanita ode as described in the application for Disposal Works Construction Permit No'____(Z ------_ _ __.___._-_. dated....... .....................!.........._.... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------------------------------------------------------------------------- Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....Y.. ..............OF.......r5�..%.., Ff. G- r!!.: t .................... �; r Permission is hereby granted- 1✓----_-�� A.F t•---_._._.. to Constr&f ( ) or e�epair ( /-)'an Individual Sewage Disposal System atC•�No -''" ' 7-=------------------------------------.---•--.... ---------------------------------------------- ---- - ---------•------ 6D� r Street / Z _ 7 ) '- as shown on t e applicati n for Disposal Works Construction Pe'rr No..... ... .....''Dated__-.__.____..._ 5 ? Board of Health T.. DATE---- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS y:. COVERS TO BE WATERTIGHT AND TOP OF FOUNDATION BROUGHT TO WITHIN 6" OF FINAL GRADE SEPTIC SYSTEM PROFILE FlahG�Y Environmental Services ,� EL. ; EL. .0' (not to scale) INSP. PORT W I 3" OF GRADE CLEAN SAND P.O. Box`339 2" of$" to Y" DOUBLE WASHED EL. . (0' Harwich, MA 02645 hr 4" CAST IRON or EQUIVALENT PEASTONE OR GEOTEXTILE 774.994. ��66 MIN. PITCH 1/4" PER FOOT FILTER FABRIC 4"SCHEDULE 40 PVC PIPE 4" SCHEDULE 40 PVC PIPE VENT IF REQUIRED FLOW LINE (first 2'to be level) 95' 1.40 0/0 ��� Yi 5' 1 °;•. . 4 .. a lON " :.'•: L. EXIST. io 14" .t '� .. :. :y �' Q ®® o°o°oOOOe •'�•:• 00000000000 ° �1=11=1!'���t� t� °°°o606 C EL.55.7 EL.55 5' 0000000 0 0 0000 . 0 0 0 0 0 0 o O��o ®� O ®� o°o°o°o°c 0 0 0 0 0 0 0 0°0°o°o°e 2.0' / EL. 54.2' EL.54.03' o0 0°000°000°000 �� �0®��� ® 0 0 0 0 `1 GAS BAFFLE EL.54.0 °00000°0°0 000000 000o0o0°C- 0' 000,0000000 0°0°0o a .' ° a o0000o00C o0 0 0 0 0 •• a °o°o°o°oC EL.52.0' (H-20 D-BOX) N`v . . .. 6"CRUSH ID STONE OR SOIL ABSORPTION SYSTEM ° MECHANICALLY COMPACTED ADD (2) 500 GALLON H-20 CHAMBERS (DATUM: ASSUMED) �� 3" to 11" DOUBLE WASHED STONE WITH 4'STONE AROUND IN A 1500 GALLON SEPTIC TANK 4 2 12.83'X 42.0'X 2'CONFIGURATION cPRoaosEDl BOTTOM OF TEST HOLE EL. 47.0' EL. 47.0' USGS ADJUSTMENT: N/A LOCATIONMIAP GROUNDWATER ELEV: N/A N TH �9852, 114.0' 86 H-1 TH-2 14.9' West Bay Rd. ;0 0. LOCUS t<o 57.4' 19.5' BENCHMARK: d TOP OF FNDN y EL.58.0' p NTS W RAGE (SLAB) SK OF MqS DRIVEWAY �� D r ` 2.3' EXISTING O R!. &T. FL ,H ,T j 9 56 COLLAPSED CP N 2 ODUELLING DECK O lr �GtSTrr*� cP �JV S4NITAR1111 (� a LOT B 36,754 SF# _ MAP 116 LOT 90 DATE.,211612021 REVISED: J SITE AND SEWAGE PLAN FOR w 1a931, B&B EXCAVATION, INC./ PAUL DWORKIS 44 EEL RIVER ROAD (OSTERVILLE) BARNSTABLE, SCALE : 1 " = 40' MA REF.'LCP 16162 A&PB 85 PG 25 PAGE 1 OF 2 04 I TOP OF FOUNDATION COVERS TO BE WATERTIGHT AND SEPTIC SYSTEM PROFILE Flaherty Environmental Services BROUGHT TO WITHIN 6" OF FINAL GRADE . (not to scale) EL. 60.0 EL 58.0 INSP. PORT W I 3" OF GRADE CLEAN SAND P.O. Box 331 J.. 2" of$" to z" DOUBLE WASHED EL. 58.0' Harwich, MA 02645 ,. —� 774.994. 1166 4" CAST IRON or EQUIVALENT PEASTONE OR GEOTEXTILE }� MIN. PITCH 1/4" PER FOOT FILTER FABRIC 4"SCHEDULE 40 PVC PIPE 4" SCHEDULE 40 PVC PIPE f VENT IF REQUIRED FLOW LINE (first 2'to be level) s'. • 15' 5.30 —�.- o EL.55. ' _� Mug q . f co000°0oc .. L. EXIST. �o • ' OD a o000o0o0c —► 00000°000°o o ��LJLJLJfp CM —' jEq� o°o°o°o°c EL. 55.7 —i 0000 0 0 0 0 0 0 o D o c EL. 55.0' 0 0 0 0 0 0 0 0 EL.54.03' °o°o° o o°o°o°o° 00 ��� Q °o°o°o°oc If' o 0 0 0 0 0 0 0 0 0 o c 2.0' L. 54.2' o o°o°0°0°00000 O. O O O O• O 0 00000000C— GAS BAFFLE EL. 54.0' o 0 0 0 0 000000 �0 �Q � I] o 0 0 0 10'MIN.(2.5%I_ o 0 0 0 0 • 0 0 0 0 c '..;• o 0 0 0 0 0 0 • • ": °0°0°o°oc EL 52.0' (H-20 D-BOX) le-V 6" CRUSH D STONE OR J, SOIL ABSORPTION SYSTEM ' '••: MECHANICALLY COMPACTED ADD (2) 500 GALLON H-20 CHAMBERS (DATUM: ASSUMED) 3" 1500 GALLON SEPTIC TANK WITH 4' STONE AROUND IN A 5.0' to 11" DOUBLE WASHED STONE 4 2 12.83'X 42.0'X 2' CONFIGURATION BOTTOM OF TEST HOLE EL. 47.0' EL. 47.0' USGS ADJUSTMENT: N/A LOCATIONMAP GROUNDWATER ELEV: N/A N TH As Built West Bay Rd. 44 Eel River Road m Locus Osterville- MA = 4 O TO B 3 NTS 2 �'o� 2 3 1 4 O Yip F B 11.0� 16� 6�� 23.0� LL- 11 cJ N E 2 6' 26� 8 c 23' 5" 2 7" DWELLING DECK sG/STEREO DATE:311012021 7REVISED: A AS BUILT PLAN FOR B& B EXCAVATION, INC./ PAUL DWORKIS 44 EEL RIVER ROAD (OSTERVILLE) BARNSTABLE, NOT TO SCALE MA REF.LCP 16162-A&PB 85 PG 25 PAGE 1 OF 2 ........ ... ......... .... .. . ..._... ..._... ....... ..... _...... ................. GENERAL NOTES DESIGN CALCULATIONS SYSTEM DETAIL Flaherty Environmental Services 1. ALL PRECAST COMPONENTS TO BE H-10 P. O . Box 331 RATED UNLESS OTHERWISE SPECIFIED. Harwich, MA 02645 DISTRIBUTION BOX AND ANY COMPONENTS NUMBER OFACTUAL BEDROOMS 3 774.994. 1166 WITH ANY ANTICIPATED VEHICULAR TRAFFIC TO BE H-20 RATED. GARBAGE DISPOSAL UNIT NO 2. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF GARBAGE TOTAL ESTIMATED FLOW GRINDER. (I10 GAUBR/DAYX 3 BR) 330 GAL./DAY 3. MUNICIPAL WATER IS AVAILABLE. REQUIRED SEPTIC TANK CAPACITY 660 GAL. 4. ALL CONSTRUCTION TO CONFORM WITH — 251 310 CMR 15.000 AND ALL OTHER SIZE OF SEPTIC TANK 1500 GAL. (PROPOSED) APPLICABLE LOCAL, STATE AND FEDERAL CODES AND REGULATIONS. SOIL CLASSIFICATION 1 5: INSTALLER/CONTRACTOR TO REVIEW& . . , VERIFY ALL ELEVATIONS AND DETAILS AND DESIGN PERCOLATION RATE <2 MIN./INCH REPORT ANY DISCREPANCIES TO DESIGNER PRIOR TO CONSTRUCTION OR EFFLUENT LOADING RATE 0.74 GAL./DAY/FTz Q Q 12,83' ASSUME ALL RESPONSIBILITY. LEACHING AREA 6. INSTALLER/CONTRACTOR IS RESPONSIBLE (2)x(25.0'+ 12.83)(29 _ 151 SF FOR MAINTAINING SAFE WORK AREA, 25.0'x 12.83', =320 SF VERIFYING ALL UTILITIES AND NOTIFYING 471 SFx 0.74 =348 GPD "DIG SAFE" (1-888-344-7233) 72 HOURS PRIOR TO CONSTRUCTION. USE(2)500 GALLON H-20 CHAMBERS WITH 4'STONE 7..ANY CHANGES TO OR DEVIATIONS FROM INA 12.83'X25'CONFIGURATIONAS DIAGRAMMED THIS PLAN MUST BE APPROVED IN WRITING BY FLAHERTY ENVIRONMENTAL RESERVE LEACHING CAPACITY N/A SERVICES AND LOCAL BOARD OF HEALTH. 8. FINISH COVER OVER COMPONENTS IS NOT TO EXCEED 3'PER 310 CMR 15.000 UNLESS SHOWN PER PLAN. 9, ALL ABANDONED SEPTIC SYSTEM, (NTS) COMPONENTS TO BE PUMPED DRY AND FILLED.WITH CLEAN SAND OR REMOVED AND REPLACED WITH CLEAN'SAND. 10,ALL COMPONENTS TO BE PROVIDED WITH SOIL EVALUATION WATERTIGHT ACCESS PORTS WITHIN 6" OF TESTHOLE#1 TPT#21-018 TESTHOLE#2 TPT#21-018 - FINISH GRADE. Evaluator- David D.F/ahertyJr.,RS Evaluator: David D.F/ahertyJr.,RS 11,ALL SEPTIC TANKS DISTRIBUTION BOXES Don Des 5 DonSE Des 5 , C r BOH Witness: Don Desmarais,RS BOH Witness: Don Desmarais,RS �q OF AND PIPING TO BE INSTALLED Date: February 3,2021 Date: February 3,2021 i �A ` WATERTIGHT. qD-t 12.NO KNOWN WETLANDS OR WELLS WITHIN TH-1 ELEV.56.0' TH-2ELEV.56.0' TM J -� 150 FEET OF PROPOSED LEACHING. 0"-s" A LS 10YR 3/2 0"-s" A LS fOYR 3/2 I`! 121 13.THIS IS NOT A CERTIFIED PLOT PLAN AND •p UNDER NO CIRCUMSTANCES IS THIS PLAN �01STER�O TO BE USED FOR ZONING OR BUILDING s"-30" a Ls 10YR 5/6 9"-30" B Ls 10YR 5/6 s'%1 TAM PURPOSES. "I 14.LOT IS SHOWN AS ASSESSOR'S MAP 116 LOT 90 . 1 7PERC AT 48' certify that on November 12,2002,l have passed 15.LOCUS PROPERTY IS NOT LOCATED the examination approved by the Department of WITHIN AN AQUIFER PROTECTION Environmental Protection and that the above analysis SITE AND SEWAGE PLAN has been performed b me consistent with the FOR Y O DISTRICT(ZONE II), required training,expertise,and experience described B& B EXCAVATION, INC./ in 310 CMR 15.018(2)." 30"- 132" C MS 2.5Y 6/6 30"-120" C MS 2.5Y 6/6 PA UL D WORKIS 44 EEL RIVER ROAD (OSTERVILLE) BARNSTABLE, MA G.W.ELEV.N/A G.W.ELEV.N/A _ BOTTOM TH-1 ELEV.45.0' BOTTOM TH-2 ELEV.46.0' PAGE 2 OF 2 DATE:211612021