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0175 EVANS STREET - Health
�.175 EVANS ST, OSTERVILLE -A= 142-143 I X i • No. 4210 1/3 BGR a ESSELTE 0 0 0 0 t lo�f�3 -- e � v /a�a, � �'ii�r�- ` /t�7r� �i TOWN OF BARNSTABLE v UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS' ASSESSORS MAP NO. �'- /7T PARCEL NO. /,otZ—/�- —L, -�6 le ADDRESS; 5,-: VILLAGE% Js i��LLE� CONTACT PERSON ��� PHONE NUMBER LOCATION OF TANKS: . CAPACITY: TYPE. OF' FUEL AGE: TYPE: LEAK OR CHEMICAL: DETECTION -SYS'EM! DATE OF PURCHASE OF EACH: 1. 7ZZ:� 2. 3. 4. 5. DATE OF FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS PLEASE PROVIDE A SKETCH SHOWING THE H LOCATION OF TANKS ON THE BACK OF THIS CARD. (� A4 � 1 r� a � � � l Q �� From the desk of (617) 428-2467 Chief John M. Farrington Centerville-Osterville Fire Department �75 ! 5EWo.f4E-PERMIT -►`►O. _ - Al - t ab=aILIZ3 -LEJUa- __INSTALLER-S-IJ-�-NI-E—�-ADDRE-SS ,.� �.� --BUILDER 5-1J-/�t✓l-E ADDRE—SS '--pl�,-TE P-ERtv�1T ISSUE—:D -�---D ATE CO M P L 1-AtACE- I SS U ED_•'_/ .� .� -� .' ' .,.. � .. 1 ' i<. k... .. � tI .. . [ - .. R .. F � » I l qcA. f3 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' 175 Evans St. N Property Address ��f Joseoh Cali r �, Owner Owner's Name a information is M> required for every Osteryille ✓ MA 02655 04/23/2019 *� page. City/Town State Zip Code Date of Inspection a. q 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. Important:When A. General Information 5 �7 filling out forms- � goat p on the computer, use only the tab 1. Inspector: key to move your cursor-do not Adam Riker use the return Name of Inspector key. Riker Land Construction �y Company Name PO Box 726 Company Address South Yarmouth MA 02664 City/Town State Zip Code 508-776-6460 S14590 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. 1 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 04/23/2019 Insp or's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc-rev.6/16 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 ,M 175 Evans St. Property Address Joseoh Cali Owner Owner's Name information is required for every Osterville MA 02655 04/23/2019 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 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: Septic tank,distribution box and SAS observed to be operating with no failures or indications of past failure conditions. 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.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 175 Evans St. Property Address Joseoh Cali Owner Owner's Name information is required for every Osterville MA 02655 04/23/2019 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and.the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 175 Evans St. Property Address Joseoh Cali Owner Owner's Name information is required for every Osterville MA 02655 04/23/2019 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 i i Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 175 Evans St. Property Address Joseoh Cali Owner Owner's Name information is required for every Osterville MA 02655 04/23/2019 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® 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. ❑ 2 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.] ❑ ® 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 E ❑ 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 Swage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 175 Evans St. Property Address Joseoh Cali Owner Owner's Name information is required for every Osterville MA 02655 04/23/2019 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 El ® ng information p f rmation was provided b the owner, occupant, or Board of Health y p El ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: 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 GPD- t5ins.doc•rev.6116_ Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G7M 175 Evans St. Property Address Joseoh Cali Owner Owner's Name information is required for every Osterville MA 02655 04/23/2019 page. City/Town State Zip Code Date of Inspection D. System Information Description: Three bedroom single family residential dwelling with town water. Number of current residents: n/a Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available Oast 2 ears usage d 20171 (a GiP4 g Q Y 9 (gP ))� 2018=Q9 PLC Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 175 Evans St. Property Address Joseoh Cali Owner Owner's Name information is required for every Osterville MA 02655 04/23/2019 page. City/Town 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: realtor/homeowner Was system pumped as part of the inspection? ❑, Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: n/a BI-Annual pumping recommended 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.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G M 175 Evans St. Property Address Joseoh Cali Owner Owner's Name information is Osterville MA 02655 04/23/2019 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Tank installed in 1974 , distribution box and two 500 gallon chambers installed in 04/30/2015 Were sewage odors detected when arriving at,the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2.5 feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): no leaking observed Septic Tank(locate on site plan): Depth below grade: 1.5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1000 gallon precast concrete tank If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 5x5x8'6" Sludge depth: 1211 t5ins.doc•rev.6116 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 M 175 Evans St. Property Address Joseoh Cali Owner Owner's Name information is required for every Osterville MA 02655 04/23/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 22" Scum thickness 6" Distance from top of scum to top of outlet tee or baffle 3" lt Distance from bottom of scum to bottom of outlet tee or baffle 11 How were dimensions determined? Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): No obvious defects observed . Tank is 1000 gallons and depending on occupancy should be pumped at on a Bi -annual schedule . 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 117 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 175 Evans St. Property Address Joseoh Cali Owner Owner's Name information is required for every Osterville MA 02655 04/23/2019 page. 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.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �7M 175 Evans St. Property Address Joseoh Cali Owner Owner's Name information is required for every Osterville MA 02655 04/23/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert equal to two outlet Inverts 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.): no evidence of carryover or high water stains 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 N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 175 Evans St. Property Address Joseoh Cali Owner Owner's Name information is required for every Osterville MA 02655 04/23/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: El leaching number: 9p its ® leaching chambers number: 2x500 gallon chamber ❑ 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.): Soils were dry aboved chambers wioth no indications of effluent present Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No 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 ,M 175 Evans St. Property Address Joseoh Cali Owner Owner's Name information is required for every Osterville MA 02655 04/23/2019 page. 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.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc-.): t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts N W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �7M 175 Evans St. Property Address Joseoh Cali Owner Owner's Name information is required for every Osterville MA 02655 04/23/2019 page. City/Town 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 A 56'�'' 3 � = � 0 a = 6817 .. 7b 's� y 3 ,. 7S t5ins.doc•rev.6/16 Title 5 Official Inspection Form: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 GA SVB'e 175 Evans St. Property Address Joseoh Cali Owner Owner's Name information is required for every Osterville MA 02655 04/23/2019 page. City/Town 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: >12 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: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Test hole on file ❑ Checked with local excavators, installers- (attach documentation) ® Accessed USGS database- explain: maps indicated 20'to ground water You must describe how you established the high ground water elevation: Hand augur to 12'with USGS maps 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 t. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 175 Evans St. Property Address Joseoh Cali Owner Owner's Name information is required for every Osterville MA 02655 04/23/2019 page. City/Town 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 AII,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 r No. v��� !d , Fee ��v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0[pplitatlon for Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(✓jUpgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or L,o No. /7st„r ,5 51' Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel 1 ` ;Z &13 Sor�CC-fI LLG Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. `C %6S A Txmua 1Nc. 9'1vy mvewt iv5 walks Type of Building: Dwelling No.of Bedrooms 3 Lot Size /Y S"�(,� sq.ft. Garbage Grinder( ) Other Type of Building Jr5A5)R',►4-JCJ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) :3 3C2 gpd Design flow provided 3 N67�� gpd Plan Date J/Ce�J Number of sheets 2_ Revision Date Title Size of Septic Tank Type of S.A.S. Sq(,_��(j�l Description of Soil Nature of Repairs or Alterations(Answer when applicable) .hN� � 2- 5-00 e,411 y `/'/O dam 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. Signe Date vly k Application Approved by Date Application Disapproved by Date for the following reasons Permit No. C>Aa/ x /n 7- Date Issued144 No. o� / ,�G lL r ` Fee /v V k., THE COMMONWEALTH OF MASSACHUSETTS Enteredincomputer: Yes PUBLIC HEALTH DIVISION - TOWN OFIBARNSTABLE, MASSACHUSETTS J JrILDtID1I for NsyDBaY .4pstem Construction Permit -Application for a Permit toT&struct{ ) Repair(Vie,Upgrade' ( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /yS ,5 5 t' Owner's Name,Address,and Tel.No. Assessor's0ap$acCe�111`ey A, `�i su/tCG f i L LG Installer's Name,Address,and'J_el�No` Designer's Name,Address,and Tel.No. 1a2os1us A i3(cw4Y- A)C *, I--/V IN to P✓iNs f c�li/k S Type of Building: t Dwelling No."of`Bedrooms _ Lot Size / sq.ft. Garbage Grinder( ) Other Type of Building �-p �,, � o.of Persons Showers( ) Cafeteria( ' ) Other Fixtures I Design Flow(min.required) :3-30 gpd Design flow provided 3�& gpd Plan Date /b ai Number of sheets 2 Revision Date Title Size of Septic Tank �jc�s� ,,.�, Type of S.A.S. ,��ii� Description of Soil ' T I Nature of Repairs or Alterations(Answer when applicable) 4� Date last inspected: Agreement: 1 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: Signe Date d G Application Approved by - Date �l C� 63 Application Disapproved by Date for the following reasons Permit No. C;Lo/ Date Issued ----------------------------------------- --------------------- _ -- ------- - -------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliante THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by_ll_�, Ck, A 1� „t -TNC at �4 4- 0s f 4 r L/,f f_ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Nq�/5-/U'�),dated Installer`11t)e+z, A Rlb2b,..-) INC Designer r&4 ,-jt— r c ✓ICC #bedrooms '� Approved design flow 1 3 ''�(� gpd The issuance of this erm t shall not be construed as a guarantee that the system wi fun,tio/r as des ned. - - - Date O Inspector 1 --------------------------------------------------------------------------------------------------------------------------------------- No. Q 0 Fee /©C) THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal 6pstem (Construction Permit Permission is hereby granted to Construct( ) Repair(� Upgrade( ) Abandon( ) System located at 1!15' and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be onipleted ithin three years of the date of this ,ermit. Date j y C7- �j' Approved by A\ I .Aegu �f Barnstable �ltory Services w+ T chard V:Aah,]:x�ferim Director �vsrna[.Yj ��f 1• Publa�.: .e113 ,1Ivlsaon � Pra Hwy�'. Tlap?nas'IiYic�e�n,Drr ector . i 20Q MR-In S_tr.let;Hyaunis,,MA 02601 Of I e; 508-862-4644 Fax: 5.08-790-6304 Installer &_Desi o Certificatloli Forin D �e; �( Sewage Permit# 1 ssessor's Nlap\P��rcel �y 2--) 3 Do agner; Installer: ,.(A Adi Z•C,,\o 9 rvyz s<-A( e (c 1j� Address: UL Qn LI J�z y was issued a permit to install a' ` date) (installer) se;�ic system at _ . . . , , �: . ..,;b'ased on a design drawn by (address) l;•i�✓_T-��, �.��-e-�. `tom dated j 1 (designer) - i _I.certify that the septic system referenc d 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. I certify that the septic system referenced above was installed .with major chaisgf,s (i,e, greater than-10' lateral relocation of the SAS or any vertical'relocatiort of any component of the septic system) but in accordance -With State & Local Regulations, Plan revision or certified as-built by designer to follow, ,trip out (if required) was inspected and the soils were found satisfactory,. I I certify that the system referenced abov_;was constru i F `? with'the terms of the IAA approval letters (if applicable) I T tn No.3340 1~ (Installer's Signature) ' �e F;� ��",k ' (17esgnex'.s Signature) (Affix Designer's Stamp Here) P-111ASE RETURN TO _9,_A`RN'SqTABLE P LIC HEALTH DIVISION��CI<sI'TXFICATE • 'O�Vk COMPLIANCE STILL NOT BE ISS D UNTIL BOTH TITS, FORNI -AM AS- B LT`CAR ARE::R.ECEMD BY THE B: N:)TABL] PIIT3LIC I C� �T Dl VIS Ol°d.' rsigner Certification Form Rev 8-14-13,doc ' - F TOWN OF BARNSTABLE LOCATION 1-75- SEWAGE# cL®I S (O2, VILLAGE C`���cY� 11 P ASSESSOR'S MAP.&PARCEL ,q ;' —1 L13 INSTALLER'S NAME&PHONE NO. A 1 th aS N C— SEPTIC TANK CAPACITY LEACHING FACILITY.(type) SC® qCA ( Cti1 (size) NO.OF BEDROOMS OWNER ,)X J- L`. PERMIT DATE: COMPLIANCE DATE: 0 Separation Distance Beiween the: NO Ne cxk- )OtKC 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 Pr Or 1-7 Boa - 38 tcl h G8,7 1 -7a, s 75� � II Town of Barnstable P it Department of Regulatory Services s &AMSTABM 's Public Health Division Date �A iMd]& ,6�' 200 Main Street,Hyannis MA 026 1 t . ,I I Date Scheduled f 9 Time Fee Pd: ire U` 6' , SO Isuitability Assessment for Sew 'spos l Performed By: t?kVM-cn4-e_t Witnessed-By: _ LOCATION & GENERAL INFORMATION - Location Address I—7r E�q�S ff Owner's Name 5U�ryI-J-I (- V Address l Y CJ Cie (*u C_ej+P__ M i q 30 Assessor's Map/Parcel: l y Z—I k-' 3 Engineer's Name a NEWCONSTRUCTIONpQ REPAIR t",/ Telephone# _56T'7 37—/ 76 Land Use S IC/`��'t�+"c.� ( Slopes'(%) � Surface Stones Distances from: Open Water Body 7 Zl� ft Possible Wet Area N/�ft Drinking Water Well —7 S ft Drainage Way A)I ft Property Line tS ft Other ft a!► u. er vdm ame,dimensions of lot,exact locations of test holes&perc tests,locate wetlands fn proximity to holes) F �i4I = 3� Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: nA Weeping from Pit Race Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: __—_-______in, Depth to sell mottles; in. Depth to weeping from side of obs.hole. in, Groundwater Adjustment ft. Index Well# Reading Date:_ Index Well level Adj,factor All,Clmuadwiiier Level; o ,. . . PERCOLATION TEST wtv Thne„ Observation I �� Hole# TV—' T .3 Time at 9". Depth of Pere t 1 Time at 6" Start Pre-soak Time @ Z 1)"ime ff'-V) End Pre-soak G Rate Min/Inch. LZ L. rz Site Suitability Assessment: Site Passed�_ Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- t ***If percolation test is to be conducted within 100' of wetland,you must first notify th Bar'nstable C onservation Division at least one �1) week P g g rior to be innin . °�� I Q:IS EPTICIPERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# 1 Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) -IZ �-5 to a2Y1 —r3 z, Med S��d Z` /(v DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,% ave —�o L-5 �4 DEEP OBSERVATION HOLE LOG Hole# 3 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Cpsistency.%Grave ZS �� I DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil' Other Surface(in.) (USDA) (Munsell). Mottling (Structure,Stones,Boulders. Consisten ° -� L A- s co 01 z Flood Insurance Rate Map: Above 500 year flood boundary No— Yes_4 Within 500 year boundary No Yes Within 100 year flood boundary No�7 Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in,all areas observed throughout the area proposed for the soil absorption system? Q 5 -- If not,what is the depth of naturally occurring pervious material? Certification I certify that on l� �_�_(date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 3 10 CMR 15.017. 11 v , Signatu Date re r Q:\s.EprlC\PEPCFORM.DOC r (A Barnstable �trti Town of Barnstable � Regulatory Services Department Q p BARNST"M p • ,�� � 'b Public Health Division , 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 SECOND NOTICE Richard Scali,Acting Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2851 2552 �y March 5, 20Y SERFCATI, LLC 14 Ocean Highlands Gloucester, MA 01930-5210 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 • The septic system located at 175 Evans Street, Osterville,MA, was inspected on 10/23/2013, by Douglas Brown, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system needed further evaluation under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: o System is in hydraulic failure. • Distribution box full of soil & roots; and lines going to SAS You are ordered to repair/replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF TH BOARD OF HEALTH . Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\175 Evans St Osterville MA Nove 2013.doc i+ ter Town of Barnstable Barnstable Regulatory. Services Department j aicaC j MASS. Public Health Division i639 �� 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard Scali,Acting Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7012 1010 0000 2851 1050 - - ---November 12, 20.13 . i Roger& Evelyn Savino 14 Ocean Highlands Gloucester,MA 01930-5210 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE.5 The-septic system located at 175 Evans Street, Osterville, MAMA was-inspected on 10/23/2013, by Douglas Brown, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system needed further evaluation under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • System is in hydraulic failure. • Distribution box full of soil & roots; and lines going to SAS You are ordered to repair/replace the septic system within sixty (6.0) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH. Thom c ean, R. ., CHO • Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection-Failures or Future Eval\175 Evans St Osterville MA Nove 2013.doc Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=9244 Z _ tf�y�R+i����i✓ �..m W'1..,«....v�-w.www." gek�ls -.a^i e W Logged In As: Pa rceI Deta I I Tuesday, March 4 2014 Parcel Lookup Parcel Info Parcel 142-143 Developer LOT 64 ID Lot Location F175 EVANS STREET IPri Frontage 190 - SecROBBINS STREET__.__._ _.__- .__..__ Sec 139 Road Frontage VillageOSTERLE - Fire VIL C-O-MM District - Town sewer exists at this Road -—---•__-r___..___-_ address Ni p _�-� Index 0509 Asbuilt Septic Scan: 1421431 Interactive r 142143 2 Map rl Owner Info_ Owner ISURFCAT1, LLC m ! Co- owner Streetl'14 OCEAN HIGHLANDS Street2 City GLOUCESTER _ � StateFM—Aj Zip 01930-521 Country Land Info _ ..... _ Acres�0�33 _ j Use Single Fam MDL-01 1 Zoning aR�C - Nghbd 0109 Topography Level _ �� Road[Paved Utilities IPublic Water,Gas,Septic Construction Info _...__ _. .-. _- Building 1 of 1 '. Year ir1974 i Roof Gambrel Ext`Wood Shingle Built 1 Struct Wall Living1512 Roof As h/F GIs/Cm AC None a Area' ) Cover� P � Type ._W..�__.� _ Int ____;� Bed �_ ._oo _ BM a Style Colonial Drywall ms a E yq Wall Rooms�2 Bedr Int . �___.-.___ .Bath -__„__ Model residential I Carpet. , i Full+ 1 H Floor Rooms Wzrp _ __ Heat _ .;� _ Total I _ _._.._._. ., Grade;Average I Type Hot Water Rooms!6 Rooms _. _. Heat, . - _.__- Found- Stories 11.8 Fuel!Gas ation'Typical Gross http://issgl2/intranet/propdata/ParcelDetaii.aspx?ID=9244 3/4/2014 https://tools.usps.cQm/go/TrackConfinnAction.action?tRef=fullpage&tLc=1&text28777=&tLabels=70121010000028511050 English Customer LISPS Mobile Register!Sign In Service rJg us J. odYP• Search USPS.com or Track Packac Quick Tools Track Ship a Package Send Mail Manage Your Mail Shop Business Solutions Enter up to 10 Tracking A Find Find USPS Locations Buy Stamps Custom so o TrackingTM i HavequerServWe'r Cal ul Have questions?We're here to help. p a Hold Mail Change of Address Tracking Number:7 01 21 01 0 000 028 51 1D%, 1 I Requested label is archived. Restore Archived Details> Product & Tracking Information - Available Actions Postal Product: Features: Certified Mail- i. i 1 November 15,2013, 4:04 pm Deiiverecl GLOUCESTER,MA 01930 . w .....- - s ._. lo . ..............Track Anther Package What's your tracking(or receipt)number? i Track It I' t ... ........ ....... ..... ....., LEGAL ON USPS.COM ON ABOUT.USPS.COM OTHER USPS SITES Privacy Policy> Government Services, About USPS Home> Business Customer Gateway) Terms of Use> Buy Stamps&Shop> Newsroom> ' Postal Inspectors> FOIA> Print a Label with Postage> USPS Service Alerts> Inspector General> No FEAR Act EEO Data) Customer Service) Forms&Publications) Postal Explorer) Delivering Solutions to the Last Mile> Careers> Site Index) joUSPSCOalf 1 Copyright)2014 USPS.All Rights Reserved. https:Htools.usps.com/go/TrackConfinnAction.action?tRef=fullpage&tLc=1&text28777=&tLabels=7012101000... 4/1/2014 1 , I . f l '4 - t vi, IN �. -tL .� 1 ..... . Ir I : , r 1 I l , , 4 y I I, 1 : - � I , • +B1 , f U a- T HIE Town of Barnstable - rnstabie Regulatory Services-.Department ANUmficaCf 1 snxNsrwat.E. "3 ,�� Public Health Division a 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard.Scali,Acting Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2851 ,1050 November 12, 2013 Roger& Evelyn Savino 14 Ocean Highlands Gloucester, MA 01930-5210 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 175 Evans Street, Osterville,MA MA was inspected on 10/23/2013, by Douglas Brown, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system needed further evaluation under the guidelines of 1995 TITLE V (310 CMR. 15.00) due to the following: • System is in hydraulic failure: • Distribution box full of soil & roots; and lines going to SAS You are ordered to repair/replace the septic system within sixty (60) days from the date you receive this notification: Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BO OF HEALTH Th0 c ean, R. ., CHp Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\175 Evans St:Osterville MA Nove 2013.doc Commonwealth of Massachusetts Title 5 Official Inspection: Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 N 175 EVANS ST Property Address SAVINO Owner Owner's Name information is required for. OSTERVILLE MA 10-23-13 every page. Citylrown 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. Important:When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. DOUGLAS A BROWN INC Company Name ` P.O. BOX 145 Company Address CENTERVILLE MA 02632 'Bd0" Cityrrown State Zip Code, 508-420-4534 `S14297 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 ins'p' Rion. The spe on was performed based on my training and experience in the proper function and qa:p enance of'on sit sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15�_*0 of Title 5(310 CMR 15.000).The system: P,"A a zp ❑ Passes ❑ Conditionally Passes ® Fails, r ❑ Needs Further Evaluation by the Local Approving AuthorityCo s 10-23-13 Inspector ignature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board' of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the . report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority.. ****This report only describes conditions at the time"of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under' ` the same or different conditions of use. K C t5ins•3/13 • Title 5 Official n; action Form:Subsurface Sewage Disposal ,stem•Page 1 of 17 Commonwealth of Massachusetts . . Title 5 Official Inspection Form: Subsurface Sewage Disposal System Forme;Notfor Voluntary Assessments 175 EVANS ST - - Property Address SAVINO Owner Owner's Name information is OSTERVILLE MA 10-23-13 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) } Inspection Summary: Check A,B,C,D or E/always complete all of Section D- A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: DISTRIBUTION BOX WAS FULL OF SOIL AND ROOTS I DUG THE SOIL OUT AS MUCH AS I COULD AND THE SOIL WAS ALSO IN THE LINES GOING TO THE S.A.S. INDICATING FAILURE 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•3/13 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 175 EVANS ST Property Address SAVINO Owner Owner's Name information is required for OSTERVILLE MA _ 10-23-13 every page. 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): El The system required pumping more than 4 tim es a year due to broken or obstructed pipe(s). The system will pass,inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of.Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 I - Commonwealth of Massachusetts W Title 5 Official Inspection Fore Subsurface Sewage Disposal System Form -Not for Voluntary Assessments, wM , 175 EVANS ST Property Address SAVINO Owner Owner's Name information is required for OSTERVILLE MA 10-23-13 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects 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 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 m a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis.-must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No 771 Backup of sewagg into facility or system component due to overloaded or ED. Ej clogged SAS or cesspool El ® Dischargeor ponding of effluent to the surface of the ground or surface waters due to an overloaded.or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 - w } Commonwealth of Massachusetts , w Title 5 Official Inspection Form, Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 175 EVANS ST Property Address SAVING Owner Owner's Name : information is required for OSTERVILLE MA 10-23-13 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® 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.] ❑ ® 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 El the system is located in a nitrogen sensitive area (Interim Wellhead Protection El 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•3/13 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 5 of 17 I Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 175 EVANS ST Property Address ' SAVING Owner Owner's Name information is required for OSTERVILLE MA 10-23-13 every page. Citylrown 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 , ❑ N. Pumping information was provided by the owner, occupant, or Board of Health ❑ ® ,� Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recent) or as art of . ❑ ® 9 Y Y p this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth,of liquid, depth of sludge and depth of scum? ® 1:1 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 t r w Residential Flow Conditions: x Number of bedrooms'(design): 3 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 W A t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 k Commonwealth of Massachusetts e Title 5 Official Inspection form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments = M 175 EVANS ST Property Address SAVINO Owner Owner's Name information is required for OSTERVILLE MA 10-23-13 every page. City/Town State Zip Code Date of Inspection D. System Information Description: SYSTEM CONSISTS OF A SEPTIC TANK D-BOX AND INFILTRATORS WITH STONE THE ORIGINAL PIT IS ALSO STILL BEING USED Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes ❑ Nb' Laundry system inspected? ❑ Yes ❑ No Seasonal use? :❑ Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)):,. Detail: Sump pump? ❑ Yes [:I,. No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: ' Design flow(based on 310 CMR15.203): . Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑' Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No 'Water,meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection dorm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 175 EVANS ST Property Address SAVING Owner Owner's Name information is required for OSTERVILLE MA 10-23-13 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.), . Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 175 EVANS ST Property Address SAVING Owner Owners Name information is OSTERVILLE MA 10-23-13 required for every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1996 ACCORDING TO AS-BUILT Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet a r Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments,(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): . Depth-below grade: 1.5 feet Material of construction: ® concrete ❑ metal = ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑.Yes 0„ No Dimensions: Sludge depth: t5ins•3113 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 M 175 EVANS ST Property Address SAVINO Owner Owners Name information is required for OSTERVILLE MA 10-23-13 every page. City/Town State Zip Code Date of Inspection 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; El concrete El metal ❑fiberglass El polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 175 EVANS ST Property Address SAVINO Owner Owner's Name information is required for OSTERVILLE MA 10-23-13 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons , Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): .d "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 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 M , 175 EVANS ST Property Address SAVING Owner Owner's Name information is required for OSTERVILLE MA 10-23-13 ' every page. Cityfrown State Zip Code• Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): BOX WAS PACKED SOLID WITH SOIL AND ROOTS ALONG WITH THE INLET AND OUTLET _ LINES Pump Chamber'(locate on site plan): Pumps in working order: ❑ Yes ❑ Nc* Alarms.in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition.of pumps and appurtenances, etc.): ' y "If pumps or alarms are not in working order,system is a conditional pass. Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located,-explain why: . NO OBSERVATION PORTS.FOUND THELINES GOING FROM THE D-BOX TO THE S.A.S WERE FILLED WITH SOIL T t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection: Form o Subsurface Sewage Disposal System Form Not for Voluntary Assessments M Sy0 175 EVANS ST Property Address SAVINO - Owner Owner's Name information is required for OSTERVILLE MA: 10-23-13 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ; ❑ leaching pits number: ® leaching chambers number: x 4 INFILTRATORS ❑ 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.): SYSTEM APPEARS TO BEOVER RUN WITH SAND AND ROOTS Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth 7 top of,liquid to inlet invert T Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 EVANS ST Property Address SAVING Owner Owner's Name information is required for OSTERVILLE MA _10-23-13 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t t5ins•3113 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 175 EVANS ST Property Address SAVINO Owner Owner's Name information is required for OSTERVILLE MA 10-23-13 every page. City/Town 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 P t5ins•3/13 R - Title 5 Official Inspection Form: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 175 EVANS ST - Property Address SAVING Owner Owner's Name information is required for OSTERVILLE MA 10-23-13 every page. CityrFown 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: GREATER THAN 14 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: Date F ❑ Observed site(abutting property/observation-hole within 150 feet of SAS) ❑ Checked with local'Board of Health -explain: El Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 r Assessing As-Built Cards Page 2 of 2 •� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 175 EVANS ST Property Address SAVINO Owner Owner's Name information is required for OSTERVILLE MA 10-23-13 every page. CitylTown 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•3/13 Tit le 5 Official Inspection Form:Subsurface Sewage Disposal System-,Page 17 of 17 http://www.town.bamstable.ma.us/Assessing/HMdisplay.asp?mappar=142143&seq=1 10/24/2013 Assessing As-Built Cards Page 1 of 2 1 C' 1 TOWN OF BARNSTABLE LOCATION ' �� � SEWAGE#24 VILLAGE j Cr\�"Ar ASSESSOR'S MAP&LOT -/ � INSTALLER'S NAME&PHONE NO. __sue. SEPTIC TANK CAPACITY ,u7O (Cry<,4e LEACHING FACa.mt:(typej irvArjrS(sae).�=1. S'V- 6 fO\A NO.OF BEDROOMS BURDER OR OWNER �: COMPU, PERMITDATE: I I/(o I ANCE DATE: - i� TA(- _ Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist A on site or within 200 feet of leaching facility) .L dL� Feet Edge of Weiland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility, acility Not W Feet Furnished by 2�;,4 LA 1 yT. g R +o a td PR �I CStLL y http://www.town.Barnstable.ma.us/Assessig/HMdisplay.asp?mappar=142143&seq=1 10/24/2013 TOWN OF BARNSTABLE oe LOCATION 1 �Vc�,�5 SEWAGE # AQ VILLAGE_ { �/\�I-�. ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. I�MJ� 2 S'�YMCi SEPTIC TANK CAPACITY `�o CsC�� OX i ri 0Per LEACHING FACILITY: (type) 1 A 7'(1',`'Vr YA tC (size) NO.OF BEDROOMS a, �n BUILDER OR OWNER PERMITDATE:� ��� / �'� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility '(\E u Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Q Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility Feet Furnished by a s r,LK 13 A QX i �a p 3 t -its T ko �Lt5l e'� ('d1 (��q^;C1. q Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=9244 Logged In As: Parcel Detail Thursday, November 7 2013 Parcel Lookup Parcel Info Parcel j142 143 ( Developer LOT 64 ID Lot Pri Location F175 EVANS STREET Frontage 196 f SecROBBINS STREET _. __. __.__� Sec`139 Road Frontage Village JOSTERVILLE 1 Fire C-O-MM District Town sewer exists at this Road ---� � ad dress;No Index 0509 Asbuilt Septic Scan: I 142143_1 Interactive MapRl - 142143_2u`, Owner Info OwnerSAVINO, ROGER&EVELYN Owner %SURFCAT1, LLC Streets 114 OCEAN HIGHLANDS Street2 City[- LOUCESTER State Zip 01930-521 _ Country F J Land Info Acres 10.33 Use JS ngle Fam MDL-01 Zoning FRC�_� Nghbd Topography Level Road Paved Utilities I Public Water,Gas,Septic Location Construction Info Building 1 of 1 Year �' � YearBuilt 119 IS Ro°t lGam rel Wall t od Shingle Living Roof ��� AC " 1512 ( jAsph/F Gls/Cmp None y. Area Cover Type 1 4. Style lColonial Int Drywall Bed 2 Bedrooms I Wall 1, Rooms .;,Gaagi3as ,'k,, 00 Model Residential Int Carpet Bath 1 Full Fl oor Rooms *�: �Y _ 11 ___..._...�. Heat Total __ 6Rooms Grade Average ( Type Hot Water Rooms Heat Found-r _ Stories 11.8 Fuel was ation iTypical Gross http://issgl2/intranet/propdata/ParcelDetail,aspx?ID=9244 11/7/2013 q.,2 f4>_3- No. /USEETTS Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE. MASSAC 01ppYication for loiooml *patent Construction Permit Application is hereby made for a Permit to Construct( )or Repair('I<an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. C �0, o,, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nat re of Repairs or Alterations(Answer when applicable) U Qtb Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Bo d eaZt .�� Signed Datel✓ Application Approved by 441 =C Application Disapproved for the following reasons Permit No. Date Issued /US Fee 'No. THE COMMONWEALTH OF MASSACHUSETTSPUBLIC HEALTH DIVISION —TOWN OF BARNSTABLE., MASSACTTS Application for Oigpaal *pztem Congtruction Permit Application is hereby made for a Pernut to Construct( )or Repair(V)an On-site Sewage Disposal System at: Location Address or Lot No. # Owner's Name,Address and Tel.No. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. n r � a�, (AQA�q j - i-0 �'1s✓. 7 -�;X>ti cl Type of Building: E Dwelling No.of Bedrooms Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow y`y gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Descriptio f of Soil Nature of Repairs or Alterations(Answer when applicable) /-W \ cc,\ C.JQ VA (1 X Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss ed by this Board ea t Signed Date is Application Approved by Iz Application Disapproved for the following reasons Permit No. 7 ` �� Date Issued' 6A b j THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certificate of Compliance - THIS IS TO CERTIFY that the n-site Sewage Disposal System i lled( )or repaired/;eplaced�)on//I(o If by SC U C� t'� ��t.�/�`''L for & G,i has been constru'cteq in acc rdance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Z . Use of this system is conditioned on compliance with the provisions set forth below: I 00 No. .r. ! Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS &.5poal *pgtem Construction Permit 'i Permission is hereby granted to to construct( )repair( t�l'an On-site Sewage System located at U i 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. All construction mu t be completed within two years of the date below. �- i Date: Approved by ( / 4 /, i r- e ' CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL NVUItKS Co gS'I'ItUC'I'IUN I'EItMII' NVIT110U1 DESIGNED PLANS) I hereby certify that the application for disposal works construction permit signed by me dated �' � C Co , concerning the ,. property located at S� meets all of the following criteria: • There are no wetlands within 300 fect of the proposed septic system • There arc no private wells within 1 SO feet of the proposed septic system • The observed groundwater table is 14 feet or greater,•below the bottom orlhe leaching facility 1 .1 • There is no increase in(low and/or change in use'proposed • There are no variances requested or needed. Sim LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER IAttach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submittedl. E� 0 Cal 7 i No-all----- Fn$... ld.................. IIA THE COMMONWEALTH OF MASSAdHUSETTS BOARD ® HEALTH 1q2 . ..--- ---OF............ I� � iration -for Disposal orkii Cnlanfitrurtion prinit 0 pplic 'on is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst t - - `--41---•---•----•-•---•-••-•--------------------------•-•---•----•------ Location.Address or I of o. .................................................. d,.3..1----..R l._Gi r. ...... . a i ...... ... W k Owner A dress Installer Address Q Type of B ilding Size Lot............................Sq. feet U Dwelling—No. of Bedrooms------I----------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building _-__ No. of persons---------4.............. Showers (/ ) — Cafeteria ( ) dOther fixtures ---------- ------------------------------------------- -------------------------------------------------------------------------------- --------•--- W Design Flow...._.......-SP.........................gallons per person per day. Total daily flow.........eJ A0...___.__-------.------gallons. Septic Tank l-Liquid capacitv�Ba d___gallons Length................ Width................ Diameter...........----- Depth....-_.---.----- xDisposal Trenches No- -------------------- Width...... �N�-- Total Length.................... Total leaching area-.-_---__-.-__-_sq. ft. Seepage Pit No...._/............. Diameter__La0,0V_.§4Qepth below/inlet_________ _.._.__.. Total eacli'ng area....-_.----------sq. it. z Other Distribution box ( ) Dosing tank ( ) .0 b, / - 3/_d/,y' aPercolation Test Results Performed by-------------------------------------------------------------------------- Date--------.------ -•----------------.-.-.. ,4 Test Pit No. 1________________minutes per inch Depth of Test Pit.........._......... Depth to ground water........-.---------.---. �14 Test Pit No. 2................minutes per inch Depth of Test Pit.-_.____.._.______-- Depth to ground water._.--....-----------.-- o1_..r p L Description of Soil----10-------- #f d r1 - -�.....---r�. ,� `�- �' .. x �(' ------------------------------------------------- ------------------------- - () W ------------- tl t.r� ------------------------------------------------------------------------. ---------------------------------- VNature of Repairs or Alterations—Answer when applicable..-.•----------------------------------------------------------------........------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------- --------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code— The undersigned further agrees not to place the system in'.. .' operation until a Certificate of Compliance has bee issued by the board of health. �. Sign, I �Date I Application Approved By----- -- ------------------ Date+._... Application Disapproved for the following reasons:......................................................................:..g ` : ate y, --------------------------------------------------------------------------------------------------------------------------------- == -------------------------------------- Date PermitNo......................................................... Issued_. ----------.-•---•--'•ate—•- ---- •---- r. •, ................... THE COMMONWEALTH OF.MASSACHUSETTS'> ; BOARD ®' HEALTH. III loop - OF_ Appliration -for Uhipwial Worko Tiatto#rttr#ion Vrrmft o { Application is hereby made fora Permit to Con§truct ,( ) or,Repair ( } ;an Individual Sewage Disposal System at: --------- --------- Location-Address or`Lot o� .y� Owner % ..l5.. dress p Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms-_---__s ..__... Expansion �Ajttic ( ) Garbage Grinder.( ) p, Other—Type of Building . --- No. of persons________�Gr______________ Showers (/ ) — Cafeteria ( ) QOther fixtures ----------------------- ---- ..............--•-------------------•---------------------------------------------------------------------------------- W Design Flow.:_--------SP________________________gallons per person per day. Total daily flow.........�a._:____---____--.__-.-.-gallons. WS(g9tic.Tarrk T Liquid capacity 0-..gallons Length---------------- Width---------------- Diameter------------.... Depth.-___-__-..__. x Disposal Trench' No_____________________ Width._ ,.. ,e---- Total Length--__---. - Total leaching area-------------.------sq. ft. -/Seepage Pit°-No _.1_____________ Diameter._ ,6V...At t4epth belo inle T � 1 trea._ _.__ _.._____.sq. It. Z Other Distributrori+box ( ) Dosing tank ( ) � � � t � aI"Percolation Test Results Performed by------- -------------•---•••••--•••-••-•••-••-••----•-•---••-•--•-•••-•-- Date........................................ ,� e,�t Pit No. 1...............minutes per inch Depth of Test Pit.................... Depth to ground water....._ . -__.--. -- .- ri ,,. sPit No. 2................minutes per inch Depth of Test Pit___________________. Depth to ound water________._ _ � j "" ' D Descrrptton;.of Soil----- tom!d' �-• !a' --- -------- -------- -----------•.._- x - , --- --------•------•- U Nature of Repairs or Alterations. Answer--------------------------------------------------------------------------------------------------------------------------- when applicable.------------------------------------------- ------------------------------- ------------ -----------------------------------------•-----------------------------------------------------------------------------------------==----------------------------------------------------------------- Agreement: :, The undersigned agrees to install. the afor'e'described 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 bqeja issued by the boar of health. --- •----- -- Srgn rap / ' Date Application Approved By---=- --- .............. ------•--- Date Application Disapproved for the following reasons.*...............•• -•-- • •-- -••••-----...•--•-•......------------------------•-----•-••-•----•--•---•---- •--------=-------------------------------------------- -------•--------------------..._..---•---------•-•-•------------------------------------------------=--------------------------------------•..••- • Date PermitNo......................................................... Issued-....................................................... Date r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H)ALTH �rx#i$ir #r f f�rrnt ltattre TH IS TO ICELR. FY, That.t)oe•Individual Sewage DtsposaL Syste>n,,�onstructed ( ) or Repaired ( ) :i by -- ---- -- Installer at --------------- T f t �. y� has been installed in accordance with the provisions of Article—XI of The State Sanitary C*�f sf ` m the application for Disposal Works Construction Permit No ... ___ ....._..... dated.......�./_ '_/......_..!__`_! THE ISSUANCE'OF THIS CERTIFICATE SHALL NOT BE CONSTRUED.AS AL GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY.- DATE..............................: Inspector..................................................:................................. THE C .MON4VEALTH OF MASSArCHUSETTS BOARD HEALTH . ...� ....OF... ` S. ... ........... .. � ryry , No._--_4Z. _� FEE......................../ --•-• - �i� tt1rk� Q � rttr#gait: rrutt# Permission is _ e y ranted----! jam" •--•-- - -•-• ................ to Constr ( or Re a' ( ) Individual ew e '`;s tem at No.- ,�. .m z ----- "-��'' S. t. !• as shown on the application for Disposal Works Construction m' No. - ..___. __ a ed.:.. ...... ... _........ a L .... '.:Board,of..Health r DATE:_.=.._.._.. ----- ------------------------ FORM 1255 HOBBS & WARREN: INC., PUBLISHERS`•' x - - - - - -.- 4. '.S.0 f4_ 'PA T:H:'-_ 0� 5.3.75 � 3g O FQR48 k. � ma ` e7rxy- cLl (21° O: S U C.a t; E S T C D 5 4T E LA I«.L1 T" _SC.A LF O J_ _ _ REVt F! P 5-6-74_ — . .RUCtk `5AVFNO ,- - . J k N O �p�3u t Q a an„�Est4o�o Z 1 0 W �-3=ooj e 1 taxis Yinq gnrwge wwll \ 2 2'-O" I b I I I 2 xB Floor join#s N I!o"o.L. I 4'4" L I i I P.T.2 x_sleepers I m C I V I N<w G nil palY�npor bnrricr Inpp<d!o"+.p.d on sl.b below e 1 E ` y a L5 ° ^ Y z xe floor iaists e I moo"o.c. " ° Y - ° 175C L I �G%i�i'rING PR-AI-I�NG -� I ------ --- -- e V I I � I I o '•.. o a` 01 - GLo�r r 1p Gxi.ting q.r.q.w.0 's -- \ ( ti vew%m a . E O v _________ sio,oio 10 'n Andersen®AWlol ' -t ilA�iTG�PeP�o01-1 FU O h vnN+<d L<I - c - -=----------------- - --------------- m A if 'D Ned eiling joists to r f+us w/I I-I v0 or equiv. 1 a s 1. Q w =^N � a K diimpson H Z.ei hurriLwn<Y<s e 1 ro•o.L. 1 - ':.�t�7`..— _ -�— P� Z W V m 3 Inat.11ed From+he inside on newr<f+er.. \ .--. '� Q � um"iU 30 -- -- ���IIIIII��IIIIIryIIIII���-��IIIIIryIIIII��-_-I��ry�I1IIryIIr--IIIryI�IIIryryI�--�llry��IIIIII��-- -- -- I 1 +- a_ , N<w daubl.2,1 0 pcf+ers<2 9'o L Q n Q I` , o• Tunnel ekYl�ght+o L<iling below J -- c P Y a_ v, Ul vv IL f- -- -- -- -- 11 _ n existinq,Gerwge Aspec#R-n+io f L/W)•'1.00 - d I I I I \ Q" Q This pl.n w.s d<sign.d in.wcorMnoe with I I I u the In+un<tiannl�esidentinl God.2 009 edition and the t1<ss.Lhus<t+z 7 51.00 Bf'h 0d14'ian. a>impson LhT 2 I s reps e 1 m"o.L I I - Window pro#ec+lon+o conform with 16 o o.". I I 1 9'-O• 9'-O• v 0 1.2.1.2 Pro+.L#ion of openings. t o 0 3 _ owt m N Va �V n I II I 9wwlls Nv aLTue \_\ I I New w<Ils I li I t wm`o nt5 + 3 Naw double 1 x l 0 F-nf+err e 2 9"o.L. _ hie+e: m O O t 3 0 Q•< t.+ered to top Lord of exis+inq+russ< r, n All M—. r...n+s f rli—lops xe+a - be site vuifled by G<n<r<I Gantr<c#or- I \ .#time of Lon.#ruction lw uEQ z , G +i•y Z nd Pbor Prnmi•y \ L- -- - J�- - -- -- I SN�� OS hmakev<#eLtor �- __ <ilmp.on H ss hurr'w<n<tie I�•>.L.� -- -- �- - - - - -- - DANIEL BqG V a°? rc d o rtwt<Iled from+he in:We on cw ref+us. 1 � MM N 1 C BEAU -DRAWING TYPE: P-OOP F-AMe PLAN NO. 46253 Firs+Floor Frame Plan Firs+Floor Plan .. O� GI STEM roof Framing Plan c� G ssN SHEET�O � NUMBER: n =ovum ooE -v l • - = ao JwOOt , p pp J0 a —m FM m = w am��aO VOc Q f L N 7 G ' 0 I I S } K 14 �L______________________________________1 - roimpsanm LhTA2 Ls+rapse 24"oL. - L_______________________________________a Continuous ridge ven+ -Fr-ON-r ELENATIOhj I/2"Plywood gusset _ _ u-1 ..00 - - Exis+inq asphalt shingles p hale: I/4"= L-- --_ -_--_--_ Exis}ing1/2"6vx plywood sheer+hinq • Exis+inq 2x4"truss"raf+orse 24"o.c.+o remain C Oauble 2 x I O F�nf}ers e ff 4' '+. } W W Proper vans e 2 4"o.a. t 2"F.G.Insula+ion Nail aeihnq jails to rafters w/ I I I l-O or equw. x 4 roimpsan H 2.°,hurricane ties G 2 4" I. ''"� •• '- F-emave axis+inq"truss'webbing ` Q r Aluminum LU gutters to drywells -` ...... ....... ._. ... - _... --- ... .._ -.. _ — rL. Gon+Inuous soffit ven+(+yp.) - 0 i. - GLO�iET PJEp�00F( Exis+inq 2 x4 wall studs}e remain F 2 x 2 0+ud shims e I!o"o.a.(+yr.) ry ry 2'•H.D.Insulation 2 1 <+yp.l Q W ." p N p N m I 9/4"APA rated t.fq.subflaor Naw!o)'1il poly vapor barrier Z - 1I '�' glued and nailed.. lapped lo" +aped •� m° 3 ry I (L _______ ____ ___ ____ ___ ___-� I I w rn U c N c W w W L___ ____ ___—__ _ __ - --- ----� - Ezis+inq garage slab L- U) In O U U ®a �Pj�LEFT ELE�/ATIOFJ P.T:2 x_hleepers !L liL u U o <i a2 VOW Y N veo� mOO JOc30 C a . - rym vado v d ® tvkOFU48 ye�Ja' �c� DANIEL �p v m '€ w ° `o o CROTEAU CIVIL No. 46253 DRAWING TYPE: I 8TE¢ �� puildiny heel ion"�" `S�ONAL, I h---------------------------------------, F---------------------------------------J � 5HEETNUMBER: 4 ci r-A�ELE�/ATION f T f ---------------- S t LEGEND N - O,STT�'RYILLJ�' - 20 -- EXISTING CONTOUR ® "C2 (� x 20.12 EXISTING SPOT GRADE 'Y 100,13 �> 100,09 PROPOSED CONTOUR �' eagP I W EXISTING WATER SERVICE FDRT�IS �'AY G EXISTING GAS SERVICE osHu °j` 99.60 R➢N� v � -p.H.W.-- OVERHEAD WIRES 4y °O�e TEST PIT BENCHMARK o� > 1 99,99 4 99,15 99,87 9 .71 S3�630 \`. LOL7lS x 99.29 98.93 ►l LOCUS MAP •� ?� 99,32 ���r' NOT TO SCALE pOAr \ Q is p X 100,21 x loo, 100,23 ::'• ..' : o GENERAL NOTES: O 99.53 IRRIGATI❑N :. / . 100, 8 �- ... 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL P�� \ 98.43 BOARD OF HEALTH AND THE DESIGN ENGINEER. -�- 100,06 0.59 '� 2. ALL WORK AND MATERIALS SHALL CONFORM T0, THE REQUIREMENTS EXISTING S.A.S. 2�, \ '' W OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE (approximate location) 100.56 1 +I LOCAL RULES AND REGULATIONS. TO BE ABANDONED 100,36 I LOT'r64 �� 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR EX/STING TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE J ; ` �9K09 DESIGN ENGINEER. 1 Q4 HOUSE( �BLU 142 143 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 99.14 0� ^h / \ TOF=10#1 14,590 •;±SF } FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN + 9 �1 \; \ 100.25 x / I 9 �. ENGINEER BEFORE CONSTRUCTION CONTINUES. / 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. STM 9'98 N/ W 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF / THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF O � x 9 9.4 81 2 N HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. POUT 1 0.2V 0 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. °9e 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS 1O 1' -12.8- 9 °j / / , <�;�?; i z `y 1 97,88 AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 99,89 / 97.26 DIRECTED BY THE APPROVING AUTHORITIES. o 'uO 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY 9819 qj a� E THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING STONE/DRI Vt A I.TE, 4 Y:• I .`::.'.`:: ,:. ::;.. .:...,'`., CONSTRUCTION. RESERVE TP-12 0 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS 00.03 - - U AREA a L,._ __ / .� � IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND / " b 21.3-~-I .} - 0 99.21 / { o REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 98.12 0 0 / j, �� 1'3. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND 99.31 151.65 J ( a IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. FENCE 98,96 CB 14. THE ENGINEERING IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED OF 96,64 N 86°37 41 W ------- -� SEPTIC SYSTEM COMPONENTS NOT SHOWN ON THE PLAN. Mgs9�P\ S PROPOSED S.A.S. o PETER T. G� EXISTING SEPTIC TANK 96.30 PROPOSED SEPTIC SYSTEM UPGRADE PLAN Mc CIVIL INV(OUT)OF A97,27f=98.60 II 175 EVANS STREET, OSTERVILLE, MA o CIVIL "' No. 35109 1 Prepared for: D.A. Brown, Inc., P.O. Box 145 Centerville, MA 02632 Rio OLD LEACH PIT f fG/S1� \�` a Benchmork Set OWNER OF RECORD (approximate location) Engineering by: SCALE DRAWN JOB. N0. E OUTSIDE COR./BOTT. STEP SURFCATI LLC ELt=100.27 Engineering Works, Inc. 1"=20' P.T.M. 267-14 14 OCEAN HIGHLANDS (1 fJ GLOCESTER, MA 01930 3 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET N0. (508) 477-5313 1/6/15 P.T.M. 2 of 2 1 IT Il NOTE: TO PREVENT BREAKOUT, TFiE PROPOSED -FINISH-GRADE-SHALL NOT BE _<_ EL:97.0 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED S.A.S. SOIL LOG INSTALL RISERS & COVERS OVER 'INLET & PROPOSED D-BOX PROVIDE TWO ACCESS MANHOLES TO WITHIN 3" OUTLET AND SET TO 6' OF FINISH GRADE INSTALL RISER & COVER OF FINISH GRADE FOR :INSPECTION PURPOSES DATE: JANUARY 2, 2015 (REF P#14,604) T.O.F.=101.0t SET TO 6' OF GRADE } f f F.G. EL.=99.3t ` SOIL EVALUATOR: PETER McENTEE PE, (SE#1542) ' �•-F.G. EL.=100.2t F.G. EL.=99.6t F G EL.=98.5t WITNESS: DONNA MIORANDI R.S. r �INTAIN 27 GRADE (MIN.) OVER S.A.S. HEALTH AGENT Buz" �,,�w, y ELEV. TP- I DEPTH ELEV. TP.-Z DEPTH :. L = 33' L - 5 99.4 A 0 99.5 A 0' " ®'SCH4o(PVC)IN ®"SCH O(PVC) LOAMY AND LOAMY AND 6., - 10YR 4 2 10YR"4 2 as as 98.4 B 12" 98.7 B 10„ 6' asa�aaa�4: as®ease LOAMY SAND LOAMY SAND EXISTING 48" LIQUID aaaaaaa 10YR 5 8 10YR 5/8- LEVEL INV.=97.27 4' 4.8' t' 4' 9 6:9 / 30 GAS BAFFLE INV.=96.77 INV.=96.60 C 97.0 30 PROPOSED D-BOX EFFECTIVE WIDTH i= 30E�42„ C INV.=96.50 2-500 GALLON LEACHING CHAMBER EXISTNG SEPTIC TANK S SURROUNDED WITH STONE AS SHOWN MED. SAND MED. SAND " H-10 RATEDI, 3 i " LAYER OF 1/8" TO 1/2" 2 2.5Y e 5Y 6/8 6/6 DOUBLE WASHED STONE - • TOP CONC. ELEV.=97.3f (OR APPROVED FILTER FABRIC) NOTES: BREAKOUT ELEV.=97.00 INV. ELEV.=96.50 mama 88.4 132" 88.5 132" 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE eases ®NOaa ease aaaaa NO GROUNDWATER,. PERC RATE <2 MIN. IN. INVERTS, PRIOR TO INSTALLATION. BOTTOM ELEV.=94.50 / 2) D-BOX SHALL BE SET LEVEL & TRUE TO 4' 8.5' 4' GRADE ON A MECHANICALLY COMPACTED SIX 4' OF NATURALLY OCCURRING VARIES-REFER TO SKETCH INCH CRUSHED STONE BASE, AS SPECIFIED IN PERVIOUS MATERIAL - ELEV. TP-3 DEPTH ELEV. TP-4 DEPTH . 310 CMR 15.221(2). 5' MIN. SEPARATION TO G.W. LEACHING SYSTEM SECTION 0" 0" 3) INSTALL INLET & OUTLET TEES AS REQUIRED. NO G.W. EL.=88.2 3/4 . TO t-t/2" DOUBLE .99.2 A 99.3 A WASHED STONE LOAMY SAND LOAMY SAND 4) CONTRACTOR SHALL INSTALL.A GAS BAFFLE ON - 10YR 4/2 10YR 4/2 THE OUTLET TEE. � SEPTIC SYSTEM PROFILE ,} 98•2 B 12" 98.3 B 12" { LOAMY SAND LOAMY SAND 10YR 5/8 10YR 5/8 96.9 28„ F C 96.8 30" BACK OF HOUSE PERC C PO RCH CH 42 30"/ " . DESIGN CRITERIA ^{ 8.5 I ` 1--12 -- .. r s MED. SAND MED. SAND NUMBER OF BEDROOMS: 3 BEDROOMS T1 L_ ITT. t 2.5Y 6/6 .2.5Y 6/6 SOIL TEXTURAL CLASS: CLASS I `n IBOTTOM AREA l 00 DESIGN PERCOLATION RATE: <2 MIN/IN i 320.0 S.F. DAILY FLOW: 330 GPD DESIGN FLOW: 330 GPD a Y a 88.2 132„ 88.3 132 •I---21.3--I GARBAGE GRINDER: NO acr NO GROUNDWATER, PERC RATE: <2 MIN./IN. LOCOTY PERIMETER=75.6' J CO LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF SAS DIMENSIONS iD �b .74 GPD/SF SKETCH USE 2-500 GALLON LEACHINGAM I CHAMBERS IN SER E S PROPOSED SEPTIC SYSTEM UPGRADE SURROUNDED BY 4' DOUBLE WASHED STONE-ALL SIDES 175 EVANS STREET, OSTERVIL_LE, MA SIDEWALL AREA: 76.4'(PERIMETER LENGTH) x 2'(EFF. DEPTH) = 151.2 SF '� Prepared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 BOTTOM AREA:............................................................................ = 320.0 SF Engineering by: SCALE _DRAWN JOB. NO. TOTAL AREA:.......................................... 471.2 SF �� / ....................................... LAYOUT Engineering Works, Inc. NTS P.T.M. 267-1 4 S.A.S. - 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74 GPD/SF(471'.2 SF) = 348.7 GPD (508) 477-5313 1/6/15 P.T.M. 2 Of 2 �I I�;