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0178 EVANS STREET - Health
178 EVANS.STREET Osterville A = 142 - 142 1 No. Fee C� s I ra r Fee [ , THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0(ppliLation for Bisposal 6pstem Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade'(54) Abandon( ) ❑Complete System 0 Individual Components Location Address or Lot No. 1-T8 E VAr,S STiree, " Owner's Name,Address,and Tel.No. bar ERv:%\e, _TA vnES Y, Surf Assessor's Map/Parcel 14-L -Z Installer's Name,Address,and Tel.No. '3(,,,3�ti{� yAA- Designer's Name,Address,and Tel.No.'_& r �-Z?j b37 7 ¢a�.f 1b. 00f co. Z.wc. Type of Building: Dwelling No.of Bedrooms Lot Size RP4 Z 3(o �- sq.ft. Garbage Grinder( ) Other Type of Building `J;n�le 42*4�—:kj No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) LA l7 gpd Design flow provided S 5�. - gpd Plan Date 3 U�?�� Number of sheets Revision Date Title V on 5-r -ep—t Size of Septic Tank I b0 Type of S.A.S.(3 ( r�� Ybc7 C aL. L.C.. Description of Soil Nature of Repairs or Alterations(Answer when applicable) CWj"�y)" i-b-0 Z1-�L, T O �-�- Date last inspected: Z d Z O Agreement: i The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in i 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 Boar of He lth. Zo Sig Date Application Approved by Date _ Application Disapproved by Date for the following reasons Permit No. 7- Date Issued ., ;. ..t ,.F, .,- ..P i�aY c +r.`�",,. .-t`,4, aV'"'-.Y ,,.� d r*'''�^c�,., tP"'.d`�1r,R.. ,l�"� --t. cr..•..,. ;..J+r:,� .,�:i. �..�r... � %r:.' .s s No. O a .. .`•�&„ , Fee Entered in computer: ,- HE COMMONWEALTH OF MASSACHUSETTS ; Yes 4 PUBLIC HEALTH DIVISION wlOWN OF.BARNSTABLE, MASSACHUSETTS. ,r i Yitatioriyfor VeoOsaY' pstem Construttion permit fi Application for a Permit to Construct( ) Rel-Ipair O Upgrade,'O Abandon(- � ❑Complete System jZ Individual Components Location Address or Lot No. 1778 L d AYh 'Sr¢ ?re T` Owner's Name Address,and Tel.No. • TAMeS Assessor's Map/Parcel 14-L 1-4 ' Installer's Name,Address,and Tel.No. v%, cy.yV400- Designer's Name,Address,and Tel.No'.�' " 7 Type of Building; Dwelling No.of Bedrooms Lot-Size , lA�Z.�.r`to sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons" Showers"( )-Cafeteria(.: ) ,Other Fixtures >I, Design Flow(min.rrequired +4 ew1. -•'gpd Design flow provided L4 S 5-. -I..- :�"" gpd••" Plan Date .7 "Z®7.1 Number ofusheets, Revision Date T i le- F7 9 V 4-n 51� 1 Size of Septic Tank Type of S.A:S.( 3V (�tr,,e e. 56a el at Description of Soil Nature of Repairs or Alterations(Answer when applicable)" �5 1� ( �• '[`I+R'�•�^ 'T t� tj Date last inspected: Q C> Agreement: t The undersigned agrees to ensure the construction and maintenance of the"afore described on-site sewage disposal system in lacordahce`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. Sid,.; � ...----. �,, . Date 3 Application Approved by Date Application Disapproved by U Date j for the following reasons Permit No: i o.2 l — 11D Date Issued THE COMMONWEALTH'OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TOO CE(RTIFY_,that the On-site Sewage Disposal system Constructed( ) Repaired(. ) Upgraded(/_ Abandoned( )by [�o (—C,. { C.. at. f.� � S �i'C-GT ay r2.w�C�c. has been constructed in accordance f� with the provisions of Title 5 and the for Disposal System Construction Permit No7d-zI' i dated "{ Installer �w� ,�-� 001 e-p. L Designer ' { _,,(�, hr 1 "t #bedrooms Approved design flow S^. �„„, gpd The issuance of this permit sha l got be.construedas a guarantee that the system will fi eti•6n' 'desi� ed. Date ZJ C J Inspector 1- __._ ._,. No. Fee` !6lb THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS misposaY �psteut oustruction 3dermit f f f Permission is hereby granted to Construct( )�"�Repair(� )� �"'Upgrade) Abandon(. ) System located at I �( 1: U 1��''i ✓f 1-e-t-T f 'C` i'Z_1.11 y s: .. 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 completed,within three years of the date of this permit.. Date . y" i , Approved by , o Town of Barnstable ', IRE Regulatory Services ti .�. Richard V. Scali, Interim Director rn>Msr M Y , 9MAM Public Health Division i639. �0 ' '0r�nr " Thomas McKean,Director, _.. • i 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 4-29-21 Sewage Permit# Assessor's Map\Parcel 142/142 �'C: Ergo crneeruI ':r iic._ Installer: Robert B. Our Co., Inc. (RBO Designer: 5+ ) 77 Address: Cron�oe.rry ll�I ,�i 0 y_ Address: .363 Whites Path Ea54. ware-�%avn HA 62_53 South Yarmouth,MA On 'ZI RBO was issued a permit.to install a (date) •(installer) septic system at 178 Evans Street based on a design-drawn by (address) �C, ' t n 5 io eex in TV1 dated 3-29-21 4• F (designer) I certify that the septic system referenced above was installed substantially according to,the design, which may include minor approved changes such as lateral relocation of ` the:distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. „ X JI certify that the septic system referenced above was installed with major changes (i.e. great r than 10' lateral relocation of the SAS or any vertical relocation of any component —off e septic-,system) but in accordance with State & Local Regulations. Plan revision or t certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed i iance with the terms of the I\A approval letters (if applicable) c L v iRCHILL At N (In taller's na CML .41 ' (D ner's Signature ,(Affix De i p Here) PL SE RETURN TO ARNSTABLE PUBLIC HEALTH D SION. CERTIFICATE OF_COMPLIANCE_.WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc t TOWN OF BARNSTABLE � LOCATION l 8 -5?, SEWAGE#ZOZ 1 — It VILLAGE—1:-'t<I(AL ASSESSOR'S MAP&PARCEL C Z—i- INSTALLER'S NAME&PHONE NO. — SEPTIC TANK CAPACITY 1500 LEACHING FACILITY.(type) C-RAMa&(size) JZ. 3. NO.OF BEDROOMS OWNER PERMIT DATE: .4 ZI i CI COMPLIANCE DATE: 2S Z Separation Distance Between the: ,I Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility NO FlJ200 I Z eet 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 F FURNISHED BY 06eez--T- —�- t)(AL _ �o s HE'D Z. 1 Iq �a 2 it's a� 4 �1 141131 61 . r c Commonwealth of Massachusetts /'yoj -/yam Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments s. 178 Evans Street _ Property Address Alina Morgado _ • .._ - — Owner Owner's Name information is required for every Osterville ✓ MA 02655 3-13-20 — - page. City/Town State Zip Code . Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. `���uuuuurrur� �a ��`�s�ZH�F Important:When A. Inspector Information 5l4 / fillingoutforms `gy3I JAMES cyu'� on the computer, m use only the tab James D.Sear_s Name of Inspector key to move your cursor-do not Jim The Inspector Man % o w•'Q . �. . use the return -- --- 'y ! r O` - — key. Company Name ,,�������rStnN S �`\`` P.O.Box 784 _ — -- mb Company Address West Yarmouth _ MA 02673 City/Town State / 508-364-4398 _ S1623 Telephone Number License Number B. Certification certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system- 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 3-13-20 I ector'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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 18 ,y c Commonwealth of Massachusetts _ -- Title 5 Official Inspection Form �. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 178 Evans Street _- Property Address Alina Morgado _ — Owner Owner's Name information is Osterville MA . 02655 3-13-20 required for every Y page. Cit !Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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.- The system is a 1500 Gal. Tank D Box and pits. 2) 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): t5insp.doc i rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 178 Evans Street Property Address Alina Morgado _ Owner Owner's Name information is Osterville MA 02655 3-13-20 required for every _-._--_ _ _ page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired, ❑ 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): F. , ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ' ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) 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. a. 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: 4 t5insp.doc•rev.7126/201a Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ie Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 178 Evans Street Property Address Alina Morgado _. Owner Owner's Name information is Osterville MA 02655 3-13-20 required for every page. Cit Y Rown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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: for This system passes if the well water analysis, performed at a DEP certified laboratory, o f ecal en and the presence of ammonia nitrogen and nitrate nitrogen is equal coliform bacteria indicates absent g q P 9 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. c. Other: 4) System Failure Criteria,Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: 4 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 t5insp.cloc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 178 Evans Street Property Address Alina Moroado _ Owner Owner's Name information is Osterville MA 02655 3-13-20 required for every ---- --- -- _ page. Gty/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ to Liquid depth in awspoWis less than 6"below invert or available volume is less � 4 than 2 dayflow R t S ❑ ® 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 water supply 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 2000 gpd- 10,000 gpd. ® 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. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in'Section C.4. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 178 Evans Street Property Address Alina Morgado _ -- Owner Owner's Name information is Osterville MA 02655_ 3-13-20 required for every di-y own State . Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered yes to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week`period? El ® Have large volumes of water been introduced.to the system recently or as part of , this inspection? ® El available 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)] f ' r t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 .e i .. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .� 178 Evans Street Property Address Alina Morgado Owner Owner's Name information is "I terville MA 02655 3-13-20 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): - 4 — Number of bedrooms (actual): 4 440 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Description: 1500 Gal. Tank D Box and two pit's. _ 3 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): 2018-188,000GaI 2019-202,800Gal's Detail: Sump pump? ❑ Yes ® No Present Last date of occupancy: Date ` Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 1e t5insp.doc rev.7/2612018 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 178 Evans Street Property Address _Alina Morgado Owner Owner's Name information is MA 02655 3-13-20 required for every Osteryllle -- page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: — — Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes- ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: - - -- t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form � e Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 178 Evans Street Property Address Alina Morgado Owner Owner's Name information is Osteryille MA 02655 3-13-20 rpe ge. for every City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known) and source of information: 1986 Permit #86- 1296/2017 Permit #2017- 188 D Box._ Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 25„ Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC El other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence.of leakage, etc.): Pipeing is 4 PVC SCH -40. t5insp.doc•rev.7126/201a Title'5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ,- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments v 178 Evans Street L' Property Address Alina Morgado Owner Owner's Name information is Osterville MA 02655 3-13-20 required for every City/Town State Zip Code Date of Inspection page, D. System Information (cont.) 6. Septic Tank(locate on site plan): 15" _ Depth below grade: feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age:• years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No 1500 Gal, Precast H-10 Dimensions: 211 Sludge depth: 28„ Distance from top of sludge to bottom of outlet tee or baffle of) - Scum thickness 1211 Distance from top of scum to top of outlet tee or baffle 18" Distance from bottom of`scum to bottom of outlet tee or baffle --__ How were dimensions determined? Asbuilt- Plan-Tape Sludge Judge __ Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank and outlet cover at 15" below grade w/inlet cover at 6". Inlet tee w/outlet baffle. No sign of leakage or over loading. t5in5p.d0C•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 110 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ` Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 178 Evans Street Property Address Alina Morgado Owner Owner's Name information is Osterville MA 02655 3-13-20 required for every _ _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: JScum 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 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts , - - Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 178 Evans Street _ Property Address Alina Morgado — Owner Owner's Name information is Osterville MA 02655 3-13-20 required for every City/Town State Zip Code Date of Inspection page. D. System Information (cont.) 8. Tight or Holding Tank(cont.) , 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 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 --- Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x16"-30" Below grade w/two line's out. Box is clean and solid w/cover at 10". Note: New . Box 2017.No sign of over loading or solid carryover. t5insp.doc•rev.7/26/2018 ' Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ` s • 178 Evans Street 7 Property Address Alina Morgado Owner Owner's Name information is Osterville MA 02655 3-13-20 required for every - — -- page. city/Town State Zip Code Date of Inspection D. System Information (cont.) p 10. 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. 11. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: n ® . leaching pits number: 2 ❑ leaching chambers number: ❑ -leaching galleries number ❑ leaching trenches number, length: , ,° ❑ leaching fields number, dimensions: — ❑, overflow cesspool number: 3; ❑ innovative/alternative system f _ Type/name of technology: t6insp.doc-rev.7/26/2018 y J Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of.18- - , Commonwealth of Massachusetts - , r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 178 Evans Street u Property Address Alina Morgado _ _ -- Owner Owner's Name information is Osterville page. Cit MA 02655 3-13-20 required for every y/Town --- State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is two 1000 Gal. precast pits w/2' stone. Pit# 1 30"water w/cover at 1'.Pit#2 I'water W/cover at 10". No sign of over loading or solid carry over. 12, 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 Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form �i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments uy' 178 Evans Street Property Address : Alina Mor ado Owner Owner's Name information is required for every Osterville MA 02655 3-13-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): i t5insp.doc-rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts .9 Title 5 Official Inspection Form I1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . 178 Evans Street Property Address Alina Morgado Owner Owner's Name information is Osterville MA 02655 _ 3-13-20 required for every .- page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 14. 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 j? FAR 3�'1CK o 1 v,r/, R r�a2 17-1 O 3 t � A-1 - H-3 r r` r t5insp.doc•rev.7/26t2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form •I' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a v 178 Evans Street u Property Address Alina Morgado Owner Owner's Name information is Osteryille MA 02655 3-13-20 required for every - -- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope E ❑ Surface water ❑ Check cellar ❑ Shallow wells N� 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: 6-8-83 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ . Accessed USGS database-explain: w You must describe how you established the high ground water elevation: T.H.on Design plan 6-8-83 12' no G.W.. Bottom of pit at 8' below grade. Bottom of pit at above T.H. Depth. Before filing this Inspection Report, please see.Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form I; Subsurface Sewage Disposal System Form Not for Voluntary Assessments 178 Evans Street Property Address Alina Morgado Owner Owner's Name information is Osterville MA 02655, 3-13-20 required for every State Zip Code Date of Inspection page. City/Town E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section'. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C, Inspection Summary: 1, 2, 3, or 5 completed as appropriate t 4 (Failure Criteria)and 6 (Checklist)completed k - ' ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to.high groundwater included • I T Ya e ' r t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 1 e ' J � No. Fee THE COMMONWEALTH OF.MASSACHUSETTS Entered in com ter: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS s 4pliLation for -Mispo8at OpStrut Construction 3pErmit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) El-Complete System Vndividual Components Location Address or Lot No. 1')� �Ve�nS �jlr � N�\�(, Owner's Name,Address,and Tel.No. r Assessor's Map/Parcel 1 a /O Installer's Name,Address,and Tel.No. Designer's Name,Address;and Tel.No. sck,>�t c,\ C-' 1� Z�3 4c� >cr—re�,w* Type of Building: (LPN.,l Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank t' Type of S.A.S. Description of Soil C'-Nature of Repairs or Alterations(Answer when applicable) K2D��L� ajc�5��� Q �O-G lW 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 o Health. aa i to l0 ) 7 Application Approved by te 40?4qDate Application Disapproved y for the following reasons v Permit No. Date Issued --------- -- Q �1 C�� r No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered incom uter: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pprication for Misposal 6pstem (Construction Permit � a 1 Application for a Permit to Construct,O Repair Upgrade( ) Abandon( ) ❑COt plete System Individual Components ti Location Address 9vtot No,.11 4 v r hS ,oS Iry i 1V, Owner's Name,Address,and Tel No. Me,n vet„ �''� 0('Sq d U Assessor's Map/Parcel 1 Installer's,Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. )Q6.rh.uu* Z� Type of Building: Q$ LA 0bt-ct Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other � Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures s Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank w 1 ` Type of S.A.S. Description of Soil -- a Nature of Repairs or Alteration (Answer when applicable) k C Q--kk S c,. O-I.G W 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.... i e ', G ate Application Approved by _ Date r Application Disapproved by Date for the following reasons Permit No. Date Issued —------------------------------------------------------------------------------------------------------------------ ------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( t/ Upgraded( ) 'Abandoned( )by 115�C t,V\ rA (--rrAn\ at \'7){ 9 V c_._^S Sk 0skC,"1 has been cons cted' CC ti ti ti with the provisions of Title 5 and the for Disposal System Construction Permit No U 3 rt Installer S� (7 n)N. rn, 17c-tom n� Designer ' #bedrooms Approved des flo, ""'`{ d pp gn gP 1 The issuance of this permit sh 11 not be co trued as a guarantee that the system wi'1 functio de igned. i Date (p / �/ Inspector �p ------------ -- ---------------------------------------------------------------------------- No. .w :. Fee: ' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION'-BARNSTABLE, MASSACHUSETTS `disposal *pste. Construction Permit Permission is hereby granted to Construct( ) Repai� Upgrade( ) Abandon( ) System located at SC F_v ck^S 6SI cN \� 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:Cons c'on m t Ze o ted within three years of the date of this permit. Date Approved by Kan II TOWN OF BARNSTABLE LOCATION �{ L%U�l\� SEWAGE# " VILLAGE ASSESSOR'S MAPP&PARCEL INSTALLER'S NAME&PHONE NO. t '�,5�`y< 's-n,c�.ac� `-t SEPTIC TANK CAPACITY LEACHING FACILITY. (type) (size) NO.OF BEDROOMS OWNER n n< PERMIT DATE: ) '� COMPLIANCE DATE: y Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY i ;� � a _ , 4��� k�� � � v � . � __ THE COMMONWEALTH OF MASSACHUSETTS BOA RQPF - HEALTH IOWJ.�.................0F........ JU?'.ish.� � ---......-----------------...._.. Appliraation for 11hipos al Works Towitrnrtuan ramit Application is hereby made for a Permit to Construct (� or Repair ( ) an Individual Sewage Disposal System at: ..........W. fJz.... : .......... :ate . �..... r................................. /� �j 0.' ? p� / Cc�y g� 4L�ot`N�o. �_� /� (f �, �j q .........1.Y.y:W^Y. Location dresl Z— ............. zl _.. L. AJ5sd .4e:4 {1/6 1.1K�:Cl..d:�Cl1lk4.. Owner Address aW ................ .... - . . ....�. :......... Installer Address UType of Building Size Lot. .......Sq. feet , Dwelling—No. of Bedrooms........... ...........................Expansion Attic ( ) Garbage Grinder (k) Other—Type T e of Building No. of persons............................ Showers f-� YP g ---------------------------- P ( ) — Cafeteria ( ) Q' Othe fixtu es ........- ------- W Design Flow........ . __ __ ._._.__, ___._gallons per person per day. Total daily flow...................... ..........gallons. WSeptic Tank—Liquid capacity��#?_)..gallons Lengthh0.:'fQ.__.. Width._°...-R_.._ Diameter................ Depth. _..-e?._-. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area............ ft. Seepage Pit No.......'2.......... Diameter........10_..... Depth below inlet......&......... Total leaching area...53. ...sq. ft. z Other Distribution box Dosing tank aPercolation Test Results Performed by ? .....K_.xJVS.._. g ................. Date...... .�e3._______. Test Pit No. 1... ........minutes per inch Depth of Test Pit....... .__._._ Depth to ground water.____.! .......-_- Li, Test Pit No. 2....F.......minutes per inch Depth of Test Pit.......! ...... Depth to ground water-----41_.......... Q+' --------------------------------------------------------------- •-------- -.... ..--------------------- --•.... .......... ------------------------ -..... •...... ... 0 Description of Soil..................r----.-•-- -----•-------------_.._. . W UNature 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'A.I'ILE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. S >----•---- ----------- -...- Dale Application Approved By...---•--------r �-� !`�- ....----••----------------- ----- Date Application Disapproved for the following reasons----------------------------------------------•---------•----•---------------•--•---•-----•------.......----_..._ -•-------•------•----•-••-------------•-----•---.....----•------•--------.....--------.......------------•----------•---•-----•-----•-----•--......---•-•--------------•...........--•-•-•-----•-------- Date Permit No...... . ----�-- ---- .............. Issued....................................................... -.._ Date TOWN OF BARNSTABLE LOCATION 1-,0 j �J Ve-yt 5 S` ` SEWAGE VILLAGE � � I ASSESSOR'S MAP & LOTlq Z l�/ f INSTALLER'S NAME & PHONE NO.6r3f C6n5f, SEPTIC TANK CAPACITY/ 5 �a LEACHING FACILITY:(type)erE'_ Cask 6 k 7 � (size) 6®6 NO. OF BEDROOMS PRIVATE WELL O PUBLIC WATER BUILDER OR OWNER �j DATE PERMIT ISSUED: 3— oZ6 - 0 7 DATE , COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ;� B i I �� s S , . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................OF...... l.7. ( C. .. Appliraation for Disposal Works Tonstrurtiun Prrmit Application is hereby made for a Permit to Construct ( ✓� or Repair ( ) an Individual Sewage Disposal System at: ..... .. .v_Q --.................( T ✓i i-: ------ ---------------------------------------La_ �3 ...... ......... Location- dress Lot No. M.�►Ju .. -, MA#�_o_....----•--------- TQ=-- r��----- �r ± =...tlAtSK.l1A�c.t1 Owner -•....................•-.------. = -F� Address a � Installer Address � Type of Building Size Lot-••(-__-.t.______o.......Sq. feet U Dwelling—No. of Bedrooms............ _________________________Expansion Attic ( ) Garbage Grinder ( )C) aOther—Type of Building ............................ No. of persons................_........... Showers ( ) — Cafeteria ( ) dOther fixtures ---------------------------------------------------------•----------------•-------------------------••••------------- W Design Flow____________ ___ __ ....... gallons per person der day. Total daily flow... ......._............_�<r'�Q_....... lons. WSeptic Tank—Liquid capacity�`�00.gallons Length 1Q."�?_._. Width_.`J._" .._ Diameter________________ Depth_.44,._._..`U x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area___--_-•-__•••-�--sq. ft. Seepage Pit No......._-......... Diameter.......... .... Depth below inlet.......&_........ Total leaching area....5 `)..sq. ft. Z Other Distribution box ( 11 Dosing tank ( ) Percolation Test Results Performed by... A xT�Z_-_ .... `f 6.___l �................ Date........................ � 1 Test Pit No. I....�........minutes per inch Depth of Test Pit....__.d.�-...... Depth to ground water.._...._�a-__---_-._. 44 Test Pit No. 2-----Z___...minutes per inch Depth of Test Pit........1Z'----- Depth to ground water____•................... 04 ---•----••--•--•••-•-...----••-••-........-•--••----•-•---...•-•-•----------------------------------...................................... _--------------- --- 0 Description of Soil----------------- ...... ....................... x U ......................................•-------.... 1. - �v_.n�......------------r`-u�-------------._...---------------------------------------------------------------------...--- w ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------••--••---•-----•----_.... U Nature of Repairs or Alterations—Answer when applicable................................................................................................ -------•--------------------•--•----------•--........................••---•-•-------------•---•----------.....--•---••--••-----•--•-------••--•••----•-•--•--••-•--•••-----•-------......_.__.....---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I T TLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed...................................................................................... Date Application Approved B r� -- ---...yet;--- ,- ------------------------------- -t,----�,f--- - Applieation Disapproved for the following reasons-------------------•------------------------------------•----------------•--•--------_••... •••-----•-----_._... .............•------------•-•---•---•------•-------•---..._..-----•------.-•---••-•--------••----•-----•----•---------•----•--------•---•-------•-•----•-----•-•--•••----------•------••••---..-...--- Date Permit No....C (• -.. Issued-------------------Haze---•----...-------...-----•---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................sue,. ..........OF...........- /V ....................................... (9rdifiraa#.r of Toms haanrr THIS IS TO CERTIFY, That thejndividual Sewage Disposal System constructed ( ) or Repaired ( ) by-------------- ............................................................. -----•----------•-------........--------------.._._..........-----•-----...••------------.......------ Installer has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.__,— ------+.: ...... dated------tf :. ......------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GU RA E T T THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..................... ...�__I!L_-_.�.,?.....-......................... Inspector....... ----------_____--•---••-----_._-- (Lr2 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH a ls �ol ........1u!0V.............O F.... / No. / FEE......... -f"A' `> .. Bisposaal Works Tonstritrtion anti# Permissionis hereby granted..------. ...•••----•-------.---••-•--•-----................................................................................ to Construct (..I-or Repair ( ) an Individual Sewage Disposal System atNo.•--••-• Leo(...... •--•- lit ------------------------------•----•------------------•----•---•--••--- `�1�-•� Str'�et as shown on the application for Disposal Works Construction Permit No.� _ l Dated.._..._._/ y�-� Bard of Hea DATE........ f 'FORM 1255 HOBBS & WARREN. INC., PUBLISHERS ,� / `39.9 -- - iA�ry Aea4 \Al2 . --------- - Pi r Fir . r: - ,,tt Poop. 7 rsz L+�P.MQ cw8�C11. LoO Z �.g-9 �9 c- �►sE s o ./ �i > +1 �. ME t�i--T frs8 . -i 17 E•511�N ETA °�� 51 NGt-E f=AMI Ly .- r' , bA 1 LY FUC>�j I t o x 4 = 44-0 EF' c-,SAD : �' S T t G. -T t4<;-444 X.zoo;pv- ,, C-:P.t:;; r:0. z,caa ' ski 5 two SAL 'PIT st rxwaLL..A,;2EA.^ �a 378� u 2, 5 = 9 4 Z. G tR. BO-r m A?eA - 15.7 5,1 15- 51= I. o = 197 61p, p. TOTAL- VG-1616111Q= 1099 G,p.D, 7-07AL. t44 � .1LN bW u = GGO G ®, ' L4!qr jO}j 1:7-A-�"tw'. F"' 1 h►2 M I N 0�, LASS o.a ZG 98 SOIL. ' T >_►op r. jo�.�u ! LOW 1 ° t u - 2•0 96'y �2� tC7� I�1ST. - 5� —; Itiv 9-7,2 M �. 1Nv itiv ; 'S�AA/L. ,' 2X 96•'1 � L- 97.0 v iFIT p �` wl-ray„ 1t�J, IWV. -Atvt[. f A V-146 1 =30` t;x, TE Nov I 3(o I986 �2•0 6b•z 1J0 �SG1aLE pL�� CZ, _��, l(-ID-�, I8b l cetzTI F-Y T"47 -T E' _ u pSHow►� XTER * N S ►NG Nat`l GOMCPLI1 S vN i'f l4 E .d.N� �t`T�c K 'R-E QU t�z>~t,/l 1=�"('S ��-� T��. O ST E�-V 1 Ll�•�.M,4,55, Tpw}�s .dF NSTA>3LG/�-Nb I S NET �,�PI_..IG�4�T" ; MAWU ML Mt71z LOc-,4-,-T'F-0 Wri-4 I N 7-H E5 K) UM?.1`J-r SA;?-'\ EFY ANb CG ©r-F=:5 e-=TS _. ...... / 7Y &iva �' FINISH GRADE OVER D-BOX = 51 .9'± FINISH GRADE OVER CHAMBERS 51 .5' - 52.2' PROP VENT w! CHARCOAL FILTER TO ABOVE GRADE--\., GENERAL NOTES, FL EL = 537'± SION RISER REMOVABLE WATER-TIGHT COVER OVER SLOPE 2-^ MIN. OVER SYSTEM 3/4"TO I -112" DOUBLE WASHED PROVIDE EXTEN STONE TO CROWN OF PIPE--� I UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION NTH COVER OVEP INLET & RISER TO WITHIN 6"OF FINISHED GRADE INSPECTION PORT WITH ACCESS METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL FINISH GRADE OUTLET TO WITHIN 6" OF F G. f-5" DIA. OUTLET(S) 4"SCHEDULE 40 PVC BOX TO F.G. (SEE NOTE 21) 2"OF 1/8"TO 1/2" DOUBLE WASHED CODE AND ANY APPLICABLE LOCAL RULES F.G- OVER TANK EL. 51 .5'± STONE OR GEOTEXTILE FILTER FABRIC @ FND. EL.= 51 .6 ± F MIN SLOPE 1% 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. TOP OF SAS= 4 PLACE RISERS ON ALL 3 5'MAX 8.00, CHAMBERS WITH i PROPOSED 4" SEE NOTE 23 47 42MAX. ;NLE T P I P rE S T 0 6"0 P 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SCH� 40 PVC, i �00' SEE NOTE 23 BREAKOUT EL= 47.50� SYSTEM UNLESS OTHERtA`IISE NOTED. SEWER PIPE FINISHED GRAC)E----- 7- -, 4. TO PREVENT BREAKOUT THE PROPOSED FINISHED GRADE SHALL. NOT BE LESS THAN 'I 44'± 3"DROP MAX �-J 6" 3" 3" 9" L= I I --I - -- MIN PROVIDE WATERTIGHT ELEVATION = 47-50' FOR A DISTANCE OF 15AROUND THE PERIMETER OF THE SAS. UNLESS A 2"DROP 1 JOINTS (TYP.) 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S A S. AND THE TOP OF k 4" PVC IN f--ROTA 4" PVC OUT TO THE LINER IS NOTI,ESS THAN THE BREAKOUT ELEVATION i 4" SEPTIC TIC TANK 0 0 4 i 9'T ---y I C,a i LEACHING FACILITY C) SLOPE ALL SOUD PIPE AT I 0 /, MINIMUM C--& 0 10� (48 C;0 C� .90') 12" , 1 00 CONTRACTOR CONTRACTOR SHALL I \ i 1 2' 00 C) 6, THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. I \, \-OUTLET TEE 47.40'-/ 47.23' = = CDC:) SHALL VERIFY SIZE 49' VERII Y CONDITION OF 14-/ 291 00 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION OF EXIST ING TEES '\-GAS BAFFLE 6"CRUSHED STONE FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY CD i CONTRACTOR TO PROVIDE 00 NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH AND DESIGN ENGINEER NECESSARY COMPACTED BASE SPECIFIED DROP BETWEEN TANK 1 4 0' 8,51 (TYPl 4 INLET AND OUTLET 5 OUTLET DISTRIBUTION BOX 8. ELEVATIONS BASED ON APPROXIMA TIE M.S-L. DATUM. SEE BENCHMARK LOCATIONS AS" (TYP-) TO RE INSTALLED ON A LEVEL STABLE SHOWN ON PLAN. ................. BASE. FIRST TWO FEET OF OUTLET < 4&00' GROUND WATER ELEV.= PIPFS TO BE LAID LEVEL 83'-- 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON S1 TE AT EXISTING 1 ,500 GALLON CONCRETE SEPTIC TANK 3 - 500 GALLON CHAMBEIRc' 5' MIN :CHAMBER END VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES REPORT'ANY DISCREPANCIES CROSS SECTION VIEW TYPICAL CHAMBER PPnr� TO THE DESIGN ENGINEER 1"AlLb SEPTIC 1ANK PROHLE -20 DISTRIBUTION BOX DF-"TAIL H-20 CHAMBFR UE 10 ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. -PRIOR 1 ANY ,Nf.)RK NOT TO SCALE NOT TO SCALE NOT TO SCALE 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING TI=ST PIT DATA REGULATIONS. OWNERIAPPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. sk PERC NO 2147 12 z Craoberryl I David W St�n!qa I�Ql�j -10 LOADING UNLESS ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H INSPECTOR- LOCA TED UNDER MOIRE THAN 3 FEET OF COVER OR LOCATED UNDER PAVEMENT, EVALUATOR: Michael PimetLeI.EIT,_CSE DRIVES, OR TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING ���' ` +° 27, 1999 C S E. APPROVAL DATE 13 DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. DATE March 2. 2021 ------- 14 WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE mic MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. TEST PIT REPLACE ALL JNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, ELEV TOP 52.00 FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3 . < 40.00' 15 CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN ELEV WATER SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. E�61 ING LI:ACHINC, FAIT PER AS BU11 I PERC RATE '0X T'Nlf"O B[ I I Y P r (A P P R LOCA I 4oshw e 16. PROPOSED PROJECT IS LOCATED WITHIN: 'til I FI-) w�i('.L[-AN �v4NU ASAN • i4d MAP 142 C14 DEPTH OF PERC 06, V44 0 L ♦ ASSESSOR'S MAP 142 LOT 142. TEXTURAL �-'LASS I F XIS TING 1 51M GA[LON SFP TIC I ANR lip, 236t S F 96, OWNER OF RECORD. DAMES P SURPRENANT 6-4 • LOT 14;? CL M." ADDRESS: 125 WINTERGREEN CIRCLE *In t1l'i JCL-" Vi!r-"�!`�f�! S /AA • , -0 • 52.00' Q) 7 1 4�10 .1 r 1,k OSTERVILLE MA 02655 011 Cd f Benchmark#1 r e 010 It' I �1. L Corner of Step -7; CL FEMA FLOOD ZONE X -52 Q Fill "," - * ,%. ", '15iA-0 0 ii�� Elev -00 A4Ai COMMUNITY PANEL# 25001 C0544J ul Z) Approx. M.S.L. 0 0 0 36" 49,00' 17 DEED REFERENCE. LCC#223417 .* Loamy Sand B 18 PLAN REFERENCE: LC PLAN NO. 18366-J 10Yr 516 1 48" -j 48.00'OY X, 6.8 19� ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION, •MAP 142 'dip �1- 0j. 4:0 - 0 - 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY L(-.?T 74 4, 70,�, AS-BUILT 4 .,If, I . , - FOR SEPTIC SYSTEM UPGRADE JC ENGINEERING WILL NOT ASSUME ANY LIABILITY .0 CLEAWOUT WO IF-- 6 FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE -ED IN A VERTICAL POSITION TO A 21. A 4" PERFORATED SCH. 40 PVC PIPE SHALL BE PLAC AS-BUILT H-20 Medium Sand DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE A AS-BUILT SWING-TIES SCALE- 1"=20- G GARAGE 2 5Y 61,8 REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. DISTRIBUTION BOX 0 DESCRIPTION GC-1 GC-2 HC-1 HC-2 22 OWNER I APPLICANT I CONTRACTOR SHALL BE RESPONSIBLE TO OBTAIN ANY AND ALL AS-BUILT 4" SCH 40 PVC VENT FL EL =53 7 V REQUIRED PERMITS AND APPROVALS FOR THIS PROJECT, TANK COVER IN(1) 31.0' 17 8' 23. IN ACCORDANCE WITH 310 CMR 15.401 - 15.405, THE FOLLOWING LOCAL UPGRADE LOCUS PLAN 4 TANK COVER OUT (2) 36.3' 257 APPROVALS ARE REQUESTED FROM 310 CMR 15.221(7): #178 � � 11 1 FOR THE MAXIMUM COVER OVER THE H-20 SAS EXISTING MAP 142 SCALE: 1 1000' (1.) A 1.20'WAIVER (3.00 -4 20 ELECTRIC 4-BEDROOM OT ,A-1 DISTRIBUTION BOX(3) 44.4' 27,13 144" 40-00' 12 A 0-50'WAIVER (3.00- - 3 50') FOR THE MAXIMUM COVER OVER THE H-20 D-BOX METER- DWELLING No Mottling. Standing ci, Weeping Observea CHAMBER COVER (4) 47.0' 31 0' -ES'T' FT1- DAT4 CHAMBER COVER 5) 389' 38 5' D FS I G N 1)A'T:,i' J 4L(7 PERC NO. 21-47 ------- EXISTING SPOT GRADE PVC VENT PIPE (ri) 40 0' INSPECTOR: David\N Stanton (BOH, 49/" EXISTING CONTOUR 0 NUMBER OF BEDROOMS(EXISTING) I AS-BUILT(3)50 U p _A EVALUATOR Michael Pimente! E!T CSE NUMBER OF BEDROOMS (DESIGN) 4 PROPOSED CONTOUR Z, GALLON H-20 LEACHING ��p i 1� . Oct27. 1999 41 0 C.S.E. APPROVAL DATE Ocl 7 M CHAMBERS wl STONE 4 10.� 51- DESIGN FLOW 110 GAUDAY/BEDROOM DATE __March 2, 2021 r 50 PROPOSED SPOT GRADE TP, 5 01 TOTAL DESIGN FLOW 440 GAUDAY TEST PIT 2 EXISTING GAS LINE 40 DESIGN FLOW x 200 % 880 GAL/DAY ELEV TOP 52.00' ro;� EXISTING ELECTRIC LINE 52xO' GALLON SEPTIC TANK USE EXISTING 1.500 ELEV WATER <40,00' EXISTING WATER LINE EX 3" PIPE TO BE PERC RATE 2 min./inch OF REPLACED wl NEW Benchmark#2 T LOCATION 181, Top of CB/DH 4" SCH 40 PVC AS-BUILT DEPTH OF PERC TEST PI Elev = 5&60' (2 EL=49.44' INSTALL 3 - 500 GALLON H-20 CHAMBERS wit STONE TEXTURAL CLASS 1 Approx. M.S.L. EXISTING 1 500 GALLON SEPTIC TANK SIDEWALL CAPACITY 0� /-GC-1 (LENGTH + WIDTH) (2 SIDES) (2' HIGH) (0 74 GPD/S F.) = GALIDAY AS-BUILT 4" SOLID SCHEDULE 40 PVC PIPE (33.5' + 12.83') ( 2 2' ) ( 0.74 G PD1 S.F.) 137+1 GAUDAY 011 52,00' 13 AS-BUILT H-20 DISTRIBUTION BOX L=1 22J R=411 85 /--GC-2 BOTTOM CAPACITY Fill AS-BUILT 500 GALLON H-20 LEACHING CHAMBER LENGTH x WIDTH) (0 74 GPD/S.F.) = GAUDAY (335' x 12.83') (0 74 GPDiS.F.) 318.1 GAUDAY 36" 1 49.00' GARAGE 8 Loamy Sand ACTUAL. ELEVATION "AS-BUILT" HC-1- I OYr 5/6 48" 48.00' FL EL =-53 71, TOTAL& DATE APP-D. DESCRIPTION TOTAL NUMBER OFIC'HAMBERS #178 TOTAL LEACHING AREA 615-1 SQ.FT SEPTIC SYSTEM "AS-BUILT" PLAN EXISTING TOTAL LEACHING CAPACITY 455.2 GALJDAY PREPARED FOR 4-BEDROOM HC-2 ROBERT B. OUR CO., INC. DWELLING Medium Sand C 2 5Y 616 NOTES- LOCATED AT (5. 3) 178 EVANS STREET I ) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC SYSTEM COMPONENT. OSTERVILLE, MA 02655 2 ) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE 18/ 44' SCALE- INCH 20 FT DATE: APRII. 29, 202 1 PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT DATA 20 40 80 FEET SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS 1�1' NO Mottling, Standing or Weeping Ooserved h4T (4 ARE NOT CONSISTENT WITH TEST PIT DATA, JOHN L. PREPARED BY RESERVED FOR BOARD OF HEALTH USE Ct AURCHILL JR. JC ENGINEERING, INC. 3.) PROPERTY IS LOCATED WITHIN THE ESTUARINE WATERSHEDS ONLY. Perc rate taken from Application I CIXIL for Disposal Works Construction NO. 1807 2854 CRANBERRY HIGHWAY 4-) SWING TIES SHOWN ON THIS PLAN ARE PROVIDED ONLY AS A COURTESY FOR T HE Permit No 86-1269 on fie with ell EAST WAREHAM, MA 02538 INSTALLER. INSTALLER SHALL VERIFY SWING TIE MEASUREMENTS IN THE FIELD PRIOR the Barnstable Board of Heallh TO INSTALLING THE SYSTEM CONTRACTOR SHALL NOTIFY ENGINEER IF SITE PLAN 508.273.0377 MIN vzs/o/v C,4 I.4�r,- z-4.0 /I:X REPLACED 4 MEASUREMENTS APPEAR TO BE INCORRECT SCALE 1"=20' 0b; Drawn Sy VCF, Designed By MCP (Aerked By JLC JOB No 5447