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HomeMy WebLinkAbout0086 HOLLINGSWORTH ROAD - Health 86 ,Hollingsworth Road osteryille A= 140 077 tt_ � e N I f o i 1 'f t C k`. i ti y o t F o 0 4 No. 1173 t :i '.`�`. Fee— / THE COMMONWEALTH OF MASSACHUSET'TS Entered in computer: lL PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for 33igpogal �&pgtem Cottgtructiou Permit Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) ❑ Complete System Individual Components Location Address or Lot No. ( (7St� �rj ✓w Owner's Name,Address,and Tel.No. t r l zl sfiGAtik At N5F-4qAAA PA Assessor's Map/Parcel ac � �r � v Installerse,Address,a I Tel.No. �46 ► Z�Q Designer's Name,Address and Te.No. E6(yf kn(,. �� A� 110— RAI 719 1$ OWS M!Glf Tlype of Building: / Dwelling No.of Bedrooms S Lot Size / 0 Z sq.ft. Garbage Grinder ( Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures / Design Flow(min.required) gpd Design flow provided /i gpd Plan Date Number of sheets Revision Date Title Wmkic.,eS S ? Size of Septic Tank -6o— A Type of S.A.S. " 5 00- Description of Soil wMAC RAT9G Nature of Repairs or Alterations(Answer when applicable) 11r.0 le pl. 10 Date last inspected: n 1 4I vJ j, 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 Environm tal Code and not to place the system in operation until a Certificate of Compliance has been issued by thloard of Health. Signedf7 Date _ .. 3 Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. 2e)06—9 7-3 Date Issued I 3 --------------------------------------------- --- - -- - W7 No.. Fee t THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Appt,i cation for �Bigpo5a[ *p!gtpm Cottgtrurtton Permit Application'for a Permit to Construct O Repair O Upgrade( Abandon O ❑ Complete System Individual Components l Location Address or Lot No. &kb G2 S Fblvner's Name,Address,and Tel.No.JxAA-< r�1r� 1�>,, 21 sGAT , e Assessor's Map/Parcel r' r Pr Installer's Na e,Address,ano Tel.No. j s0 9/. Z6 0 Desig er's Name,Address and Tel.No. ELVPAL L- P.6zC P - nNs�YM,ccs � Ys� �AyMIM� 12�•, ,,,� ��f�. b Type of Building: Dwelling �No.of Bedrooms t 't Lot Size sq.ft. Garbage Grinder (� Other ��Type,6 f BuiIdi g, No.of Persons Showers( ) Cafeteria( ) 1 Other Fixtures 1 „; ;r / Design Flow(min,required}11_\., gpd Design flow provided 56 j.04 gpd Plan Date 1~°, ,. `l_r_ '-I,,Number of sheets Revision Date Title S ' �, -S ?, Size of Septic Tank A 4 Type of S.A.S. ' j'���Q! 8O W—r(L ,<�_ Description of Soil �', 7 '� n 'r GlZ Nature of Repai/r�s or Alterations(Answer/when applicable) 'r 1�2 � /l Date last inspected: � U 120LA& P�cr. r)n .1 In/ Agreement: r The undersigned agrees to ensure the construction and maintenihc of the afore described on-site sewage d,ep sal system in accordance with the provisions of Title 5 of the-Environm tali Code and not to place the system in operation until'"a Certificate of u Compliance has been issued by this .°oard of Health. a ,'I Signe, �� Date 11. 3 Application Approved by A Date Application Disapproved by: Date for the following reasons P Permit No. 7 UU�—L)7 3 Date Issued I THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( �) g Upgraded (\/) Abandoned( )byr r1 at t;. I1v 1)r/1/1�-I �n 1 uo J b k evige has been constructed in accordance- with the provisions of Tillie 5 and the for Disposal System Construction Permit No. oZ(JUG —/ / 3 dated / 014. Installer Designer #bedrooms Approved design flow ��J) gpd The issuance of this permit shall no be con trued as a guarantee that the system .i•Il-function d J 'signed. Date 7� Inspector No. :) tn'T Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS / Migo�at;*p,5tem� Construction earrnit Permission is 4e,)reby7gra ed to Construct ( ) Repair ( Upgraded( )' Abandon ( ) System located at ,., P' ` ) and as described in the.above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. ..,�,.. 4,r•'4^• �•'�:St'^? i�"'^ x -it`s Provided:-Construction mus',be completed within ree years of the date of t,istf p•t. Date ° ';`rApproved by r.- ;• TOWN OF BARNSTABLE LOCATION �6U,1 6SV/09MA Z&O SEWAGE# AWL - `713 VILLAGE OSTC-{C46 e._,;r ASSESSOR'S MAP&PARCEL '.II,,/40 — -777 f INSTALL ERS NAME&PHONE NO. -r1t"OS Omway— T 7.!) cn—Vb SEPTIC TANK CAPACITY LEACHING FACILITY:(type) S®C> (size) ufil i`'l NO.OF BEDROOMS OWNER VAA PERMIT DATE: t 3 COMPLIANCE DATE: fi VA, 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) A` A Feet FURNISHED BY �L&t 5 C 4 1pei:oelp apt 3 71 s • 6 S'3�a Town of Barnstable Regulatory Services Thomas F. Geiler,Director L nneex ARM t KAM Public Health Division 1639,1�1% Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: Lftz Sewage Permit# o�006—47 3 Assessor's MapTarcel t'VD22, Designer: ��SC ](,J1/1_�jQ�l1(7 Installer: � � �ET&</Z=�/� Address: ��-� Rey R,� , Address: P.O. 22 A On �'� ' 3 � 0�' �i��,'t' �� Cas issued a permit to install a (date) (installer) septic system at based on a design drawn by f� (a dress) 1 �,�� 69WAWR�"6 dated (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. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State_ &Local Regulations. Plan revision or certified as-built by designer to follow. N OF A44 o� EDWARD L. tiG g PESCE m CIVIL - (Installer's Signature) No.32001 A90 9FO/STEP����c�'Q ASS/ONAL ENG� V (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE. RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc Commonwealth of Massachusetts. Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form 1104(0 0111/ Inspection results must be submitted on tFils form..Inspection'forms may not be altered in any way. A. General Information Important: When filling out 1. Property Information: forms on the computer,use 86 Hollingsworth Road, Osterville only the tab key Property Address to move your Jim Sullivan cursor-do not Owner's Name use the return key. 21 Rosegate Road Owner's Address v Ma 02494 'Needliam City/Town ��, State Zip Code Date of Inspection: Date 2. Inspector: James•Hollert. n-tust be submitted on tt,:s torni. Name of Inspector Holler& Son:Construction.Co.,LLC . Company Name... ._ __... ; P.O. Box 702 Company Address " i ' Marstons Mills Ma 02648�,•_, City/Town State c,l Zip Code-4 508-420-0280 < rCS � Telephone.Number B. Certification iAl I certify that I have personally inspected the sewage disposal system at this addre and th t the r- information reported below is true, accurate and complete as of the time of the ins ction. "e inspection was performed based on my training and experience in the proper function and ma ntenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passesy' ---- --- -Conditionally Passes 0 'Fails gNeeds Further'Ev elation by the Local Approving Authority Inspe tors Signature -Date The system inspector shall submit a copy of this inspection report to the Approving AuthorityF(Board s 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 senf to the buyer, if applicable, and the approving authority. ****This report only describes conditions:atthe,4imq 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. Sullivan inspection.doc•03/2006 Title 5 Officia Inspection Form:Subsurface Sewage Disposal System Page 1 of 16 --Commonwealth of*Massachuse - Title 5 Official . Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification cont Z. 86 Hollingsworth Property Address Osterville Ma 02655 City/Town State Zip Code Jim Sullivan 10-20-06 Owner's Name Date of Inspection. Inspection Summary: Check A;B;C,D or ET 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`15.3044exist. Any failure criteria not evaluated are indicated below. Comments: ��: `a ,a�=, � ��.� '•;,;.,r, . B) System Conditionally Passes: ❑ One or more system,components as described in-Me"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the.Board:.ofiHealth;iwill.pass;C,Ll or l c31V✓2 �S ?Utll ia'.0 n Answer yes, no or not determined (Y, N, ND) in.the❑ for the following statements. If"not determined,"' please explain. ❑ The septic tank is metal and,over,20ryears:old*nor the septic tank(whether metal or not) is. structurally unsound,,exhibits substantiaVinfiltration,or exfiltratiorror tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating-that-the-tank is-less than 20 years old is available. ND Explain: ti l� ? 2cE((T'!I!1@d (Y, iv. ND) !( .ihi' a 1 ."if { , ewpr r$! Sullivan inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 16 Sian;e irai✓ t;ny tr� r the I Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System.Form B. Certification`(cont:) 86 Hollingsworth Road Property Address Osterville Ma 02655 City/Town State Zip Code Jim Sullivan 10-20-06 Owner's Name Date of Inspection _ f B) System Conditionaif 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)t'o'r due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipes)are replaced obstruction is"removed ❑ distributioniboz is leveled or replaced ND Explain:,nrt ❑ The systemnequiredl��umping�smoroen hen 4 times a year due to broken or obstructed pipe(s). The system will"pass nspec{ion (wlt�i approval of the Board of Health): ❑— .-broken..pipe(s)-are rep)acedreak. cut:or nig.ri or oJe to broke ❑ obstruction is removed ND Explain: 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 16.303(1)(b)rthat the rsystem is not functioning in a manner which will protect public health, safety and th'e envIror mer}t• r'�rE `' urt " , ' ..Li IU • '��`F Ill.'?lip '"' c•s i(1s37e� i7r i (Null i alprovai Ot,w B_ar(ii .�:ti{ ;i ❑ Cesspool;or privy:;istwithin:50 feet of a surface water ❑ Cesspool or privy.is within 50 feet of a bordering vegetated wetland or a salt marsh Sullivan inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 t 1 Commonwealth-of Massachusetts -- --__. Title 5 Official Inspection Form Not for Voluntary Assessments �M Subsurface.Sewage, sposal System:Form B. Certification,,(cont.) 86 Hollingsworth Road Property Address Osterville Ma 02655 City/Town State Zip Code Jim Sullivan 10-20-06 Owner's Name Date of,Inspection C) Further Evaluation is Required by the Board of Health (cont.): 2. System will fail unless the,Board of Health(and Public Water Supplier, if any) determines that the sjis tei functioning in a manner that protects the public health, -safety`and environment• Y ❑ 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 ❑ Y P supply. ❑ The system has aseptic tank and SAS and the SAS is within 50 feet of a private water supply well. .,li'i4 ? l':1?fB( Lit t' e Board of H a i'i (c ' .�`. ❑ 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 A, , : :end environ ie7iv **This system passes Ifghe well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent:and:the,presenceiof ammonia nitrogep�and nitrate nitrogen is equal to or less than.5.ppm,, provided.that-no,;otherifaifUt re.cgjteriai are itriggered:rALcopy.of the analysis must be attached to this form. 3. Other: r ;ice i� has a sent ,a�K and Y, an , Sullivan inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System asses if trio well water anaiysis, l i`oi i,ed c: .' t- Page 4 of 16 of arum +, �, : r,: - .:....,. .. ti'. 'iC) vll'lti3r ic11N,11':. _(!l•�,=:.i cac t. t:;C.C1. . . .._, Commonwealth of Massachusetts � � o Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage,Disposal System Form B. Certification 86 Hollingsworth Road Property Address Osterville Ma 02655 City/Town State ZipCode Jim Sullivan 10-20.-06 Owner's Name Date.of nspection, _.. D)System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No. tiIA 5 ,_ . �'gage rBackapV sewage1rifMacility or system.component due to overloaded or ElJ ® clogged SAS or cesspool El ®` Discharge or ponding of effluentto the surface.of the ground or surface waters due to an overloaded or clogged SAS or cesspool El ® 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 day flow. Required pumping more than 4 times in the last year NOT due to clogged or ® obstructed pipe(s).Number of times,pumped7l to . ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion-of:cess.pool,or,privy is within 100 feet of a surface water supply or tributary to a surface watersupply. ❑ ® 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,�pbrtlon,of�a-cesspool or privy Is less than 1 feet but greater than 50 feet from'a privafe water supplylwell 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 1!system.is a-cesspool�serving a:facility with a design flow of 2000gpd- Q,0;00.0gpd.pioe(s . Number oi� times pump -o- _ - Yes No w ,, W,f . S;"4 S, ElThe system_:fails:,:l:have:determined1hatione or.more of the above failure criteria exist as described..im310 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. Sullivan inspection.doc•03/2006 —y Title 5 Official InspectionForm:Subsurface Sewage Disposal System- f-my pbr b r� of a ce,- .pooi ci S, Page 5 of 16 Corrmmoriwealth ofMassachusetts Title 5 Offic,ial Inspection Form Not for Voluntary Assessments Subsurface SewageDlsposal System Form B. Certification`(cont_) 86 Hollingsworth-Road Property Address Osterville Ma 02655 Cityrrown State Zip Code Jim Sullivan 10-20-06 Owner's Name' nate-of Inspection. 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 NOs: 4'^ vage niFr105?l �1/Stpr?l F r`? ❑ ''' ®" the sys em is within 4��feet of a surface drinking water supply ' ❑r' ` ® the'system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection ❑ ® Area—IWPA) or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat-under-Section;E'or failed under Section D shall upgrade the 0. :41SPe- n system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. ;he system is within 400 feet o.' ng tri �.r,.re _ w „in ieet 3f ,. . _, ,;idtjred a oiani icani -t; cGi under Sei i0 _Or0-7znC';i with 310 AMR 15.304. The s,, ;orn Sullivan inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 L . Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessmenfs M Subsurface Sewage Disposal Systern"Form . C. Checklist 86 Hollingsworth Road Property Address Osterville Ma 02655 City/Town State Zip Code Jim Sullivan 10 20 A6 Owner's Name Date:of Inspection,.' . Check if the following have been`done'You must indicate"yes" &"no as to each of the following: YES NO ® ❑ Pumping information was provided by the owner, occupant, or Board of Health _ ka 6 ... ❑ ,J, ®7ar}, A�W e�ny�Qfrthy 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 beenintroduced 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 dwellirig inspected for signs of sewage back up? ® " ' `r❑ —Was the site-inspected f sgns of bre,ak out? Z, ❑,)i;o;w,rwWere-,all system.components,excludingkthe,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 maintenaiice-of"subsurface sewage disposal systems? The size and;location ofthe_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-ofdistande is unacceptable) [310 CMR 15.302(5)] i 'd"V'as the site inspected for sins 6; oreeik. cu." ,jeie. ii systern components, 6xclua n; „e 'M ?!lfdrrrauon oil the ,^_-roper f? ^; 6. 11_:iiicf Sullivan inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 7 of 16 w ; Sra% r; o,fl n e3 ? Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary.Assessments h: Subsurface Sewage Disposal.,Svstem Form- D. System Information 86 Hollingsworth Road Property Address Osterville Ma 02655 City/Town ;State Zip Code Jim Sullivan 10=20-0& Owner's Name Date of Inspection. 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 Number_of.current residents3nn d 4 ts Does residence have a garbage grinder? ElYes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? _. _ ® Yes ❑ No Water-meter readings, if available (last-2 years usage (god)) Sump pump?'ic.,. :;i_i_. s ❑ Yes ® No 10-13-06 Last date of occupancy: Date Commercial/Industrial.Flow.Conditions:;,, Type.of.Establishmenti ienis: Design flow(based.on.310.CMRJ5.203): Gallons perday(gpd) Basis of design flow(seats/persons/sq ft. etc!):.- ser Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary wastecdischargedto the TitIeE5system? ❑ Yes ❑ No Water meteCreadings, if available: Last date of occupancy/use: Date Other(describe):.... _ .. �,.�........ Sullivan inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System _ n,. Page 8 of 16 Commonwealth of Massachusetts-----,------------, Title 5 Official In pection Form ° Not for Voluntary Assessments Subsurface Sewage Disposal SyStem'Form, D. System tem Infor mation cont. 86 Hollingsworth Road Property Address . Osterville Ma 02655 City/Town State Zip Code Jim Sullivan 10-20-06 Owner's Name Date:of:LngpectionT General Information Pumping Records: _. Owner Source of information Was system pumped:as.part R thejnspection? � ❑ Yes ® No r - � �., -I:�i. .it�i � .l:lY'i_r. .�''i�'j - 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 ❑ ... ar Shared;system � esrorrno i 1fi Yes, attach previous inspection records, if an ❑ Innovative/Alternative.technology. Attach a copy of the current operation and `r'`maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a-copy of the DEP approval. 4 ❑ Other(describe): Approximate age of all components, date;installed(if known) and source of information: 28 Months Were sewage odors detected when arriving at the site? ❑ Yes ® No ;; iareU ;ystc-m ,/ :�er no) (if v,— 'f, N' r Sullivan inspection.doc•03/2006 _ Title 5,Official.lnspection Form:Subsurface Sewage Disposal System- Page 9 of 16 , V Commonwealth'-f-Massachusetts Title 5 Offici=al Inspecaion Form Not for Voluntary-.Assessments Subsurface Sewage Disposal System Form 4 D. System Information (cont.) 86 Hollingsworth Road Property Address Osterville Ma 02655 City(rown State Zip Code Jim Sullivan Owner's Name Date of Inspection Building Sewer(locate on site plan): Depth below grade: feet Material of copstructi n: ;+ t 4,� ❑ cast iron ® 40,PVC at ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition ofjoints, venting, evidence of leakage, etc.): n Septic Tank(locate-on site-plan)--.- Depth below grade: --_ i ;;~ 1 Fay-,P ;;feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: ^ VC `! ^;;,E,, . _: ' years Is age confirmed by a Certificate of Compliance?(attach a copy of, certificate) i - El Yes El No -- tc -- - -------------------------------------------------------------- ----------------- Dimensions: 1500 Gallon Sludge depth: Distance;from top.of sludge tabottom of outlet tee or baffle No Sludge I No Scum Scum thickness:iu� €e_r Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A How were dimensions determined? N/A Sullivan inspection.doc•03/2006 U mrn! 'ritle 5 officialInspection Form:Subsurface Sewage Disposal System Page 10 of 16 l Commonwealth, of.Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System.Form D. System Information (cont.) 86 Hollingsworth Road Property Address, Osterville Ma - 02655 City/Town State Zip Code Jim Sullivan i 10.-20-0,6 Owner's Name Date of Inspection 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 Trapj(locate on site.plan Depth below grade: feet Material of construction: ❑ concrete ""❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: T_ 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::,: 'p, 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.): Tight or Holding Tank(tank-must.be7 pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑,metal_r,_ ,.,., ❑fiberglass ❑ polyethylene ❑ other(explain): 1:-::l b t VI . Vi Z-I. Sullivan inspection.doc•03/2006 �c-, Title 5 Official Inspection Form:Subsurface Sewage Disposal System - Page 11 of 16 _ I r Commonwealth;of,Massachusetts Title 5 Official Inspection Firm Not for Voluntary Assessments Subsurface Sewage Disposal System Form' D. System Information (cont.) 86 Hollingsworth Road Property Address Osterville Ma 02655 City/Town State.. Zip Code Jim Sullivan 10m,20-06 Owner's Name Date of Inspection Tight or Holding Tank (cont.) Dimensions: Capacity gallons,, Design Flow: S. gallons per day. Alarm present: ❑ Yes ElNo a Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping' Date Comments (condition of alarm and float switches, etc.)';_ ,s *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate.on.site plan): p Depth of liquid level above outlet invert rail p „ 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.): i3r +'�ei {!+oat s--, tches, Pump Chamber(locate on site plan): - - Pumps in working order: ❑ Yes ❑ No Alarms in working order,1c,.r,i ; ,: t. c .r-,,- ❑ Yes ❑ No i3�^-.i:. i,ll present must Je Opened) ;Icy .tom Jin Sullivan inspection.doc•03/2006 . Mtle.5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 F Commonwealth of-Massachusetts u Title 5 Official Inspection Form Not for.Voluntary Assessments Subsurface Sewage'Disposal System Form D. System Information (cont ) 86 Hollingsworth Road Property Address Osterville Ma 02655 City/Town State Zip Code Jim Sullivan. : 10 20-06. Owners Name Date of Inspection, Comments (note condition of pump chamber;condition of pumps and appurtenances, etc.): Soil Absorption System,(SAS)e(locate on site plan, excavation not required): �.,;;a,aP ti o«I S,rstem Form If SAS not located; explain why: Type: ❑ leaching pits--- -------- `cF number ® leaching chambers cr amber, � omit,. .: number:,, «; 2 ❑ leaching galleries ~- number: ❑ leaching trenches number, length:, ❑ leaching,fields ;_ _ . number, dimensions: ❑ : --t i!,-_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, etci) �c �fcg ;is Chambers are completely dry, have no staining, and the sand on bottom is pristine! Sullivan inspection.doc•03/2.006 _ Title 5 Official Inspection Form:Subsurface Sewage Disposal System- .,.f�lv4 ,..sS o Page 13 of 16 Commonwealth of Massachusetts " u w Title 5 Official •Insp ection Form ° Not for Voluntary Assessments Subsurface Sewage Disposal System FQrm;= D. System Information (coat) 86 Hollingsworth Property Address Osterville Ma 02655 City/Town State Zip Code Jim Sullivan. ' 1020-06.`' Owner's Name Date of Inspection '? 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.s9li'A1 )ressessmerrts -em Form Depth of scum layer Dimensions of cesspool'f'O l 3 Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments:!(note condition of soil, signs of hydraulic,failu d; level of ponding, condition of vegetation, etc.): — — ire .,.,�. .,.. ,. .:.. :,;,riv•..,. i..+J. vu F;�inirc.a � N:ai t a .��,��, „ ; manic ._ .-a _.,c. _ .. Privy(locate-omsite plan): Materials of.construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): G a + ,f,t�te Midi*i� f of SOif signs �i nv jra u? "J E i-Ve c i_j Sullivan inspection.doc•03/2006 s Title 5 Official Inspection Form:Subsurface Sewage Disposal System L'. Page 14 of 16 Commonwealth of Massachusetts Title 5 Official Inspection -.Form a Not for Voluntary Assessments �y Subsurface Sewage Disposal.System Form D. System Information (cont). 86 Hollingsworth Road Property Address Osterville Ma 02655 City/Town State Zip Code Jim SullIvan 10=20-06� Owner's Name Date of Inspection. Sketch Of Sewage Disposal System. Provide a`sketch'of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. '•w.a t L Ur:if sWyr�@E nsTi a v.ii � ..✓y 'ia v. .. .. ... a try. Assa-s `'tJ,•4 �,;jY jl err, 0i.jl CID t- Vail ?0-�t>> rcaf 5 em llrl,rl('P r4 �' I. of A . At to -o a q o Z �3 - 0 3 CI-o - 63- 3 �g-o Sullivan inspection.doc-63/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 15 of 16 I Commonwealth of Massachusetts: Title 5 :Offcial� Ins v�ection Form .p _ ° Not for Voluntary Assessments Subsurface Sewage.Dlsposal SisternForrn D. System Information (cost ) V 86 Hollingsworth Road Property Address Osterville Ma :, 02655 City/Town State Zip Code Jim Sullivan 10=20=06' Owner's Name Date of Inspection Site Exam: T Slope Surface water ta- Zj Check cellars A ss6s trren+tt Shallow wells cSysl.ern Fd rT, Estimated depth to ground water:- Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record r.--;,"j -25-06 If checked, date of design plan reviewed:,. w Date2c},on ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑__;,,, i�iChecked with.local excavators, installers-(attach documentation) ❑ _.. : Accessed USGS database-explain: You must describe how you.established the high ground water elevation: Plan on record for repair, system expansion Checked with local excavators, installe,,s aiiac" :_ir Sullivan inspection.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 r r� TOWN F BARNSTABLE C LOCATION //0// Sk_"611 SEWAGE # O?Oiy/'�07 �III.LAGE 5 l Cry .I IC ASSESSOR'S MAP & LOT j�I INSTALLER'S NAME&PHONE NO. •MDR e G-� � t-Eo�B`cS�cq SEPTIC TANK CAPACITY , 0Q �"��' LEACHING FACILITY: (type) 5300601 Ch9M kel CaI (size) 2"E' t(3 t NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: LH'S-0 4 COMPLIANCE DATE: S d 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 Weiland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet `` Furnished by Y - q8 Ad - OR G qq B3 - qi , z TOWN OF BARNSTABLE LOCATION Po' ,AlaLL i riG'SGual?T/� f�y SEWAGE# YIL.LAGE �S l e/r U��L�_ ASSESSOR'S MAP &LOT1 - G 77 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY PS'S FGr/L LEACHING FACILITY: (type) 14,/DT/ 6W ��"/�? 1 esize) �T NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 fee f leaching facility) Feet Furnished by �� fmi�V Cyr MNe �f I s Fee No. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes � PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS 0(pplication for loioozaf *potem Cow6truction Permit Application for a Permit to Construct( )Repair(p,�Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. �� NQ�I,n w og A � Assessor's Map/Parcel IyQ ',17 1 ,cr��llc ham. b' cg`y°j Installer's Name, ddress,and Tel.No. Designer'S's Name,Address and Tel.No. �c-uc� 0.cG 1I sTcT oltin �c. ��1oroST i10 Clocru-��e`C�w/ij O3Tcr�.l1 se,8-L a8-Ssdrj' W., cr0, L W 536 Type of Building: Dwelling No.of Bedrooms Lot Size t9 �0a sq.ft. Garbage Grinder(Vo) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 33® gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Co?S Z2 i0�� f Size of Septic Tank /0-0 611. Type of S.A.S. 2-S00 G��Cff�m �� Description of Soil Q � /D = LrOAM /'O y 35'g Z 046,zA 3y g"' i30 va Cat�n !v FKJs�r Nature of Repairs or Alterations(Answer when applicable)-nJ7a9// /50or 691 7;4 9-8ux, d-b 00 6,el e4e�L3 to A la IO�XaS� c�1 w y O�(`1A Stvnc Rw ro ��c� 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 issu by this Board of He y Signed ey Date n Application Approved by Date Application Disapproved for the following reas Permit No. Date Issued 7-�...i�_-..��-.. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer Yes' PUBLIC HEALTH DIVISION -TO®WN OF BARNSTABLE, MASSACHUSETTS - r 2pprication for �Digpogar *pgtem Construction Vermit Application for a Permit to Construct( )Repair(Upgrade( )Abandon( ) ❑Complete System ❑Individual Components -Location Address or Lot No. C0(7 ��Q 4 ,n�S�u o r��1 f Owner's Name,Address and Tel.No. Assess r s Ma /Parcel � Installer's Name,Address,and Tel.No. '` Designer's Name,Address and Tel.No.t�S50C"O V _Jo 56, S� 110 fluU - et�w.i} 0C Type of Building: 19, n !0a ,yo Dwelling No.of Bedrooms Lot Size 7 sq.ft. Garbage Grinder( ) Other Type of Build rt No.of Persons Showers( ),,Cafeteria( ) Other Fixtures Design Flow ' '� gallons per day. Calculated daily flow gallons. Plan Date Aj y 1-1-3 Oy y Number of sheets l Revision Date Title Size of Septic Tank /500 G,9/. J Type of S.A.S. 3)-�00 CA CHA '" �2" j I A ' Description of Soil 1,0AM /® 't-3y ors L o4,h�.SArW 3y ^- /3�v= J`/�or�� %" S Nature of Repairs or Alterations(Answer wh n applicable) —�%7s7AI 11504 691 7t_�,, i �l Fl I.� �IOyXa�r lC� L-1 070_4 STunc R� ,_,V7 11" 1 I Date last inspected: Agree rent: 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 ZoaZrof He I Signed ¢ Date Application Approved by ® Date Application Disapproved for the following reaso s Permit No. Date Issued r r ' THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,,that the On-site Sewage Disposal System Constructed( ) Repaired (Upgraded Abandoned( )by 5 NU r c(i n �c5•�S i , V4 � at U � O h tdin acc rdance with the Title 5 and the for Disposal System Construction Permit No. 1Ve datedonstru e�1 j 0 Installer `"ce Y 1�C� S d Designer �v��n L i1 SSv- The issuance of this permit shall not be construed as a guarantee that the sys twill ti)ctionl a desi needd. Date Inspector `\ �^'' S a � , a • -- ----- ----- -- --------,—`� No. — — �/ � —— Fee v THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 1wigpogar *patent Con.5truction Vermit Permission is hereby granted to Pons-uct( )Repair Up grad )-Aban on( ) System located at 86 / ^ and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Consfruttion most b completed within three years of the date of this rmi . Date:_ Approved by �_4 I f oFt Town of Barnstable Regulatory Services BARNSr BL 9 �nss i6 Thomas F. Geiler,Director �A 3q. 1� '��►��° Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Designer Certification Form Date: ..1U lD 200 - Designer: J DoYL-E' 1 550C IAZL Address: 170 CIA`/ 1�4rCJ4V,LLC M4 02s3 U'Taov�/^�65� On 2i / - ao was issued a permit to install a (date) (installer) septic system at g� }�o(�j UJ65t0�27Z� Rb�9-l� P Y based.on.a design I drew, (address) dated _ e 2 u 0 41 I certifythat the septic system referenced above was installed substantially according to the design. I certify that the septic system referenced above was installed with changes but in accordance with State & Local Regulations. Revision or certified as-built by designer to follow. A. o� j64N Nn.33a£9 /STCR4:`1%^ 1. (Designer's Signature) (Affix Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Desiper Certification Form I TOWN F BARNSTABLE C LOCATION ��/ it,-vr SEWAGE # 0?0 —ZO VII,LAGE 5`�t`v ASSESSOR'S MAP & LOT INSTALLER'S NAME.&PHONE NO. •rl��-c �'r "b' eQ SEPTIC TANK.CAP ACITY: O e LEACHING FACILITY: (.type) s�'G�f,®l Ch,411 c2i Al (size) oZ,5-t'463 NO.OF BEDROOMS BUILDER OR OWNER ARF PERMTTDATE: L(-13-d,L( COMPLIANCE DATE: S a 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 T �; � S-5 FAILED INSPECTION COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENT 14 mA PA CEL , 1 Aek 2 8 2004 , 0 TOVviN .� u 1; wJ( E HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMEN SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 86 HOLLINGSWORTH ROAD OSTERVILLE,MA 62655 Owner's Name: C/O CENTURY 21 JAMIE REGAN Owner's Address: PO BOX 2100 MASHPEE COMMONS,MA 02649 Date of Inspection: 4/2/04 Name of Inspector: (please print) JOHN GRACI,INC. Company Name: SEPTIC INSPECTIONS Mailing Address: P.O. BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: _ Passes _ Conditionally P1 ss _ Needs Further v uation by the Local Approving Authority X Fails J Inspector's Signature: , . 'j Date: 4/2/04 The system inspector shall submit a c y 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 shal submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments SYSTEM FAILED TITLE V INSPECTION. STAIN LINES INDICATE MAIN CESSPOOL AND OVERFLOW HAVE BEEN FULL OVER PIPE. SYSTEM HAS NO EFFECTIVE LEACHING LEFT IN IT. SYSTEM NEEDS TO BE REPLACED. ****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. Titles 5 incnPrtinn Fnrm h/15mon 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 86 HOLLINGSWORTH ROAD OSTERVILLE,MA 02655 Owner: C/O CENTURY 21 JAMIE REGAN Date of Inspection: 4/2/04 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: SYSTEM FAILED TITLE V INSPECTION.STAIN LINES INDICATE MAIN CESSPOOL AND OVERFLOW HAVE BEEN FULL OVER PIPE. SYSTEM HAS NO EFFECTIVE LEACHING LEFT IN IT.SYSTEM NEEDS TO BE REPLACED. B. System Conditionally Passes: _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. n/a The septic tank is metal and over 20 years old* or the septic tank(whether metal or not).is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: n/a n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed ND explain: n/a Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 86 HOLLINGSWORTH ROAD OSTERVILLE,MA 02655 Owner: C/O CENTURY 21 JAMIE REGAN Date of Inspection: 4/2/04 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance n/a "This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen.is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: n/a Page 4 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 86 HOLLINGSWORTH ROAD OSTERVILLE,MA 02655 Owner: C/O CENTURY 21 JAMIE REGAN Date of Inspection: 4/2/04 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for aminspections: Yes No X _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ X Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow _ X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped n/a. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. _ X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed.at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] YES (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems-in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply _ X the system is within 200 feet of a tributary to a surface drinking water supply ,. X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. � 4 Page.5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 86 HOLLINGSWORTH ROAD OSTERVILLE,MA 02655 Owner: C/O CENTURY 21 JAMIE REGAN Date of Inspection: 4/2/04 Check if the following have been done.You must indicate"yes"or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period X Have large volumes of water been introduced to the system recently or as part of this inspection? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up`? X _ Was the site inspected for signs of break out'? X _ Were all system components,excluding the SAS, located on site'? X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid, depth of sludge and depth of scum? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X _ Existing information. For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] . 5 f Page'6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 86 HOLLINGSWORTH ROAD OSTERVILLE,MA 02655 Owner: C/O CENTURY 21 JAMIE REGAN Date of Inspection: 4/2/04 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Number of current residents: 0 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)):,VW Z_ 230� Sump pump(yes or no): NO Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no):NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM _Septic tank, distribution box,soil absorption system X Single cesspool X Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: 1955 PER AGENT Were sewage odors detected when arriving at the site(yes or no): NO Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 86 HOLLINGSWORTH ROAD OSTERVILLE,MA 02655 Owner: C/O CENTURY 21 JAMIE REGAN Date of Inspection: 4/2/04 BUILDING SEWER(locate on site plan) Depth below grade: n/a Materials of construction:_cast iron _40 PVC Xother(explain):'ORANGEBURG Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): i TOWN WATER SEPTIC TANK: (locate on site plan) Depth below grade: 0" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confinned by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: n/a Sludge depth: n/a Distance from top of sludge to bottom of outlet tee or baffle: n/a Scum thickness: n/a , Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a How were dimensions determined: n/a Comments(on pumping recommendations, inlet and outlet tee or:baffle condition,structural integrity,liquid levels as related tooutlet invert,evidence of leakage, etc.): n/a GREASE TRAP:_(locate on site plan) ' Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a . Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a r o-. t: Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 86 HOLLINGSWORTH ROAD OSTERVILLE,MA 02655 Owner: C/O CENTURY 21 JAMIE REGAN Date of Inspection: 4/2/04 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:_(if present must be opened)(locate on site plan). Depth of liquid level above outlet invert: n/a 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.): n/a PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a R Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 86 HOLLINGSWORTH ROAD OSTERVILLE,MA 02655 Owner: C/O CENTURY 21 JAMIE REGAN Date of Inspection: 4/2/04 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type n/a leaching pits, number: n/a n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a 6' X 8' BLOCK CESSPOOL overflow cesspool, number: n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): STAIN LINES INDICATE SYSTEM HAS BEEN FULL AND IS IN HYDRAULIC FAILURE.SYSTEM NEEDS TO BE REPLACED.SYSTEM WAS EMPTY AT TIME OF INSPECTION. CESSPOOLS: X(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: 1 Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: 6'X 6"' Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): STAIN LINES INDICATE SYSTEM HAS BEEN FULL AND IS IN HYDRAULIC FAILURE.SYSTEM NEEDS TO BE REPLACED.SYSTEM WAS EMPTY AT TIME OF INSPECTION. PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): n/a 4 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 86 HOLLINGSWORTH ROAD OSTERVILLE,MA 02655 Owner: C/O CENTURY 21 JAMIE REGAN Date of Inspection: 4/2/04 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. dL AIR Alb 3'1 in f Pager 11 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 86 HOLLINGSWORTH ROAD OSTERVILLE,MA 02655 Owner: C/O CENTURY 21 JAMIE REGAN Date of Inspection: 4/2/04 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: HAND AUGER- 12+FT. TOP OF FOUNDATION = 32.97E PROVIDE PRECAST CONCRETE EXTENSION RISER FINISH GRADE OVER CHAMBERS = 28.3' FINISH GRADE FND. EL.= VARIES WITH CONCRETE COVER TO FINISH GRADE OVER 4" SCHEDULE 40 PVC TOP OF SAS= INLET & OUTLET COVER FINISH GRADE OVER D-BOX= 27.90't MIN SLOPE 1�L 25.35 (TYP.) MIN. ACCESS COVER FREMOVABLE CONCRETE COVER (TYPICAL FOR 3) TO WITHIN 6" OF FINISHED GRADE SLOPE ® 2% MIN. OVER SYSTEM FINISH GRADE OVER TANK EL.= 28.1 ---..-.-- i 5" DIA. OUTLET(S) TOP OF SAS=25.35' 9" MIN. 36" MAX. ------ 36" MAX. 25.52 25.52' NEW INVERT 24.52' (TYP.) 4" PVC - `(SCH 40) ,: 4" SCH. 40 PVC 9" MIN 2" DROP MIN. 36" MAX. SLOPE @ 2% MIN. = _ "' ' '"" " ;' _ 3" DROP MAX. rn SLOPE C� 1% MIN. CONCRETE RISER , :;... . 0 C� � , L� 00 0 00 0 0 00 0 Dr (� 00 0 INV(out)=26.10 _ WATERTIGHT INV(out)=25.27 48" JOINTS (TYP.) 2" PVC IN FROM /-PROVIDE L� o LIQUID PUMP CHAMBER 4" PVC OUT TO LEACHING INV(in)= 25.52' LEVEL C FACILITY , • OUTLET TEE 22" ZABEL FILTER MODEL 2 4.8 5 12' 0 0 � 0 0 #A1801-4x22 (BAFFLE ON MIN. 24.65 BOTTOM) 22.52 '-� 4.0' 8.5' 8.5' 8.5' 8.5' 4.0' 5 OUTLET DISTRIBUTION BOX TO BE INSTALLED ON 1 r in A LEVEL STABLE BASE. FIRST TWO FEET OF OUTLET 12.5' 17.0' 12.5' (o PIPES To BE LAID LEVEL. BOTTOM OF TEST PIT EL 16.37' (CROSS SECTION VIEW) -------- EXISTING 1500 GALLON SEPTIC EXISTING DISTRIBUTION BOX NEW 500 GAL. LEACHING CHAMBER 2 EXISTING 500 GAL. LEACHING CHAMBERS NEW 500 GAL. LEACHING CHAMBER TAN K DETAIL CHAMBER PROFILE NOT TO SCALE NOT TO SCALE NOT TO SCALE (EXISTING 3 BEDROOM DESIGN UPGRADE TO 5 BEDROOMS) 2" B ,/A TO 1/2" GENERAL NOTES DOUBLE WASHED STONE LEGEND 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION METHODS 5 BEDROOM DESIGN SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL CODE AND I ANY APPLICABLE LOCAL RULES. 42.00' 3/4" TO 1-1/2- PLACE RISERS ON ALL DOUBLE WASHED 100 EXISTING CONTOURS 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF CHAMBERS TO FINISHED GRADE STONE TO CROWN OF 8.50 2 5.00' $.50 DESIGN DATA HEALTH AND THE DESIGN ENGINEER. PIPE 02 PROPOSED CONTOURS NUMBER OF BEDROOMS: 5 3. 4" SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL DESIGN FLOW: 110 GAL/DAY/BEDROOM SYSTEM UNLESS OTHERWISE NOTED. o02 PROPOSED SPOT GRADE 0 0 TOTAL DESIGN FLOW: 550 GAL/DAY 4 DESIGN FLOW X 200% = 1100 GAL DAY EXISTING OVERHEAD UTILITIES 4. TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE LESS THAN ELEVATION = / 29.43' FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE SAS. UNLESS A 40 MIL n EXISTING 1500-GALLON SEPTIC TANK OK GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF THE LINER IS NOT EXISTING GAS LINE LESS THAN THE BREAKOUT ELEVATION. N ADD 2 500 GAL. LEACHING CHAMBERS 4 TOTAL 1 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. 00 ( � � � � EXISTING WATER LINE N 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. _ _ I BOTTOM CAPACITY TEST PIT LOCATION (LENGTH x WIDTH) (0.74 GPD.F.) = GAL/DAY PROPOSED 4" SOLID SCHEDULE 40 PVC PIPE 7. LOCAL BOARD OF HEALTH TO BE NOTIFIED PRIOR TO BACK FILLING WHEN SYSTEM IS -- (12.83' x 42.0') (0.74 GPD/S.F.) = 398.76 GAL/DAY NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS NOT TO BE BACK FILLED 4.0' 4•9' (�•) 4.0' SIDEWALL CAPACITY --------- LIMIT OS S.A.S. / STONE WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH. 8•50' 4.00' (LENGTH x WIDTH) (2 SIDES) (2' HIGH) (0.74 GPD/S.F.) = GAL/DAY (12.83' + 42.0') (2) (2) (0.74 GPD,,/S.F.) = 162.30 GAL/DAY EXISTING DISTRIBUTION BOX 12•83' 4.00' 17.00' (TYP.) (TYP.) 8. ELEVATIONS BASED ON APPROXIMATE USGS DATUM OF 27.50' OBTAINED FROM A MAG NAIL SET AS SHOWN ON PLAN. PROPOSED LEACHING CHAMBER BOTTOM OF TEST PIT EL. 16.37' TOTALS 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION THROUGH TOTAL LEACHING AREA: 758.19 SQ.FT. EXISTING LEACHING CHAMBER DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES PLAN VIEW OF S.A.S. TOTAL LEACHING CAPACITY: 561.06 GAL./DAY TO THE DESIGN ENGINEER. CHAMBER END VIEWO O O EXISTING SEPTIC TANK 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE STRUCTURES SHALL BE MADE SCALE: 1 = 10' WATERTIGHT. NOT TO SCALE (PROPOSED 5 BEDROOM DESIGN) 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE THEY SHALL I f�'•'�- , •� TEST PIT DATA TEST PIT DATA WITHSTAND "-20 LOADING. 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. 28.90 B. FND• INSPECTOR: Don Desmarais INSPECTOR: Don Desmarais '✓' �'.-1 ;: � M _ � ��: ;,° , EVALUATOR: Edward L. Pesce, P.E. EVALUATOR: Edward L. Pesce, P.E. = 1 ` ` ° t`st ' ( ` 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND PROPOSED 500 GAL. LEACHING ',.` ; • ' ' `� f� J "^6 ' _ DATE: April 24, 2006 DATE: April 24, 2006 °� a 1 `.. 'c` M UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING I X _ CHAMBER EACH END P P rFv , �I 11-T d ` �' FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM BENCH MARK - _ ; J F. �. i 5 ' �� + : CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR P.K. NAIL #2 ELEV. l 28.40 __ 5�9,0� TEST PIT #: 1 TEST PIT #: 2 ��., - 1'- 1 �. lg; 15.255(3). X ELEV TOP 28.02 ELEV TOP = 27.87 i _ 1 . w 1 ? , °` 6p 47' ' �- 4-FT. OF STONE ALL _ ' ' `: �` a I >_ z t 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN SITE I Q Q I 27.80 {I - _ _ _ ELEV WATER = N/A ELEV WATER= N/A �� 'r ' CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. ' -� AROUND (TYP.) �--� �• '�_ �r y t. j �#�, Jan of 'f 1� X w ' r r v t Q PERC RATE = 2 Min In PERC RATE - 2 Min In ` � n '= 6.80 / / , » £ t 16. PROPOSED PROJECT IS LOCATED WITHIN: ASSESSORS MAP 14�( PARCEL 77 ' N N DEPTH OF PERC = 51 "-69" DEPTH OF PERC = 40"-58" 'S :* '`S=M1: 17• FEMA FLOOD ZONE ( AS SHOWN ON COMMUNITY PANEL250001 0016 D 29.34 EXISTING SOIL ABSORPTION � � $ } ro �-t 18. PLAN REFERENCE BASED ON SITE SURVEY PREPARED BY JOHN DOYLE ASSOCIATES DATED APRIL 28.3 <`-�.. #. -•: �r � . „a"•'�r' ;� �' ...ems Bft&*, .- SYSTEM - (2) 500 GAL. , TEXTURAL CLASS: 1 TEXTURAL CLASS: 1 , ' "� 04, 2004. LEACHING CHAMBERS t , 29.51 i 3 '=�,"� ,.� �k �� � �,,.. • �� , '�. :° 19. DEED REFERENCE: BK. 19898, PG. 297 ' N/ I ` +ram }�tk Sri" ''` ` • CENTERVIL 20. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. I ~ W' 21. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE I 28.40 28.02' 27.87' ' �� - -^- "� FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY SED ONLY EXISTING �, r p 29.67 p p LOT NO. I W el - F A� xT; ., rea,e Bav Q - p DISTRIBUTION r r� �-/ O Leaves/ Organics A Sandy Loam p r vq 4 I + FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. 19,702 S.F. r rr¢ �s p f 29.84 BOX r W�cl 8" 27.35' 8" 27.20' £ i �, .. I �,, q A Loamy Sand B Loamy Sand 10YR. 5/8 Z ZI 1 27.90 18" 26.52' 24" 25.87' �. U � w � ' y ' ' •ga9 �, '` :carte � Nack�, `� ' !' - - ` W - W 29 0 I 1 g Loamy Sand 10YR 6/8 _- - - N i DECK �� , - c� M 5 `' = ,,obi' PROJECT Z 29.98 ' EXISTING SHED 25•82' ' 40" 24.69' 40" 'I �`" �* 1F �`• LOCATION DWELLING FIN. - CIS , G�/ FLR. EL. °' i PROPOSED SEPTIC SYSTEM UPGRADE 32.97 SHWR. I -, _ �- I / EXISTING 1500 GAL. '= �L T PREPARED FOR: J GAS 0 SEPTIC TANK ' S1" JIM AND CHRISTINE SULLIVAN -' I ' S8" 21 ROSEGATE ROAD ' 0 I DECK 2 90 ^I Med. to Fine Sand 2.5Y 7/8 NEEDHAM, MA 02494 00 69" I 2 I l� O C U S PLAN LOCATED AT ' 30.47 _ X 31.1 �,' 2.5Y 7/4 86 HOLLINGSWORTH ROAD C Med. to Fine Sand SCALE: 1 " = 1000' OSTERVILLE, MA 02655 30.7 , RESERVED FOR BOARD OF HEALTH USE ��N OF Mgss Drawn By: JDF I 0 p L. Designed By: EP __0p w 28.6 0`� EDW.SG L• n ' 156 27' _ _� -- 28.10 / o PC VIOL ui M Checked By: EP ENGINEERING X ; No G.W. Observed No.32001 & ASSOCIATES .-_ _ 138" 16.37' 9 wp �� �r h JOB No.: /� - No G.W. Observed 9 FGIs1eP �� Edward L Pesce, P_F SITEPLAN N 132" 17.02' ��SS/ON �G\ 4 51 R A Y M O N D R D Date: SEPT.25,2006 20 0 20 40 PLYMOUTH, MA 02360 SCALE: 1 = 20' 1"=20'-O" � epesce@adelphia.net Phone:508-743-9206 Sheet- 1 OF 1 cel 1:508-33 3-76 30 FAX:508-74 3-0211 4 . R 2 / .:FLOOR E . 3 7 _ -F H L 9 EM PRO F/ eSEWA G� sYsT O .5 7 q a LO CHI F/N/SN G .a E IPA N//^//MU M sL O P /o E O F A X b G M 9 / r Y fi _ LO AMY Y : A X, I w `3G M S I�ID G A I MAXJNAX , /ST OX 1N G SU P _ M /H N I - ` NV _ _ _T � 2 .34- EL N E 5,10 2 .Z _ /Z M/ . /NN ME t/ E c x „ S R - �4s 3 MA r D ; Z: I/E / T E s O R F / z s oN CH 40 VG n C 4 P ; � sc ; ! D LEVEL ' N 40 Pv c L Q!/l `. V N INV. l V. IoMN 4 1 NV .� 2 . 2 r N v G.27 3 S ZL OZ I 2 3 d E U 2 4Z 2 / h M 5 5 5 2S / ! Z ti a c► r—u o 4 4 P o c� V _ 4 r. .e WASHED a k , D L E WASH E a T 69 N NAMB R 2 FF EPT � ,a 8 5 0 ' T N 'E /Z - 0 0 : o - - o o c� NE SAiI/d C OSE AL: E -Sr c- IeOP A SDO G PR CA PT/ P I T 4 9- 0 9- . YV LE o ET _7�E R TANK lTH /N T P 2 r O c s �9 o 2 3l 5 27. ,MR ) O PT D 5Y5TEM S' L i4.850R / N L .Z E 17 of F s T BOTTOM E T Pr I 7_ E E STE E L. / 2 .S WAG sY D SiG N C C 1H •9L ULATID S N R N� OU Li T '�WA NOT. N t/ E� CO N _DE !G s N L E,DA lLY OW T�5 DAT e 2. F T MAR. H 3� vo ` 13 D O X_ 3 R OMs to � . 1 PD y8 D A1�M, 33 GP.D s o c� VA L 1/ ✓ NN L A L�oY E Z E U E . , , R /R D A� P`SOR T/D/J' , Q AR�q i 25 33 G = ; D PA o 7 6 sF A XC v T !3 cE 4- .1) Y f# A o R w s 4 NE -sr US 2 a o N E E Wb 3, P .-T E s R CA T ER ATE i C CN�iM.BE s � M/ H W1 - F T L' l F 8 E H o you E ' o �- lV AR iD , h'C° , P EP G 2l 0 2 5 G'. _17 TN D O MB R BsoRPT �► E v s A AP EA , PRO 1 /o N so L` / S" .7L X (/ L T A CLASS. . ONE O E M `OTT A A 2 2� R I . 83x 5 .3 o , s .�s E Z W H 1� s7-©nrE / AREA 2 S.G� So x 2 w 0 TA .a 7 s F: Z7 iG D S E � nt F u o� � R W/TN N .4RI�AGE s os � , L /)N VIEW s, . C LE _ A ! 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