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0110 JOBY'S LANE - Health
110 Job tane ` A= 121 0 Osterville z �r } r� 6 F c r- a r x i No. aO ( J (al Fee i t 2 i. c -�"' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pptiLation for Misposal �bpstpm Construction i3Prmit Application for a Permit to Construct( ) Repair(411"Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or,L t No. //O ToIOA L"e Owner's Name,Address,and Tel.No. OS+'/1/I If'o, AA O-C e11` SC O+j-- Assessor's Map/Parcel i;L •- I a Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. �OJ,�GS lvfc �5 L/JC S� _ -7I�1 7N C�°T Type of Building: Dwelling No.of Bedrooms 3 Lot Size 416,79''Z sq.ft. Garbage Grinder( ) Other Type of Building J P s jC)yr\,) c;rA No.of Persons Showers( . ) Cafeteria( ) Other Fixtures Design Flow(min.required) Z 15 p gpd Design flow provided 3y3,y gpd Plan Date 2 '` -1 rc3 Number of sheets 2. Revision Date Title Size of Septic Tank_e%1 t>f i N t Type of S.A.S. t-C G C!NldA etl -5'k h3 C_ i()`07 t Gc V PC1 Description of Soil Nature of Repairs or Alterations(Answer when applicable) Aop�c O�J() S LC G+ cHC�hP�f Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signe Date - Application Approved by Date , Application Disapproved by Date for the following reasons Permit No. Date Issued ' � • V ^+ # ..i a r_« . _ r �,s' s..r w i„ . rrTM..... -i4 l x r. .. � � .. , 1 " 4 Y � No. �Q ( � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 4plication for Disposal *pstem Construction Vermit i Application for a Permit to Construct( ) Repair(') Upgr ode( ) Abandon( ), ❑Complete System ❑Individual Components . Location Address orbot No. //O Jobi�s LGtie Owner's Name,Address,and Tel.No. C)Sixn,V I l�' n�tkc1��11, Sc m., Assessor's Map/Parcel 12 — j P•(7) Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. l7j( a�JSn�C S _�C70-7JSS ►,� c�-l►rvc [ c�r�t Type of Building: Dwelling No.of Bedrooms 3 Lot Size yG,11-z-" sq.ft. Garbage Grinder( ) Other Type of Building y P �� ��� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 2 gpd Design flow provided gpd i- Plan Date `� - ' 1`�j Number of sheets 2 Revision Date Title Size of Septic Tank (F)1 t Sf i N Q Type of S.A.S. L C. Cthr1Jy1V 0y 1 5 I n] Q 16 X 37►0 V P(, J } Description of Soil I Nature of Repairs or Alterations(Answer when applicable) t tJ%Vn)� G Pew � -to p tiJ C� S L C(® c' cAM P✓,�j 'i I� 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. Si gn ed r .✓ � `-?�---- Date 5r -tea—l� i• 5 Application Approved by ��. Date Application Disapproved by /i Date - ft. for the following reasons h 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(V<' Upgraded( ) Abandoned( )by T:k3 Aol) A f at 1 id .1 6V,r/S rtj,� E' has been constructed in accordance with the provisionsof Title 5 and the for Disposal System Construction Permit No. dated Installer n cS A k2Xc,,In1 Designer NN #bedrooms Approved design flow gpd The issuance of this permit shall not a const ed as a guarantee that the system will_function as desi�gned f Date j ! Inspector •� -" - • --- --"----- ----------------- -"--- -- --------- ----------- _----- _- -= -------=-------------------------- ------ - --------- No. Fee , THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstel Const action Permit Permission is hereby granted to Construct( ) ` Repair(1/) Upgrade,( tt ) Abandon( ) System located at I l o _S O�Y S `'� t" CAS r"r�'1 1 Z' i 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. i Provided:Construction must be completed within three years of the date of this permit. Date j Approved byF- � f l t Town-of Barnstable T"E r Regulatory Services h�P` yT Richard V. Scali, Interim Director MASS. a Public Health Division 039.i639� `0m �F Thomas McKean,Director 200 Main Street,Hyannis,MA-02601 Office: 509-962-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: '� 1 Sewa e Permit# !- �� g �tC,Sp��-�;��p Assessor sMap\.Pai-cet I� � Designer: l n ;r7ee f In wo rbis J,a c : Installer: Address: lZ -W, Crbssl ,e (J f24 Address: ( ( T:;�,e s V Ae e MA O z4 Y4 L1,64r'v Ao Net 0701- On �' �) f �N�. was issued a permit to install a. (date) (instal r septic system at /�d /( � �/f1i based on a des�_m drav�n by (address) Evt�ine e "n�i WC AU /11 C , dated I 16 / (designer) v 1 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. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral.relocation of the SAS or any vertical relocation of any component of the septic system).but in accordance with State & Local Regulations Plan revision.or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was construcie nce with the terms of the I\.A approval letters (if applicable) al%OF J PETER T. a FA*NTEE CIVIL tnstaller-'sgnature) NO.351% qFQ/STE *11 (Designer's Signature) (Affix Designer tamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COTAIPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. .QAScptic\Dcsiencr Ccrtification Form Rev 8-14-I3.doc oF� Town of Barnstable. r# Department of Regulatory Services Public Health Division xt,4 � Date 4- �A s639. :200 Main,Street,'Hyannis MA 02601 , s - r P - DateScheduled Tlme Fee Pd. A* Sol Surtab �ity Assessment,fo>=- S ge Z) spa, al: t Performed[3y: f-�e'- M`` '11'u -Lt i Witnessed By: LOCATION &GENERAL INFORMATION r Location Address' Owner's Name. f t Yle Address 1 I'� 110 s Assessor's MapTareek. Engineer's Name NEW CONSTRUCTION, REPAIR Telephone.# SW- Lj-77-,$`3 1 Land Use •Slopes M Surface Stones Distances from: Open Water Body: ft Possible Wet Area ft Drinking Water Well* ft !`i Drainage Way ft Property Line 'ft, Other, {t SKETCH:(Street name,dimensions of lot;exact locations of test holes&pert tests,locate wetlands in proximityto holes) 9 • t k Parent.material(geologic) dU �1(hs� re-I TF-Zr Depth to Redroek Depth to Groundwater. Standing Water in Hole:. 1 � Weeping from fltt PAce: Estimated Seasonal.High Groundwater DETERMINATION FOR SEASONAL HIGH'WA.TE,R TABLE Method Used: Depth Observed standing in obs.hole: __ in, Depth lo.Soll rnottltix:. �,b u in. Depth to weeping firm side of:obs.hole: in. Groundwater Adjustment ft. Index Well#: Reading Date: Index Welt level A41,facto? " .Y Adj.Clroundwnter Uve[.� PE1tCOLATIONTE+.S"T Observation j,:��1 Hole# Time at:h" Depth of Pere Z2-/ Tlme,at 6" Start Pre soak Time;:@ .� oo^� Time(9„-6") End.We-soak L P✓5 M`L Rate MitidInch, _ ✓ Site Suitability Assessment: Site Passed Site Failed:, Additional Testing Needed(Y/N)' Original: Public Health.Division Observation Hole:Data To Be.Completed on Back----------- *If percolation test is to he conducted within 100'.of wetland,you trust first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:ISEPTIQPERCrpRM..DOC. DEEP::OBSERVATION;HOLE LOG Hole T7. Depth from, 'Soil Horizon Soil Texture .'Soil Color Soil Other Surface(Iin.) (USDA) (Munsell) Mottling '(Structure,Stones;Boulders. o i ten ravel ©—� S tc °C12 8 3Z � loawty sqt.� l`o`I �8 c Y�1( DEEP OBSERVATION HOLE"LOG Hole#�Z- Depth from Soil Horizon Soil Texture r Soil Color' Soil, Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Grave)) C M4CJ Sc,,,.&' 7 DEEP.OBSERVATION HOLE LOG Hole# Depth-from Soil Horizon Soil Texture Soil Color Soil; Other i Surface.(in.) (USDA) (Munscll) Mottling (Structure,Stones,Boulders:. Consistency, oGravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consisten -------------- Flood Insurance Rate Map:, Above 500 year flood boundary No_ Yes Within 500 year boundary No 0?, Yes Within t00 yeai flood boundary No Yes, Depth of Naturally Occurring Pervious Materia Does at least four feet of naturally occurring pervious inaterial exist in,all areas observed throughoutfloe area proposed for the soil absorption system?If not,.what is the depth of naturally occurring pervious material? Certification I certify that on _ �� s (date)I.have passed the soil.evaluator examination approved by the Department.of Environmental Proteetion and that the above analysis was performed by me consistent with the required train• ; xpertise and experience described in 310.CMR 15.017.. Signature. �..c..--� Date QASEvnOPERCFORM.DOC i ASSESSORS MAP NO: ., PARCEL NO: C2 NO... ._. . . . Fss.......l .c.)...... THE COMMONWEALTH OF MASSACHUSETTS €j -7 gZ,,6 BOAR® OF HEALTH APPROVED TOWN OF BARNSTABLE ea,nst.ab►e .onservation Depattmolil Aliptiratio n for Di-qVnsal Works Tiluli ` Sig(ed Dato Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal y(© System at Ll . ........���.! S .---------...---------------------------------------- ------"¢-.c7--7-..........---- e.. ocation-Address or Lot No. �hl7ma� i�u..e.�s Address Installer Address Type of Building Size Lot_Z/..... ..._..._..Sq. feet U a Dwelling—No. of Bedrooms..J..........................-..........Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ----------------•--------------•-----------------------•-••--•••••-•--•------•-•--••--------••-•-••-••••-•-----•---•-•••.....--•••-••............-•-• W Design Flow........1.[_U............................gallons per person per day. Total daily flow.......3 3 0_.........................gallons. WSeptic Tank—Liquid*capacityl_4DQ.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by Y)fr.:,L n l-................................. Date.:4dLColg___-------- P4 Test Pit No. 1......./.......minutes per inch Depth of Test Pit.... d.......... Depth to ground water.n0._L _.. f� Test Pit No. 2................minutes per inch Depth of.Test Pit---_................ Depth to ground water........................ ............................................ ....................................................... ODescription of Soil_.!'2nE1 !R .......................................------------------------------------------------------------------------•-•------------- x 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia ce has been issued by the board of health. Signedt.. Compliance has --------------------- g wr,G 3 7_ ApplicationApproved By ............._1. - `1--- 3------------------------------------------------------------------------- ----- ..7 2... Application Disapproved for the following reasonr: .......... ... .. .................................... .. .. .................................................................. ---------------------------------------- ----------------- - -------------------------------------- ------------------------ --- ----------------------------------------------------------------- - -- ------- --------------------- Dare PermitNo. ........ 1-. � ------------------------- Issued .................------- -are.................................... q LY ��7 I D No.--4-32- ! r: - Fms.......fQ.U...... THE COMMONWEALTH OF MASSACH-USETTS -7 BOARD OF HEALTH TOWN OF BARNSTABLE ,Apure#inn for Uiipnial orkii C�omitru un anti# �` �-9ez Application is hereby made for a Permit to Construct f or Repair an Individual Sewage Disposal PP Y ("�f) P ( ,) g , 1 �Q System at; -" ................-• -----•----•......•................ .....•• :...__. ----•-•---- E . r ? � --•.................... Location-Address or Lot No. f r �!• �F Owner Address W Installer Address Pq Type of Building Size Lot__/g:.7f------•-•----Sq. feet ` U Dwelling—No. of Bedrooms..,......................................Expansion Attic ( ) Garbage Grinder ( ) pa,I Other—Type of Building No.No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures .................................. W Design Flow.........111.............................gallons per person per day. Total daily flow---------- ............................gallons. WSeptic Tank—Liquid capacityl-<!_f_ .gallons Length................Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank•( ) _ Percolation Test Results Performed by---- (. �" Y _.nti� ................................... Date... � Qg --._.._...... W Test Pit No. I....... .......minutes per inch Depth of Test Pit----!.�2......... Depth to ground water•L_!_'j.�7-!__. f•>~ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W •-•--•-••••---------------------•••-••--••---••••--•------•••••••--•--••----•-•.._.......................................................................... 0 Description of Soil._ ......................................................'/" U ••---••-••••-•-•-----••-•-••-•••-••---••-•--•-•--•-•--••-•---•--••...-••--••---•-••-•......_••••.-•-----•-•-•-•-•••-•--•-••--•••-.._...--••--•-•-•...•••-•--...._••••.-•-•--.-••--•. l W UNature of Repairs or Alterations—Answer when applicable._____.......................................................................................... cr. Agreement: <3 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental 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 .. G........ ---------_ .....� Dace/ Application Approved BY ------------- ... .. .---- --....................------------............-------- -- . . -- ....--1- , -p'�a-r -52- Q Application Disapproved for the following reasons: ..................................................................... --...........----------. --------........--....... Dare PermitNo. ........� �>--?...................... Issued ...............................------------------------------------- �� / Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BAR����TTNSTABLE Certiftrate of Comp lame THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by........................ c ....... _ �d.............. -------------------- ---- ---------.........--..--....--..............--...................................................... Insraller has been installed in accordance with die provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ...... ��..� f ------------ dated ------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE � CON= STRU D AS A GUARANTEE THAT T HE SYSTEM L FUNCTION SATISFACTORY. DATE Inspect ' --------- ----� .- ----..................../�'.:.. /---../.... ... , � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No...�,�.�'..�,�.��. FEE..... 6..0.......... �i��rg��1 nrk� �nn��rnr�ilan rrmit Permission is hereby granted..............6 .......................... to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo................---- .'Zg_7.....-----.. � ...... ----.--........ ......................................................... L/ (I Street as shown on the application for Disposal Works Construction Permit No.- Dated......................•................... Board of Health DATE................... ---•-}--- `�tt-S 5/ FORM 36508 HOBBS&WARREN,INC..PUBLISHERS -- 1 r _ I (14. N Eby E q poa� ol -, .FLD1+�I-?J SEpn iTAtJit 3. .iC1SD:J=�4956�t i -- + - � - , Its L E l&410 G 5 5 ' _1=4 gT -APP �y 43SF T1-;� Q a "� r 1 PerotATIoN IZAT , L''►N Att�l 44 !, a : e� N: � /D 117 tag S �o9733et „vT ti "v19A �T� � _ r / � 1 � , rr i 1,7 412. K. 4�oG� �G 3Z A TF=33 ov VT ENV •t z �- I y � ;' ; r LE�1GE{; �iF_LD 11JJ 24Z �tp. 2q 4 _. 2SL V^ALr A. d 4 4 Q d�4 Bo J f 5 , r , � TbfJE $dSE i MLA•.I —i $� ° f t t I _.. , 4 , j F _ {' T. FT 77 Lib; s �. µ 'DETAIL FBI L(17 I OF CIETIF I E PLOT_ PLAQ- -� L — I► � I SGAL� 4D 17ATE 3. 2':9Z ins AMo85 511 i ; i _ 4 r 2l•92 l GQZTIfif TlaT T�tE �wu.+N� F I l SETBA, zL CzE �oF_THE TowN�oF:►3A2h�5T 2aLc PL "� .` 24� P� 13q f�Nb15 fJr�/r7^lyO�/A7>=h ;�IIrN,ul A.•FLDob I �pATE P¢OFESSIO Al LAn1D S or< LAID SUPZVEyCS i_ mils I D.rJA--- r'R� S j�-TIIS�-pL'A'iJ t5 �1DT BASEb D�1LQ+1 Ii 20M iJ. U Glvlt✓ ��IJ[�iW��=u; I - - 51� _ E r 5_evE osTEIZv,U.i_. P MASS• sl�a L IsAU-o' or-�ScTs .f3c useb . l 'tSTQurU s N F�zoPC AF L-1 c;k Igo w Eu ! 4 Commonwealth of MassachusettsMW ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 110 Joby's In Property Address Nancy Dietz 34 Court St. North Chatham Ma. 02650 Owner Owner's Name information is required for every Osterville Ma. 02655 6-7-12 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, I use only the tab key to move your 1. Inspector: cursor-do not David J Burnie use the return Name of Inspector key. .. David J Burnie Mgmt, Inc Company Name 307 A Commerce Park North , Company Address So Chatham Ma 02659 City/Town State Zip Code 1-866-980-1440 SI 386 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: R ® Passes ❑ "Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by.the Local Approving Authority 6-7-12 Xspectore'sisrg=5�idre - Date The system inspector:shall submit a copy of this inspectior report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments' 110 Joby's In Property Address Nancy Dietz 34 Court St. North Chatham Ma. 02650 Owner Owner's Name information is required for every Osterville Ma. 02655 6-7-12 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System installed as designed. i B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes', "no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): _ t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments' { M 110 Joby's In Property Address Nancy Dietz 34 Court St. North Chatham Ma. 02650 Owner Owner's Name information is required for every Osterville Ma. 02655 6-7-12 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health):- ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ .Y ❑,N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y. ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)'that the system is not functioning in a manner which will protect public health, safety and the environment: ; El Cesspool or privy is within 50 feet of a surface water 0 Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-111'10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 110 Joby's In Property Address Nancy Dietz 34 Court St. North Chatham Ma. 02650 Owner Owner's Name information is - required for every Osterville Ma. 02655 6-7-12 page. Cityrrown State Zip Code bate of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well*". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool El ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El Z. Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow t5ins-11/10' Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form TM Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �< 110 Joby's In Property Address Nancy Dietz 34 Court St. North Chatham Ma. 02650 Owner Owner's Name information is required for every Osterville Ma. 02655 6-7-12 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ' ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design.flow of 2000gpd 10,000gpd. El ® 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. t For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D: Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system.is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 5 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form ;3 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments s•'' 110 Joby's In :. Property Address Nancy Dietz 34 Court St. North Chatham Ma. 02650 Owner Owner's Name - information is required for every Cisterville Ma. , E, 02655 6-7-12 page. Cityrrown State ." Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided,by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ Z Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location Of,the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example,.a plan at the Board of Health: ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CM 15.302(5)] D. System Information Residential Flow Conditions: ' Number of bedrooms(design):. 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330gpd t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , ' 110 Joby's In Property Address - Nancy Dietz 34 Court St. North Chatham Ma. 02650 Owner Owner's Name information is required for every Osterville Ma. 02655 6-7-12` page. Cityrrown State Zip Code. Date of Inspection D. System Information ` Description: 1000 gallon septic Tank, distribution box and leaching field made of 3 flow diffussors and stone. Number of current residents` 5 Does residence have a garbage grinder? ❑ Yes ® 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(gpd)): yes Detail 2011= 334 gpd................2010= 381 gpd Sump pump? ❑ Yes'® No Last date of occupancy: Current • Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No- Industrial waste holding tank present?- ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins 11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 110 Joby's In Property Address Nancy Dietz 34 Court St. North Chatham Ma. 02650 Owner Owner's Name information is required for every OSterVille Ma. 02655 6-7-12 page. Cityrrown State.: Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Current Date Other(describe below): General Information Pumping Records: Source of information: None per BHD Was system pumped as part of the inspection? Yes ❑ No If yes, volume pumped: 1000 gallons How was quantity pumped determined? Truck site glass Maintenance Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool 4 ❑ Overflow cesspool ❑ Privy , ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) . ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 • x Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 110 Joby's In Property Address Nancy Dietz 34 Court St. North Chatham Ma. 02650 Owner Owner's Name information is - required for every Osterville Ma. , 02655 6-7-12 page. City(Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Plan date Revised 4-27-92 Were sewage odors detected when arriving at the site? ❑ Yes Z No Building Sewer(locate on site plan): t _ 24 Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC - ❑other(explain): Distance from private water supply well or suction line: 1 feet Comments(on condition of joints, venting, evidence of leakage, etc.): Normal as to what we can see. Septic Tank(locate on site plan): 13" Depth below grade: . feet Material of construction: ® concrete ❑ metal ❑ fiberglass _ ❑polyethylene ❑ other(explain) Normal, some decay. l If tank is metal,list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments,. 110 Joby's In Property Address Nancy Dietz 34 Court St. North Chatham Ma. 02650 Owner Owner's Name information is ' required for every Osteryille Ma. 02655' 6-7-12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 61- Scum thickness 12" � Distance from top of scum to top of outlet tee or baffle even Distance from bottom of scum to bottom of outlet tee or baffle 101. How were dimensions determined? Tape and Estimated. 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 needed pumping and found some decay of Concrete tank. Tank was pumped at time of inspection. ` Grease Trap(locate on site plan): Depth below grade: feet, Material of construction: ❑ concrete ❑ metal" ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 b Commonwealth of Massachusetts ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments, 110 Joby's In Property Address Nancy Dietz 34 Court St. North Chatham Ma. 02650 Owner Owner's Name information is required for every Osterville Ma. 02655 6-1-12 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): , Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: i Material of construction: ❑ concrete ❑ metal El fiberglass' ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day , Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 1 t5ins•-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts ' Tale 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 110 Joby's In ' Property Address Nancy Dietz 34 Court St. North Chatham Ma. 02650 Owner Owner's Name information is required for every Cisterville Ma. 02655 '6-7-12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Normal level 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.): Some sludge in d box. Pump Chamber(locate on site plan): , Pumps in working order: ta❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Located and viewed using a sewer camer. No standing water in leaching. could not acess all diffusors. d box at normal level and all three lines were clear, no standing water. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M ,•�''r 110 Joby's In ' Property Address Nancy Dietz 34 Court St. North Chatham Ma. 02650 Owner Owner's Name information is required for every Osteryille Ma. 02655• 6-7-12 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) e Type: , • . A ❑ leaching pits number:s ❑ leaching chambers number,. ❑ leaching galleries number: ❑ leaching trenches number, length' ® leaching fields number, dimensions: 3 flow diffusorsand stone ❑ overflow cesspool number ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No standing water in lines. 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 6ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 7 Commonwealth of Massachusetts . Title 5 Official Inspection- Form n Subsurface Sewage Disposal System Form-Not for Voluntary Assessments - �,M 110 Joby's In Property Address Nancy Dietz 34 Court St. North Chatham Ma. 02650 Owner Owner's Name ' information is T required for every Osterville Ma. 02655 , " 6-7-12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) ' Comments(note condition of soil, signs of hydraulic failure, level of pondring,,condition of vegetation, etc.): Privy(locate on site plan): Materials of construction:• _ Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.): , >-y r , ` , r .. t5ins•11/10- Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17, f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , t M 110 Joby's In Property Address Nancy Dietz 34 Court St. North Chatham Ma. 02650 Owner Owner's Name information is required for every Osterville Ma. 02655 6-7-12 page. City/Town State Zip Code Date of Inspection D. System Information (cont:) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately • • V x� i. c `+t a . • t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Comm irimf#h of MassachusetIs Title 5 Official Inspection Form H- RMAftm h&MV06M is Ile for e"e`'` stye zip cof tie of iripa D. System information (corn.) Sketch Of Sewage 018PW System:PnoVM a view Of thedispose!system.inciuding ties to at least two permanent refer enoe landmarks or benchmarks.Locate an wens within 100 feet Lade where ptlbbe water supply eaters the building.Check one of the boxes below: ❑ hand4wich in the ama below Q dreg ahached separate1y * a 9 11 .< i-` t {_[B!p rr 6l � f�� a - } b�•iit10 w T�SteiFaRt •P�Bi5�7T Commonwealth of Massachusetts f a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M „ ' 110 Joby's In Property Address h, Nancy Dietz 34 Court St. North Chatham Ma. 02650 Owner Owner's Name information is ' required for every Osterville Ma. 02655 6-7-12 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: Check Slope ® Surface water d ® Check cellar ® Shallow wells Estimated depth to high ground water: 17.50' below grade at leaching field location 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: 4-27-92 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain:' Test hole plan dated 4-27-92 shows water 17.50 below grade at leaching field location. ❑ Checked with local excavators, installers-(attach documentation)' ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Test hole dated 4-27-92 shows Water at Elevation 17.50'The system was installed in the area of Grade elevation 36.00'The bottom of the leaching field is 4.5' below grade and has a seperation of 13'to actual goundwater. This location is in Well#MIW 29 Zone C the level for May 2012 is 8.43'and calls for a 3.7'adjustment. 13.00' less adjustment of 3.7' allows for a seperation of 9.3'seperation to estimated high ground water. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 110 Joby's In Property Address Nancy Dietz 34 Court St. North Chatham Ma. 02650 Owner Owner's Name information is required for every Osteryille Ma. 02655 6-7-12 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file y P t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 f ' LEGEND N --20 -- EXISTING CONTOUR ® pOa x 19.98 EXISTING SPOT GRADE o� ca o 40 PROPOSED CONTOUR M11 e ox o P RE PROPOSED SPOT GRADE -JdGW- UNDERGROUND WIRES W EXISTING WATER SERVICE 0 0 FW-05 p WETLAND FLAG IFW-050 ISOLATE DEPRESSION FLAG k WETLAND SYMBOL 61j p` e° ar �c TEST PIT � ro��� BENCHMARK lJ � R�er c3` O Ro LOCUS MAP NOT TO SCALE l.' PARCEL A 46,792±SF PARCEL ID: 121-120 0 Off- +20.13 3 v 00' I / FRESH WATER 11 FW06 1 WETLAND 62 0 p / O + . 1.11 / 20.65 1 FW05�, OF w WORK LIMIT/SILT FENCE 958 '-FW 20.67 l ISOLATED NON-JURISDICTION,gL / 19.61 / l DEPRESSION <500 SF ' / E / / IFw08' - 01w (yI x 2168 / IFW109 - - 19.08 .__.Z N 66�p"I /use 19.9 400 S IFw� /r0 `• // X 18.35 IFW106 /n' +27.31 105 19.35FWI / 0 11 1'8.36 IFW104 19.03 t 27.06 /' / O STK � G� �/ ��x / /h`• // 1 26.2 �l IFWS / V /�� I 25.28 / /. IIFW101 18 20.90+ / 2/ I / '�1839 � IF 0 23.95 .. .Gieplin9 }22.94 / 1 �A `Wedge of / \\ 26 2St w+•22:59� �100 /J \ x 23,5825.96 �� \\ 26.08 1�j0% \24,61'+ STRIPOUT AS REQUIRED � 2 71 �', 26.11 ' DECK 0 25.21 WITHIN BOUNDARY \ �� �� 4.52 x EX/STING `'�• SEE NOTE 11, SHEET 2 o \ �' _ �o \ x HOUSE(#1 i 0) x 24.1e �? -• DECK T9F=31.6f I� O 24.91 24.45 24.32 P b Z C�i7 26.56 c98\ y�i / + 16 4 PORCH \6% - EXISTTNG SEPTIC. TANK TO REMAIN 30.36 29.86 J INV.(IN)=26.87f a o°. •.:: \ i... : .::,;•.;_.+:k..^. 27.8 27.39 INV.(OUT)=26.56f' \\\\ \' :<;.':'``::• \� A E 27.9 OF 44 sx 30.41 / EXISTING S.A.S. \ \ � In° o PETER T. ✓ TO BE ABANDONED ° MCENTEE _ o.7s'J:;: ` :5,.: of P CIVIL No. 35 109 JBENCHMARK CORNER/BOTT. STEP 3 .o5 E ' EL.=JO.44 �K �\ I 31.19 O�3 .28 CBdh CATC BASIN . J FLOOD ZONE DESIGNATION 34.81 32.75 PROPOSED SEPTIC SYSTEM UPGRADE PLAN MAP NO. 25001CO544J EFFECTIVE DATE: JULY 16, 2014 110 JOBY'S LANE, OSTERVILLE, MA ZONE X Prepared for: Scott Mitchell, 110 Joby's Lane, Osterville, MA 02655 WETLAND CONSULTANT OWNER OF RECORD SCALE DRAWN JOB. No. MARSH MATTERS ENVIRONMENTAL MITCHELL, SCOTT R & Engineering by: P.O. BOX 554 KARLA D Engineering Works, Inc. 1"=30' P.T.M. 306-17 Yi' FORESTDALE, MA 02644 110 JOBY'S LANE 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. 978-434-1228 OSTERVILLE, MA 02655 (508) 477-5313 2/1/18 P.T.M. 1 Of 2 J`r ' i NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL: 26.3 ' FOR A DISTANCE OF 15' AROUND THE . PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL RISER AND COVER INSTALL RISER & COVER OVER ONE CHAMBER(MIN.) OUTLET AND SET TO 6" OF FINISH GRADE . SET TO WITHIN 6" OF FINISH AND SET TO WITHIN 3" OF FINISH GRADE TO SERVE T.O.F.=31.6t GRADE . AS AN INSPECTION M OL XrM:A- v 59, C EXISTING F.G. EL.=29.2t F.G. EL.=27.0f F.G EL.=26.5 to 28.8t bV s L = 29' L - 16' S=1% (MIN.) p S=1% (MIN.) 4"SCH40 PVC 4"SCH40 PVC e"f_ 2" LAYER OF 1/8" ,a.I TO 1/2 DOUBLE 14" s 12" WPW WASHED STONE EXISTING 48" UQUID OR TO FILTER FABRIC) LEVEL INV.=26.56 INV.=26.10 PROPOSED 3.5' 3' 3.5' _ „i , GAS BAFFLE INV.=26.27 D-BOX EFFECTIVE WIDTH = 10' DOUBLE 1 AAHED H-10 RATED INV.=25.80 STONE EXISTING SEPTIC TANK USE 5 LC-6 LEACHING CHAMBERS IN SERIES WITH 3.5' OF DOUBLE WASHED STONE-ALL AROUND H-20 RATED NOTES. TOP CONC. ELEV.=26.6 ___ BREAKOUT ' 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INV. ELEV.=25.80 E3 E3 E3 0 EA ER E3 ELEV.=26.3 INVERTS, PRIOR TO INSTALLATION. I E3 E3 EA EA E3 E3 EA I 2) D-BOX SHALL BE SET LEVEL AND TRUE TO BOTTOM ELEV.=24.80/ GRADE ON A MECHANICALLY COMPACTED SIX 3.5' 5 X 6' = 30' 3.5' INCH CRUSHED STONE BASE, AS SPECIFIED IN 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH = 37' 310 CMR .15.221(2). PERVIOUS MATERIAL /I. 3) INSTALL INLET & OUTLET TEES AS REQUIRED. 5' (MIN.) ABOVE G.W. -� 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE BOTTOM OF TP„ EL=19.8 _ LEACHING SYSTEM SECTION AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. _ 5) USE OF THE EXISTING SEPTIC TANK IS SUBJECT TO THE APPROVAL OF THE BOARD OF HEALTH SEPTIC SYSTEM PROFILE OR IT'S REPRESENTATIVE. N.T.S. GENERAL NOTES: 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED. BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. A'_L WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 40.1 0'F THE-STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE \ \ LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: �\ Ss? EXISTING 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR HOUSE#110� TO INSPECTION AND APPROVAL7BY THE BOARD OF HEALTH AND THE �'�\ EAN� ECK TOF=31.6f D ESIGN ENGINEER. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 0D. \� FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. de 3821�' PORCH 5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF _ THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF a HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY TOWN WATER SUPPLY. 8. THERE ARE NO POTABLE WELLS WITHIN 150 FT. OF THE PROPOSED PROPOSED SEPTIC SYSTEM. 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS AGREED UPON BY OWNER. AND CONTRACTOR OR AS OTHERWISE S.A.S. LAYOUT IDIRECTED BY THE APPROVING AUTHORITIES. 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY SOIL LOG THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS DATE: JANUARY 17, 2018 (REF. P#15566) IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND SOIL EVALUATOR: PETER McENTEE SE#1542 REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3), OR AS WITNESS: DONALD DESMARAIS RS HEALTH AGENT OTHERWISE DIRECTED BY THE APPROVING AUTHORITY. 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE. ELEV. TP- 1 DEPTH ELEv. TP-2 DEPTH INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. 13. THIS ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC 26.1 A 0" 24.5 A 0" SYSTEM COMPONENTS NOT SHOWN ON THE PLAN. LOAMY SAND LOAMY SAND 10YR 4/2 10YR 4/2 25.3 B 8" 23.8 B 8" w DESIGN CRITERIA LOAMY SAND LOAMY SAND 10YR 5/8 10YR 5/8 NUMBER OF BEDROOMS: 3 BEDROOMS 23.4 32" 22.2 28" SOIL TEXTURAL CLASS: CLASS I C PERC C DESIGN PERCOLATION RATE: 2 MIN/IN (0.74 GPD/SF) 22"/40" MED. SAND MED. SAND 2.5Y 6/4, 2.5Y 6/4 DAILY FLOW: 330 GPD DESIGN FLOW: 330 GPD / 19.8 HIGH G.W. _ 76" 19.8 HIGH G.W. _ .57" GARBAGE GRINDER: NO 7.5YRGs O /s 7.5 YR5/8 EXISTING SEPTIC TANK: 1000 GALLON CAPACITY 16.3 STDG. G.W. - 117" 16.3 STDG. G.W. - 98" PROPOSED D-BOX: 1 INLET, 3 OUTLETS, (H-10) 16.1 120" 15.5 108" LEACHING AREA REQUIRED: (330 GPD) -_ 445.9 SF PERC RATE: <2 MIN./IN. .74 GPD/SF ESTIMATED HIGH GW, EL.=19.8 USE 5 LC-6 LEACHING CHAMBERS IN SERIES WITH PROPOSED SEPTIC SYSTEM UPGRADE PLAN 3.5' OF DOUBLE WASHED STONE-ALL AROUND 110 JOBY'S LANE, OSTERVILLE, MA SIDEWALL AREA: (10.0' + 37.0') x 2 -x 1' = 94.0 SF Prepared for: Scott Mitchell, 110 Joby's Lane, Osterville, MA 02655 BOTTOM AREA: 10.0' x 37.0' = 370.0 SF Engineering by: SCALE DRAWN JOB. NO. TOTAL AREA:............................................................ 464.0 SF / Engineering Works, Inc. N.T.S. P.T.M. 306-17 DESIGN FLOW PROVIDED: 0.74 GPD/SF(464.0 SF) = 343.4 GPD ✓ 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET N0. (508) 477-5313 2/1/18 P.T.M. 2 of 2