Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0010 MARION WAY - Health
10 Marion,Way O;terville F/R A = 120 132 TOWN OF BAR ISTABLE _ LOCATION�.IO �A�,-,`�� tv�, SEWAGE # VILLAGE OS7P�"✓,"�/e ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY A;100 LEACHING FACILITY: (type) G✓lfrc 3 30�S . .. (size) 10 X 30 X d NO. OF BEDROOMS o2 BUILDER OR OWNER PERMITDATE: ��/�" 0.3 COMPLIANCE DATE: 9 v I�+03 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 513 _ e �w TOWN OF BARNSTABLE SEWAGE # VILLAGE V ^I/' iiS�1 J o ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY X LEACHING FACILITY: (type) AgPP < (size) NO.OF BEDROOMS BUILDER OR OWNER'.!`/'f' 2;A' &M) iFJe+ r e.��G PERMITDATE: 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 fe 11 e o eac 'qg facility) Feet Furnished C y^� V o, t S , 9� d y T l s a Z?61,m f-5 /l P eolz �7 4199 LO.CATI01 SEWAGE PERMIT N0. VILLAGE _ �S i c'/1 )li/ice /'►�!� INSTA LLER'S NAME i ADDRESS '410 c a-,-,t s 041-ex BUILDER OR OWNER DATE PERMIT ISSUED 7? DAT E COMPLIANCE ISSUED /®vv - � f ' W n �v ter. � c G � "'� �� `� . � ►, a -� .. ,. COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS kiwi DEPARTMENT OF ENVIRONMENTAL PROTECTION --rob . H-. TITLE 5 _ OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 10 Marion Way Ostervi e --/U?�— Owner's Name: Vincent & Roberta Demore Owner's ner s Address: 90 R k oc meadow Road Ext Tlxbr�da /NA 1 569_ � Date of Inspection: Name of Inspector:(please print)!,, Sean Jones Company Name: William E. Robinson SepticService Mailing Address: P O Box 1089 Centerville. MA Telephone Number: (5081 775-8776 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.1 am a DEP approved system inspector pursuant to S ion 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes + Needs Further Evaluation by theiocal Approving Authority Fails Inspector's Signature: Date: /� O The system inspector shall submit a copy of Zs inspection report to the Approving Authority(Board of HeaRhvr. :. 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 seat to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments , ""This report only describes conditions.at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 f r � Page 2 of 1 OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION continued Property Address: 10 Marion Way Ostervi e Owner: Vincent & Robert Damore Date of inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D 7A. Sy m Passes: 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: J 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 ycs,no or not determined(Y,N,ND)in the for the following state explain. ments.If"not determined"please The septic lank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or ex-filtration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. •A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or Idgh static water level in the distribution box due to broken or obstructed pipes)or 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 distribution box is leveled or teplaced ND explain: The system required pumping more than 4 times a year due to broken or obstrt.acd pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is mm yed ND explain: f Page 3 of l l OFFICIAL INSPECTION FORM .NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 10 Marion Way Osterville Owner: Vincent .& Roberta Damore Date of Inspection: " l0 06 C Further Evaluation is Required by the Board of Health: n/ 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 is accordance with 310 CMR 15.303(I)(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"frond 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 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: 3 r Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 10 Marion Way Osterville Owner: Vincent & Rgberta Damore Date of Inspection: Z(1210 D. System Failure Criteria applicable to all systems: You must indicate`des"_or"no"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or / clogged SAS or cesspool V Static liquid level in the distribution box above.outlet invert due to an overloaded or clogged SAS or / cesspool _ t/ Liquid depth in cesspool is less than 6"below invert or available volume is less thin Va day(low Required pumping more titan 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 I00,feet of a surface water supply or tributary to a surface / water supply. _ .✓/ Any portion of.a cesspool or.privy is within a Zone I of a.public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well: Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.(This system passes if the well water analysis, performed at a DEP certified laboratory.,for coliform bacteria and volatile organic compounds indicates that the well is free.from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm;provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.) (Yes/No)The system fails. I have determined that one or more ofthe 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: /V To be considered a large sy tcm the systein,must servc a.facility with a design-flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the systeml 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 11 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[ivied.The vvmer or operator of arty 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 f + Page 5 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY AS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM , PART B CHECKLIST Property Address: 10 Marion Way Os ervi e Owner: Vincent & Roberta-7Damorb Date of Inspection: I 010 t3 Check if the following have been done.You must indicate`yes"or"no"as to each of the following Yes/�`�o 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!lows in-the previous two week period? t /Have large volumes of water been introduced to the system recently or as part of this inspection?„ Were as built plans of the system obtained and examined?.(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? ✓ Were all system components,excluding the SAS,located on site? Z— Were the septic tan{;manholes uncovered,opened,and the interior of the tank ins ected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum 7 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 Existing information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Pant is at issue approximation of distance is unacceptable)13 10 CMR 15.302(3)(b)) Page 6 of 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 10 Marion Way Osterville Owner: Vincent & Roberta Damore Date of Inspection: FL W CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 'c 330 6 P 0 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x R of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): n1D Is laundry on a separate sewage system(yes or no):/-'D [if yes separate inspection required) Laundry system inspected(yes or no): ,� Seasonal use:(yes or no): Atli Water meter readings,if available(last 2 years usage(gpd)): 2005 — 751000 Sump pump(yes or no): N O — , 0 0 Last date of occupancy: r,.,tA+ COMMERCIAL/INDUSTRIAL 1\f/A Type of establishment: l Design flow(based on 310 CUR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last date of.occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): /V If yes,volume pumped: lQallons--How was quantity pumped determined? Reason for pumping: TYPZ OF SYSTEM Septic tank,distribution box,soil absorption system _Single cesspool Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval —Other(describe): Approximate age of all components,date installed(if known)and source of information: SQP+'� rF 1,3 yfL5IA tie1,, Lee-C,L-FC Id CJZan'3 Were sewage odors detected when arriving at the site(yes or no): A1c7 6 1'agc 7 0( I I - OFFICIAL INSPECTION FORM—NOT FOlt VOLUNTARY ASSESS(11EeNTS SUBSUR ACE SE`VAGE DISPOSAL SYSTEM INSPECTION F0101 PART C SYS'11111 INFORMATION (continued) Property Address: 1 0 Marion Way 0stervi e Ots•ncr: Vincent & Rober a amore D41c of lnspecllon: �� C, BUILDING 5E1VE11(locale on site plan) Depth below grade: f a rr f/ ' Materials of construction:_cast irun V40 PVC_other(explain). Distance front private water supple salt of suction line:_ Cununerrls(on condition of joints,venting,evidence of Ica/k/agc,etc.): ()eC4- .. SEPTIC TANK.Z(10(:Att on site plan) / Depth below grade: � c ' Material of construction:Zlul,crctc metal fiberglass lwl).cUtylcne If tank is metal list age:_ Is age col,Gmted•by a Certifica ccnifrcatcj te of Compliance (yes or nu): (attach a copy -If Dimensions: l von 64l(n7as Sludge depth: Distancc Goal top of sludge to buttum of outicl Icc or bafllc: Scum thickness: Distanct: from tup of scull,to lop of outlet Icc or baffle: (c r` Distancc from button,of scum to bottom of)inlet Ice or battle: Ilow were dimcnsium dcicnnincd: BP.e.tcd covers Gti( _ c71 G yti.G4 Srcrp.�-�tf Comments(oil pumping(cco,ul,cntdatiol,s, inlet and outlet Icc or bafllc condition, structural inlc6rily,liquid IcV.cls as rclatcd to outicl ulvctt,evidence of leakage,etc.): T.►l�l- Co✓cr o; ! c� l co/ e r ,..lee l fi lover r•c Gect..rs��_ �•r- (•ems`C�..Q e..o:( ��. C.at,� •u,✓_.L:,._ GREASE TRAP:N/(Il tc un site plats) DcpQt below grade: Nlatcrial of consUuclivrt:`ton(rcle ,total fibcrglass_pol)-cthplcnc _otltcr' (cr,plaul): _ Dinuasions: Scum tllickrtcss: Distance from lop of scum to lop of outicl Ice or bafllc:_ Distance front bolloln uf`tcunt.tu buttum o(uwlet tee or bafllc: Date of last pumping: Cununenls fun pumping Ic(onllltel,datium,in1cl and uullct Icc ur bafllc cundilio:t, shut Dual inlcgrit)', liquid levels as rclatcd to ou11cl illYcil,nActtcc of leakage,c1c.): _ ,'age 8 of I I OFFICIAL INSPECTION DORM -NOT FOR VOLUNTARY ASSL;SSNILNTS SUUSUIU�ACL SEWAGE DISPOSAL SYS7•L:A1 INSPECTION FORNI PART C SYSTM INFORAIATION(continued) ProperIy Address: 10 Marion Way Osterv1 e Owner. Vi ricent & Roberta Damore Dale of lospcclloo: _ Jp N TIGHT or HOLUM'TANK: �(tajik must be pumped at lime of ins section Inca 1 )( to un site plan) t)ep`h below grade: Material of eonslruclion:__cunucte_mtetal_fiberglass_Itulyelliylene other(explain): Dimensions: Capaciq:_--------- I lolls Design flow. gallons/day Alarm present()-cs or no): Alarm level: Alann in wurkin urdcr Date of last pumping; 6 [Jcs or nu):— Cununcnts(condition of alarm and nua(switclics,crc.): U15TIl1UUT10N UOX._(if present must be opencd)(locate on site plain) Dcpth of liquid level above outlet im•crt: DID Conuncnts(note if box is level and distrlbu,-...to outlets equal,any evidence of solids cam over,any evidence of leakage intu or out of bux,ctc.): QaX t.�er fowl � d S r.: o� / Co�G�rf o� Pv� a c 4 ha I'UhIP CIIAMBILK: /A(4 atc on site plan) Puutps in winking ordcr(ycs or nu):_ Alarms in working ordcr O•cs or no): Cununcnls(nine condilion of pump chautbcr,condition of pumps and appurtenances, ctc.): Page9oflt OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C f SYSTEM INFORMATION(continued) Property Address: 10 Marion Way s ervi e Owner: Vincent & Roberta Damore , Date of Inspection: —IT�ioh b SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation notrequired) If SAS not located explain why: Type a. leaching pits,number:_ leaching chambers,number: leaching galleries,number: leaching ► }�� 'S trenc i e hes,number, length: � LD X 30 � 01 �� 3 C 3 3 leaching fields,number,dimensions: overflow cesspool,number: innovative/altemative system Type/name of technology: Y. Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): �� 71 - iluro . CESSPOOLS:,J(/(`c esspool must be pumped as part ofinspection)(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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY/'(locate on.site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 1 l OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 Marion Way Os ervi e Owner: Vincent & Roberta Damore Date of Inspection: 6 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. 3 0 aca 3(;,' 10 Page l l of l l OFFICIAL INSPECTION.FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C , SYSTEM INFORMATION(continued) Property Address: - 10 Marion Way Osterville Owner. Vincent & Rob r a Damore Date,of Inspection: SITE EXAM Slope Surface water Check cellar. Shallow wells Estimated depth to ground water S feet Please indicate(check)all methods used to determine the high ground water elevation: ✓ Obtained from system design plans on record-If checked,date of design plan reviewed: 3 4PLOa 3 Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: o.- 471c a.fi 44-,e-+ wet eAeo,j f4eu a,(- /ace 11 kA No. FEE COMMONWEALTH OF MASSACHUSETTS V/- Board of Health, \ �,.L, , ,MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade(/Abandon( ) - ❑Complete System ❑Individual Components Location to Ukft,ok.)t wner's Name Map/Parcel# yj 3 Z Address G •�,,t Lot# (y A Telephone# Installer's Name _ C ti Designer's Name 42 CANTERBURY LANE Address Address 508f540 2534 Telephone# ��� moo?ff- �SrJs /Y Telephone# Sf Building Lot Size ZZ (44- sq.ft. ng No.of Bedrooms Garbage grinder-Type of Building No.of persons Showers ( ),Cafeteria( ) Other Fixtures Design Flow (min.required) gpd Calculated design flow `�J � Design flow provided ':�JD gpd Plan: Date bC% a ZP'!- v`'7 Number of sheets Revision Date Title 1 Description of Soil(s) -5yz-T �►e-ra, �p;i..� \` l-.s��l Soil Evaluator Form No. Name of Soil Evaluator S• d uu U; Date of Evaluation D B--C t+a'i DESCRIPTION OF REPAIRS OR ALTERATIONS The undersign agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further afire t no o place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date -/,/, ,403 s No. (��///��� � .�. r.., FEEv (� i C®MM®NW LTII OF MASSACIIUStf TSw e� �b Board of Heald, 1 '-�^�-� MA. c APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade(t//AbandonO - ❑Complete System ❑Individual Components Location (p g� I Owner's Name Map/Parcel# .W-.% I i-o(3 2 Address46, Lot# A Telephone# _ ND ASSOCL+TES Installer's Name C ti //O �, Designer's Name 42 CANTERBURY LANE i Address AwAddress 508/540-2534 Telephone# ��� '�,?fJ- ys J`S— Telephone# SE ng + Lot Size z�G3 sq.ft. of Bedrooms. 2.., Garbage grinder ( f Building No.of persons -Showers ( ),Cafeteria ( ) Other Fixtures Design Flow(min.required) gpd Calculated design flow Design flow provided �! (� gpd Plan: Date 60� - P"S' v Number of sheets Revision Date Title 1 Description of Soil(s) `�t_'3T S►t'T- ( -X \� L..e�t Soil Evaluator Form No. Name of Soil Evaluator 5'•�i�uJ u T= Date of Evaluation De--Cot"01 DESCRIPTION OF REPAIRS OR ALTERATIONS �, •,. The undersan grees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agr t5to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. 1 / p Signed / . Date . / ��"• 3 a otions tZ +•°- — dr�,}i.....T ,. `" � •` '"F. w :," x� :._�Sy W..,fiti'M�., *.#le rey^P*p9'Pa. 'rr. ,�L T'r�� •4�^�F'•., .y�?".,T 44.... No. V —3 FEE COMMONWLALT14 OF MASSACHUSETTS Board of Health, ` Yl St►e • CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded ( ),Abandoned ( ) by: 1 r atA21 a has been installed in accordance with t e r�visi ns of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No.V X ---05 3 dated t/ d Approved Design Flow (gpd) i Installer "O \ Designer: Inspector: Date: 9 . _ The-issuance of._this:permit shall-not be=-co. ons n " trtr .g ued.as_auarantee�thatthe_system-willfunction_as designed.'"��"�"'�v� �u•r- �--•. `;�->�- �•'' Nol�� _ \r; FEE a �(✓ COMMONWEALTH OF MASSACHUSETTS Board of Health, B O) (lit--L,/NIA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is herebygnteqWA '; Construct( ) Repair( ) Up ade( ) Abandon( ) an individual sewage disposal system at 1/ l 0 I \l . II as described in the application for MA IW03Disposal System Construction Permit No.' _ '4S3, dated t (I- Provided: Construction shall be completed wiVhinjthree years of the date of this,prhit. All local onditions must be met. /� 1f Form 1255 Rev.5196 A.M.Sulkin Co.Boston,MA Date � Board of Health /I i" TOWN OF BARNSTABLE SEWAGE # 200S- yS LOCATION /tJ / �r;v-� i.✓.i 120 -13 2 VILLAGE Qsrr'�.v ASSESSOR'S MAP &LOT _ / ..yc INSTALLER'S NAME&PHONE NO. � SEPTIC TANK CAPACITY I LEACHING FACII.ITY: (type) !el- 3,�� 5 (size) j NO. OF BEDROOMS BUILDER OR OWNER PERMTTDATE: q"t G' 0 3 COMPLIANCE DATE: v 4' Separation Distance Between the: Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet i on site or within 200 feet of leaching facility) exist Edge of Wetland and Leaching Facility(If any Feet within 300 feet of leaching facility) jFurnished by LJ O t.Z 4'L 4�\ COMMONWEALTH OF MASSACHUSETTS. EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS RFIVE® DEPARTMENT OF ENVIRONMENTAL PROTECTION • � _�_ MAY 19 2003 ` FAILED INSPECTION TGbvHE HEALTH DEPTN OF ABLE TITLE 5 OFFICIAL INSPECTION.FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: ~U A Owner's Name MAP 2 Owner's.Address:/ FHi� SS� - Date of Inspection: LOT Name of Inspector.: please.print) J• rolot Company.Name: . Mailing Address: -0 )q-�V� Telephone Number. I 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 Passes Needs Further Evaluation by the Local Approving Authority. ils Inspector's Signature: := Date: 6, «1c3 c.v i The system_inspector shall submit a copy of this inspection report to the Approving.Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP..The original should be sent to the-system.owner and copies sent to the buyer, if applicable, and the approving authority. Notes and'Comments._. s ****This report only describes conditions at.the time.of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different. conditions of use. Title 5 Inspection Form. .6/15/20.00 page 1 Page 2 of 11 L OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM -PART A CERTIFICATION (continued) Property Address:/0 er G ILIA Own Dane of Inspection: 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. Co.m m en ts:11 B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to.be replaced or repaired.The system, upon completion of the replacement or repair; as approved by the Board of Health,will pass. Answer yes, no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over.20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltratiori or.tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: ` Observation of sewage backup or break out or high static water level 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: .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: 2 Page.3 of.11 OFFICIAL.INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOS_AL SYSTEM INSPECTION FORM PART A' CERTIFICATION;(continued) Property Address:. 0 /� w �. Owner: Date of41spection: 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 CM11 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 bf 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,I 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 we1L _ 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 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: 3 , Page 4 of l] OFFICIAL INSPECTION FORM-:NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: ,4. Owner: Date of In pection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yet No , y/ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ Discharge or ponding of effluent to the surface of the ground.or surface"waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool f Liquid depth in cesspool is less than 6"below invert or available volume is less than'/z day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped 4 _ ✓ 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. _ V . Any portion of a cesspool or privy is within a Zone 1 of a:public well. _ 7 Any portion of a cesspool or privy is within 50 feet of a.private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet.from a private water supply well with no acceptable water quality analysis. [This system:passes if the well water analysis, performed at a DEP certified laboratory,,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility,and the presencepf ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,.provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.]. (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CNIR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correctthe failure. E: Large Systems: To be considered a large system the-system must serve a facility-with a'design flow of 10;000 gpd to 15,000 gPd You.must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply, the system is within 200 feet of a tributary to a surface drinking water supply _ the system is:located in a nitrogen sensitive area(Interim Wellhead Protection Area—I WPA)or a mapped Zone II of a public water supply well Ifyou.bave answered"yes"to any question in Section E the system is considered a significant threat,or answered. es m Section D above the large system has failed.Y g y 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 10 R pg y 3 CM 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 w , Property Address: Owner: c Date of In peetion: 3 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: Z/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.volurnes of water been introduced to.the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as N/A) L/ _ 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: Yes no V Existing information.For example,a plan.at the Board of Health. Determined in the.field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302,(3)(b)] 5 Page 6 of l 1 OFFICIAL INSPECTION-FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .PART C SYSTEM INFORMATION Property Address: A Owner Date of 41npecti2o2n: A,Z FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_ Number of bedrooms(actuaI): DESIGN flow based on 31 p,CM 15.203(for example: 1`1.0 gpd x#of bedrooms): Oc;20 Number of current residents: Does residence have a.garbage grinder(yes or no):Ia& - Is laundry on a separate sewage system (yes or n if yes separate inspection required] Laundry system inspected(yes or no Seasonal use: (yes or no)- Water meterreadings,� ble(last 2 years usage(gPd)) ©Z-- 9d®l9® Sump pump(yes or no Last date of occupancy: COMMERCIAL/INDUSTRIAL 40— Type of.establishment:. Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5'system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records , Source of information: Was system.pumped as.part of the i spection(yes or no):�4� .:.If.yes, volume pumped;- --gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _,,Aeptic tank,distribution box,soil absorption system Single cesspool _Overflow cesspool _:Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance,contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval _Other(describe): Approximate age of all components, date installed(if known)and source of information< Were.sewage odors detected when arriving at the site(yes or no): 6 I Page 7 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM-INSPECTION FORM' PART C SYSTEM.INFORMATION(continued) Property Address: D Owner: Date of*nDection: BUILDING SEWER(locate on site plan)/ Depth below.grade:. Materials of construction:_cast iron _40 PVC - other(explain):' Distance<from private water supply well.or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: a oocate on site plan) Depth below graded Material of construction:._concrete . metal fiberglass_polyethylene - _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):, (attach a copy of certificate) n.Dimensions:- Sludge depth:,�� I/ Distance from top of sludge to bottom of outlet tee or baffle: ! Scum thickness: Distance from top of scum to top of outlet tee or baffle: 3 j Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: f��� Comments(on pumping recommendations,Ulet and outlet tee or baffle condition,structural integrity, liquid levels s related to outlet invert vidence of leakage,etc. l GREASE TRA ocate on site plan) y Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum.thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffler Date of last pumping:. Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity; liquid levels as related to outlet invert,evidence of leakage,etc.): ^ - 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner Date of n pection:. C�3 TIGHT or HOLDING TANK:/20-(tank must be pumped at time of inspection)(locate on.site plan) Depth below grade: Material of construction: concrete metal fiberglass --_-Polyethylene other(explain):. Dimensions: Capacity: gallons Design Flow:. gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm:and float.switches,etc.): DISTRIBUTION BOX: �if present must be opened)(locate on site plan) Depth of liquid level,above outlet invert Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of kage into or out of box, tc.): MBE R locate on site plan) � PUMP CHA ( p ) Pumps in working order(yes or no): Alarms in working order(.yes or no): Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): ; 8 f f Page 9 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY,ASSESSMENTS ` SUBSURFACE SEWAGE;DISPOSAL.SYSTEM INSPECTION FORM PART C: - SYSTEM INFORMATION.(continued) Property Address:' ILIA Owner. l Date of In ection: SOIL ABSORPTION SYSTEM (SAS): ✓(locate on site plan, excavation not required) If SAS not located explain why: TYPe - - �aching pits,number: Teaching chambers,number: leaching.galleries,number: leaching trenches,number, length: leaching fields,number, dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure,,level of ponding,damp soil,condition of vegetation, ag.,b, 6f�A� aWd&. 76 CESSPOOL(pesspool 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 or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition°of vegetation;etc.): PRIVY- locate on site plan) Materials of construction:. . Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic.failure,level of ponding,condition of vegetation, etc.)` 9 Page 10 of 11 OFFICIAL INSPECTION FORM NOTFOR-VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Gt/ Owner: / �i Date of i spection: U3 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. yb 10 I Page I I of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 2 dl'�5A , Owner Date of Inspection: 2 SITE EXAM ` Slope' Surface water Check cellar Shallow wells Estimated depth to ground water•.Z feet Please.indicate(check)all methods used to determine the high ground water elevation: Obtained from system.design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with:local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground wMefelevation: r . 11 Permit Number: Date: Completed by: � HIGH GROUND-WATER LEVEL COMPUTATION Site Location:_ �e2 /!///°�/Q� �it/��/ �5 ��/G'/ ' Lot No. :Owner. C/ .IJ9 Address: Contractor:_yLP� / Z1KL517_ Address: Notes: STEP' 1 Measure depth to water table G_ _ I to nearest 1/10 ft. ...:.: ........: .:.................. ....... .Date U month/day/Year STEP 2 Using Water-Level Range Zone and.Index Well'Map locate site and determine`. " OAppropriate index well ...............:............... r�'!/- �� OWater-level range zone ........... :... :.:......:..... STEP 3 Using monthly report."Current Water Resources-Conditions" I, determine"current depth to 0 03 �e water level•for index well .......::... ........... month/Year_ STEP 4 Using Table of.Water-level.Adjustments for index well (STEP.2A), current depth to water level for index well (STEP 3)., and water-level zone (STEP 2B) determine water-level adjustment........................................... STEP 5 : Estimate depth to high water by subtracting the water level adjustment (STEP 4) from'me"asured depth to water level at site (STEP.1) ...........:.................. ........:.•- : Gb'/✓� Figure 13.--Reproducible computation form. 15 it 1 i .. i i' t ^ � _ S f ,� C � r . � �. � �\ � � � . �1 � �. �� � _ k e k . � _ � . If to � � .. 3� ��� �4 d [.� — -._.._ ;f !� �i `aV - 9 f1 _ .. a .�V I _ - . � � � o� _ � � . _ �� � [� p � - _ ._ - k k7 _ . .� � - - ': � - �. _` � .. f .. - _ .. . � .. - �- �-- ti �, '�-.. :: s h �\ _ _ - ._ DATE; ,12/,31/98 PROPERTY ADDRESS: 160 Ma*ri'on Way � Ostervllle ,Mass . e� F, ,T CEIVEO 02655 �`" BAN 1 1 1999 TOWN OFBARNSTABLE AI.HpFpl On the above date, I Inspected the septic system at th' "above address. This system conslats of the following: 1 . 1-1000 gallon ,septic tank. f 2. 1—Distribution box . 3 . 1-1000 gallon precast leaching pit. Based bn my Ineoactlon, I cerfllyy the PwIng or�ditions: 4. This is•• a title Five Septic. S.ystem,.� 7Code ; 5. The septic syste-m is in proper working order at ,the present time . SIGNATURE: /'• Name: J P�Kacomber Jr,_ • i ; . . -.— --__ — Com an J, P•Macoigber & � on• 'Inc . 9 1 P Y--------------- ---- o Address• _ ,,—__.:.1-- _ --- . Q Cen J1itLk4jj.;2QZ2 32 -JAN '� 0 1999 ftw N Phone:__,, SQ8 4 �2.7�-�338----__— •.I � q� THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR E ANTY JOSEPH P. MACOMBER •& SON; INC. Tank+-Csupoola-Leachlleldi . Pumprd 4 Inst4110 Town Sewer Connections P.O. Box 66' Centerville, MA 02632.0066 77.643N 775-6412 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617)292.5500 TRUDY CORE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 10 Marion Way Name of owner F r e d & Carol B a g a r e l l a Osterville ,Mass . 02655 Address of owner: Box Data of Inspection: North Falmouth ,Mass . 02556 Name of Inspector:(Please pmo Joseph P.Macomber J r , 1 am a DEP approved system Inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) ComparyNme: J. P.Macomber R Son Tnr _ MadiingAddress: _Rnx 66 Centervi 11 P ,Mass _ 02632 Telephone Number:5 0 8—7 7-5—3 3,3$ 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 Inspection. The Inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: asses _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails JrJ Inspector's Signature: Date: /✓✓� /�� The System inspec shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)wkNn thirty (30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department ot►Environmental Protection. The original should'be sent tovw system owner and copies sent to the buyer,if applicable,and the approving authority. . NOTES AND COMMENTS revised 9/2/98 Page Iof11 i�}Printed on R"Ied Paper r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address; 10 Marion Way Osterville ,Mass . Owner: Fred & Carol Bagarella - Date of k-PDcdcn=12/31/9 8 INSPECTION SUMMARY: Check A, B. C, oI A A. SYSTEM PASSES: I have not found any information which Indicates that any of the failure conditions described in 310 CMR 1.6.303 exist. Any failure criteria not evaluated are Indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: �Q 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. Indicate yes,no,or not determined(Y, N,or ND). Describe basis of determination In all Instances. If"not determined",explain why not. The septic tank Is metal,unless the owner or operator has provided the system Inspector with a copy.of a Certificate of Compliance(attached)indicating that the tank was Installed within twenty(20)years prior to the date of the Inspection;or the septic tank, whether or not metal,is cracked,structurally unsound,shows substantial Infiltration or exfUtration, or tank failure is imminent. The system will pass Inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. A0 Sewage backup or breakout or high static water level observed In the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass Inspection if(with approval of the Board of Health). broken pipes)are replaced obstruction is removed distribution box Is levelled or replaced The system required pumphig-more than four-times•a year due to broken or obstructed pipe(s). The system wilhpan— Inspection if(with approval of the Board of Health): - -- broken pipe(s)are replaced obstruction is removed revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) PropwtyAddress: 10 Marion Way Osterville ,Mass. owner: Fred & Carol Bagarella Dow of kwPecti= 12/31/98 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: l7 Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and 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 WHICIiYALLPROJECT THE PUBLIC ME LLTUAND SAFETY AND THE EA UMONMEHTs Cesspool or privy Is within 60 feet of surface water Cesspool or privy is within 60 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 AND SAFETY AND THE 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. *6 The system has a septic tank and soil absorption system and the SAS is within a tone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 60 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 60 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the pres nce of-ammonia nitrogen and nitrate nitrogen is equal to or less than 6 ppm. Method used to determine distance /V� (approximation not valid).- 3) OTHER AA revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) PrcpertyAddress: 10 Marion Way Osterville ,Mass . owner: Fred & Carol Bagarella Drte of Inspection: 12/31/9 8 D. SYSTEM FAILS: You Tust Indicate either"Yes" or"No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of•towage intofecili"r-system component•due tto an overloaded orrcleggedSAS•or•cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid le distri level in the ution box above outlet invert due to an overloaded or clogged SAS or cesspool. � ,cam•� �T Liquid depth in cesepeel-i less than 6" below Invert or available volume is less than 112 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped( . Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy"ithin a Zone I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for ••coliform bacteria,volatile organic-compounds,ammonia nitrogen•and nitrate nitrogen. - E. LARGE SYSTEM FAILS: 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: 41P The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system 4-within 200 feetof-e-vibutary4oasurfaoo4FkAiwg-water•suppiy 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further inforptation. revised 9/2/98 Page 4of11 i i SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM. PART B CHECKLIST Property Address: 10 Marion Way O s t e r v i l l e ,Mass . Owner . Fred & Carol Bagarella Date of Inspection: 12/31/9 8 Check If the following have been done:You must Indicate either"Yes" or"No" as to each of the following: Yes No Pumping Information was provided by the owner,occupant,or Board of Health. _ None of the systsm�composants.Mawbaen puaMwd►Eo>4st-j"sttwo.-%vo"aaadtbe•system hasbawaacoiaiaggW5W lflow rates during that period. large volumes of water have not been Introduced Into the system recently or as part of this Inspection. As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. •� The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components,-Acluding the Soil Absorption System,have been located on the site. _ The septic tank manholes were uncovered,opened,and the Interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. The size and location of the Soil Absorption System orrthe site has been determined based on:- Existing information. For example, Plan at B.O.H. _ Determined in the field(If any of the failure criteria related to Part C is at Issue,approximation of distance is unacceptable) 115.302(3)(b)) _ The facility owcar.(and-w—pa^}4,Jf dlffaraw informatioa;Dn t►.n prppnr,nalntnn, Qf SubSurface Disposal Systems. i I revised 9/2/98 Page 5of11 SUBSURFACE SEWAGE DISPOSAl.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 10 Marion Way Osterville ,Mass . Owner: Fred & Carol Daft of Inspection: 12/31/9 8 FLOW CONDITIONS RESIDENTIAL: Design flow: 116 g.p.d./bedro m. Number of bedrooms(deli n): Number of bedrooms(actual): Total DESIGN flow Number of current residents: Garbage grinder(yes or no): Laundry(separate system) (yes or no): 0 ; If yes,sepata Inspection.required Laundry system Inspected (yes ore Seasonal use(yes or no):_19 Water motor readings,If avai able(last two year's usage(gpd): Sump Pump(yes or no): IVU Last date of occupancy: /`1 COMMERCIALMIDUSTRIAL: n Type of establishment: Design flow: 4 pad ( Based on 16.203) Basis of design flow Grease trap present:(yes or no) Industrial Waste Holding Tank present:(yes or no)-Ay Non-sanitary waste discharged to the Title 6 system:(yes or no)- Water motor readings,if available: 4:219 - Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and so rce o information: Syst u ed atpirt of ins ction:(yes or nolelP If yes,volume pumped: Q gallons /1 Reason for pumping: / 4";- TYPE OF YSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (If yes,attach previous Inspection records,If any) �{ I/A Technology et .Attach copy of up to date operation and maintenance contract _JL1L Tight Tank 444 Copy of DEP Approval Other APPROXIMATE AGE of all components,date installed{if known)-end source o 4nformation: Sewage odors detected whowerriving at the site:.(yes or no)XIA revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATiON(continued) Property Address: 10 Marion Way Osterville ,Mass . Owner: Fred & CaROL Bagarella Data of Inspection: 12/31/9 8 BUILDING SEWER: (Locate on site plan) Depth below grade:-6d Material of construction:_cast iron/0 PVC_other(explain) Distance from private water supply well or suction line a 7' Diameter_ Comments:(condition of joints,venting,evidence of leakage,-etc.) Joints appear tight Nn Pvi dAn.re of 16nU�s ; Sy t- — - - SEPTIC TANK: (locate on site plan) iJ Depth below grade: /� Material of construction:_iceconcrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age Js.age.confirmed by Certificate of Compliance(Yes/No) Dimension-- Sludge depth. Distance from to Judge to bottom of outlet tee orbaffie:,Z'1�&1 Scum thickness: Distance from top of scum to top of outlet tee or baffler Distance from bottom of scum to bolt m of outlet to or baffle: � How dimensions were determined: 'y Comments: nl (recommendation for pumpin ,condition of iet and outlet tees or-baffles,depth of liquid level in relation to outlet invert, structural-integrity, evidence of leakage,etc.) u m p tank every 2-3 Xe a r e I n l P R o ii t l P t t P P c are in pl arp Ami Qni d 1 evel at the outlet lavei:t j—s -J— t GREASE TRAP: Cr (locate on site plan) Depth below grade: Material of cons tr on;VkconcreteilA�rnetaW, Fiberglass,VAPolyethylone/}!,6other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or battle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity. evidence of leakage,etc.) Grease trap is not present revised 9/2/98 Page 7orii SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 Marion Way Osterville ,Mass . Owner: Fred & Carol Bagarella Dot.of Inspection: 12/31/9 8 TIGHT OR HOLDING TANK:A69t(Tank must be pumped prior to,or at time of, inspection) (locate on site plan) Depth below grade: Material of construction:/concrete)ftmetalARFiberglass4lPolyethylene//Qother(explain) AIR Dimensions• Capacity: A14 gallons Design flow: AW gallons/day Alarm present AW Alarm level: 00 Alarm in working order:Yes Ngjj* Date of previous pumping: A14 _ Comments: (condition of inlet tee,condition of alarm and float switches,etc.) Tight or holding ranks are not prPSPnt - DISTRIBUTION BOX.. (locate on site plan) Depth of liquid level above outlet Invert: N Comments: (note-if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box, etc.) — -— Box has one lateral • No evidence of solids rarry nvPr Nn PUMP CHAMBER;Q�n) (locate on site pla Pumps in working order:(Yes or No) Alarms In working order(Yes or N)) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) UMD chamber is not nrPSPnt --- revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORMA PART d SYSTEM INFORMATION(continued) Property Address: 10 Marion Way 0sterville ,Mass . Owrwr: Fred & Carol Bagarella 12/31/98 SOIL ABSORPTION SYSTEM(SAS):_21,kr4V(locate on site plan,If possible:excavation not required,location may be approximated by non-Intrusive methods) If not located,explain: Type: leaching pits,number: leaching chambers,number: leeching galleries,number: O leaching trenches,number,length: leaching fields,number,dimension overflow cesspool,number: Alternative system: Name of Technology: Comments: (note condition of soil,signs of hydraulic failure,level of ponding, damp soil,condition of vegetation, etc.) Loamy sand to fine coarse snnd _ Nn signs of hjcdrni,lir fail ,,,-o n r =n n d i n oC n i I i —n.0 t—ri n MPV®8 01; -3.6•i- -8—ii-6- SI•�•�-� CESSPOOLS: e- (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(cesspool must be pumped as part of Inspection) esspoo s are not present Comments: (note condition of soil,signs of hydraulic failure,Ievel of ponding,condition of,vegetation, etc.) Cesspools are not present . PR(VY:2hjx (locate on site plan) Materjals of construction: /U/Q Dimensions: �Li9 Depth of soUds• Comments: (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation,etc.) Privy is not present . revised 9/2/98 Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 Marion Way 0 s t e r v i l l e ,Mass . Owner: Fred & Carol Bagarella Darts of Inspection: 12/31/9 8 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) ► �'; ohs Q o� .p h s� j /O BAR /6 ,a revised 9/2/98 Page 10of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART'C SYSTEM INFORMATION(continued) Property Address: 10 Marion Way Osterville ,Mass . Owner: Fred & Carol $agarella, Date of 4sspection: 12/31/9 8 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep _ SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater Feet Please Indicate all the methods used to determine High Groundwater Elevation: 0 tained from Design Plans on record bserved.Site utting property, bservation hole,basement sump etc.) determined from local conditions Checked with local Board of health Checked FEMA Maps _zchecked pumping records Checked local excavators,installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) Used water. contours Map . Gahrety & Miller Model 12/16/94 revised '9/2/98 Page 11of11 �a nrnrs rnrrsrTrrnram•nmr.rnrta•enrsnrr.•s.•rtr�rrr�s�n*+rm trent-o T+nress�mss+ .rR•rrr srnr—:,.tr.r••� TURN OF Barnstable BOARD OF HEALTH �- 4„�• •.•-T'�^SUBSURFACE 9F.HAG.E DISPOSAL SYSTEM IN�9PF�CTION FORM - PART D^- CEtt'fIF1CnTi0N� ' 1 -TYPE OR PRINT CLEARLY- 1 PROPERTY INSPECTED STREET ADDRESS _ 10 Marion Way Osterville ,Mass . ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME Fred & Carel Bagarella PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr . COMPANY NAME J. P.Macomber & S-fi' Inc . COMPANY ADDRESS Box 66 Centerville, ,Mass. 02632 Street Town or City State LIP COMPANY TELEPHONE ( 508 775 - 3338 FAX ( 508 790 - 1578 R CER'rIFICATION STATEMENT A I certify that I have personally inspected the sewage disposall system at this address and that the information reported is true , accurate , and complete as of the time of .inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check o et System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR M 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILEll* The inspection which I have con tcted has found that the system fails to Protect the j)ublic health and the environment in accordance with Title 5 , 310 CMR 15 , 303, and as specifically noted on PART C - FAILURE CRITERIA of this inspection form , Inspector Signature Date _� _ Onb copy of this rtification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF HEALTH. * If the inspection FAILED, the owner or""oparator shall upgrade - the within o'ne year of the date of the inspection, unless allowed or required m otherwise as provided in 3.10 CMR 16 . 305 . partd.doc 7� No.------.. l :.. Fss...- THE COMMONWEALTH OF MASSACHUSETTS BOAR HEALTH Appliratiou for Dhipoiial Workii Towitrurtiou rantit (Application is hereby made for a Permit to Construct ( Plor Repair ( ) an Individual Sewage Disposal System at ®# .1....................................#---?, ............. yr � " .. f ��i err ... Installer Address Type of Building . Siie Lot.......I..... .�.S, feet U Dwelling—No. of Bedrooms___._._. ___________________________Expansion Attic ( ) Garbage Grinder44 ( ) `4 Other—T e of Building No. of persons............................ Showers — Cafeteria a Other fixtures ------------------------------••-- . W Design Flow.............. . ------------------gallons per person gr�l . Total daily flcff-.__..__..._ -+ _�--...._..._._._.. l$s.�� allons Len th._ __.. Width..... ...10 Diameter................ De W. Septic Tank—Liquid capacityj_ g p Disposal Trench—No..................... Width-. .--............. Total Length......... _....._... Total leaching area....................sq. ft. _Seepage Pit No.........I-----__... iameter....... ........ Depth below inlet......(?..._.-_j. tal 1 thing .....�e�_---Q..sq. ft. z Other Distribution box (� Dosing t ( ) + —A'4mrs (a Z e 7 `" Percolation Test Results Performed by..._._.. k p-.---- tj , .----•---------- Date........... a�-..�. Test Pit No. I......;L....minutes per inch Depth of Test Pit...... ............ Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ .............. --------------- .....- yl�&------- ---------------•-----•----------...._..escrponooil------------- FcU1 .---S. ----;--••----• V .---•----------------•--•-----------•.------------------.......-----••-•----------------------------•----•.............................................................. -------------------------------------------------- --------------------------=------------------------------=------------------------- ----•-•------•••--••------•••----•--•-•---•----- VNature of Repairs or Alterations—Answer when applicable___'.......................................................................................... ... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage,Disposal System in accordance with the provisions of TIT,i 5 of the State Sanitary Code—The undersigned furtl er.agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. igned•.. ..... ....... -------------------------------------------------------------- ................................ Date Application Approved B ba✓ - �PP Y Date Application Disapproved for the following reasons:......................... ................................. ................. --------------------------------------------------•---•--..-------------------.--------•---•------------------------------------------------------------------------------------------.------ Date PermitNo......................................................... Issued....................................................... Date t _7 �.._ No........... ...... FEic....!!:::n............... THE COMMONWEALTH OF MASSACHUSETTS BOAR HEALTH WAI . . . , , --,-A1xA4,6 0 F..O_�R* ............................ ....................................................../.......................... Avvftr4tion for Dhipoiial Vorku Ton.i3lrurtion Urrmit Application is hereby made,for a Permit to Construct or Repair ),'an- Individual Sewage Disposal System at: If....... ...................... ................... . Allf ......................... ................... ............. ..................................... ............. �................. (4 Address ................... .................................................................................................. .Yns Address Type of Building Size Lot............. Sq. feet U Dwelli —No',.�'Ofi-Bedrooms... ..........................Expansion Attic arb -e'Grin.der I_4 Tg, ag '4 ......................... .S how;er's* Cafeteria 04 Other—Type of Building ........................... No. of persons.. P4 Other!fixtures .......... ............................................*------------------------------------------ ..... ................................... ons per perso irea Design •Flow�............ .r-jr..................gall Total dallw flo ---------- --------- ---- S"'Liquid capacityl-0-04, ... Width_. Diameter._.... Depth_._ . .04 Septic Tank allons Length.-V Disposal Trench—N Width- ------- Total Length........... .... Total leaching area sq. ft. Z 'r.l... - ------------------- . Seepage,Pit No......... 14meter........lb--------- Depth below inlet......to. dotal I eaghijig area__. eU ..sq. ft. Z Other Distribution box Dosing tank ,,XDate:_._____.. k/4 dir + _ ".I Percolation Test Results Performed by----------- ....................0...... ... --------V---------- Test Pit No. 1...... .____.minutes per inch Depth of Test Pit....... .; ----- Depth to ground water---------.......... Test Pit No. 2-----_ ..minutes per inch Depth of Test Pit___________ ___Depth to..ground'water t...................I ..... .............. .......................... .................................... 0 Description of Soil............. SA. .............................. . ...............................................I................... -----------------**----------------------------------------------------------------------------------............................................................................................ ..... .............. .............................................................................. ............................ ..................................................... ................... 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 TIT111 5,of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the boa?. f health. ignVed ., -------------------------------------------- ................................ Date A plication Approved Zoe- p. By.......... ...........Z .. ..... -- - ___ Date Application Disapproved for the following reasons:................................. .............................................................................. ......................................... ....................................................................................................... ................................................. Date PermitNo.....................................................•--- Issued................................I................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD -OF HEALTH ................... .............OF........ ......I.................................................. rfifiratr of Tjoutpliana THI,,SIS TO CERTIFY, That the Individual Sewage Disposal System-constructed or Repaired by.................... .. ................le--..............................il..........V........................................................................................................... Installer/ r4l zl) at...... ........./ 11..... ............................. ....................�& ........................................ ............................................... has been installed in accordance with the provisions of 5 e State Sanitary C de as described in the ated application for Disposal Works Construction Permit N ............ d- ----- --- ................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. InspectoL DATE.......... )6 .9r-- ............................ ..4...................................... ............................-------------- ----------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS j BOARD OF HEALTH .7, ........:.OF......._.......:... .......................••__•...__ ........ .. No._....:.._ FEE..... ................ M, M0111111al Works. OV.0notrudion. "Vanti Permissionis ..hereby gra(ed�-••---•. ....... ... ............................................................................................................... .to Construct or Repair�. an Individual Sewage Disposal System at No............... V. -------------7......................................................................................................................................................�i..... Street A as shown on the application for Disposal Works Construction Pex-mit No.__ .... ......... Dated.... e - "I ...................................... ............. .......................... Board of ealt DATE........................................... ..................................... FORM 1255 HOSES & WARREN, INC., PUBLISHERS �t,�u�. �rannti.�•(' - �Tit-�r�t>M �•� .-�� .�_ _._ ._.._�--_..r ��t �o -- --- - � �- Ohl L`( 'G'L 0%,C/ Ito C.-P-V. �. + lJ Ste- I.OC>p 6gL.. 1T - USE. lbCx=� GA.LF SUr-W s,LL AZF A. - L50 .F. y y 'z.:S = -7S G.•PD. ,(�y , (�--) So ��. i .o = SO C�.P D. GJ�tL d TOTAL 'L7 tW.SIC",t.l = .425 G.R'L7• E��Q TZ>T&t-- `tOa t L`( r—LACDw = 33D 6 w. GM.VGDLOTCOQ 04TE . C !u 2 miw' o2 .(a 4 jam,•4-•w �f { -Z2,(034 'S ,aL .NFe t , w 1 TsT F.lu LQAKi. ej"P.P I Qao �uv `.i luv.=�{1.0.41 rlq I W V. ►►�Iv. PIT LgcN d ° SA U, WASHED } GCAE:t": �.'4 ,� ✓A�` t-- f C.M IZ T l V=-r t"W. A T" ..T '?w t�t.►-�%t� S t vv v o.� ; fs,t:.N ` 2 N T Q .c t ;P t;-: VJ i VIA •Tt4C-- '51 vr=� ..I"C—. • - RZ E G 1.S'�['E�IZi't� it,.1,.►J!� �U��1 c�(w r.�,� Tt-t IS h tw:A�t t5` �.!o-r 't�•,A�>CL7 vi...i A�J - iw-9rQ :✓1C.1-, T jiJC'_,�i~�'_�`� tr T` t?�L tJSCrfis ,`�`Gs ,'T7t��i t reklte.Jl� 1_b"C . l tw—e,, } i tl I. 4 .wr..+-,..,.+r.-�•..a+i.w.-+:. - .. _, -.. �..-.+errs+.-.. _ t 17i qe T,11T -Z\\,T,, 7� 's Fin/Grade EL 38'f 1 1 J � . ' s� Fin. Grade El. 38.f 1b Remain r 1 I 1 J / S g9Gy rod< m;Qc° to Si 2' trashed stone o 9' Thiox WI'' EL 35.0- 4" PVC Perforated Throu Bout +a CY y��►. ...„N9' 9 Pca CAI 3i, NV EL 314' — 1 1/l' flashed Stone � ' RD d I BWstfng IO'Yin 14' r LV EL Srunp •�i.. '�•'..• tm;i;i;{:' !® IA - �' , c,, ..Gu , To Remain I1bY LL , 61.13 •'•'• Stone wfd'tb varfesw to 4 Yaz '��' i,� t/! Us � uid Level 4s. 36.8' 61.33 z� a°a'a• •30 1 2" He. ht •°a a off' � a'` P �Anhuf AR 9 ;: . : .: : : ': EYl Depth d / Y]a d °3� "i G« stir .� or t€aix/5 DISTRIBUTION BOX a°6. 90" Length ° ,F " 9 0 El 33 with end ea ,.,a` PRECAST REINFORCED CONCRETE DISYYUBUTION BOX 52 P -► ' ( - '` • , : Install on a level base Minimum vsrall thickness = 2" Cultee 330 - H 20 PRO „ POSED INFILTRATOR TRENCH �► a Minimum inside dimension = 12 5 � ', �OSTCRVR EXISTINGTANK Outlet 1000 GALLON SEPTIC TA Outlet inverts shall be equal to each other and at 2» minimum {a below inlet invert. EI 28.0' of Bs The distribution lines from the distribution box shall all have j CA p a " equal inverts as determined b , flooding r' x to q 3 ng the distribution box Adj. High Ground the height of the distribution line invert after all lines have Kater <EI. 24' (Mapped) I_,C) C TITS AT-A. P been sealed in place. Invert adjustments shall be made by filling with durable and Tees shall be constructed of Schedule 40 PVC and shall extend a nondeformable material permanently fastened to the line or minimum of 6" above the flow line of the septic tank and be on reconstructing the lines until all inverts are of equal elemtion. the centerline of the septic tank located directly under the clean-out manhole. The inlet pipe ele va tion shall be no less than 2" nor more than 3" above the invert elevation of the outlet pipe. 90060 Septic tank shall have a minimum cover of 9': ��g ��. The outlet tee shall be equipped with gas baffle. Note: �� Remove all unsuitable material 5' around SAS" 4 _ down to the "C" layer (El 60.0) and replace with clean 37 granular sand per 310 CMR 15.255 (3), (4), (5). 37 and (6). wb,� Pump and Remove Proposed SAS GENERAL CONSTRUCTION !VOTES Existing Leach Pit Infiltrator ASSESSORS MAP 120 PARCEL 8D _I. All the workmanship and materials shall conform to D.F P Title 5 and Contaminated Trench FE21A DATA- ZONE "C"'s� � - ' � Soils •- _ _ _ _ _ _ and the Town of Barnstable rules and regulations for the subsurface o� 2 ,' ` ' - - - 38 'rs disposal of se wage. y p4 �,zo 16' ZONING DISTRICT' RC.RPO 2. At least one access port over tank tees shall be accessible ko 0VERLAY DISTRICT TYf' rilthin 6" of finish grade, with any remaining access ports brought EM Storm • Drain Rim to within 12" of finish grade. El. 37.35' 3. All components of the sanitary syrstem shall be capable of Datum: NCMi- tiflthstanding H--10 loading unless they are under or within 10 ft Existing Driveway JJ ' 39 of drives or parking: H-20 loading shall be used under or within 10 ft of drives or parking unless noted. Plastic equals may be i 25 used in lieu of all precast units 4. The excavator) contractor shall verify the location of all site deck 12' utilities prior to any excavation, and shall be responsible for all matters relating to electric easements , 5. Sewer pipes shall be 4"' Schedule 40 PVC laid at 0.02 slope. R = 30.00 J t d/b 6. Any mosonrj, units used to bring covers to grade shall be L = 4712 mortared in place. 38 7. Finish grade shall have a minimum slope of 0. 02 ft per foot. i E� G DWELLI 40 LOT 6A JJ ?2, 634fsq. ft. MUM 10 OF J 40 1 . Existing 1000 Gallon to -Kfl 1397t° Soil Loy,, J J \ Tank To RemainIsi E$`�, Test Date: August 29, 2003 s• `� JJ , , � `" 38 Soil Evaluator.- Stephen Doyle ._ � � 38 Se wage S tstem U ra de Plan Prepared For. Pero Rate: <2 Min,/Inch THE CA.HILL El. 38. 0 Design Da ta: In 011 Two Bedrooms = 2 X 110 gpd = 220 gpd Required Flow OSr t e.r'Tell e, Ma ssa Ch uS e t is "A SL 10�� 3112 (NO Garbage Disposal))6 Scale. 1" 20, Da te: ,September 3, 2003 » Use: Infiltrator Trench "B" j 10yr , 8 �30'f30'f10'f107 x 2.0 = 160 `� Prepared By. ,2g" Stephen J Doyle and Associates MED 30 x 10 = 300 42 Canterbury `Lane, E. Fal outh, .NIA 02536 460 x 0. 74 = 340 GPD Total Design Flow Telephone: 5081540-2534 TO v s i ca a� I:E�?1 c . •c FINE SAND 2.5Y 614 pere 48" 120" El 28. 0' No f rater Encountered NO, DATE DESCRIP77ON 8Y