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Home My WebLink About0054 MILNE ROAD - Health 54 Milne Road Osterviiie P A ti. V } s TOWN OF BARNSTABLE LOCATION `/ f1?vL rl k,0,44 SEWAGE # 2,010 Y:fO VILLAGE DS'%'GI^tft`,Gf- ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. ^5'2D—973LS c/os� .�Ot�3 ��Ds SEPTIC TANK CAPACITY LEACHING FACILITY: (type) Y—�OtdS OG�/—L3o�,%%fie �`:-X NO. OF BEDROOMS BUILDER OR OWNER too W 4fP%5 PERMTTDATE: l/- 9—/0 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 feet of leaching facility) Feet Furnished by +_ G ��y� r _ .� � � � ... � � �� i s�` . � S - - � � q a � � � �� _ Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for.Voluntary Assessments 54 Milne Road 'W' Property Address Johnathan Jaxtimer Owner Owner's Name X> information is Osterville MA 02655 8/31/2017 , required for every State Zip Code Date of Inspection '^-r page. City/Town - IFYms 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, use only the tab 1. Inspector: key to move your cursor-do not James Ford I use the return Name of Inspector key. , Ford Septic Services, LLC Company Name P.O. Box 49 Company Address Osterville MA 02655 City/Town State Zip Code 508-862-9400 S12482 Telephone Number License Number B. Certificati on 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 ❑ Fails Needs Further v luation by the Local Approving Authority 9/5117 Inspect r Signature Date The s t m inspec or shall submit a copy of this inspection report to the Approving Authority(Board of Healt or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 god 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. 15ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 �0 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Milne Road Property Address Johnathan Jaxtimer Owner Owner's Name information is required for every Osterville MA 02655 8/31/2017 page. City/Town State Zip Code Date of Inspection B. Certification (Cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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): 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ,M 54 Milne Road Property Address Johnathan Jaxtimer Owner Owner's Name information is required for every Osterville MA 02655 8/31/2017 page. CitylTown State Zip Code. Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed, ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh l5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts t Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments rf 54 Milne Road Property Address Johnathan Jaxtimer Owner Owner's Name information is required for every Osterville MA 02655 8131/2017 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water . supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other`. D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of.sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 R Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal,System Form - Not for Voluntary Assessments r 54 Milne Road Property Address Johnathan Jaxtimer Owner Owner's Name information is required for every Ostervllle MA 02655 8/31/2017 page. CityfTown 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. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ K 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. ❑ z Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ 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. l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 L- Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Milne Road CAI Property Address Johnathan Jaxtimer Owner Owner's Name information is required for every Osterville MA 02655 8/31/2017 page. Cltyfrown 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? ® . ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms desi ri : 2 2 ( g ) Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 t,ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 54 Milne Road Property Address Johnathan Jaxtimer Owner Owner's Name information is required for every Osterville MA 02655 8/31/2017 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 . Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?_(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): Detail: unavailable Sump pump? ❑ Yes ® No Last date of occupancy: currently 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 M Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: 151ns•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts t Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 54 Milne Road Property Address Johnathan Jaxtimer Owner Owner's Name information is required for every Osterville MA 02655 8/31/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: unavailable Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the.DEP approval. ❑ Other(describe): !Sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 54 Milne Road Property Address ` Johnathan Jaxtimer Owner Owner's Name information is required for every Osterville MA 02655 8/31/2017 page. City/Town State Zi Code P Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: system installed - 11/20/2010 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): �I Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 14" feet Material of construction: ® concrete ❑ metal ❑fiberglass 9 ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gal. Sludge depth: l5ins•3/13 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 i i Commonwealth of Massachusetts MOW Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,A.a 54 Milne Road Property Address Johnathan Jaxtimer Owner Owner's Name information is required for every Osterville MA 02655 8/31/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 29 Scum thickness 4 Distance from top of scum to top of outlet tee or baffle 5 Distance from bottom of scum to bottom of outlet tee or baffle 10 How were dimensions determined? measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert., evidence of leakage, etc.): The tees were present. No sign of leakage. Grease Trap (locate on site plan): Depth below grade: n/a feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene El 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts = Title 5 Official Inspection . Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Milne Road Property Address Johnathan Jaxtimer Owner Owner's Name information is required for every Osterville MA 02655 8/31/2017 page. City/Town State Zip Code Date of inspection- D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection)'(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): N/a 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 ISins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Milne Road Property Address Johnathan Jaxtimer Owner Owner's Name information is required for every Osterville MA 02655 8/31/2017 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 even 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.): The D-box was normal. No solids were present Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 assachusetts Commonwealth of M 1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments e 54 Milne Road Property Address Johnathan Jaxtimer Owner Owner's Name information is required for every Osterville MA 02655 8/31/2017 page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) Type e . ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: Bodiffusem, 25 x11.32 ❑ 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.): There was no sign of failure from the Field. A camera was used for the inspection Cesspools (cesspool must be pumped as part of inspection),(locate on site plan): Number and configuration Depth —top of,liquid to inlet.invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No 15ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 54 Milne Road Property Address Johnathan Jaxtimer Owner Owner's Name information is required for every Osterville MA 02655 8/31/2017 page. City/Town State Zip Code .Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/a (Sins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Milne Road Property Address Johnathan Jaxtimer Owner Owner's Name information is required for every Osterville MA 02655 8/31/2017 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 Qqc,� � Q � a 0 a3 3r� aS` a 'P as y 3 S3 q3 1 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 f Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments - 54 Milne Road Property Address Johnathan Jaxtimer Owner Owner's Name information is required for every Osterville MA 02655 8/31/2017 page. City/Town State Zip Code. Date of Inspection D. System Information (cost.) • Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 25' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design"plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: ❑ Checked with local excavators, installers -(attach documentation ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Topo and water contours maps Before filing this Inspection Report, please see Report Completeness Checklist on next page.. 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts o- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 54 Milne Road Property Address Johnathan Jaxtimer Owner Owner's Name information is required for every Osterville MA 02655 8/31/2017 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 l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 IL No. �_O f 0 _ L1 5e Fee C� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppYitatiou for Disposal *pstem Construction permit Application for a Permit to Construct(e,�—Repair(4--Vpgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.f,• lofmi e Owner's Name Address,and Tel.No. Assessor'sMap/Parcel //8— 02-el I taller's am Ne,Address,and Tel.No.,-$e/—+Z0—�f'J_V$ Designer's Name,Address,and Tel.No. LCS CPLj Q6 IjS p�gl^H G`1f�'jIG �V' Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 'a' y gpd Design flow provided 33 C gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1;Wj7W11 /,! 410 6/.d[, �f A9 `!G Ts9h �0-.134-X y--R,0 v OF y 2/0 NPS /60-0 [3D Y�t�oi=r=vr-rs av/rIll /Vo 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. q Signed Date 000, Application Approved by `l- Date Application Disapproved by U Date for the following reasons Permit No. 0 y Date Issued fd .� nh No. 9 010 1 �� Fee Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppYication for ]Disposal 6pst m Construction Permit Application for a Permit to Construct(,e - Repair(, 'grade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.s',? Wilms Owner's Name,Address,and Tel.No. p0t�cr'v///r kr>wl� f�v�i�rS' ' Assessor's Map/Parcel - U Installer's Name,Address,and Tel.No. 9%38 Designer's Name,Address,and Tel.No. E ✓ns G y 11c 10-/),-ram S /s D�rve-e_`i e� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other .-� Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) -- ;L gpd Design flow provided �j�j - gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations Answer when applicable) 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. Signed , 4 I` _, Date �" �] r0 Application Approved by ; _ `` as Date r /`9-f U Application Disapproved by ? ,i Date for the following reasons Permit No. ?d 0 -1 0 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed(s—j Repaired(y Upgraded( ) Abandoned( )by\ /*�eA:24 L2, �� 6Z q at has been constructed in accordance ,,ll with.the.provisions of Title 5 and the for Disposal System Construction Permit No.goIO tI50 dated Installer Designer J&eee - a #bedrooms Approved design flow /"lJ gpd The issuance oft is p rmit shall not be construed as a guarantee that the system will nc imh designe l. Date Inspector �.✓. �• _ . . - . . - - -------vV------- No. a D�d I 50 , Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Bisposal 6pstem Construction Permit Permission is hereby granted to Construct Repair Upgrade( ) Abandon( ) System located at Sy Wt L Al 1' and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. 6.��g Date E 1 Approved by f 4- Town of Barnstable �TME Regulatory Services Thomas F. Geiler,Director i snartsrnUZ 9�A . ®� Public Health Division lFn3°' Thomas NlcKean, Director 200 Main Street,Hyannis,MA 02601 ° Office: 508-362-4644 Fax: 503-790-6304 Installer & Designer Certification Form Date: l( I 1G Sewage Permit# 0--(q Assessor's Map\Parcel (« 02-`( Designer: rtAll M MCy e Installer: TO e-'7 bk 1t31C1rr' t Address: X Address: 9-t Cet In tv,CPf R-W GzS37 On r (` �I ` 10 e" Dt�6fr'O S was„issued a permit to install a (date) Gristaller) septic system at y M Ae R.t bsfuV'Ile based on a design drawn by (a dress) ln,�Y�e_�l dated /I A/ `O (designer) 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 ancU'or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. OF MgS�9C ARR YER (I staller's Si,nature) No. 1140 REGISTE�� I S01 TWP� 11 ll 1 ►� esianer's Signa re) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNS BLE PUBLIC HEALTH DIVISION. CERTIFICATE OF CONIPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Health/Septic/Designer Certification Form 3-26-0d:1doc i Town of Ba 'nstable P# Department of Regulatory Services • Public Health Division Date " i �.AENBr'ABL$ • 1 . KAM 1639. ems$ 200 Main Street,Hyannis MA 02601 '�rFD 1A>•'t� ' Date Scheduled }��° 'Time _ Fee Pd. J oil' Suitability Assessment for Sewage Disposal Performed By: t L� i ! Witnessed By: bJ L, < </✓. �`a% i LOCATION & GENERAL INFORMATION Location Address /�- �/l �l� �G Owner's Name a oPo JTCJY �✓i� (�; MA v 1 I Address S (()2-Lj Assessor's Map&4=1-. C Engineer's NameDO-CY�,\NEW CONSIRU�CION " REPAIR Telephone# SU � Z,�o22 Land Use rt5dQity a_p Slopes(%) '� = v Surfaeestones 4 Distances from: Open Water Body �� ft Possible Wee Area ft Drinking Water Well >lD ft Drainage Way ft. Property Line ! ft Other ft SKETCH:(Street name,dimensiotis of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 28 30 32 "�" ''•' 201J9 ft 36 54 32 PROP. 1,500G w SEPTIC TANK ` ❑ co a \ TH-1 \ • \ \ \ a 20 It a:oa \\ 0 T \ LJ Oj Z / mo d. I I -_ von.oTH-2 42-41' 32 o —W= —W— W a ° W I j l o EX15T.CE55POOL \ I',I; III (NOTE 10) \ W z GARAGE. i PAVED DRIVEWAY` 1 \ i A \— IF I i i (d) fr- n.. � Y)✓�J y/ Pareo6aterial(geologic) ' Depth to Bedrock m , [� Deptw Groundwater. Standing Water in Hole:' i Weeping from Pit Face o I-- Estitrfmd SWqnalhigh Groundwater d-I 1 0 0 tTERMNATION FOR SEASONAL HIGH'WATER TA�3LE Method Used: I __ip, Depth 10 SON mottles, In• Depth Clb�served standing in obs.hole: in, Groundwater Adjustment Depth toiweeping from side of obs.hole: J Adj.ACtor..,.�� Adj.Groundwater Level,,,,°. Index Well# Reading Date Index Well levzl ' I PERCOLATION TEST . Date:.o- Observation Tithe lit 9" :.• Hole# Time at G" .------- Depth of Pere 0 Time(9"-6' --- Start Pre-soak Time.@ )/� r ; End Pre-soak /`/® 1 Rate [inJInch ,r ssed X Site Failed; Additional Testing Needed(YM) Site Suitability Assessment: Site Pa :elth Division Observation Hole Original:.Public I Data To Be Completed on Back--- J j ***If percola#61t test is to be conducted within 100' of wetlan.d,:You must f] 0 notify the Barnstable C61I servation Dhision at least one(1) week prior to beginning. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other I.Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel OIL( I/ ll N DEEP OBSERVATION HOLE LOG Hole# ?/ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel) DE SERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel DEEP OBSE VATION HOLE LOG Hole# Depth from Soil Horizon oil Texture Soil Color Soil Other Surface(in.) ( DA) (Munsell) Mottling (Structure,Stones.Boulders. Consisten ra I Flood Insurance Rate Man: / Above 500 year flood boundary No Yes ___✓__ Within 500 year boundary No Yes Within 100 year flood boundary No_ Yes Depth of Naturally Occurring Pervious Material Does at least-four feet of naturally occurring pervi, u terial exist.in all areas observed throughout the area proposed for the soil absorption system? �� If not,what is the depth of naturally occurring per bus material? Certification I certify that on �' (date)I have passed the soil evaluator examination approved by the Departmen o nvironmental Protection and that the above analysis was performed by me consistent with • the required trai i ;expertise and experience descr ibed in 3.10 CMR 15.017. Signature Date Q:\.SEPr1CV'ERCFORM.DOC Commonwealth of MassachusettsT 43 t Executive Office of Environmental Affairs Department of Environmental Protection ERE � o:2003RPlSTABLEDEPT T= OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION ,SAP I PaRcEI, t n 2 6r Property Address:54 Milne Rd Osterville MA 02655 LOT Property Owners Address:54 Milne Rd.Osterville MA 02655 Owner.George Minton Date of Inspection:09/16/2003 Name of Inspector.(please print)Bruce Butterworth Company Name:_ Wind River Environmental Telephone Number:978-562-4500 x, 45� 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 systt V Passes _ Conditionally Passes Needs Further Evaluation by the Local Approving Authority ails Inspector's Signature: . 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-o 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:Older system used full time. ****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-same or different conditions of use. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:54 Milne Rd.Osterville MA 02655 Owner:George Minton Date of Inspection:09116J2003 Inspection Summary:Check A,B,C,D or E ALWAYS complete all of Section D. System Passes: X 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 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 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 exictinu tan i a w;x9 dying septic tank as approved by:he Beard 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 2�ve c Bald is available explain: — - Observation of sewage backup or break out or high static water level in the distribuijon box due to broken or obstructed pipe(s)or due to a broken,shifted 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 for the following statements.If not determined" 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 Not Determined explain: f OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION(continued) Property Address:54 Milne Rd.Osterville MA 02655 Owner:George Minton Date of Inspection:09/16/2003 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. System will pass unless Board of Health determines m accordance with 310 CMR 15.303(1)(b)that the system is not bunctioning in a manner which will protect public health,safety and the environment: Cesspwl 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)determin s 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 colform bacteria and volatile organic compounds indicates that the well is free from pollution from said 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. Other: f OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:54 Mine Rd.Osterville MA 02655 r Owner:George Minton Date of Inspection:09/16/2003 System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _ x Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ x Discharge or pondng of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _jLStattc liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _x Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/4 day flow _ x Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Nmnber of tnnec� — x Any portion of the SAS,cesspool or privy is below high ground water elevation. _ x Any portion of cesspool or privy is within TOO feet of a surface water supply or tributary to a surface water supply. x Any portion of a cesspool or privy is within a Zone I of a public well. _ x Any portion of a cesspool or privy is within 50 feet of a private water supply w(�. x Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.[This system passes if the well'water analysis,performed at a DEP certified laboratory,for conform 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] No (Yes or No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system falls.The system owner should contact the Board of health to determine what will be necessary to correct the failure. Large Systems: To be considered a large system the system must serve a facility with a design flaw 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-DEP)or a mapped wetland 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 S"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. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Properly Address:54 Milne Rd Osterville MA 02655 Owner:George Minton Date of Inspection:09/16/2003 Check if the following have been done You must indicate yes'or no as to each of the following. Yes No x —Pumping information was provided by the owner,occupant,or Board of Health _ x Were any of the system components pumped out in the previous two weeks? x _Has the system received normal flows in the previous two week period? ____ - e sy r or as p o mspect-wn x Were as built plans of the system obtained and examined?(If they were not available note) x _ Was the facility or dwelling inspected for signs of sewage back up? x _ Was the site inspected for signs of breakout? x Were all system components,excluding the SAS,located on site? x Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth)f sludge and depth of scum? x Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has.been determined based on: Yes no x _Existing information.For example,a plan at the Board of Health. 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)j i OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM 1114FORMATIONFLOW CONDITIONS Property Address:54 Milne Rd.Osterville MA 02655 Owner:George Morton Date of Inspection:09/16/2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms{design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 220 Number of current residents: 2 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system yes or no): No (if yes separate inspection required) Laundry system inspected(yes or no): No Seasonal use:(yes or no): No Water meter readings,if available(Iast 2 years usage ump pump or no): No Last date of occupancy: CurLw&Occupied USTRIAL — - - � - Type of establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(seats/persons/sgfi,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):No-Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information,: OWW supplied info Not pumped in the last 4 vears Was system pumped as part of the inspection yes or no): Yes If yes,volume pumped:gallons 600 goal. gallons How was quantity pumped determined? By the sight tube on the MM truck. Reason for pumping:To check the condition of the tank TYPE OF SYSTEM JL Septic tank,soil absorption system Single cesspool -A—Overflow cesspool ---Privy Shared system(yes or no)Cif yes,attach previous inspection records,if any) _Innovative/Altemative 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: Over 30 Years.The soure of the information was an interview with the property owner Were sewage odors detected when arriving at the site yes or no): No OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:54 Milne Rd.Osterville MA 02655 Owner:George Minton Date of Inspection:09/16/2003 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:(locate on site plan) Depth below grade• 7 1" teri of cons ruction: X concrete metal_fiberglass or polyethylene other(explain) Concrete barrel block construction tank is metal list age: copy of certificate) Dimensions: 1000¢al Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle:no sludge Scum thickness: no scorn Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Comments(on Pumping recommendations,inlet and outlet tee or baffle condition,structure integrity,liquid levels as related to outlet invert,evidence of leakage,etc.):Tank condition good,No baffles.Recomend that sanitary tee's be installed in tank liquid level well below outlet. Is age confirmed by a Certificate of Compliance(yes or no): No (attach a copy) GREASE TRAP: (locate on site plan) Depth below grade:_ Material of construction: concrete metal_fiberglass_polyethylene_other (Main): 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:54 Milne Rd.Osterviile MA 02655 Owner:George Minton Date of Inspection:09/16/2003 TIGHT or HOLDING TANK (tank must be pumped at time of inspection.)locate on site plan Depth below grade: Material of construction: concrete metal. fiberglass polyethylene other(explain): Dimensions: Capacity: goon Design ow: gallons/day Alarm present yes or no): Alarm level: AlaM)ji worldtg er(ves ors) Date of last pumpmg: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: None (if present must be opened and 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 canyover,any evidence of leakage into or out of box,Etc.): PUMP CHAMBER: (locatc on site plan) Pumps in working order(yes or no): Alarms in worldng order yes or no): Comments(note condition of pump chamber,condition ofpumps and appurtenances,etc.):. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:54 Milne Rd Ostervflle MA 02655 Owner:George Minton Date of Inspection:09/16/2003 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required if SAS not located explain why. Type X Ieaching pits,number: leaching chambers,number: leaching galleries,number leaching trenches,number,length:Number unlatowm lenth is24 ft. _ leaching fields,number,dimensions: X overflow cesspool,number:_ innovativdahernative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,edition of vegetation,etc.): Soil is course.No signs of hydraulic failure now or in the past,vegetation normal 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 or no): Comments(note condition of soil,signs of hydraulic failure,level of pomding,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.): OFFICIAL INSPECTION FORM-NOT FOR VOLINTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INFO FORM PART C System information(contmned) Property Address:54 Milne Rd.Osterville MA 02655 Owner.George Minton Date of Inspection:09/16/2003 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 tie building. �.o �1 v\ �,d ePrCi OFFICIAL INSPECTION FORM-(NOT FOR VOLUNTARY ASSESSMENTS) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:54 Milne Rd Osterville MA 02655 Owner:George Minton Date of Inspection:09/16/2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 20& Please indicate(check)all methods used to determine the high ground water elevation: x Obtained from system design plans on record-If checked,date of design plan reviewed x 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) x Accessed USES da*atase-explain• I ar r rcr:c a i,��a You must describe how you established the high grn, d cvarPr P : I.took the high ground water level from the USGS web site.I also angered a hole three feet below the pits and no ground water was encountered. Title 5 Inspection Form 6/15/2000 DEPARTMENT OF ENVIRONMENTAL PROTECTION 1 ' 4 y OSTERVILLE 28 30 32. 34 36 201.19 ft 36 34 32 z / / /'— --- --— I 1 `—----- --- LIMPS R, W i i/ i Y PROP. I ,500G I RD: ` w , SEPTIC TANK N d I zo ft TH-1 'zsoo'Li \ \ , � I ' 10 ft Ij, T z �\ Xa o \ LOCUS. Z, Z \ _I Imp. Ports 2.4 1' .32 o I' —yam —W— - — — Li II 1 \; LOCUS MAP X EXIST.CE55POOL (N - O)' LI i I '(NOTE 1 PLAN REF: 9755 D ".,, • ' «� ,. t w PARCEL Cl1 71021, 18/024 \ , .PROPERTY IS WITHIN AZONE .OF'CONTRIBUTION.. \ PAVED" "DRIVEWAY GARAGE • , • I SEPTIC I , TI �REPAIR-' s PLAN LOT LOCATED AT: I I:AREA = 19644' sf 5+- LIE —ROAD 4 1 r- OSMTERVILLE; MA 28 30 32 34 36 191.69 ft M 36 ' PREPARED FOR GENERAL NOTES: 34 � POWERS ' s NOVEMBER 8, 2010_ 1. ALL CHANGES TO THIS.PLAN MUST BE APPROVED BY THE LOCAL t BENCH MARK p SCALE: , 1"=20° BOARD. OF HEALTH AND THE DESIGN ENGINEER. .. 4. _ ,•� .,t ? " ` 2. ALL WORK AND 'MATERIALS SHALL CONFORM TO THE REQUIREMENTS` '• �, TOP OF FOUNDATION R` OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE ELEVATION = 37. 49 OF LOCAL RULES AND REGULATIONS. ` 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED.PRIOR BA - \ RNSTABLE GIS DATUM TO INSPECTION AND APPROVAL BY THE,BOARD OF HEALTH'AND THE ARC Io DESIGN ENGINEER. r, P / —FAEYER 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING , " N0. 1140 ENGINEER BEFORE FROM THOSE WCONSTRUCTION CONTINUESN HEREON SHALL BE . LEGEND TO THE DESIGN - LEGEN D i .. r � .. ♦._ ".. ..is i F 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. — , 51 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF a PROPOSED CONTOUR ''. L� THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OFNITAR�a HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. PROPOSED SPOT GRADE-, 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. -- 98 EXISTING CONTOUR 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. + 96.52 EXISTING•SPOT GRADE 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY D A R R E N M. ^'MEYER,. R.S. ( THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING W— EXISTING WATER SERVICE (APPROX) CONSTRUCTION. 10. EXISTING CESSPOOL TO BE PUMPED, CRUSHED AND FILLED PER TITLE V. ® TEST PIT P.O. BOX 981 _ 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION . EAST SANDWICH, M A. 02537 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVE Y • 13. NO PRIVATE WELLS WITHIN 100 FT. OF PROPOSED LEACHING :Lv (5 0 8)3 6 2—2 9 2.2 14. ALL PIPING TO BE 4" SCH 40 0 1/8"/FT (UNLESS SPEC. OTHERWISE) SURVEY REFERENCE: 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A GARBAGE GRINDER PLAN OF LAND BY WHITNEY & BASSETT 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING DATED: MARCH 1947 SHEET 1 OF j2'-' NOTE: TO' PREVENT BREAKOUT, THE PROPOSED NOTE: MAGNETIC TAPE TO BE PLACED OVER'ALL! COVERS FINISH GRADE SHALL .NOT BE <. EL:32.64 , L FOR A DISTANCE OF, 1.5, AROUND THE : { 'PERIMETER' .OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. 'INSTALL RISERS & 'COVERS OVER INLET & INSTALL RISER'& COVER INSTALL:A 4" DIAMETER INSPECTION PORT OVER =' �`� O MqS T.O:F. EL.-37.49 . � ' OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE „ ONE CHAMBER- (MIN.) AND'SET TO 3 OF-F.G. F.G. EL.=36.50f F.G. EL:=37.Ot e. F.G. ,EL:,36:Ot • f k F.G. EL 35 0('MAX.) ARR ,` :�A( s1 e M�1'14p / 9" MI7XER L 40't " L =' 15' L--'-10.(MAX INSTALL-TWO INSPECTION PORTS (MIN.)0 S=1% (MIN.) : 36.M : 0"S=1% (MIN.) 0 S=1% (MI ) r 4»SCH40 PVC 4 SCH40 PVC 4 SCH40'»PVC S I E1P� �..,•- fr NITAR H t4" e" 11.2" TO, : INVERT INV.=34.50`, 4e"LuwIo >, k LEVEL INV.=34.25, 1� r ry INV;-32.80 4 ROWS OF 4 UNITS. AT 6.25/UNIT =.25'/ROW • GAS BAFFLE PROPOSED. , D-BOX.. r . : . : DB 5 INV:=32.25 SOIL ABSORPTION ,SYSTEM :(PROFILE) INV. - PROPOSED 1,500,GALLON'SEPTIC TANK .. .:1. . RESTORE,VEGETATIVE COVER _ EXISTING SEWER OUTLET . _. . . , $, _, .. .~,. „ . :, .. - .. .; .;, BACKFILL` WITH CLEAN :PERC SAND ° u.: +'..<.r ,. INV. 35.49 • :. .. ,. • r T TOP F CHAMBERS_ 75� r .. e NOTES: HAL VERIFY ALL EXISTING ,r: 1) CONTRACTOR,SHALL L L PIPE INVERTS PRIOR TO CONSTRUCTION r .. r,- ', •, ._, - , .. AK T=TOP ELEV:=32.64, • ., .' ,.,. ' P ,: 2 TANK AND SHALL BE: SET LEVEL AND TRUE 'TO ,. ) ,ELEV32.25 , :4 . . . GRADE.:ON• A.MECHANICALL COMPACTED tiSfX , . ;.. BOTTOM ELEV.=' 31.31:, k- :.. INCH CRUSHED, STONE BASE., AS SPECIFIED IN { �.EXISTING`SUITABLE' . . v 2:83 . 310 CMR 15.221 2 �. . : �. _ ` MATERIAL' �: �. � . _.. 5 MIN; ABOVE BOTTOM OF _.: .a ,. �.- 3 . INSTALL 1NLET & OUTLET .TEES AS REQUIRED. . . , w _ _.- f J6. . •. ,. ... . EFFECTrVE ;WIDTH 4 x. 2.83, 11.32 *. T.P. EXCAVATION OR G:W. � n 7.56: PROVIDEDSE -4'-ROWSF' -1 A 16008D k - { ) U 0 4 6. DS _' BOTTOM-.OF •TESTHOLE EL.=23.75 _ BIODfFFUSER UNITS..-NO STONE' . '�� ` � ROFi� R tl i la _ r, • A ' ,SEPTIC,- SYSTEM PROFILE. . � . , . v . TYPICAL. SECTIONTA , 'i .. a 11 , e 16 :.., -... -' .. 4. is ,,,- ', ,.:: ,' '.. ,. .. , k•'.. _ _ x,�. e e, S� P 13110 N 'CRITERIA' w DE C . E r t ; „ • ,a : f.� 34':- -I s, DATE:. OCTOBER•,28,.,2010 .NUMBER OF :,BEDROOMS, 2 BEDROOM EXISTING/3 BEDROOM. DESIGN -' ,: ; •' - :, .. 4 SOIL TEXTURAL CLASS. . CLASS 'h SOIL.EVALUATOR, ,.DARKEN M. MEYER, R,S., ,CSE: #1614 SECTION END 'CAP" - ' ` ' N w.'h� WIT ESS.. , `DAVID.:STANTON,."BARNS:,B.O.H. _. N PERCOLATION -RATE: <2 MIN IN ¢.., z „ ' DESIGN, / r . , %: . _ Elev. „- TP. De t FU DAILY FLOW. : 3 BR X 1 1.0 GPD BR 330-G:P.O., DeRth „ . 3 p , ,. 34.75 16 ADS• 16OOBD BIO IF SER .'UNIT DESIGN FLOW: 330,.G.P.D, - _ r; i FILL MODEL ,16 HICAP LL GARBAGE GRINDER:: NO NOT DESIGNED FOR GARBAGE GRINDER M v : " ¢, (NOT ) 34.25. _ g 34.30. : 6, LENGTH, ; , 76 p ` • A ::� I' • • A LOAMY SAND NOTE: UNIT CONFIGURATION,AND. AVAILABILITY•SUBJECT • SEPTIC TANK: 330 gpd x 2 660 gpd USE NEW 1,500.GALLON SEPTIC TANK. LOAMY SAND a TO CHANGE WITHOUT NOTICE.. PRODUCT DETAIL MAY » - tOYR 3/2 roYR 3/2DIFFER: EFFECTIVE LENGTH- 75 LEACHING AREA, REQUIRED: (330) = 445.94. S.F. : SIDE,WALL'HEIGHT 11.2" SLIGHTLY FROM.ACTUAL APPEAR s 33.75 12.' 33.64 14' �n 6 APPEARANCE. .74 B : B OVERALL HEIGHT 16 - + u BOX: 5 UT (MINIMUM) y LOAMY SANG .1 LOAMY SAND .~ 4640` TRU e" DISTRIBUTION 0 LETS � EMAN BL I/D IOYR 6/8 OVERALL WIDTH , .6 1 OYR,6/6 PRIMARY S.A:S. 32.50 27^ 32.64 26^:. CAPACITY 13:6 CF HILL/ARD, OHlO 43026 USE 4 ROWS OF 4 - 16" ADS 16006D BIODIFFUSER 'UNITS-NO STONE (101.7 GAL) ADVANCED DRAINAGE SYSTEMS, INC. MED. SAND_ �. MED. SAND ` (8 BOTTOM TOMUAREA: 16E UNITS .x'NERAL 56.25PPRO LF xA4.730R SF7 LFS�/47 LF O S BIODUFUSER) 2.5Y 6/4 PERC ®30.75 .2.5Y 6/4 ' / _ PROPOSED' SEPTIC SYSTEM' SITE PLAN DESIGN FLOW PROVIDED: 0.74(473 GPD/SF)`= 350.02 GPD > 330 GPD req'd 54. . M I LN E ROAD OSTERVI LLE ' MAT 23 75 1�32" 23.80 132". PERC-RATE':<2 M1N/IN: .("C HORIZON)~ - Prepared for:-Powers "a' NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN 'JOB. N0. _ DARREN M.MEYER,R 5 Eco Tech Env. NTS D.M.M. - �l, Darren M. Meyer, R.S., CSE, 'hereby certify that'I am currently,approved by MADEP pursuant to 310 CMR 15.017 POBOX9B1, (508) 367-8097 to conduct,soil evaluations and.that the above analysis has been performed by'me consistent with the DATE CHECKED 'SHEET NO. requirements of'310 CMR 15.617. 1 further certify that+have passed the Soil.Evil. Exam, October,'1999.'- EAST SANDWICH MA 02537 508-362-292211, 1 1/08/10- D.M.M. 21 of 2 r , r n I n n,a�4x ., .. U , .. n--. .:. ... 5 .: ' ., , '- :.. ., • 1, rJ