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HomeMy WebLinkAbout0015 OLD SALEM WAY - Health 15 OLD SALEM WAY, OSTERVILLE r A 166 065 a No.......:: Fps...........................- THE COMMONWEALTH OF MASSACHUSETTS ' BOARD OF HEALTH = -------------- ---------0F.........,&� - --- ................................... Appliratiun for Disposal 10orkii Tunitrndiun ramit Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal syst .. l� ............ ........1. •-- • ......................................................... ation- ress or Lot No. Owner - -•-.-Address W ••• .....2.14 / 4 ;'V Inst Address dType of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms__._.. _.... _Expansion Attic ( ) Garbage Grinder ( ) �t / No. of ersons____________________________ Showers — Cafeteria a Other—Type of Building [ p ( ) ( . ) Otherfixtures -------------------------------------------------------•-••-••-•-•-•-••-----•.........---•-•--._......••--•-•-••-••-••••......•......---•--.......... n W Design Flow............. _....__._._._______gallons per person per da .-Total daily flow____.___... ._ 5�..__..._.._.._gallons. WSeptic Tank—Liquid capacity-IMPQgallons Length___-___. .:,width........V. Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length....__:__r_ �_._ Total leaching area.____.___.__.:.____.sq. ft. Seepage Pit No..........I-------- Diameter......... Depth below inlet... 9C . ._._. t leachi area..Ia.0_-Lsq. ft. Z Other Distribution box ( ) Dosing tan '-' Percolation Test Results Performed by__ t.. _ .__(,! _ ..__.._ Date.__.��.�a -"7 7 Test Pit No. 1................minutes per inch Dept of Test Pit.................--- epth to ground water........................ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 1---------- O Description of Soil................................ 1¢'+�?�..` �l.cu _ l "y,� x - l - _. : � --- ........... U ....•••••-•••-•----.••••--•----••-•-••••-••-•••••-•--••••..-•-•••_..._...-••••••...•--••••--•-•-•-•--•••....-•------------••••--••-•••-••-------•--•-•-•-•---••--•-•--•-•••-•----•-.........•-=.--••••••. W ...............-----------••••-••••-••-•-••-•---•••-••••--------------•---•-----------•----•••---------------•••---•-------------•--------•-•••--•-•-••••-••••••-•----•---•---•-•-•--•......-------•-. VNature of Repairs or Alterations-Answer when applicable............................................................................................... -----------------------------------------------------------------------•----------.....----------------------------.......------------------------------------------------------------------.......... Agreement: I The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iIHE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance hasp een issue byte boa f health. Si ped..... �...... -•--.•••--- �S �7 { Date Application Approved By..... .. -•. •.._ ------------------------------------ ...-•-. ...... . Date Application Disapproved for the following reasons:__...••••-•-••••••••-••••••••-•-•••••---••--•-•-•---•-••------•••......•-•-----•--•••........................ ---•----------------------------------------------------------------------------------------------------------------•--------••••-------•-----•-•-••-••--••••--•--•••-----•••-----••-------------•---. Date PermitNo......................................................... Issued_....................................................... Date L� Fss..`.'......._............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........OF....... .: ::.... , pphrtt#ion for Disposal Works Tonstrurtion Prrmit Application is hereby made for a Permit to Construct (✓") eor Repair ( ) an Individual Sewage Disposal systt_.it.. .... v .L.:. y ............................................................ ation- dress or Lot No. .... .. .........�:. - ---------------------------- ...........----....................__..._..._. W t Own Address er- �. .. � a Inst Address dType of Building ,,, _; Size Lot............................Sq. feet Dwelling—No. of Bedrooms._____ ____ .......................Expansion Attic ( ) Garbage Grinder ( ) per, Other—Type of Building _ �'�'�.. No. of persons____________________________ Showers ( ) — Cafeteria ( ) Q' Other fixtures ................ .....................------------- -------------•--- •- --- -....-------...--------- W Design Flow....., _____ ....................gallons per person per day. .Total dail figw............ ..............gallons. WSeptic Tank—Liquid capacity 4 ?gallons Length....... Width__. Diameter________________Depth................ x Disposal Trench No __ ___.Width____ � _ Total Length.......... t_ Total leaching area_____ ......sq. ft. Seepage Pit No.......... >_____ Diameter -•---- ,.`Depth below inlet___....... t leachi a ea_... ....../..Sq. ft. 77, z Other Distribution box ( ) Dosin to '-' Percolation Test Results Performed by:_ � '- 470 � ' -• -- .... .G��''� ------- Date........................................' � 4 Test Pit No. 1._______________minutes per inch Dept of Test Pit ___._._._______. Depth to ground water......................... Test Pit No. 2................minutes per inch Depth of Test Pit____________________ Depth to ground water........................ ,� D Description of Soil '1�?1ti > .-.. --:�� - '"fd r±t: l•.._.. x ------ W -•------•--•-----------------•••----•••-------•-----•-- ------------------------...-------------------•------------------------------------------------•---•--•-----•---•----------------------- V Nature of Repairs or Alterations—Answer when applicable______:::......................:..•____:_______.____.__._._._._.._____._;............... Agreement The undersigned agrees to install..the aforedescribed Individual Sewage Disposall System in accordance with the provisions of TITLE 5 of the State Sanitary Code- The and .signed further agrees not to place the system in operation until a Certificate of Compliance hasp een issue by e boa 'f health: Application Approved By-•-- "* t' Date Application Disapproved for the following reasons............. Date Permit Igo...::_. •- --- Issued--•------------••---------------- T ----- --�:�------_. .............. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 4 T. IS IS T? RTI/ That ndi al Sewage Di-posal System constructed or Repaired ( ) by..!:. ej..e ------------ taHer ' at_ "-- . � _ :. - lft �t��- modZ - has been,-installed in accordance with the provisions of r :` of The State Sanitary Code as described in the application for Disposal Works Constructlon''i'ermit No.. ____. _________________ dated-_/7!_ $`_..� __..__.__.____._.__ THE ISSUANCE ,OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM VYIL ° FUNCTION SATISFA`CTORY. DATE:..._-- .................. _.. Inspector '/ THE COMMONWEALTH OF MASSACHUSETTS w BOARD' Qfj HEALTH - ..........OF............. e!!X.e............................................... z :x No • .__ FEE park To Fermi# Permission is hereby granted__.`_ •:___. [ ___._ .__._:_7___l.lf • to Const ct �� Repair' ( ) an n vidual Sew g p stem at No.. _•_tzGhG : '"' t Street as shown on the application for Disposal Works Construction m>t M67 Dated__._ `_ '`' _ .......... �� . DATE ...............�:_._. ._.. y Board of 1 ...................... N:K Heal FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) A I I m / �0(' �'J LI DATA AV-aA. - iC70 S•F. ., to tTl^l =Nl AZInt,o ST-. 'i1 TAnfC • �-1 A w ;-�,�.t ar�f '�[..t3w = 33G? 6.P.C. �L �i•�. -• _- �-- � # .. < r,L&P,CtJ i~dTE : � IN 2M7►J' 021;=Y�. F FAV ty • --•--"---R .min—.r j�fi��. '��F•i�s ..ti (..off n Q fiat• i a� iuv. + SJ are, 4r/'/off 'DIS( 1w. 6AAL. 9(011 .r Z i oa© 4 4 l INv, :. Ins- �G,u 9c, Z ; FIT wasp-teta r--QTti tr=CJ PI.CT � i_ V4 • - - - -- �., L oars 'Ci ci h-i ; i { Ire t 4 ScAt I '� GCS ta.I La / Ct�tzTl4=mil Tj-!AT T1 ��tv,JtC�C.1l�(, SUvtiv1.4 �'t,. A,t.! {2r' t= r: :.*•.1c_i�_ tit I?t�r�c�1 Gc�n,rtntr�'S W►'i't-{ Tiat;. •�j1 vC- t-tla� �- � . { Vr-QulQ=—MEN "T-; of 'r"C—:. r Lk ' OuL.r j t {i4� C�I_A►-1 ! QCST IIA-SCO A'•W !O•xrrE VVkL-LLB. MASI;, ( �1.1!✓1+ _t.t i ��(l.:lt:"I' 'WC: U�4:'1txC•�i �til1L i L'i C lJ 4 a.I 1 tJ i !_ 1 41 t i�[�1'" TOWN OF BARNSTABLE f LOCATION Old e SEWAGE# oo a V VILLAGE al� ASSESSOR'S MAP&PARCEL 166-06 INSTALLER'S NAME&PHONE NO. � SEPTIC TANK CAPACITY LEACHING FACILITY:(type)A J,1�6 , JWe4 K a!5 (size) A, P i o f X 14,4q, � NO.OF BEDROOMS C7 OWNER Lg PERMIT DATE: ' I` u c) 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 jf -WN OF(B��ARNSTABLE LOCATION ) �S 0�JA SEWAGE# .�� b-63 4 VILLAGE 0S-(;-02-U[U g, ASSESSOR'S &PARCEL /4;6 0 6 INSTALLER'S NAME&PHONE NO. Ro6,'A . ► A SEPTIC TANK CAPACITY 3s5- 44,,ra-ih�� Oki LEACHING FACILITY.(type) (size) NO.OF BEDROOMS OAR 3c' IdA4 PERMIT DATE: S- 3-��_ 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 \y �. _ � \1 `j'. 1 • , M ` `� THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M A�C(, I DATA VILLAGE IN TLLER'S IMAM;E 8' ADD F�ESS � ,-�- C . ► , v z Win.... ":�2>A- \IeAleLex, t r B U I'L Di R OR OWNER DATE PERMIT ISSUED .►� � ® ATE COMPLIANCE ISSUED ti 1 i - � �� 2aa�t- �Z(o � . .� No. C � , Fee A00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �( PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZppYication for �Biopo5al *_ p5tem Con.5truction Vermit Application for a Permit to Construct O Repair(Upgrade O Abandon O ❑.Complete System, ❑Individual Components Location Address or Lot No. /6 Ow SALT M U)A%i Owner's Name,Address,and Tel.No. mregv ll)-t TAMAs Assessor's Map/Parcel 6 _ S Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. IPWaLA5 A- X51-20utr+J ZoL Type of Building: Dwelling No.of Bedrooms 3 Lot Size /-I" sq.ft. Garbage Grinder ( ) Other Type of Building /�p�qr_ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) _5 3n gpd Design flow provided :31.?j gpd Plan Date Z11Z I B Number of sheets Revision Date Title RL go S1-6 ir— U1)C eA9_r Lrar.J Size of Septic Tank 10W 1�--X/5T/NC Type of S.A.S. 2 5--0 RaI/..j 6&,n beq% Description of Soil S G r I" 4 Nature of Repairs or Alterations(Answer when applicable) (\)S+FA-IL1'CICUj S- S 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 B of Health. Signed Date /7 0 Application Approved by s Date ,S /? O Application Disapproved by: Date for the following reasons Permit No. D6 1 `-cD Date Issued 15, 3 20� 2CydG 1 C,(p L/h 1Z,-\/5 i, No. 1 ( ) Fee Entered in computer: ; THE- .OMMONWEALTH OF MASSACHUSETTS Ye PUBLIC HEALTH DIVISIOON - TOWN OF:BARNSTABLE, MASSACHUSETTS - 2pprication for �Bigogal *pgtem Cow5truction Permit Application for a Permit to Construct( ) Repair(4100Upgrade( ) Abandon( ) ❑.Complete System ❑Individual Components Location Address or Lot No. I S D'd SA L 1=M W/It N' Owner's Name,Address,and Tel.No. osreRvoYe. T61MAS# Assessor's Map/Parcel /G _ S Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. V0,)G j N'a h wzow k) T^ �_ �Nf�✓r>,o�%�J G✓ask5 Type of Building: . Dwelling No.of Bedrooms 3 Lot Size /1.12.7 sq.ft. Garbage Grinder ( ) Other Type of Building Aw),e No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required gpd Design flow provided 3 31 F?) gpd E Plan Date Z QIm Number of sheets � .3 Revision Date Title P40 ao&LR s6 U La19AQi— PCor,) Size of Septic Tank 1000 E-X/57'lNC Type of S.A.S. 2 500 9 l W C�)6m bac, V I Description of Soil S r,Y !P I Nature of Repairs or Alterations(Answer when applicable) t U5 t A IPW t,J I Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Bo r of Health.`' Signed l'/� Date /7 Application Approved by Date '' /?hq Application Disapproved by: ZZ Date for the following reasons E ' I Permit No. 2 06 -- I Z Date Issued :� /3 200 ----------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (✓Y Upgraded ( ) Abandoned( )by ✓ 4x 23�o,,.✓ at / d Lt> /✓, has been constructed in accordance with the provisions of Title 5 and the for Disp sal System Construction Permit No. 2.001- 12(p dated .S/1 3 ZOo� Installer lGS �!iw,.j�_I AK Designer :t-i i.vr In- C //✓G/It #bedrooms Approved design flow_J,3 I gpd The issuance of this pe it shall not be construed as a guarantee that the system � w�'ll f���designed. Date Inspector Av---------------—----------------------- ——— No. /__a 06 (j�2� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS Wigpogal *pgtem Congtruction Permit Permission is hereby granted to Construct ( ) Repair ( Upgrade ( ) Abandon ( ) System located at / 54Z ` Cc li and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. f 47 Provided: Constructio must be completed within three years of the date of this pe it. Date S / 20"m Approved by c •S. f Town of Barnstable IR.e Services Thomas F...Geiler,Director Pnbuc Healt�i sion Thomas McKean,-Director 200..A j*'Street,Hyannis,MA.02601 Office SDB'862-444. Fax: 508-79.0-6304 I11 toiler.&Designer Cet c tto>�i Form .�..,.�.....r..` .. ...gym Sews a Permit# Assossor.'s:Map\Parcel Date:. ..... .... ,g. Designer:; -ee iK, ��c r: :. ^li�� Installe X Address: -any a Le 69- 2�cyy V � cb`'`I n �A L was issued a permit to instal la 0 ., .._,) . installe ( _r) G septic system at, l S n t Sc.�,2 k9 CST_ based on a design drawn:by (address) dated ;(ct ner) I chi a y that the septk.system.referenced above was installed ubstantially according to the desiV whtch.may include mirror approued changes such as:lateral relocation of tie distltit�11 box and/or septic tank: I Ceti bet he s :fy septic system referenced above was installed with mayor changes r than 10 lateral relocation of the SAS or any vertical relocation of any component oftl septic system)but in accordance with State &:Local ahons: Plan;revision':or ce# as built by designer to follow. �P�SN OF Miss o�� qcy PETER T. MC , ENTEE -{ f's $1 dire' T CIVIL �' 9 PJo.35109,Q Q y ��S/OVAL��G\ �eexas Signature) (Affix Desgner.'s Stamp Here) PIN AART COMPLIANCE '1I:L NO.T' B ISSUED'UNTIL BOTH THIS FORM AND AS-BUII,T _CARD ARE RECEIVED BX THE BARNSTABLE PUBLIC HEALTH DIVISION THANK YOU Q:HWWSeptic/Desigper Certification Form 3-26-04.doc AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATION 01 LOC4 SEWAGE#E 12 6 VILLAGE P ASSESSOR'S MAP&PARCEL 166-06 INSTALLER'S NAME&PHONE NO.. jG;� A 1 jfQUtj Tn;C SEPTIC TANK CAPACITY 1000 EA 15b!pt LEACHING FACILITY:{type` A"b35 (size) 1 E.a X.14.C NO.OF BEDROOMS _3 OWNER_l( t�rta PERMIT DATE; 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 t 31 http://issgl2/intranet/propdata/prebuilt.aspx?mappar=166065&seq=1 7/26/2019 4 j ._ r Town of far st�be Depart ent of Regulatory Services blice~ lth D �i�ign Date 200 Main Street,Fiyanms ivlA 02601 Date Scheduled l/ Time. Fee:Pd r 4 f ►foil Suitabii Assessment or Seta a isp g Performed By Ci/ G �'� G Witnessed B t ,. y • Q MOM Location Address Owner's N `G �me 1 d Le • D 5r�✓ I� ...��' k Address 15 6 S E �q',^f Lu.� II Assessor's Map/Parcel: w do ^O tp $ Engineer's.Name ' c &' 'e /�G f"e NEW CONSTRUCTION REPAIR ;Telephone# 5 a f — 7 3-Z Land Use `IDS c CJ�xwI�Y^tl I Slopes(30) 2't-/� Surface Stbues_[Npt Distances from Open Water Body V_ft Possible Wet Area0_ft Drinking Water Well Drainage Way 7esd ft Property Line f ft Other ft : c SKETCH:(Street came,dimensions of lot,exact locations of test holes&perc tests,locate wetlands to proximity to holes) r I 2 i /40tr)-e 1 UL �M 'Parent mat&ial`(geologic) t U �5'/ Depth to fledrook �/ Depth to Groundwater,-Standing Water in Hole: ��/�� Weeping from Alt Paco n/1� Estimated Seasonal High Groundwater >- `� tCl''ATiC1�I:OR SEA 9,D 1 •�'GI�WAT Method Used: Depth Observed standing in obs.hole: In, Depth to Boll mottles: ln, -A"—Depth-to weeping from side'of obs.-hole: -- — :-:_'ln., -,Groundwater Ad ugment - - lndex.Well# Reading DaU;:- - Index Well level Y, 'Ad.factor '"`Agj,Groundwater Loyal-44 ® � OL Atm. R Observation ' Hole# / Time at 9" Depth of Perc 30 Time at 6' _ �w Stan Pre-soak Time; .. Time(9"•6") End Pre-soak ' t Rate MinAnch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) ir Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1) week prior to beginning. Q:\SEPTICIPERCFORM,DOC DEEP OESERVATION HOLE'LOG 11010# _ l Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) .(Munsell) Mottlin Structure,Stones.Boulders• g ( . (4,3 b. 2 M-c. Sw✓1 2.5`C ! • '•1� �'EP'aB���R'V�T�Ol'��C?��Lai �� ' • I�l<le#,::, D th frani' ; eP : - Soil Horizon SoilTcxturc Soil Color (USDA Surface(in.) ) (Mpnsell) ottling (StructureStones,Boulders. ' oflsistenc Ora.. 0 Fi-00 tVATIO i ROLE LOG Depth from Soil Horton , Soil Other..Soil Texture Soil Color i . , (USDA) (Munsell) Mottling _ (Structure,Stones,Boulders Consistency,%Gravel) _ DepchYrom bttr R ERVAT aI� IOLESoil Horizon Soil Texture 1 LOG Color Soil Other Surface(in.) (USDA) (Munsell) Mottlin • g (Structure,Stones,>3oulders. Consistency.&Qravel) Flood Insurance Rate May: Above 500 Year:flood boundary... No— Yes- within 500 year boundary No Yes within l00 year flood:.boundary_No Yes Depth of lYaturally Oceurrine Fervious:Material Does at least fear feet of naturally occurring pervious material exist in all,areas observed throughout the ardk proposed for the soil absorption system? �S If not,what'-is,thi depth,of-naturtilly occurring pe ous material?. Ce ti—,�ff d _n I certify that on_ l (date)I have passed_.the.soil evaluator examination approved byFElte Department of Environmental Protection and that the above analysis was_:performed by me consistent with t the,r:equ>xed"tratnin` expertise and e'xpezience descnbed'in 3I CMR,15.017 , ti Q 1SBl'T1CURrCFORM DOC D y ' �• 3 COMMONW'EALTH.OF MASSACHUSETTS �rI EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS yi c' DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTON. NIA 02108 617-292-5i00 WILLIANS.F.VELD TRUDY COXE Governor . - Secretary, ARGEO PAUL CELLUCCI DAVID B.STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - Commissioner PART A CERTIFICATION Property Address: 15 Old Salem Way, Osterville Address of Owner: E. Anderson Date of Inspection: ��'� �j^g 7 (If different) 428 Central Ave Name of,tnspector: Wm E Robinson Sr Milton, MA 021 84 ` - I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: Wm E Robinson- Septic Service - Mailing Address: PO Box 1 089 , Cent-prvi 1 1 ,- , MA 02632 Telephone Numbery 5 0 8 t 7 7 S-R 7 7 6 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: V Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: _ Date: f!,2,Li —3 7 The System Inspector shall submit a copy of this inspection report to the Approving Authority within 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 of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, Or D: Aj SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: BI YSTEM CONDITIONALLY PASSES: Orre--ar more systerrr components as.described-m-the'L-Gnd+t-ional-Ras7V-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. 1 Ind4ate 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 exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the Wortd Wide Web: http:/Mww,magnet.state.ma.us/dep F SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 15 Old Salem Way, Osterville Owner: Anderson Date of Inspection: B] SYS M CONDITIONALLY PASSES (continued) 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). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass —j inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed Cl FURT ER 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 the ublic health, safety and the environment. 1) S STEM WILL PASS UNLESS BOARD Of HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER ICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water J 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 APPROPRIATE) DETERMINES THAT T�E SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE E VIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and the 5A5 is within a,Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 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 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates tha 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. Method used to determine distance (approximation not valid). 3) THER (revised 04/25/97) Page 2 of 20 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 15 Old Salem Way,- Osterville Owner: Anderson Date of Inspection: i/—:x I- D] SYSTEM FAILS: You m t indicate eir.er "Yes" or "No" as to each of the following: it have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis IIfor this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct fhe failure. Yes �10 Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. I . 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-bok-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. Required pumping more than 4 times i'n 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 is within a Zone I of a public-well.;_ - t Am• 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 p acceptable water quality analysis: If the well has been analyzed to be acceptable, attach-copy of-well water analysis for )� coliform bacteria, volatile organic cormmunds,-ammonia nitrogen and'riarate nitrogen El LA GE SYSTEM FAILS: You ust indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: 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 1' 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) The wner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program, requi ements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised.04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 15 Old Salem Way, Osterville Owner: Anderson Date of Inspection: //—Q"- `1-9 ? Check if the following have been done: You must indicate either "Yes" or"No" as to each of the following: Yes No - y1 _ Pumping information was provided by the owner, occupant, or Board of Health. V _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow 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 nornsanitary or industrial waste flow. - _ The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System, have been located on the site. 1/ _ 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 on the site has been.determined based on: _ The facility owner (and occupants, If,different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. _ Existing information. Ex. Plan at B.O.H. Determined in the field (if any of the failure criteria related to.Part Cis at issue, approximation of distance is unacceptable) [15.302(3)(b)) revised 04/25/97) Page 4 of 10 SUBSURFACE SEWA GE GE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 15 Old Salem Way, Osterville - Owner: Anderson Date of Inspection: j/—JL 7-13 /J FLOW CONDITIONS RESIDENTIAL: Design flow: 3 S 0 g.p.d./bedroom for S.A.S. ' Number of bedrooms:3 Number of current residents: I Garbage grinder (yes or no):I(_J Laundry connected to system (yes or no) Seasonal use (yes or no):/,, d Water meter readings, if available (last two (2) year usage (gpd): 1996 — 148, 000g Sump Pump (yes or no):h. d 1997 — -1-32--1 000g-_' Last date of occupancy: C MERCIAL/INDUSTRIAL: Type establishment: Design low: gallons/day Grease ap present: (yes or no)_ Industri I Waste Holding Tank present: (yes or no)_ Non-sa tary waste discharged to the Title 5 system: (yes or no)_ Water eter readings, if available. Last 4ate of occupancy. OTHE - (Describe)_ Last of occupancy:_ GENERAL"INFORMATION PUMPING RECORDS and source of information: _ System p mped as part of inspection: (yes or no) If yes, volume pumped--- gallons - - Reason for pumping: FSYSTEM TYPE O,,,,Septic tank/distri but i on 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 etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of.information: Z,5• \./- S __ Sewage odors detected when arriving at the site: (yes or no) 'L J (revised 04/25/97) Page 5. 0f 10 f. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Old Salem WaY, Osterville Owner: Anderson Date of Inspection: B DING SEWER: (loca a on site plan) Depth below grade: Mater I of construction: _cast iron _40 PVC _other (explain) Dist nce from private water supply well or suction line Di eter Com ents: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: (locate on bite plan) Depth below grade: /a Material of construction: Zconcrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: [� "` F 6 — Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 3 0 Scum thickness: C -L7 Distance from top of scum to top of outlet tee or baffle: , Distance from bottom of scum to bottom of outlet tee or baffler_ - - How dimensions were determined: —I- Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert structural integrih evidence of leakage, etc.) 1 s `— ^ %> / ° f.e A'`' 6 sip a? GREA E TRAP: (locate n site plan) Depth low grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Din sons: Scum ickness: Dista ce from top of scum to top of outlet tee or baffle: Distan a from bottom of scum to bottom of outlet tee or baffle: Date o last pumping: Comme ts: (recom endation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integri , evidence of leakage, etc.) (revised 04/25/97 B ) Page 6 of 10 r - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Old Salem -Ways -Osterville Owner: Anderson --,-- Date of Inspection: ilr2, —Q r T16 T OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (locat on site plan) Depth low grade: Materi I of construction: _concrete _metal —Fiberglass =Polyethylene _other(explain) Dim nsions: - - --_ Cap city: gallons Desi flow: gallons/day Alarm evel: Alarm in working order _Yes; -..No - Date of orevious pumping: Comme ts: (conditic n of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOXY/ - (locate on site plan) Depth of liquid level above outlet invert: Comments: .(note if level and distribution is-equal, evidence of sol s carryover, evidence.-"of leakage into or out of box, etc.) - - - PUMP CHAMBER:_ (locat on site plan) Pu s in working order: (Yes or No) Al. s in working-order (Yes or No) Com ents: (note ondition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Old Salem Way, Osterville Owner: Anderson Date of Inspection: i i-;I- -7 -? SOIL ABSORPTION SYSTEM (SAS): / (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) if not determined to be present, explain: Type: leaching pits, number:) leaching chambers, number:_ leaching galleries, number:' leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) /G�� � �� / � ie - - ,ice�.�<•�" !- F' �- ti �- c<..- �-2 G /� / CIE�POOLS: _ (loca on site plan) Num r and configuration: Dept -top of liquid to inlet invert: Dept "of solids layer: De h of scum layer: Dii ensions of cesspool: ' aterials of construction: - Indi ation of groundwater: -- -_ inflow (cesspool must be pumped as part of inspection) Comme ts: (note c ndition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) P VY: _ (Ia to on site plan) Mater Is of construction: Dimensions: Depth of solids- . ents: (note ondition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) Page 6 of 10 —SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - — PART C SYSTEM INFORMATION (continued) Property Address: 15 Old Salem WY, Osterville Owner: Anderson = _ Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include.ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) 153 (roviaad 04/25/97) Pago 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Old Salem Way, Osterville Owner: Ander s O.n Date of Inspection: .x Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions -""Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) n r17 (revimed 04/25/97) Page 10 of 10 L - f COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ? ONE WINTER STREET, BOSTON. MA 02108 617-292-5500 WILLIAM F.WELD TRUDY COXE Governor Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner PART A CERTIFICATION Property Address: 15 Old Salem Way, Osterville Address of Owner: E. Anderson /Date of Inspection: / ',X 9—q 7 (If different) 428 Central Ave Name of Inspector: Wm E Robinson Sr Milton, MA 02184 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: Wm E Robinson Septic Service Mailing Address: PO BOX 1089 , Centervi 1 1 t' MA 02632 Telephone Numbers 5 0 8 7 7 5—R 7 7 6 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the inform orted below is true, accurate and complete as of the time of inspection. The inspection was performed based on my trai and experience in roper function and maintenance of on-site sewage disposal systems. The system: to Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: ll e,2-0i~ The System Inspector shall submit a copy of this inspection report to the Approving Authority within 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 of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] STEM 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. Indi to 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 exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the World Wide Web: http:ttwww.magnet.state.ma.usldep ej Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 15 Old Salem Way, Osterville Owner: Anderson Date of Inspection: 7 B] SYS M CONDITIONALLY PASSES (continued) 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). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four 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 C] FUR T ER 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 the ublic health, safety and the environment. 1) S STEM WILCPASS UNLESS-BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER ICH WILL PROTECT THE PUBLIC HEALTH AND 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) SY TEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT T E SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE E VIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 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 50 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 presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) THER (revised 04/25/97) Page 2 of 10 I, I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 15 Old Salem Way, Osterville Owner: Anderson Date of Inspection: 2`77 D] SYSTEM FAILS: You t indicate ei:!:er "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined 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 he failure. Yes 140 Backup of sewage into facility or system component due to an 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. 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 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. 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] LA GE SYSTEM FAILS: You ust indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: 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 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) The wner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requi ements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 c + SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 15 Old Salem Way, Osterville Owner: Anderson Date of Inspection: 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. V _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow 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. 4 _ 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. L _ All system components, excluding 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 on the site has been determined based on: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. Existing information. Ex. Plan at B.O.H. V _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)] (revised 04/25/97) Page 4 of 10 f 4 ? SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 15 Old Salem Way, Osterville Owner: Anderson Date of Inspection: //--;L 4^1)ij FLOW CONDITIONS RESIDENTIAL: Design flow: 3-3 a g.p.d./bedroom for S.A.S. Number of bedrooms:j=— Number of current residents: Garbage grinder (yes or no):/mac) Laundry connected to system (yes or no) Seasonal use (yes or no):/4- d 1996 — 148, 00 0 Water meter readings, if available (last two (2) year usage (gpd): g Sump Pump (yes or no):!+, e) 1997 — 13 2 , 000g Last date of occupancy: )j-i:—�/! COA MERCIAUINDUSTRIAL• Type )atary stablishment: Desigow:_gallons/day Greasap present: (yes or no)_ Indust Waste Holding Tank present: (yes or no)_ Non-s waste discharged to the Title 5 system: (yes or no)_ Watereter readings, if available: T ccupancy:cribe) ccupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pL-fm ped as part of inspection: (yes or no) eJ If yes, volume pumped: gallons Reason for pumping: TYPE OF STEM 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 etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) "k, 3 i (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Old Salem WaY, Osterville Owner: Anderson Date of Inspection: �` c��4 7 B U DING SEWER: (Loca a on site plan) Depth below grade: Mater I of construction: _cast iron _40 PVC _other (explain) Dist nce from private water supply well or suction line Di eter Com ents: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:,(, (locate on bite plan) Depth below grade: Material of construction: 4/concrete _metal _Fiberglass _Polyethylene —other(explain) If tank is metal, list age _ Is age-confirmed by Certificate of Compliance —(Yes/No) Dimensions: — Sludge depth: `1--11 Distance from top of sludge to bottom of outlet tee or baffle: I Scum thickness: 6—8' Y Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffler How dimensions were determined: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet inve , structural integcrity, evidence of leakage, e1c.) S ' '� �`a %� 1 a ° '°"'" %t " 4. E GREA E TRAP: (locate n site plan) Depth blow grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimens ons: Scum ickness: Dista ce from top of scum to top of outlet tee or baffle: Dista a from bottom of scum to bottom of outlet tee or baffle: Date o last pumping: Comme ts: (recom endation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integri , evidence of leakage, etc.) (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Old Salem Way, Osterville Owner: Anderson Date of Inspection: /h-2.`Y_q T T OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (looat on site plan) Depth low grade: Materi I of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dim nsions: Cap city: gallons Desi flow: gallons/day Alarm evel: Alarm in working order_Yes; _ No Date o revious pumping: Comme ts: (conditi n of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:(/ (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribur.ion is equal, evidence of so Ii s car over, evidence of leakage into or out of box, etc.) PUMP CHAMBER:_ (local on site plan) Pu s in working order: (Yes or No) Al s in working order (Yes or No) Com ents: (note ondition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Old Salem Way, Osterville Owner: Anderson Date of Inspection: -7 SOIL ABSORPTION SYSTEM (SAS): / (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, numbed leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) CE POOLS: _ (loca on site plan) Num er and configuration: Dept -top of liquid to inlet invert: Dept of solids layer: De h of scum layer: Di ensions of cesspool: aterials of construction: Indi ation of groundwater: inflow (cesspool must be pumped as part of inspection) Comme ts: (note c ndition of soil, signs of hydraulic failure, level of ponding„ condition of vegetation, etc.) P VY:_ (lo to on site plan) Mater a of construction: Dimensions: Depth of solids• Com ents: (note ondition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Old Salem WY, Osterville Owner: Anderson Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) l f � (revised 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Old Salem Way, Osterville Owner: Anderson Date of Inspection: //- 5--2 •7 ;x Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) (revised 04/25/97) Page 10 of 10 1 LEGEND ,l INa —— 101 —— EXISTING CONTOUR x 100:98 EXISTING SPOT GRADE ��;� eum s Rr� R°°, CP B (Sheet 2) = --eHW OVERHEAD WIRES L 31373. 9. G EXISTING GAS SERVICE toe Rd o. A W EXISTING WATER SERVICE a a plum $ a 500 GAL CHAMBER EXISTING SEPTIC TANK— TEST PIT WITH 3' STONE AT TOP OF TANK, EL=101.65 BENCHMARK se uit Rd P a m S TWO LOCATIONS INV.(OUT), EL.=100.32f - o`a o°7B r 11.2' x14.5' € N r7 0 0 o S 11'44'10" W LOCUS 110.00' I �, A_ LOCUS MAP �/1 'i� _ Benchmark Set NOT To' SCALE lIF— i s CONC. AT BULKHEAD COR. EXISTING LEACH PIT - � / -- � TO BE PUMPED, FILLED W1 TPt1 ••• • • k�o� \ \�` �� EL.=102.45 (Assumed) GENERAL NOTES: ' SAND & ABANDONED '� O 1 ., �O= . SHED I� 9 \1 �� 06 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL 10 k �'1 BOARD OF HEALTH AND THE DESIGN ENGINEER. i / 0 3 � 7.e of town —� 1 \ \\ 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS _2, rsd , . 10 g \ p ( OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE A- j �. LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW: 01 6 8 �\ —310 CMR 15.405(1)(b): .� •-\> 1) A 17' variance, S.A.S. to cellar wall, fora 3' setback. 40 MIL-POLY LINER SET 1 k,C�� 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT'BE BACKFILLED PRIOR EL=100.0 TO EL.97.0 lip 46 TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE CONNECT. BOTH CHAMBERS DECK DESIGN ENGINEER. 1 �� 8�\ `' WITH COMMON PIPE 1 N ( I 3'�-- �4 HR p�S \ z �\ 4. ,ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ; 2t ENGINEER BEFORE .CONSTRUCTION CONTINUES. OD Ln I L____J ,EX/ST/NG to U! OR 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. cp I cfl U JJJJJJ 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 11 "1 HOUSE (#15) GARAGE �� ?f THE CONTRACTOR OR OWNER TO.NOTIFY THE LOCAL BOARD OF TOF=103. 12f �'�� �. A_ HEALTH FOR PROPER INSPECTIONS _DURING CONSTRUCTION. I I porch _ . 103�p 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. THERE ARE NO WELLS WITHIN 150' OF THE,PROPOSED S.A.S. 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED-AS ` I118 10�) 10� Paved AGREED UPON BY OWNER AND-CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. 8 4 6 - Drive way 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY. -=—?_--_ _ _--102 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING Q , 1Oi------_ --------_— --- ' LOTF)7 CONSTRUCTION. \ 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS 11 329f.:/S.F. IN THE AREA' BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND Man. / VV REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). —�� — l' ,,VCCi5 12. AREAS .REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL 'BE parcef— — —--__ —— _____y —101 ��OF INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL / 110.00' — �pa �qSs 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND ----___ IN 11'44'10" E gCyG IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. --- —___ PETER T. b ---�a0---- i o McENTEE — ——— " CIVIL Cn ` �'—+100 No.35109 PLAN REVISION - 5/16f09 9 edge of pavement g9 99 QUO 9FQ/3T�P�0 @ REVISE S.A.S. LOCATION, CONFIGURATION & SETBACK. TO CELLAR WALL VRIANCE. 9S ��ssiolu ENG PROPOSED SEPTIC SYSTEM UPGRADE PLAN OLD SALEM WA Y 15 OLD SALEM WAY, , OSTERVILLE, MA S�t(It drCk Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO. CRAIG & KRISTI TAMASH Engineering Works, Inc. 1"=20' P.T.M. 125-09 15 OLD SALEM WAY 12 West Crossfield Road, Forestdale,' MA 02644 DATE CHECKED SHEET-NO. OSTERVILLE, MA 02655 (508) 477-5313 4/24/09 P.T.M. 1 Of 2 ti r NOTE: TO PREVENT BREAKOUT, THE PROPOSED ` FINISH GRADE SHALL NOT BE < EL:99.7 ' FOR A DISTANCE OF 15'. AROUND THE PERIMETER OF THE S.A.S. (3) 5" DIA.OUTLETS SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S, :I INSTALL RISERS & COVERS OVER INLET & INSTALL 'RISER & COVER -INSTALL RISER & COVER OVER ONE CHAMBER AND 15.5", rE 16 2" T.O.F. OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE SET TO 3' OF F.G. TO SERVE AS INSPECTION PORT EXISTING ` F.G. EL: 103.3f(MAX.) • /' � F.G. EL.=102.5t � F.G. EL: 102.6t • • . `1 12„ 15.5" L - V L - 33'(MAX) S=1% (MIN.) ® S=1% (MIN.) T 4"SCH40 PVC 4"SCH40 PVC 2" LAYER OF 1/8" TO 1/2 g•• 'DOUBLE WASHED STONE • y.. 07 •'4 OEFFEC as (OR APPROVED FILTER'FABRIC 14" s B$BBBH-10 "LOADINGEXISTING 48" UQUID INV.=•100.32t aaaaa -3/4" TO 1-1/2" DOUBLELEVEL INV:=100.30 INV.=100.13 3' S.2' 3' WASHED STONED-BOX GAS BAFFLE E WIDTH 11.2'PROPOSED D-BOX ' ' WITH INLET 'TEE INV:=99`.20 N.T.S. SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS. SURROUNDED WITH STONE AS SHOWN H=10 RATED TOP CONC. ELEV.=100.3' BREAKOUT ELEV.=99.70 rEMOEO 0 INV. ELEV.=99.20 Ba e NOTES: 1) D-BOX SHALL BE SET LEVEL AND,TRUE TO aaaam amuse ® ® ® GRADE ON A MECHANICALLY COMPACTED SIX' ease aaaam 37" INCH CRUSHED STONE BASE, AS SPECIFIED IN . BOTTOM ELEV.=97.20 310 CMR 15.221(2). 3' 8.5' 3' N Z ® ® U®® ® 2) INSTALL INLET & OUTLET TEES AS REQUIRED. •. 5` MIN. ABOVE BOTTOM OF EFFECTIVE.LENGTH = 14.5' 3) GAS BAFFLE TO BE INSTALLED 'ON OUTLET- TEE T.P. EXCAVATION OR G.W. AS MANUFACTURED.BY TUF-TITE, ZABEL OR EQUAL LEACHING SYSTEM SECTION 4) AS COVER OVER SEPTIC TANK, D-BOX & S.A.S. NO GROUNDWATER, EL=91.7 T 102" SHALL BE 36", SEPTIC SYSTEM PROFILE ` N.T.S. 4" KNOCKOUT o" DIA. C SOIL LOG 2 DESIGN CRITERIA �� OVER ' DATE: APRIL 16, 2009 (REF#12;521') 4" KNOCKOUT / 4" KNOCKOUT 62" NUMBER OF 'BEDROOMS: 3• BEDROOMS , SOIL EVALUATOR: PETER McENTEE PE r SOIL TEXTURAL CLASS: CLASS I WITNESS: DAVID STANTON. R.S: s T ». HEALTH AGENT DESIGN PERCOLATION RATE: <2 MIN/IN ELEV. TP- 1. DEPTH ;ELEV. TP-2 DEPTH 4" KNOCKOUT DAILY FLOW: 330 G.P.D. 011 DESIGN FLOW: 330 G.P.D. 102.2 A 0, 102.3 A SANDY' LOAM SANDY LOAM GARBAGE GRINDER: NO 10YR 4/2 10YR 4/2 1"01.9 4" 102.0 4,> EXISTING SEPTIC TANK: 1000 GALLON CAPACITY B SANDY LOAM SANDY LOAM B • 500 GALLON CAPACITY, H-10 LOADING • - LEACHING AREA REQUIRED: (330) = 445.9' S.F. 10YR 5/8 10YR 5/8 .74 99.2 C1 36" 99.3 C1 36" CHAMBERS USE 2-500 GALLON LEACHING CHAMBERS IN SERIES PERC N.T.S. SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 1 66" SIDEWALL AREA: 2 CHAMBERS x 2(11.2' + 14.5') X 2 = 205.6 S.F. M-C SAND M-C SAND .r PROPOSED SEPTIC SYSTEM UPGRADE PLAN , BOTTOM AREA: 2 CHAMBERS x 11.2' x 14.5', 324.8 S.F. 2.5Y 6/4 ?.5Y 6/4 15 OLD SALEM WAY, OSTERVILLE, MA TOTAL AREA:.......................................................................!................ 530.4 S.F. Prepared for: D: A. Brown, Inc., P.O., Box 145, Centerville, MA 02632 AREA BLOCKED BY POLYLINER: 2 x 14.5' X 2' = 58.0 S.F. Engineering by: •° SCALE' ;DRAWN JOB. N0. NET AREA.............................................................................................472.4 S.F. 91.7 126' 91.8 126" En ineerinn Works Inc NTS. P.T.M. 125-09 PERC RATE <2 MIN/IN: ("Cl" :HORIZON) 12 West Crossfieldd Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. DESIGN -FLOW PROVIDED: 0.74(472.4) = 349.6 G.P.D. NO GROUNDWATER ENCOUNTERED (508) 477-5313 4/24/09 P.T.M. 2 of .2 LEGEND o N y4vk • _ T • • � - � --— 101 —— EXISTING CONTOUR x 100.98 EXISTING SPOT GRADE ��;• eum s R'ver Road Sheet•2) . --6HW— OVERHEAD WIRES 31373 B ; 3 LC P G EXISTING GAS.SERVICE ce Vottey Rd A N n b1/ EXISTING WATER SERVICE ° 500 GAL CHAMBER EXISTING SEPTIC _TANK TEST PIT S� �a a WITH 3' STONE AT TOP OF TANK,—EL.=101.65 ®i BENCHMARK Se uit Rd QO�a m S TWO LOCATIONS INV.(OUT), Et.' 100.32E o`a F°7es w 11'.2' x 14.5' y e N � o o S 11*44'10" W LOCUS Js4 i 110.00' I do k LOCUS MAP i Ben chm ark Set NOT TO SCALE EXISTING LEACH PIT lr—'— - i—� `� CONC. `AT BULKHEAD COR. GENERAL NOTES: TO'BE PUMPED, FILLED w/. � ' I• � • • • kip \ _____ �` ��� EL:=102.45 (Assumed) ' SAND & ABANDONED �O� SHED. TP't1 I\y�?j8 1� �--- — � \jp6� 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL \ jp 0 1�� "�� _ - jp3� BOARD OF HEALTH AND THE DESIGN ENGINEER. i 1p_2 I_ • o — — \ 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS jp edge of.lawn �jp� \ OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE 1 K LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW: t. Ipl, 6 8 ?\ \' —310 CMR 15.405(1)(b): - Cb 1) A 17' variance, S.A.S. to cellar wall, for a 3' setback. 40 'MIL POLY LINER SET 1Q A- 7 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR EL.=100.0 TO EL.97.0 �p ' �4,6° T0. INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE o 1---- I / DECK �� 8\\ 3 DESIGN ENGINEER, CONNECT BOTH CHAMBERS / p WITH COMMON PIPE '1 cn j 3�` H �4 HR _ jp�'S Z �\ 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING * 1 v I I O I 4 \ ,FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. u ry ry sr 5. ALL ELEVATIONS .BASED ON ASSUMED DATUM.' t cn I -=--� SEX/STING. �' Ln co 1 co Ln 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 10 'I t HOUSE (#15) GARAGE _ + THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF IM I TOF=lO3. 12f ,—a� k HEALTH FOR PROPER INSPECTIONS DURING .CONSTRUCTION porch � j03e0 � 7. WATER`SUPPLY PROVIDED BY TOWN WATER SERVICE. � :8. THERE ARE NO WELLS WITHIN 150' OF.THE PROPOSED S.A.S.' 9. ALL AREAS' CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS j0 j0 Paved AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. Driveway' 10. IT SHALL BE THE RESPONSIBILITY OF THE. CONTRACTOR TO VERIFY -- �?____• -102 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING o 1 OZ------- ` t CONSTRUCTION: LOT 67 11.., WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS' ��. �1/1 .329E S.F. - IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE .S.A.S. AND 1 /V/aP , 'b'6' -REPLACE WITH CLEAN SAND -AS SPECIFIED IN,310 CMR 255(3). 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE Parcel —V r�— ———___ — ____y —101 INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL j ` 1— 110.00' y — 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND --- IN 11'44'10" E OFM IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. �H. �; 00 PLAN REVISION 5/•16J09 1 PETER � > ed. a of pavement ItAcENTEE REVISE S.A.S. LOCATION, CONFIGURATION "& SETBACK TO CELLAR WALL VRIANCE. 9J 9 P 99 99 c� CIVIL No:35109�0 �Q. 6LD SALEM WAY TAP G PROPOSED SEPTIC SYSTEM UPGRADE PLAN /0 All"_ 15 OLD SALEM WAY, OSTERVILLE, • MA Prepareda for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO. t 1'=20' P.T.M. 1 — RAI KRISTI TAMA N ry 25 09 C G & S En Works Inc. Engineering 15 OLD SALEM WAY 12 West .Crossfieldd Road, Forestdale, M_A 02644 DATE CHECKED SHEET OSTERVILLE, MA 02655 (508) 477-5313 �. 4/24/09 P.T.M. 1 f 2 NOTE: TO PREVENT BREAKOUT, THE PROPOSED 4 FINISH GRADE SHALL NOT BE < EL:99.7 FOR A-DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. I (3) 5" DIA.OUTLETS INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL RISER & COVER OVER ONE CHAMBER AND 15.5° I� 16 -I 2" OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT T.O.F. F.G. EL: 103.3t(MAX.) ;•...,,. .... EXISTING F.G. EL.=102.5t F.G. EL: 102.6t E E60.' 15.5" 2L = 1' L = 33' MAX. 6" ® S=1`o (MIN.) ® S=1%((MIN) '; 2" LAYER OF 1/8" TO 1/2"4"SCH40 PVC 4'SCH40 PVCDOUBLE WASHED STONE a (OR APPROVED FILTER FABRIC „ t4" saaaaB 2EXISTINGaa' uQUID aaaaaaa --3/4" TO 1-t/2" DOUBLE H-10- LOADINGINV..=lO0.32f - WASHED STONELEVEL 3' EFFECTIVE WIDTH 3' BINV.=100.30 INV.=100.13 D. OX GAS BAFFLE - 11:2'PROPOSED D=BOX EXISTING SEPTIC TANK WITH INLET TEE INV.=99.20 N.T.S., 2-500 GALLON LEACHING CHAMBERS SURROUNDED WITH STONEAS SHOWN .. H-10 RATED < TOP CONC. ELEV."=100.3 BREAKOUT ELEV.=99.70 ®®®� ® ® ®®� , ' INV. ,ELEV.=99.20 ease NOTES: 1) D-BOX SHALL BE SET LEVEL AND TRUE TO a6aaa aeB®a ' ®®®®®® ® ® ®®® GRADE ON A MECHANICALLY COMPACTED SIX ease 666aa 37. , INCH CRUSHED STONE BASE, AS .SPECIFIED IN BOTTOM ELEV.=97.20 3'. 8.5' 3' `w ®®®®®® ® ®®® ED 310 CMR 15.221(2). _ E3 LTE3 ® ® ®®� N .> 2) INSTALL INLET & OUTLET TEES AS REQUIRED: .. 5' MIN. ABOVE BOTTOM OF ., EFFECTIVE LENGTH = 14.5' Z 3) GAS BAFFLE TO BE INSTALLED ON`OUTLET TEE J.P. EXCAVATION OR.G.W.' AS MANUFACTURED BY-TUF-TITE, ZABEL OR EQUAL. LEACHING SYSTEM SECTION 4) MAXIMUM COVER OVER SEPTIC TANK, D-BOX & S.A.S. NO GROUNDWATER, EL.=91.7 = ,'102" . SHALL BE 36". , _ .SEPTIC SYSTEM PROFILE �• t N.T.S. 4" KNOCKOUT"'SOIL LOG . DESIGN CRITERIA zo".DIA. COVER r , DATE: APRIL 16, 2009 (REF#12,521) 4" KNOCKOUT r `4" KNOCKOUT 62" NUMBER OF BEDROOMS: 3. BEDROOMS SOIL. EVALUATOR: PETER;rMcENTEE PE SOIL TEXTURAL CLASS: CLASS I tWITNESS: DAVID STANTON„ R.S. t ;DESIGN PERCOLATION RATE:` <2 MIN/IN HEALTH AGENT. : F ELEV. TP- DEPTH 'ELEV. TP-2 DEPTH 4" KNOCKOUT DAILY FLOW: ' . 330 G.P.D. DESIGN FLOW: 330 G.P D. 102.2 A - 0, '102.3 A 0' } SANDY.LOAM SANDY LOAM - GARBAGE GRINDER: NO:. • 101.9 10YR 4/2 102.0 10YR 4/2 EXISTING SEPTIC' TANK: 1000 GALLON CAPACITY G . e 41 e 4" 500 GALLON CAPACITY, H-10 LOADING SANDY'-LOAM SANDY LOAM _ LEACHING AREA REQUIRED: (330) _._445.9 S.F. 10YR 5/8 10YR 5/8 .74 99.2 C1 36 99.3 C1 36- CHAMBERS USE 2-500 GALLON LEACHING CHAMBERS IN SERIES PERC N.T.S. SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 66" SIDEWALL AREA: 2 CHAMBERS x 2(11.2' T 14.5') x z = .205.6 S.F. M-c SAND 3 M=c SAND PROPOSED SEPTIC SYSTEM UPGRADE PLAN BOTTOM AREA: 2 CHAMBERS x j 1.2' x 14.5' 324.8 S.F. 2.5Y 6/4 2.5Y 6/4 • . 15, OLD SALEM ' WAY, OSTERVILLE, MA TOTAL AREA:..................................................................*.............:....... 530.4 S.F. Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 AREA BLOCKED BY POLYLINER: 2 x 14.5" X 2' = 58.0 S.F. SCALE DRAWN JOB. NO. • Engineering by: NET AREA.............................................................................................472.4 S.F. 91.7 •126" 91.8 126" NTS P.T.M. 125-09 Engineering Works, Inc. DESIGN FLOW PROVIDED: 0.74(472.4) = 349.6 G.P.D. PERC RATE <2 MIN/IN. ("Cl" HORIZON) 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. NO GROUNDWATER- ENCOUNTERED (508) 477-531.3 4/24/09 P.T.M. 2 of 2