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HomeMy WebLinkAbout0069 OLDHAM ROAD - Health f Adh }�9 am`-Road Osteiv lop 14, ille r 10 , rC ` c a � e t 0 r - o ' j. \; No. . .Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Zipplitation for Misposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair/"Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Loca on Addres or Lot No. G q ®/rfliia q 9d Owner's Name,Address,and Tel.No. ��tetve�l Assessor's Map/Parcel f a Q Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. t7,A ZfoWrO 1 rX, !;'68 020 AbAlKS' - /. Type of Building: Dwelling No.of Bedrooms 3 Lot Size / sq.ft. Garbage Grinder( ) Other Type of Building t es id ,*,cL) No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3-30 gpd Design flow provided gpd Plan Date j� I�?(J Number of sheets 2 Revision Date Title Size of Septic Tank 6jy� Type of S.A.S. ;Z 5 64/4-3N Description of Soil Nature of Repairs or Alterations(Answer when applicable) (n�S�kl� Lt 3 ll-xo 4,yd a /7%yo sw OVI wy Lkolly&15 coltk J/ flwtvr al. hi ty 4/cam Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signe Date 1;rljfj900 , Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued dlL� (�`� No. _ Fee THE COMMONWEALTH OF MASSACHUSETTS' Entered in computer: UBLICEALTH DIVIS:IO:N - TOWN OFARNSTAB'LE MASSACHUSETTS Yes "• 4plicatlon for Misposal 6pstrm Construction permit Application for a Permit to Construct( ) Repair(V11*`Upgrade( )iA'ban"do( )l ,❑`_Cbmplete.System ❑Individual Components Location Addres or Lot No. G q 0/C)/l �v Owner's Name,Address,and Tel.No. Assessor's Map/Parcel /g(� - //- ­ Svu f1°� Installer's Name,Address;iagid T�1!IN�o. , �` '} J esigner' Name,Address;,and el.10) �0g ao�-�/s3h' CN ,� ;lac S -y7l Sal Type of Building: Dwelling No.of Bedrooms 3 Lot Size / sq.ft. Garbage Grinder( ) Other Type of Building j f5/d&\)�-iq J No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 130 gpd Design flow providedyS,(� gpd Plan Date*'10/—,;o 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) L N s ypG�� d Lo AA-)d ,2 11,fo r(c (alll b� fG+c��J�!5 Gl/f� N� �fGNr G S�p✓ ✓)•I Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signe Date 7 a2 Application Approved by Date o 0 Application Disapproved by Date for the following reasons PermitNo.� (�p2,�-/ Date Issued --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ✓� Upgraded( ) Abandoned( )by ,, pouJN l NL at 6 q o ld X i,nn �U �s t C/l!!I�e has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No,-V-YJ —3,',l 4 dated /0//(4 1—C� Installer /2 c,,,,,,j ZNC_ Designer 1' #bedrooms Af roved-desi ow '3�(� gpd The issuance of this permi shall notrb-ee construed as a guarantee that the stem 11 ti as design . Date �(p ems' Inspecto --------------�---j-------------------------------------------------------------------------------------------------------------------- Noc� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH=DIVISION.-BARNSTABLE,MASSACHUSETTS;`,,: itsposal 6pste onstruction j3ermit --- ;, Permission is hereby granted to Construct( )t. Repair'( Upgrade( ) Abandon( ) System located at 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 comple ed within three years of the date of this permit. Date ��/�y Approved by Town of Barnstable �FTNE Tp� yQ� Regulatory Services Richard V.Scali,Interim Director aexxsrnst,e. "s"S& $ 16�Y Public Health Division _ e�0 ^?kD Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 505-790-6304 f / Installer&Designer Certification Form Date: Sewage Permit!# Assessor's Map\Parcel Zy t V c 1 C e Vl-+e__ Designer: n e �;n v . Installer: ; A QQA t�L Address: J Z W f Cf f2—,4 Address: Gr1eJ 1-L_dC0t,M A 6 Z64l y Le t„4z- V Mtk On to A QQ was issued a permit to install a (dat ) (installer) septic system at a �►(CA tla V", J1 —, 0_iL t-- based on a design drawn by (address) ;art een'.-1 . 6'V c✓LCsr Jk< dated (designer) _J!:�,I certify that the septic system referenced above was installed substantially according to the desiCD gn, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State &Local Regulations: Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in with the terms of the I\A approval letters(if applicable) p�S NRVE m Installer's Signature) M C1 4iL t4o,351t39 O RFQIStER�c (Designer's Signature) (Affix Design'e �� ! ere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL. NOT BE ISSUED UNTIL BOTH THIS FORM AND AS BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q'Septic.DesignerCertification Form Rev 5-14-13.doe Engineers note:This certification is limited to an as-built inspection of system components as installed prior to backfili.The engineer did not supervise construction of the system.The installer assumes responsibility for all materials,workmanship,backfilling to specified grades with proper compaction and setting risersicovers as shown on the design plan. Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 69 OLDHAM RD Property Address BLETZER Owner Owner's Name information is required for OSTERVILLE MA 2/10/12 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. heri�nt filling out W A. General Information When forms on the I computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. DOUGLAS A BROWN INC . Company Name r� P.O. BOX 145 Company Address CENTERVILLE MA 02632 " Cityrrown State Zip Code 508-420-4534 S 14297 Telephone Number License Number B. Certification 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 �4 y ❑ Needs Further Evaluation by the Local Approving Authority g Q 2/10/12 t �� Inspec Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(B$ard of Health or DEP)within 30 days of completing this inspection. If the system is a shared,11rster1 has a design flow of 10,000 gpd or greater, the inspector and the system owner shall sut�it tW 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. &get5ins-09108 Title 5 Official Inspection Form:Subsurfal System•Page 1 of 17 f r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 69 OLDHAM RD Property Address BLETZER Owner Owner's Name information is required for OSTERVILLE MA 2/10/12 every page. City/Town State Zip Code Date of Inspection B. Certification (coot.) Inspection Summary: Check A,B,C,D or E /always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM MEETS MINIMUM PASSING REQUIREMENTS AT THIS TIME, HOUSE WAS OCCUPIED BY 1 ELDERLY PERSON FOR MANY YEARS, FUTURE PERFORMANCE UNDER THE SAME OR INCREASED USE CAN NOT BE GUARANTEED B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 INN Commonwealth of Massachusetts . Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments « 69 OLDHAM RD Property Address BLETZER Owner Owner's Name information is required for OSTERVILLE MA 2/10/12 every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ 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 t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 L Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments „ 69 OLDHAM RD Property Address BLETZER Owner Owner's Name information is required for OSTERVILLE MA 2/10/12 every 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 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 day flow t5ins•09/08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 69 OLDHAM RD Property Address BLETZER Owner Owner's Name information is required for OSTERVILLE MA 2/10/12 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than-100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® 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. t5ins-09(08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 69 OLDHAM RD Property Address BLETZER Owner Owner's Name information is required for OSTERVILLE MA 2/10/12 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ 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 (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms}: 330 t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �t 69 OLDHAM RD Property Address BLETZER Owner Owner's Name information is required for OSTERVILLE MA 2/10/12 every page. City/Town State Zip Code Date of Inspection D. System Information Description: ACCORDING TO AS-BUILT CARD SYSTEM CONSISTS OF A 1000 GALLON TANK D-BOX AND ONE LEACH PIT ti Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: \ HOUSE IS VACANT MINIMUM READINGS ACCORDING TO WATER DEPT LO(f C(f j 7i�G piV Sump pump? ❑ Yes ❑ No Last date of occupancy: UNKNOWNDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 69 OLDHAM RD Property Address BLETZER Owner Owner's Name information is required for OSTERVILLE MA 2/10/12 every 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: FAMILY SAID TANK WAS PUMPED IN 2010 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•09108 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 69 OLDHAM RD Property Address BLETZER Owner Owner's Name information is required for OSTERVILLE MA 2/10/12 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: SYSTEM APPEARS TO BE ORIGINAL 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): 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: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ 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 4 Dimensions: 1000 GALLON Sludge depth: TRACE t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 ii Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 69 OLDHAM RD Property Address BLETZER Owner Owner's Name information is required for OSTERVILLE MA 2/10/12 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 0 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? WOODEN POLE Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): TANK IS CLEAN AT THIS TIME Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete. ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 69 OLDHAM RD Property Address BLETZER Owner Owner's Name information is required for OSTERVILLE MA 2/10/12 every 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.): TANK LOOKS TYPICAL FOR ITS AGE 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: 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 t5ins•09/08 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 69 OLDHAM RD Property Address BLETZER Owner Owner's Name information is required for OSTERVILLE MA 2/10/12 every page. City(rown 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 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.): BOX LEVEL NO SOLID CARRY OVER 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of (Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 69 OLDHAM RD Property Address BLETZER Owner Owner's Name information is required for OSTERVILLE MA 2/10/12 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: Elleaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): PIT WAS OPENED AND HAD AROUND 1.5 FT OF WATER AT TIME OF INSPECTION THERE WERE SEVERAL STAIN LINES THE HIGHEST AROUND 1 FT FROM BOTTOM OF INLET INVERT, PIT STILL APPEARS TO BE LEACHING 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 t5ins•09/08 Title 5 Official Insp ection 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 ,M 69 OLDHAM RD Property Address BLETZER Owner Owner's Name information is required for OSTERVILLE MA 2/10/12 every 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.): t5ins•09/08 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 ,M 69 OLDHAM RD Property Address BLETZER Owner Owner's Name information is OSTERVILLE MA required for 2/10/12 every 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 t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 69 OLDHAM RD Property Address BLETZER Owner Owner's Name information is required for OSTERVILLE MA 2/10/12 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water l ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: SEE ATTACHED 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: SEE ATTACHED PAPER WORK Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 69 OLDHAM RD Property Address BLETZER Owner Owners Name information is required for OSTERVILLE MA 2/10/12 every page. C4rrown 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 t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form_Not for.Voluntary Assessments 69 Oldham Road Property Address Dorothy Stevenson Owner Owner's Name information is required for Osterville . MA 02655 10/29/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to:at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. . Locate where public water supply enters the building. C) Q 1 Lot /� 1bdC� - CL I�o rn PY-4 ISinsp•08106 Title 5 Official Inspection Form'.Subsurface Sewage Disposal System•Page 14 of 15 Permit Number: Date: Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location: 6e �51IAza,* A a, 1 Lot No. Owner: ' J� y Address: Contractor.--,! Address: `. Notes: STEP 1 Measure depth to water table ll � to nearest 1/10 ft. ......................................... ............... .Date 7 10' month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: n. OA Appropriate index well. ......... OWater-level range zone ::: STEP 3 Using monthly report"Current Water Resources Conditions" determine current depth to water level for index well .......:................... month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 2B) �- determine water-level adjustment.......... L1' I i STEP 5 Estimate depth to high water 1. by subtracting the water- level adjustment (STEP 4) from.measured depth to water levelat site (STEP 1) ............................................................................................................. I I i I Figure 13.--Reproducible computation form. 15 '7 0, F / 00 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 69 Oldham Road Property Address Dorothy Stevenson - Owner Owner's Name information is required for Osterville MA 02655'. 10/29/07 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:When filling out A. General"Information HILaforms on the computer,use 1. Inspector: �. only the tab key p to move your Robert.i. Bortolotti cursor—do not Name of Inspector use the return 4 key. Bortolotti Construction, Inc. Company Name P. O. Box 704 -45 Industry road - - t Company Address Marstons Mills MA '=02648 rswn City/Town State `-f;ZiP Code x 508-771-9399 �a Telephone Number License Number. „ M tax r_ B. Certification I certify that I have personally inspected.the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: Passes . , ❑ Conditionally Passes ❑ Fails ❑,.I Needs Further Evaluation by the Local Approving Authority Inspecides signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of'10,000.gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system-owner and copies sent to the buyer, if applicable, and the approving authority. ' ****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 `t the same or different conditions of use. t5insp•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts t ' . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for.Voluntary.Assessments 69 Oldham.Road Property Address, Dorothy Stevenson Owner Owner's Name information is required for Osterville MA 02655 10/29/07 every 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: System Conditionally B S st y Passes: Y ❑ One or more system components as described in the"Conditional Pass' section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old" or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with'a complying;septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of.Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out-or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with.approval of Board.of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed l5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-.Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Ins pection .Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,. 69 Oldham Road Property Address Dorothy Stevenson Owner Owner's Name information is .Osterville MA . 02655 10/29/07 required for every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced . ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health); ❑ broken pipes)are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of.Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool.or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water I supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. t5insp-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form :Not for Voluntary Assessments ,M 69 Oldham Road Property Address Dorothy Stevenson Owner Owner's Name information is required for Osterville MA 02655 10/29/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board ofHealth (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a_DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are.triggered, A copy of.the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or ❑ ❑ clogged SAS or cesspool ❑ El due or ponding of effluent to the surface of the ground.or surface waters due to an overloaded or clogged SAS or cesspool El ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El El than depth in cesspool is less than 6" below invert or available volume is less. than Y2 day flow El El obstructed 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; cesspoolor privy is below high ground water elevation. 0 Any portion of.cesspool or privy is within 100 feet of a surface water supply or tributary to a surface-water supply. t5insp 08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 69 Oldham Road Property Address Dorothy Stevenson Owner Owner's Name information is required for Osterville MA 02655 10/29/07 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ❑ Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ❑ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no.other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ❑ 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 ❑ El 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. t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 69 Oldham.Road Property Address Dorothy Stevenson Owner Owner's Name information is Osterville MA 02655 10/29/07 required for every page. City/Town 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? a ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ElWere 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?. ® El information 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)] t5insp•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page.6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments, ,M 69 Oldham Road Property Address Dorothy Stevenson Owner Owners Name information is OStervllle required for MA 0265.5 10/29/07 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): �5 Sump pump? ❑ Yes ® No Last date of occupancy: current-year round residence Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ .No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 C Commonwealth of Massachusetts W Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form = Not for Voluntary Assessments ,M 69 Oldham Road Property Address Dorothy Stevenson Owner Owner's Name information is Osterville MA :02655 10/29/07 . required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General.Information Pumping Records: Source of,information: Pumped November'06 -provided by owner. 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) ❑ Tight tank. Attach.a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (If known) and source of in formation: 27 years Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-.Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments_ M 69 Oldham Road Property Address Dorothy Stevenson Owner Owner's Name information is required for Osterville - MA 02655 10/29/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction liner feet - Comments (on condition of joints,.venting, evidence of leakage, etc.): Septic Tank(locate on site plan): . Depth below grade: Inlet 4 -Outlet 341, feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age:_ years Is age confirmed b a Certificate of Compliance? attach a co of certificate ❑ Yes ❑ No 9 Y P ( copy ) ,. i Dimensions: 8.5'x6'x5' 6' Sludge depth.- Distance from top of sludge to bottom of outlet tee or baffle 3 Z o,, Scum thickness Distance from top of scum to top of outlet tee or baffle i Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? physical observation t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth_of Massachusetts W Title 5 Official Inspection Form.. Subsurface Sewage.Disposal System Form -Not for Voluntary Assessments M 69 Oldham.Road Property Address Dorothy Stevenson Owner Owner's Name information is required for Osterville MA 02655 10/29/07 every 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.): It's a 1000 gallon septic tank with inlet cover 4"and outlet 34" to grade, it has cement inlet and outlet tees with no scum and 6"sludge at time of inspection: Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete: ❑ metal ❑ fiberglass,,. ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle.. Date of last pumping: date 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 cons truction: ❑ concrete ❑.metal. ❑ fiberglass ❑ polyethylene ❑other(explain):, l5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 r Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 69 Oldham Road Property Address Dorothy Stevenson Owner Owners Name information is required for Ostervi Ile .MA 02655 10/29/07 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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? El Yes ❑ No Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert Working Level Comments (note if box is.level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc:): Distribution box is 36"to grade and at working level at time of inspection Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts �t W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 69 Oldham Road Property Address Dorothy Stevenson Owner Ownees Name information is Osterville MA 02655 10/29/07 required for State Zip Code every page Date oflnspection :. City/Town D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and.appurtenances; etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not.located, explain why: Type: 1 ® leaching.pits number: leaching chambers number: leaching galleries number: teaching trenches number, length: leaching fields number, dimensions: overflow'cesspool number: 0 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.): It's a 1000 gallon leach pit with cover 24" to grade, water level was 34"from cover, with staining 9" below inlet pipe at one point in time. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 t5insp•08/06 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form =Not for Voluntary Assessments 69 Oldham Road Property Address Dorothy Stevenson. Owner Owner's Name information is required for Osterville MA 02655 10/29/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont) 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 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.): t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form :Not for Voluntary Assessments M, 69 Oldham Road Property Address Dorothy Stevenson - Owner Owner's.Name information is Osterville MA 02655 10/29/07 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. . Locate where public water supply enters the building. �-j � �o©o Ic l o t5insp•08106 Title 5 Official Inspection Form:Subsurface Sewage.Disposal System•Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage.Disposal System Form-Not for Voluntary Assessments 69 Oldham Road Property Address Dorothy Stevenson Owner Owner's Name information is required for Osterville MA 02655 10/29/07 every page. Cityrrown State Zip Code "Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells l Estimated depth to ground water: 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 groundwater elevation: urn V t5insp•08l06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 C Permit Number: Date: Co mpleted leted b : 014 i p Y HIGH GROUND-WATER LEVEL COMPUTATION Site Location: GC r�(�t r Lot No. ,a Owner: if Of, Address: Contractor: e✓ Address: Notes: ®• � ��� /� is STEP 1 Measure depth to water table � tonearest 1/10 ft ................................ Date......... .................... month/day/Year STEP 2 Using Water-Level Range Zone and Index Wei 1.Map.locate site and determine: :- OA .Appropriate index well ......:............ Wafer=level range zone ..:.:..:: _ STEP 3 Using monthly report"Current Water Resources Conditions" `determine current depth to water level for index well ......... Y,7 month/year STEP 4 Using Table of.Water-level Adjustments for index well (STEP 2A),.current depth to water level for index well (STEP 3), and water-leve1.zone STEP 26 . .. determine water-level adjustment + STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from.measured depth to water level at site-.(STEP 1) ............................................................ +, ............ Figure 13.--Reproducible computation form. 15 aim L' fIc K IF THE COMMONWEA!,,-EH OF MASSACHUSETTS .- BOARD O`F H A T ............ OF....................................... App iration for Mipwial Works Tonitrurtion Prrutit Application is hereby made for a Permit to Construct (4-7r"04r Repair ( ) an Individual Sewage Disposal System at . . .... t Loc on-Aq}�rass P Q —or o ...... .--- . ... . _. .... ..... .... ............ J a�f1'Qf..- Own e r s W I t er Address T `e of Building Size Lot____ feet Dwelling—No. of Bedrooms........ ...............................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type of Building .. No. of persons............................ ShoweA — Cafeteria Q' Other fixt,uLes ... '----••--------------- d W Design Flow............ ....?.........................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity./ ens Length---------------- Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width_ ...... 1 Length............. ..... T leaching area--------------------sq. ft. Seepage Pit No....... ! tam ........... q#GlI.Caching area..................sq. ft. Z Other Distribution box ( ) Dosing tank Percolation Test Results Performed by...... . ----- G� - ............ Date..d:.?_:�..�: aTest Pit'No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water_-___._--__•_•_--.-_-__. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ .-----•••--•- ---•-•---•---•--•••••--- . .. m---- Description of Soil---••---••-f -•----- •-_ -- - �.7 -- --- x W ........................................................ -•--------••---•-------•---------------------------- ••.. =--- VNature of Repairs or Alterations—Answer when applicable............................................................................................... ----•--•--------------------------••--------------------------------------------------.................---......---------------------------------------------------------=--------=-----.............-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1Z- 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the board health. Signed_: ----- ------ ---------- ! '� � .Application Approved By....................................................................................1�._.. ------ ------------••• D -------- Date Application Disapproved for the following reasons:.............................................................................................................. ...-•---•-------------------------------------------------------•------...---------=------•-------....--------------------•--•--------•----•---•----•--------•------•-•------••----•-•--••--••.......-- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ OF..: .......................... Trrtifirtt of Tootpliaurr THIS T ERTIFY the I • pal Sewage Disposal System constructed4-�O<Repaired ( ) by............... ---_--_ ..... ------------ ______________� nstaller F has been installed in accordaZ with the provisions of T 5 of he State Sanitary Code as described in the application for Disposal Works Construction Permit No.. .�_.._ .. datedAR ... d 7 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..............•--..........----••-•---•----•-------......_•-•----•••••--••••---- Inspector.................................................................................... Nd........d...._......•� A Fes$..'„ .�"'. .... THE COMMONWFA_LTH OF MASSACHUSETTS BOARD OF H A T ............ ....OF...... Appliration for Disposal Works Tonstrnrtinn Vamit 'f Application is hereby made for a Permit to Construct ( or' Repair ( ) an Individual Sewage Disposal Syste= at -- _ ..... �. -�. .. ..... f ....... . ---- ---------- - •••- Loca on A less t or �+�°7to Owner! e SS hnstalier Address .,� U. . Type of Building Size Lot.... ,E._ 1_��'.Sq. feet 1 1 ,., Dwelling—No. of Bedrooms...._._ Expansion Attic ( ) Garbage Grinder ( ) pa Other—Type of Building ............................ No. of persons..... ................. Showers ( ) — Cafeteria ( ) Q' Other fixtures -----dr °-------------------•----..---- W Design Flow........... .........................gallons per person per day. Total daily flow................ . .0.........._._....gallons. 1:4 Septic Tank—Liquid capacity./ = Vilons Length................ Width................ Diameter................ Depth................ Disposal Trench—No..................... Width g..................Wal Length......... _. T d1 leaching area....................sq. ft. Seepage Pit No........!_ -t }iamex"�----' ------------- i*�re�ot ---•------ o al leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) /�� Percolation Test Results Performed by......*VXt.............. Date._d'..�.`Z.&............_.. aTest Pit No. I................minutes per inch Depth of Test Pit._.:.......__....... Depth to ground water..................... (i Test Pit No. 2................minutes per inch Depth of Test Pit.....................Depth to ground water..................... O Description of Soil........... .... : ,. - -r x v .. = r`---- ----- ,.' W --------- -a.,, ----------------------------------------------------------------------------------------------------------------------------------------------------- UNature of Repairs or Alterations—Answer when applicable-------------fi_................................................................................ -•------•--------------------------••------------------------------------------•----........---•-------.........---------------------------------------•---- ........................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1Z- 5 of the State Sanitary Code— The undersigned.further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed.,.Z.,,_ a- ,ram' r� Application Approved BY ;7 ---- •.._._..--•----•-� ............... Date Application Disapproved for the following reasons:------•--------•----••---•-••----------•---------------------------............................................ -••------••---------•------•-•-----•--------•---------------------------•--•-----•-•------...-------•-•--......-------------•-----•--•---------••-----------•-•--------•--••••---------•--•---•......... Date PermitNo......................................................... Issued-----....-•------•-------------•-----••-------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH (Irrtifiratr of (lomplitanrr THIS , TO ERTIFY tr the �Indl&;J�d�al Sewage Disposal System constructed ( or Repaired ( ) by............. -------------- ��nstaller at � �, ,r •'4i ------..... , p -_----------- ,. . has been installed in accorda "ce with the provisions of T 5 of he State Sanitary Code as described in the -application for Disposal Works Construction Permit No._.. .__.. '7 .............. dated_ .. ` ':7. .......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A Gtiz-NTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector..................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD HEAL � � ✓ f g .......... ..Oop F... ,.. .......... ..... 7/ No..................... FEE. '.............. . ^. n. t Grua n ki trnrt' r amit Permission is re by granted ' — w - -- ---- -••-------------•....--•---------•.. ....--------....•--_.. .. . ._.. to Construct or Repair ( ` ) Individual Sewage Dispo y at No. `. ,i - �;; ..:. - .............. w ,.� -----.... -- �� St eet as sho on th applicatio for Disposal Works Construction Permit D "', 4"7-,tr...--_._.... Bo �- .-----.-_ a d of Ifealth DATE.................................................................................. FORM 125S HOBBS & .WARREN. INC.. PUBLISHERS -�: _ TOWN OF BARNSTABLE LOCATION C 9 SEWAGE#4-0 AQ s VILLAGE 0!� �f c),�1 _ASSESSOR'S MAP&PARCEL /�LO-//O INSTALLER'S NAME&PHONE NO.M SEPTIC TANK CAPACITY 4,5 '� LEACHING FACILITY-(type) �.M2Ti 2C)(6h,(5 (size) NO.OF BEDROOMS 3 OWNER SQnCP C PERMIT DATE: 10 / ,1O COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility eet 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"D I? wo 13 n c 17 9.00 .x tit__t ,• •�..t Ti�,1"A • '� i-..�dt��{ F=1..C.v.J z t t0 � 3 = 3'30 G.P•b. _�:� , OLt::)g AM D, USE IOOd 6at_. -Pcx et_ �lT - usE (o00 G4.L . c,ux-wAt-L Aer--A .- CC70 sF i his �1 1 cj M �x- I�'C�.t/l A1ZEA t sT=r J v- T�TaI pESIGtJ = 425 r�fGGDt-d'Ctc�+ ! LL eT� : Cl" 2MI u Orz AL Z,r f A. r BAXTER/ 1 ii! !"fine✓ 't 1 I�.J •- tY A• s � Tor F'wo r.icsQ.o �G =q9 t• y. �c NIA .,� .terra � r •;+; tr�.' r IA1N.• °�� o. t• 4'pPA b J,W. 6AL.• Gg ' `$oX Sic ieu'v. � ICI��- t - ,. �c16 GAL:. 4L�"L gG• Q LAN PST WI u 'r /J WAS►1f�D - . 7►t� :5T0�.1E ti ��•d SAN*3 G.t~f-T1T=1E:L) PL.C)•T' `>I- A.V i Plzc�F=t l.._�. .L a C./�.T t o�� p,�;'T�'�?�.✓1�-�•c3 rz: u o �g AL t=, La' a 1-4C t G G!Z T t t=`( �t-!A T T t-�G-. Fou h9Dta.Tl at-I 'S t-lo+.c/►� .------,.'~--•- t-if.t,Ct�t,1 GC:.Vlr't-•��, �,V tT1-t 't"i-ti= P2�'l_t► �� �.� ;4- 4 ,e.ti�� °;C:Tt..,,Ct.`. �'GctJtTvC��::+-�Ty oG' -t��•+t • �t,A�1 �.rJiJfSP�L�' I�u2alrve� �+ -TOVJLJ G A'+l i �!L�1.�. �:� k`3 h.'r.'T'fi_ice, 4 . b•.1�'C= t cJ G. �ZCGtSt'G..i�i=b 't./L.k.1lJ SU�Vi:.YVt=•' �'t t r i."n►� i i-.1t)T l'_i�rJC.�•7 U1 -1 /•►�.l U�T��'Vll.t_L:_ U t�'rl��j. tcJ4!"'J%✓tiC:t•.t � rr.)���/t�.�' ' 'Y'ti-tt.; t.-:Fl-�isC'<r �1•lGt�1lS� A.F�t�l_.1 !�l�.,i�_.t•`ty",^ ,.` ���ws ,,,,,,�.fi.�y��r /y,.� � �( 1�'al..' ' jtl l�l:-t'l:��A/t1��L= �"�•C• �...i IJL:.�.� - - -"'_'-- 1..7t".1V�t�_�OIL.1_�✓��,!✓+sG1-4"� -. LEGEND --44- - EXISTING CONTOUR x 40.98 EXISTING SPOT GRADE •� •; o` -UGW- UNDERGROUND WIRES -G EXISTING GAS SERVICE -W EXISTING WATER SVC. TEST PIT BENCHMARKo6901dh mRoadQ'. �, 100.60 ; f f go AD OLDHAM 99.83 PK SET 98.96 ,� �� LOCUS MAP 95.35 98.76 / 97.27 • /(JPE WSO 2 E J x 1�2,49 / .:.:'. .. :' 98.65 1+.41 97.90 f:_,. :....: EP ,6 LAMP 5 p 100,00 x 101.53 / + G 9.36 lz A2. p0. 100.49 97,59 R 30 . " x o ::- 100.60 99.95 99.07 j CIO� LOT 34A 00 72+ 2 15,613f SF 0 l ~Q - 101. w / 99.86BENCHMARK .. BULKHEAD CORNER EL.=101.80 10X1,37 + 101.17 EXISTING / 101.32 HOUSE(169) BH DECK T.O.F.=102.4f BM / 100.96 101.53 0180 � Q 101.92 SUN ROOM 10128 Q 'GARAGE 101,47 / DECK i x 101.06 + 1 0186 TP3:' ' x 101. 100.57 EXISTING SEPTIC TANK x 1 6P_.:.•;' / X (TO REMAIN) 101.00 11D2,05• V.(OUT)TANK, 97.25f f TOP OF 98.58 TP-2 p6 EXISTING LEACH PIT 101. x p TO BE PUMPED, FILLED WITH SAND AND ABANDONED. PROPOSED S.A.S. 2-500 GALLON CHAMBERS SURROUNDED W/4' STONE 100.73 x 'x 101.lY o PETER T. McENTEE PARCEL ID: 120-110 CIVIL No. 35109 PROPOSED SEPTIC SYSTEM . UPGRADE PLAN c/s1 69 OLDHAM ROAD, OSTERVILLE, MA Prepared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 OWNER OF RECORD 3,5 1 Engineering by: SCALE DRAWN JOB. NO. SOARES, SUSAN W Engineering Works, Inc. 1"=20' P.T.M. 281-20 69 OLDHAM ROAD - 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. OSTERVILLE, MA 02655 (508) 477-5313 9/30/20 P.T.M. 1 Of 2 f NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE <97.00 FOR A DISTANCE OF 15' AROUND THE SEPTIC TANK PROPOSED D-BOX PERIMETER OF THE S.A.S. INSTALL RISERS & COVERS OVER INLET & PROPOSED S.A.S. OUTLET AND SET TO 6" OF FINISH GRADE INSTALL RISER & COVER INSTALL RISER & COVER OVER ONE' CHAMBER AND SET TO 6" OF GRADE SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT T.O.F.=102.4t VENT F.G. EL.=101.5f F.G. EL.=101.5t F.G. EL.=100.8t F.G. EL.=101.6t ` L 31' L = 5' 2' LAYER OF 1/8' TO 1/2' S=1% (MIN.) ® S=1% (MIN.) DOUBLE WASHED STONE 6" 4"SCH40 PVC 4"SCH40 PVC (OR APPROVED FILTER FABRIC) �p^I 2208088 s A as 14" s 2' EFF. ORIONaaa 3/4' TO 1-1/2' DOUBLE EXISTING 48' LIQUID DEPTH aaaaaaa WASHED STONE r LEVEL GAS �E INV.=96.77 PROPOSED 4' 4.8' 4' D BOX INV.=96.60 EFFECTIVE WIDTH = 12.8' INV.=97.25t 3 OUTLETS ~ (field verify) H-20. INV.=96.50 2-500 GALLON LEACHING CHAMBERS Lj EXISTING- SEPTIC- TANK SURROUNDED WITH STONE AS SHOWN H-20 RATED NOTES: TOP CONC. ELEV.=97.6t 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE BREAKOUT ELEV.=97.00 INVERTS, PRIOR TO INSTALLATION. INV. ELEV.=96.50 ease eases 2) D-BOX SHALL BE SET LEVEL AND TRUE TO aaaaaaaaaaa Baaaaaaaaaa GRADE ON A MECHANICALLY COMPACTED SIX BOTTOM ELEV.=94.50 INCH CRUSHED STONE BASE, AS SPECIFIED 4' 2 x 8.5' = 17' 4' O-.IN 310 CMR 15.221 2 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH = 25' 3) INSTALL INLET & OUTLET TEES AS REQUIRED. PERVIOUS MATERIAL EF 5' (MIN.) ABOVE G.W. 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE LEACHING SYSTEM SECTION AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. BOTTOM OF TP-1, EL.=89.1 - SEPTIC SYSTEM PROFILE GENERAL NOTES: DECK 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE GARAGE .EXISTING LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: HOUSE(169) -310 CMR 15.405(1)(b): LOCAL UPGRADE APPROVAL T.O.F.=102.4t 1) A 2' variance to the 3' maximum cover requirement, for up to 5 of- max. cover. S.A.S. shall be H-20 and vented. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING DECK SUN e5 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN N ENGINEER BEFORE CONSTRUCTION CONTINUES. � 0. ROOM 5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM. C� W �j 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 90 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF O 36- HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 8. THERE ARE NO WELLS WITHIN 100' OF THE PROPOSED S.A.S. NJ 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE �� PROP. S.A.S. DIRECTED BY THE APPROVING AUTHORITIES. 25' �1 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY S.A.S. LAYOUT THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION'. 1 1. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS SOIL LOG IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE DATE: SEPTEMBER 30, 2020 (REF#TPT-20-200) INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL SOIL EVALUATOR: PETER McENTEE PE(SE#1542) 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND WITNESS: DON DESMARAIS R.S. HEALTH AGENT NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. ELEV. TP-1 DEPTH ELEv. TP-2 DEPTH 14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC 100.7 A 0" 100.6 A 0" SYSTEM COMPONENTS NOT SHOWN ON THE PLAN SANDY LOAM SANDY LOAM 100.0 IOYR 4/2 100.1 10YR 4/2 B 8, B 6„ .SANDY LOAM SANDY LOAM 10YR 5/6 10YR 5/6 98.0 C 32" 98.0 C 31" DESIGN CRITERIA PERC 35 /53" NUMBER. OF BEDROOMS: 3 BEDROOMS. SOIL TEXTURAL CLASS: CLASS I MED. SAND MED. SAND DESIGN PERCOLATION RATE: <5 min/inch 2.5Y 6/6 2.5Y 6/6 11�ILY FLOW: 330 GPD DESIGN FLOW: 330 GPD GARBAGE GRINDER: NO 89.2 138" 89.1 138" EXISTING SEPTIC TANK: 1000 GALLON CAPACITY PERC RATE <2 MIN/IN. "C" HORIZON LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF NO GROUNDWATER ENCOUNTERED .74 GPD/SF PROPOSED SEPTIC SYSTEM UPGRADE PLAN DISTRIBUTION BOX: 1 INLET, 3 OUTLETS (MINIMUM) H-20 USE 2-500 GALLON LEACHING CHAMBERS IN SERIES 69 OLDHAM ROAD, OSTERVILLE, MA SURROUNDED BY 4 DOUBLE WASHED STONE-ALL SIDES Prepared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 SIDEWALL AREA: 2(12.8 + 25.0') x 2' = 151.2 SF Engineering by: SCALE DRAWN JOB. N0. BOTTOM AREA: 12.8' x 25.0' = 471.0 SF Engineering. Works, Inc. NTS P.T.M. 281-20 TOTALAREA:............................................................I....... 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEEP N0. DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) = 348.6 GPD (508) 477-5313 9/30/20 P.T.M. 2 of 2 ,