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HomeMy WebLinkAbout0116 OLDHAM ROAD - Health 116 Oldham Road, Osterville �_ -117--•------� A rr; 1 r F e e s t Commonwealth of Massachusetts /a 0 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 116 OLDHAM RD t Property Address { ' JUSTIN &PAMELA BERNARDO Owner Owner's Name / Information Is pSTERVILLE �/ required for every MA�_ 02655 6/4/2020 1 page. Cityrrown state Zip Code Date of inspection ; Inspection results must be submitted on this form. inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information filling out forms p �# on the computer, us e only the tab Christopher Maki key to move your Name of Inspector curthe ref not use Cape Cod Septic Services use the return Company key,, p Y Name 350 Main St. Company Address - W Yarmouth MA 02673 Cityrrown state zip code 508-775-2825 81-14423 Telephone Number License Number B. Certification I certify that: I am a DEP approved system Inspector In full compliance with Section 15.340 of Title 5 r (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the Information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience In the proper function and maintenance of on-fate sewage disposal systems.After conducting this Inspection I have determined . that the system: 1. ® Passes 2. ❑ Conditionally Passes a 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails MEMO Mm- Inspector's gnature 6/22/2020 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 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 form should be sent to the system owner and copies sent to -the buyer, if applicable, and the approving authority. Please note: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 li In the future under the same or different conditions of use. 161nsp,doc•rev,7/28/2018 We 6 Official Inspection Form;Subsurface Smogs Disposal system•Page 1 of 1s Commonwealth of Massachusetts - Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 116 OLDHAM RD k Property Address JUSTIN & PAMELA BERNARDO Owner Owner's Name information is OSTERVILLE required for every MA 02655 6/4/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: 3 ® 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 IS IN WORKING CONDITION 2) 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): t5lnsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments. 116 OLDHAM RD Property Address JUSTIN & PAMELA BERNARDO Owner Owner's Name - information is OSTERVILLE required for every MA 02655 6/4/2020 c page. City/Town State Zip Code •.Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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 pipes)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): 3) 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. a. 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: t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments. z 116 OLDHAM RD Property Address JUSTIN & PAMELA BERNARDO Owner Owner's Name informatlon is OSTERVILLE required for every MA 02655. 6/4/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (coat.) ❑ 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 b. System will fall unless the Board of Health (and Public Water Supplier, if any) ' determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank.and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) 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 t51nsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for,Voluntary Assessments 116 OLDHAM RD Property Address JUSTIN & PAMELA BERNARDO ' InformatOwner Owner's Name required for is every OSTERVILLE required for eve MA 02655 6/4/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ® 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 ® 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 water supply well.. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ 19 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 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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 CA. Yes No ❑ ❑ the system-is within 400 feet of a surface drinking water supply L ❑ ❑ 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 t5inep.cloc rev.7/2 612 01 8 Title 5 Official-Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18. Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 116 OLDHAM RD Property Address JUSTIN & PAMELA BERNARDO Owner Owner's Name Information Is every OSTERVILLE required for eve MA 02655 6/4/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15,304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or' no"for each of the following for all inspections: 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)] 15lnsp.doc•rev.7/26/2018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Y 116 OLDHAM RD Property Address JUSTIN & PAMELA BERNARDO Owner Owner's Name Information is required for every OSTERVILLE MA 02655 6/4/2020 page. City/Town State - Zip Code Date of Inspection D. System Information 1. 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 Description: g Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: �. Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes No information in this report.) Laundry system inspected? ❑ Yes Z No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d '19-380 GPD g ( Y 9 (gp )) '18-367 GPD Detail.' Sump pump? ❑ Yes ® No Last date of occupancy: • CURRENT Date t5lnsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' 116 OLDHAM RD `J Property Address ` JUSTIN & PAMELA BERNARDO Owner Owner's Name information for Is OSTERVILLE -j MA 02655 6/4/2020 required for every ' page. City/Town State Zip Code Date of Inspection D. System Information (coat.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑` No J Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes .® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5inep.doc rev.7/26/2018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form a a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 116 OLDHAM RD Property Address JUSTIN & PAMELA BERNARDO Owner Owner's Name information is required for every OSTERVILLE MA 02655 6/4/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont) 4. 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): Approximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑' Yes ® No 5. Building Sewer(locate on site plan): `} '• Depth below grade: 18"feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction liner 10'+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): LINE CHECKED WITH SEWER CAMERA AND.WAS FOUND TO BE,CLEANAND PROPERLY PITCHED t5lnsp.doc•rev:7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts U Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 116 OLDHAM RD Property Address JUSTIN & PAMELA BERNARDO Owner Owner's Name Information is required for every OSTERVILLE MA 02655 6/4/2020 page. City/Town State Zip Code Date of Inspection D. System Information.(cont.) 6. Septic Tank(locate on site plan): 11" Depth below grade: feet Material of construction: ®concrete ❑ metal ❑fiberglass El polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 GALLONS -Sludge depth: 211 Distance from top of sludge to bottom of outlet tee or baffle litScum 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 How were dimensions determined? ESTIMATED Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1000 GALLON TANK IN GOOD CONDITION. CONCRETE BAFFLES IN PLACE AND CLEAN. TANK AT NORMAL OPERATING LEVEL. COVERS 11" BELOW GRADE t5lnsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 116 OLDHAM RD Property Address JUSTIN & PAMELA BERNARDO Owner Owner's Name information is required for every OSTERVILLE MA 02655 6/4/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site'plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): r 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.): B. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: El concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5lnsp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18. Commonwealth of Massachusetts 1 . Title 5 Official Inspection Farm i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 116 OLDHAM RD `r Property Address E JUSTIN &PAMELA BERNARDO Owner Owner's Name information is required for every OSTERVILLE MA 02655 6/4/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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.): r. *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert EVEN Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): DISTRIBUTION BOX LEVEL AND WATERTIGHT l5inap.doc•rev,7/28120118 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form , Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .` 116 OLDHAM RD Property Address JUSTIN &PAMELA BERNARDO Owner Owner's Name Information is required for every OSTERVILLE MA 02655 6/4/2020 page, City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® 2-500 GALLON leaching,chambers number: CHAMBERS ❑ leaching galleries number: ❑ leaching trenches number, length: El leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage/Disposal System Form-Not for Voluntary Assessments r 116 OLDHAM RD Property Address JUSTIN & PAMELA BERNARDO Owner Owner's Name information Is required for every OSTERVILLE MA 02655 6/4/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 2-500 GALLON CHAMBERS WITH STONE FOUND WITH 1"OF LIQUID DURING INSPECTION WITH NO EVIDENT STAINING 12. 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 1,. 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.): r e t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 18 Commonwealth of Massachusetts > Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary.Assessments Lam' 116 OLDHAM RD Property Address JUSTIN & PAMELA BERNARDO Owner Owner's Name information is required for every OSTERVILLE MA 02655 6/4/2020 page, City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of pond!ng,"condition of vegetation, etc.): t5lnsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts a Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 116 OLDHAM RD Property Address JUSTIN &PAMELA BERNARDO Owner Owner's Name information is required for every OSTERVILLE MA 02655 6/4/2020 page. Cityrrown State Zip Code Date of Inspection 'D. System Information (cont.) 14. 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 t5insp.doc-rev.7/26/2018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page I of 18 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v 116 OLDHAM RD Property Address JUSTIN & PAMELA BERNARDO Owner Owner's Name information is required for every OSTERVILLE MA 02655 6/4/2020 page. City/Town 4 State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth-to high ground water: +11, 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 i ❑ -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: HAND AUGER HOLE, NO WATER ABOVE BOTTOM OF LEACHING L Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5insp.doc•rev.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r r< 116 OLDHAM RD Property Address JUSTIN &PAMELA BERNARDO Owner Owner's Name information is required for every OSTERVILLE MA 02655 6/4/2020 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6(Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 ,t • --- / \ __ ��I � \ �� . .�_ :r � r,�' , � � � �.. . � �q' 0 � �� I �� .�. � � i . _ r , q . . 6 i� - .. _ r ' S54°26'03"W ....�/ 100,00, =%y \. ly '..•"!mil -�- �-��+. 0. -" / fJ�� �t. ��t, , �• rl� A , SST z S. O . s 29.7' G` 3 z O� cn 70 .r y T I 's f r l�`i �• N54'26'03"E s 100.00, R \ EDGE OF PAVEMENT / OLD HAM ROAD —--— -- _ E_�GE OF PAVEMENT (50'WIDE) / 1 ? 12 O • 11 No. 003 _ ' �%' / � Fee$50. 00 THE COMMONWEALTH OF MASSACHUSETTS ' Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0[pprication for Mizpooar *pgtem Construction Permit Application for a Permit to Construct( )RepaiW)o Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot Nol 16 Oldham Road Owner's Name,Address and Tel.No.Eric Cabral Osterville,Mass. 02655 116 Oldham Road Assessor's Map/Parcel O s t e r v i l l e,Mass. 0 2 6 5 5 120-117 Installer's Name,Address,and Tel.No.5 0 8-7 7 5—3 3 3 8 Designer's Name,Address and Tel.No.5 0 8—2 7 3—0 3 7 7 J.P.Macomber & Son inc. JC Engineering, INC. 5 Roundhill BLV Box 66 Centerville,Mass. 02632 East Wareham,Mass. 02538 Type of Building: Dwelling XX No.of Bedrooms 2 Lot Sizel 5, 0 0 0 sq.ft. Garbage Grindelg0 ) Other Type of Building No.of Person Showers( ) Cafeteria( ) Other Fixtures Design Flow 226.8 gallons per day. Calculated daily flow2 X 1 1 0=2 2 0 gallons. Plan Date 4/2 2/0 3 Number of sheets Revision Date Title Size of Septic Tank Rxi c;ti ncq 1 000 Type of S.A.S. Existing LP_1 000 Description of Soil Sandy loam to loamy sand to medium coarse sand Nature of Repairs or Alterations(Answer when applicable) Adding two 500 gallon leaching chambers to the existing septic system. (298 2 ' ) 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 Co e and not to place the system in operation until a Certifi- cate of Compliance has been iss d by this o6d f ealth Signed �� f ` Date 4 4 0 3 Application Approved by �✓ ��- Date 2 J Application Disapproved for the following reasons Permit No. 2 0 a 3— f 7 Date Issued 2 0 --------------- �— 1 No. � 3;� •��r� }• 'J,', � - ,�. j 1 /1 � Fee +4, THE COMMONWEALTH OF MASSACHUSETTS entered in compute Yes � PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Rpprication for Digpogal *p5tem-Con.5truction permit M Application for a Permit to Construct( )RepairV, '-%)Upgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot Noll 6' Oldham Road Owner's Name,Address and Tel.No.Eric Cabral Osterville,Mass.02655 116 Oldham Road Assessor'sMap/Parcel, 120-1 17 Osterville,Mass.02655`. Installer's Name,Address,and Tel.No.5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No.5 0 8-2 7 3—0 3 7 7 J.P.Macomber & Son inc. JC Engineering,INC. 5 Roundhill ALV Box 66 Centerville,Mass.02632 East Wareham,Mass.02538 Type of Building: ? , Dwelling XX No.of Bedrooms 2 Lot Size1 5,0 00 $q3 ft. Garbage Grinder.0 ) Other Type of Building No.of Person �owers( ) Cafeteria( ) Other Fixtures Design Flow 226.8 i gallons per day. Calculated daily flow2 X 1 1 0=2 2 0 gallons. Plan Date 4/2 2/0 3 Number of sheets `` Revision Date Title Size of Septic,Tank Vxf.stina 1 000 Type of S.A.S. Existing LP_1 000 ; Description of Soil Sandy loam to loamy sand to medium coarse sand J r , Nature of Repairs or Alterations(Answer when applicable) ,Addi�nq two 500 gallon leaching, p chambers to the exstinq septic system. ('� ,8 �' ) Date last inspected: Agreement:` a _ 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 Certifi- cate of Compliance'has been issu/ d by this 'oar ealth./c Signed / , �� OO Date 4J�24/03 ' Application Approved by _AX4/,,.1 K.S. Date �/ 2 t/A 3 Application Disapproved for the following reasons / Permit No. 2 U 0 3— 1 -7 Date Issued 47/2y/0 t' f 'I THE COMMONWEALTH OF MASSACHUSETTS x BARNSTABLE, MASSACHUSETTS z "Certificate of Compliance t THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repairedy(XX)Upgraded( ) Abandoned( )by J.P.Macomber & Son inc. at 116 Oldham Road Osteryi l le,Mass. has been constructed i accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.a Lk))-17 7 dated L//?`' , Installer J.P.Macomber & Son Inc. Designex._JC4?-Nag6neering Inc. The issuance of this ermit sha f not be construed as a guarantee th the sy`st wil�function as designed,�.� Date 11 )2 0 Inspect F $50.00 No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS lwigogal 6pgtem Conotruction permit Permission is hereby granted to Construct( )Repair'((X )Upgrade( )Abandon( ) System located at 116 Oldham Road Osterville,Mass. and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this ermt/lm Date: y I `t�I tl 3 Approved by - " V C/ i ri: , i f / TOWN OF BARNSTABLE LOCATION 1_ 1� r�L I� fl/1<[ lP D SEWAGE #;?,©0 3",1 77 VILLAGE S'leg V i L e ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. �0 M A C 0,41 /3e K -/ S 0,V SEPTIC TANK CAPACITY G 0 0 LEACHING FACU-rrY: (type)A:- /,X Y Lo eZZS (size) NO.OF BEDROOMS sZ BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation_Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ® )D rCV f '��► i B1-; . 16797 IF°s332 DEED RESTRICTION WHEREAS, Erin J. Cabral formerly known as Erin J. Kennedy, of 116 Oldham Road, Osterville,Massachusetts is the owner of the land together with the buildings and improvements thereon situated at 116 Oldham Road, Osterville and more particularly described as Assessors'Map 120 Parcel 117. Also, subject property is shown as Lot 41 as shown on Plan Book 262 Page 58 recorded with the Barnstable County Registry of Deeds. Said lot containing 15,000 square feet according to said plan; and WHEREAS, I as owner of said Lot#41 have agreed with the Town of Barnstable Board of Health to a restriction on the number of bedrooms that can be included in any home now existing or hereafter constructed on said lot as a pre-condition to obtaining a Certificate of Compliance for the.on-site septic system repair/replacement/installation recently completed on said lot pursuant to State Environmental Code,Title V,310 CMR 15,000 et.seq.;and WHEREAS, the Town of Barnstable Board of Health as a pre-condition to granting the Certificate of Compliance is requiring that the agreement to restrict the number of bedrooms in any home now existing or hereafter constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document; NOW, THEREFORE, I do hereby place the following restriction on the above referenced parcel in accordance with the Town of Barnstable Board of Health,which restriction shall run with the land and be binding upon all successors in title: 1. Any home now existing or hereafter constructed on the above-referenced Lot#41 shall contain no more than two(2)bedrooms. We agree that this shall be a permanent deed restriction affecting the above-referenced Lot#41 also known as 116 Oldham Road,Barnstable,Massachusetts,as shown on a plan recorded in the Barnstable County Registry of Deeds. This restriction may be released if regulations should change or public sewer becomes available. For our title see Deed recorded in the Barnstable County Registry of Deeds Book 11535,Page 174. Executed as a sealed instrument this day oc,4ri ,2003. Sign e Commonwealth of Massachusetts Barnstable, SS. Date: 2003 Then personally appeared the above—named i n . 6g be-a I and acknowLl the foregoing instrument to be their free act and deed before me. C�C,�a�vwiNotary Public Mission expires: `Sa,, -�. � _ o c)5-- �X BARNSTABLE COUN R, U0�� REGISTRY OF DEEDS ;, C ATRUE COPY,ATTEST 4�¢., STER11ARNSTA00111 "`' X+t COMMONWEALTH OF MASSACHUSETTS EXECUTIVE,OFFICE OF ENVIRONMENTAL AFFAIRS _ DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTON, MA 02108 617-292.5500 N'ILLIAIII1 F.WELD TRUDY CC Governor Sr,rc ARGEO PAUL CELLUCCI DAVID B STRt Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissi( PART A CERTIFICATION Property Address: 1 1 6 Oldham Road Ostervi1le MA Address of Owner: 1 83 Sturbridge Drive Date of Inspection: 2/3 98 (If different) Osterville,Mass. Name of Inspector: TOGes h P_Macomber Jr. 02655 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: J.P.Macomber & Son Inc. Mailing Address: BOX 66 Centerville,Mass . 02632 Telephone Number: 508-775-3338 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reponed below is true, accurai and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: asses Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: Date: �� The System Inspe 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 god or greater, the inspector and the system owner shall submi the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owr and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, Or D: AI SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.30: Any failure criteria not evaluated are indicated below, COMMENTS: BI SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, up completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection. the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tar 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:1twww.magnet.state.ma.usroep Printed on Recycled Paper C SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 116 Oldham Road Osterville,Mass. Owner: Bobbie Berlet Date of Inspection: 2/3/9 8 BJ SYSTEM 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 ,(Zf� 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] FURTHER EVALUATION 15 REQUIRED BY THE BOARD OF HEALTH: A/1)_ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. I 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: V6 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: /Vo 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) AOTHER rd 40 (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 116 Oldham Road Osterville,Mass. Owner: Bobbie Berlet Date of Inspection:2/3/98 D) SYSTEM FAILS: You must indicate er;•.er "Yes" or "No" as to each of the following: NO I have determined that the system violates one or more of the following failure criteria as defined in 310 CmR 15.303 Tne bass for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to cor-re( the failure. Yes No 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 o, cesspool. Static liquid level in the distribution box above outlet inven due to an overloaded or clogged SAS or cesspool / laAOJ, t'i?T'" AS 6�" �C Liquid depth in*e trpool is less than 6" below inven 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(s1 Number of times pumped d. 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 ponion 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 nc 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. Q LARGE SYSTEM FAILS: You must 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 tnreat 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 11 of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information (revised 04/25197) Page 3 of 10 r 1.� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1 1 6 Oldham Road Osterville,Mass . Owner: Bobbie Berlet Date of Inspection: 2/3/98 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No 1/ Pumping information was provided by th owner occupant, or Board of Health. 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 non-sanitary or industrial waste flow. The site was inspected for signs of breakout. X _ All system components,.Q*Kluding 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. Y Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Pan C is at issue, approximation of distance 15 unacceptable) t15.302(3)(b)J (revised 04/25/97) Pegs 4 of 10 Cl SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1 1 6 Oldham Road Osterville,Mass Owner: Bobbie Berlet Date of Inspection: 2/3/9 8 FLOW CONDITIONS RESIDENTIAL: Design flow: W p.d./bedroom for S.A.S. Number of bedrooms: Number of current residents: Garbage grinder (yes or no):,!Ld Laundry connected to system (yes or no):Y.,,!� Seasonal use (yes or no):tiv Water meter readings, if available (last two (2) year usage (gpd): Sump Pump (yes or no): Last date of occupancy:k�7 COMMERCIAUINDUSTRIAL: Type of establishment: A)/¢ Design flow: allons/day Grease trap present: (yes or no)" Industrial waste Holding Tank present: (yes or no),10- Non-sanitary waste discharged to the Title S system: (yes or no)t1E?A Water meter readings, if available:�l¢ Last date of occupancy:�/� OTHER: (Describe) 44 Last date of occupancy: GENERAL INFORMATION PUMPING ORDS and source of i formati System umped as part of inspect on: (yes or no) S- If yes, volume pumped: V gal ons J ' Reason for pumping TYPE OF SYSTEM _ Septic tank/distribution box/soil absorption system _�j�, Single cesspool ,eIh_ Overflow cesspool d2a Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) —1 I/A Technology etc. Copy of up to date contract? Other 14 APPROXIMATE AGE of all components, date installed if known and sour f information: !'' po 1 ) source o Sewage odors detected when arriving at the site: (yes or no) (revised 04/25/97) Page 5 of 10 • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C . SYSTEM INFORMATION (continued) Property Address: 116 Oldham Road Osterville,Mass. Owner: Bobbie Berlet Date of Inspection: 2/3/9 8 BUILDING SEWER: (Locate on site plan) Depth below grader Material of construction: 41cast iron 40 PVC _ other (explain) Distance from�rivate water supply well or suction line Diameter l _ Commepts: (condition of joints, ve�nti g, evidence of leakage, etc.) t SEPTIC TANK:_Ie-_,?/.3 (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age /_ Is age confirmed by Certificate ofCompliance _(Yes/No) Dimensions: ! ,4hltNJ� Sludge depth: Distance from top of sludge to bonom of outlet tee or baffle: Scum thickness: tf _ Distance from top of scum to top of outlet tee or baffle: _ Distance from bottom of scum to bongip of outlet tee or baffle: How dimensions were determined: ed Comments: (recommendation for pumping, conditio of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evi ence of leakage, etc.) r GREASE TRAP:.Idlbll�— (locate on site plan) Depth below grade: Material of construct ion:4,dconcrete4,A�rnetaI L,F/ iberglass,,l Polyethylene)Ll ether(explain) Dimensions: /1J Scum thickness: A14 Distance from top of scum to top of outlet tee or baffle:10" Distance from bottom of scum to bottom of outlet tee or baffle:.AA,-� Date of last pumping: A1.Gt Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revimed 01/7S/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 116 Oldham Road Osterville,Mass . Owner: Bobbie Berlet Date of Inspection: 2/3/98 i n TIGHT OR HOLDING TANK:,t1G'&� inspection) must be pumped priur to, or at time, of nspect o ) (locate on site plan) Depth below grade: 41A Material of construct ion./RconcretewRrnetalAWiberglassN/9Pol.�•ethyleneiWiother(explain) N� Dimensions: kh Capacity: A1.4 gallons n flow: AJ gallons./day Des o g 8 Y Alarm level:MAlarm in working order,14 Yes;,,0 No Date of previous pumping: <1,4 Comments (condition of inlet tee, condition of alarm and float switches, etc.) 1 d DISTRIBUTION BOX:, (locate on site plan) Depth o; iio• ,d level above outlet invert: Comments. (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) E'l'Y�s1 r PUMP CHAn1BER:/Z&X1P1 (locate on site plan) Pumps in working order: (Yes or No)—&& Alarms in working order (Yes or No) Ajl51 Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) A /L T I (revia.d 04/25/97) P.g• 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1 1 6 Oldham Road Osterville,Mass. Owner: Bobbie Berlet Date of Inspection2/3/9 8 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, numbe : V Alternative system: Name of Technology: Comments: (note conditio of soi signs of ydraulic failure, level of ponding, condition of v getation, etc.) . y ' CESSPOOLS:A2y1L (locate on site plan) Number and configuration: Depth-top of liquid to inlet inven: AIA Depth of solids layer: NA Depth of scum layer: AIA Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as pan of inspection) Comments: (note condition off soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) /U4 7- PRIVY: (locate on site plan) Materials of construction: Dimensions: A�/1 Depth of solids:-4Z,61- Comments: (note condition of soil, signs of-hydraulic failure, level of ponding, condition of vegetation, etc.) (rovia*d 04/25/97) Pag• 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 116 Oldham Road Osterville,Mass. Owner: Bobbie Berlet Date of Inspection.2/3/98 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) J- 9 _ I A-ka So (revised o4/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPi: t. SYSTEM INSPECTION FORM I . C SYSTEM INFOI. ION (continued) Property Address: 116 Oldham Road Osterville,Mass. Owner: Bobbie Berlet Date of Inspection: 2/3/9 8 1 Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elc a:ion: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basemtni-simp etc.) _j,.ZDetermine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records heck local excavators, installers Use USGS Data Describe in your own words how you established the High Groundv/xet-Elevation. Must be completed) Used Groundwater contours map. Gahrety & Miller Model 12/16/94 (revised 04/25/97) Pic. of 10 y-•rrn r�—n..r. -rrtrnrarr•nmrrn�re-r.rr..r.:-.•st+•:rvrr:�rrrsr-rn nr�v*rav-rz.rr-•1 �.. *rs-¢'rcree-.ra—,;rrrr-T_r—r-.,--.— .' TOWN OF Barnstable BOARD OF HEALTH SOBSURFACE SEWAGE DISPOSAL ,SYSTEM INSPECTION FORM - PART D .- CERTIFICATION II •••T•• T••••• —�..1.�.�T.T.TT•R.'Ta•.TTFTTITTI'.Tt'f+"t"fR1tT-RTtr TIRTCRA'f AT'�Ti7+OlLTi . ISiIflTnTiTT'!tP^TR++I+►.�.r'•r•r•1. .—. J -TYPE OR PRINT CI.EARL)'- PROPERTY INSPECTED STREET ADDRESS 116 Oldham Road Osterville,Mass. J, ASSESSORS MAP , BLOCK AND PARCEL # / _�D / OWNER' s NAME Bobbie Berlet PART D - CERTIFICATION r NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J-P.Macomber & Son Ind' COMPANY ADDRESS Box 66 Centerville,Mass . 02632 Street Town or City S t a t 4 LIP COMPANY TELEPHONE ( 508 775 - 3338 FAX ( 508 ) 790 - 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and complete as of the time of .inspection , The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : _e System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public healLh or Lhe environment as defined in 310 CMR 15 - 303 , Any fail�Ire criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* The inspection which I have con acted has found that the system fails to Protect the public health and the environment in accordance with Title 5 , 3.10 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form , I Inspector Signature Date 2/4/98 One copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF 112AL111, * If the inspection FAILED, the owner or"'' 'Perator shall upgrade the system within one year of the date of the inspection , unless allowed or required otherwise as provided in 310 ChiR 15 . 305 . partd . doc 1 ti TfEEi COMMONWEALTH TH OF MASSA.CHUSETTS DEPARTNMNT OF ENVIRONMEENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required and is hereby authorized to use the title CERT + D TITLE S SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws . Issued by The Department of Environmental Protection. Acting Dkicctor of the [) iS ol.1 v( Witcr Pollution Control / TOWN OF BARNSTABLE VOO CX'A' ON �/a L D Ild.M lC�D SEWAGE #.-),O O 3/ 7 VILLAGE O S reR V/L C' R ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. M A C0,41 62/, -4 S o/V SEPTIC TANK CAPACITY. G D O LEACHING FACILITY: (type) w eIZ-5 (size) /3 NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE:. 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 � 4 V� t �� � � / � Q � � � � � / �� �� i_ _ � -b� � ,_ o LOCATI r -i�a—� SEWAGE # MS ASSESSOR'S MAP & LOTLER'S NAME& PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) 1-104 � NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Fee Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Fee .Edge of Wetland and aching Facility (If y wetlands exi t within 300 feet of ea hi facili - / Fee Furnished by �3�1y �1` ®t$� rn ogn;lt a s OC-ATION SEWAGE PERMIT p0. VILLAGE INSTA LLER'S NAME & ADDRESS l,1/1;FSi 9�iPll-7oLIA4 A214 B U I L D E R OR OWNER 8 � Po bt-I&WS DATE PERMIT ISSUED 3_Z � _ �v DATE C 0 M P L I A N C E ISSUED 2 �_ J Avc-,a V\\ i i. THE COMMONWEALTH BOARD OF FHEI Ac TH Ts T.. .. ...........OF........ cL..F'. .g 1,Q,.......................... ApphrFa#ion for j3hipos ai Works Tnnstrurtiun Prrutit Application is hereby made for a Permit to Construct Repair ( ) an Individual Sewage Disposal System : .� 9/.................... ....... .. ............�.� L ...n--Ad s � � or. Lot-No. ...., �... ..�. .o . / � -. _t .. '@ ........... f vd'! idp Z.1.......... ----------------------------- caner . Addres- ......--• Installer Address Q Type of Building Size Lot........:_yt...............Sq. feet aDwelling—No. of Bedrooms___...(R.................................Expansion Attic ( ) Garbage Grinder V10) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures a --------------------------------•--•-•-•--------------------...-------•---•---•----••----•-•-...........-------------------- W Design Flow.....4P.6^----a,?,. ,-.Y,�allons per person per day. Total daily flow----- _ .......1.?a..�---gallons. Septic Tank—Liquid capacityld-0.9llons Length--------_-_--- Width................ Diameter---------------- Depth................ W Disposal Trench—No .................... Width.............. ,_�ot Lenget -------------------- Total leaching area....................sq. ft. Seepage Pit No....._._0... S Diamet���. _ _. o� .................... Total leaching area.... o/....sq. ft. Z Other Distribution box ( ) Dosing talk '-' Percolation Test Results Performed b ...._ ._ . ......... Date-_- .._.__.. _'_ .�..� a Y A � _` Test Pit No. 1....� ,__minutes per inch Depth of Test Pit.................... Depth to ground water-____-_____-_-__--.__--. rT Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ a . - Description of Soil__.____ _. .....�..`�.�L__.. _ � j . --- -�... ` �T ............................................................... x W ------•----•-------•---------------•----•--•----•---------•-------------•-------...--•-----•••----•-----•-------------------------------•-----------------------•-••••----•••......------•-----------... UNature 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 iITI1 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. 4,e/� Sign ... :.Z.. ..'----------------------------------------- --------------------------------- Date Application Approved BY--------- je(�T -------------•-- -•-- . .Ix ......--�...... Date Application Disapproved for the following reasons:................................................................................................................ ....................................................•----.....--••-•••-••••-••--------......-•---........-------------•-•-----------------•-----••-•----••--••---•---••------•---•---•----•-•----------- �----az=4�_d Permit No.............•--•-•.........----•--------••-••------..... Issued---•--.- -----.Daft...... L Date 4 THE COMMONWEALTH OF 'MASSACHUSETTS BOARD OF HEALTH ... ......... .�.k....'V_.------.OF.......�c�.'4" .`J.� � ..................... Appliraatilan for Diipuiiaal Works Tnnstrairtinn Vamit Application is hereby made for a Permit to Construct ( ` or Repair ( ) an Individual Sewage Disposal System at: .... ::,a. __`" ..:...- -� /"�' ....................................) -----_ ---� '�- -- - ----------------------------------------- �y �w Location-Add,;pss or Lot No. .d./s..E?'`^ f! ! .:. ::........... ................... d 1 !t e .................................................. �! O me; JJ� / � Address a ••......... ............................... Installer Address d Type of Building Size Lot..........�{!....�....Sq. felt aDwelling—No. of Bedrooms......N!..................................Expansion Attic ( ) Garbage Grinder ( �j p, Other—Type of Building ....... ............:::...... No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures . r�-"a: ----------------------------------•--••--------•---•--------------------------------- W Design Flow.....�A. ......��`. = .,'._ allons per person per day. Total daily flow.._.. _..._ :_ _. ___gallons. 9 Septic Tank—Liquid'capacity.iot f-gallons Length................ Width................ Diameter................ Depth.................. Disposal Trench—No. .................... Width................. of Len i Total leachingarea....................sq. ft. Seepage Pit No..............:...:.. Diameter..,_. . _ '... l th 'o let.................... Total leaching area......__.....__...sq. ft. Z Other Distribution box ( ) Dosing tank. ( ) Percolation Test Results Performed by.............. " -------•------------------•-------•---------------• Date........................................ aTest Pit No. 1----- .,20.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.................. :..___. ` •--•------------------ ....................................' Descriptionof Soil........ ---- �------------••- --...................................... - x w •-•-•--------------- ---------- -•=- . -- ----- -- -------- ------ ----- --------- U Nature of Repairs or Alterations—Answer when applicable......................................................................::.............. ....... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I'111 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. Signe ... ..................... --------------- ----------------- --------- -.--... ------- Date Application Approved By---•-• !�-._.:._ ... .S'` J tI rl~-C... [i�� ....._-•'_ -•------------•----•Date----•-••--•-•- Application Disapproved for the following reasons:-•-••---•-•---•--•------•---•---••-•---••-••-----•••--•••-••-••-•--------••-----•--••-•-••...................._ .....................•---...-•----------......__......_........:.........-----................................................. .................................................................. Date Permit No...........::.:::..... ... Issued..:=----.---. .......Y..... ............. Date h l` THE COMMO WEALTH OF MASSACHUSETTS BOARD QF HEALT 1 e 7F ?: ...J.......OF..... 1... . .. ............................. Trr#ifiraa#r of Toinpliaatta 4`r, bTHISr,U 0 CERTIFY � they vI Se e i posal System constructed ( or Repaired ( ) y . .. ---------------------------------------•-•- Installer I at. ... ° _= # 4�'_ f .: .............•--------......----------------..........------------. has been installed in accordance with the provisions of T off e State Sanitary Code as described * the application for Disposal Works Construction Permit No:- ..................:........2), dated------- .......................... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FU-N•- 10N„ AISFACTORY. � ;, - DATE.............. `/ -- -3....---•------•----------------•---...-•_:.. Inspector.--- ....................... THEICOMMONINEALTH OF MASSACHUSETTS BOARD OF HEALTH No.._........12.47 .. ... 1 ©:... 4 Utivn 1 arkg ni nrtim r ani �>. ra Permission is hereey granted-•--• ........._.. to Construct ( or Repair ( ) n Individual S. �tra a Disposal System atNo..-- #,. ,...... . /a. r.. .....�...----•--.-------•---------------•--------------•------------------------------ •------- '•-- \i r Street as shown on the application for Disposal Works Construction Pe it No _.. .... Dated............................................ .•-•-•• _7 e - -------------------------- �— � � Board of Heal .' DATE.....`�� P FORM 1255 HOBBS & WARREN. INC., PUBLISHERS '. St�,•!,G l_'E �A/l/l I Lam! -�3 '�3ED1Zd G M --•�— � ,,f.�....-....,.,....�s_,F+_. '� _ � t UO GAtzsn--f--- 64ZI �t -tc -rA•�ttc = 330.. r50 % _ 4-9 56.P0. U Ste- l UC�f> 64L. � '{J / ' U�P *�.. Ntt3• Y � ISPo� &L T'!T �sE 100o Gam., / G 7C S ,-a;6wALL A�E✓a cSo s t=. t.��tt Ptt" Icy SF 2.S + 3-75 G.P.Q. So 55'. 1 .o SO r=>.P D. 1 vDU Glut. TOTAL SeYf:-V hK Q t TbT44 L Dat L�'-( FLaur �\ r.VZC%77r _ tuv.•�I�.O -Box q(d� sc-�nc (o ,. �1 L tuv �. To�tK I000 C\(e'() +may, 1w.�IL, u` e FT a' n . w►Tu •t M Was►�ED sTONt= qQ .0 V 3 u a s�a.Lc— -►z - LGtZTtF�_( T14AT TNs= 5&AOWt`1 Q1--A QZ=t' RE�.ICE �•-1F..>`t=a�J Gcv�IPL�(S vV ITK T+•-I� 51 aE c..t►-�� �,.,..�,3�" 4- �i1►jir? SC-�-L�nCtG '~C-!q:.. iQGAitcuTy O -r _ REGISctt;ED l-a.l• o >uCval(oQS 1415 PLA►-i I•S UOT ZA6C-p �v�~ ^ "` OSTE�Vtt~LG- v MASS• ` `•'=Sre=�:.nt;�.tT ��c��ic� v , ApPt_I CA."-r TOP OF FOUNDATION = 100.38' 5" DIA. OUTLET(S) FINISH GRADE OVER CHAMBERS = 97.50' - 98.50' GENERAL NOTES REMOVABLE COVER SLOPE @ 2% MIN. OVER SYSTEM 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISH GRADE OVER D-BOX= 99.72' 4" SCHEDULE 40 PVC MIN SLOPE 1% 3/4" TO 1-1/2" DOUBLE WASHED STONE TO CROWN OF PIPE METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE FINISH GRADE @ FND. EL.= 99.78' FINISH GRADE OVER TANK EL.= 99•12' 2" OF 1/8" TO 1/2" DOUBLE WASHED STONE ENVkRONMENTAL CODE AND ANY APPLICABLE LOCAL RULES. 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD Or HEALTH AND THE DESIGN ENGINEER. 20"MIN. ACCESS COVER 1 TOP OF SAS-,=-- 96.33' PLACE RISERS ON ALL CHAMBERS d 3. 4" SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL (TYPICAL FOR 3) 36"MAX. 9" MIN. TO 6" OF FINISHED GRADE EXISTING 4" /// 95.50' 36" MAX. BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED. BREAKOUT EL = 96.00 PIPE 4. TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE LESS THAN ELEVATION = 96.00' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS 2" DROP MIN. PROVIDE WATERTIGHT 6 3" 3" DROP MAX. 3"" 9" = d \ 7 JOINTS (TYP.) A 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF o '\ 4" PVC IN FROM �$ � � O C] : $a ���� O oo t THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. -96.80' SEPTIC TANK 4" PVC OUT TO �0 5. SLOPE ALL SOLID PIPE AT 1.0 % MINIMUM. 97.05, 14" LEACHING FACILITY OD oo o a 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. OUTLET TEE 96.17' MIN. 96.00' 2 0 D O D O 0 o0 0 o t 12" 0 7. LOCAL BOARD OF HEALTH TO BE NOTIFIED PRIOR TO BACK FILLING WHEN 48" oo I SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS NOT TO CONTRACTOR TO VERIFY ; oa o o oo $ BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH. ; CONDITION OF EXISTING TEES GAS BAFFLE V 6" CRUSHED STONE a o o 10.4' a 8. ELEVATIONS BASED ON ASSUMED DATUM OF 100.00' MSL �( r4rl�' raQ OVER MECHANICALLY - AS SHOWN ON PLAN. COMPACTED BASE 2'_ 8.5' 2 2, 2 +i 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION 5 OUTLET DISTRIBUTION BOX 21.0 (TYP.) THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE TO BE INSTALLED ON A LEVEL STABLE < ' I AT 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY SEPTIC TANK BASE. FIRST TWO FEET OF OUTLET 93.50' GROUND WATER ELEV.= 88.25 8.9 DISCREPANCIES TO THE DESIGN ENGINEER. EXISTING 1000 GALLON CONCRETES C PIPES TO BE LAID LEVEL. 2 - 500 GAL. CHAMBERS 5'MIN. 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE LENGTH 8'6" WIDTH 4'10" DEPTH 57' _ �+ T ! CROSS SECTION VIEW p � I STRUCTURES SHALL BE MADE WATERTIGHT. ' SEPTIC 'TANK PROFILE DISTRIBUTION y DETAIL TYPICAL CHAMBER PROFILE CHAMBE DETAILS CHAMBER END VIEW 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR NOT TO SCALE tJ f� NOT TO SCALE NOT TO SCALE ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS 41 TEST P T DATA - - - - y i " LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE Its � K THEY SHALL WITHSTAND H-20 LOADING. I ` ij INSPECTOR: ( 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND t VALUATOR FINES. SOIL E Samuel Philos Jensen. +h Lrgy ` DATE: /,pril 22, 2003 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF _ TEST PIT#: 1 t } v LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN y p rpm ELEV TOP = 99.25' COARSE SAND FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN �`� O ACCORDANCE WITH 310 CMR 15.255(3). ''� ` �` fl ELEV WATER = >11' BGS ,r r 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN PERC RATE = < 2 NIin/In SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. DEPTH OF PERC= 45"-63" 16. PROPOSED PROJECT IS LOCATED WITHIN: I MAP 120 L ? " �' ,,.,.s ASSESSORS MAP 120 PARCEL 117 TEXTURAL CLASS: 1 " h / rM � wM - 17. OWNER OF RECORD: ERIN J KENNEDY PARCEL 086 L� � ) w. f� �,..... ,� F �; ADDRESS. 116 OLDHAM ROAD l p 99.25' }{} y 0 OSTERVILLE, MA 02655 o U k �� r� 4 OIA Sandy Loam i k k 10Y R 4/2 f µ' 12" 118. PLAN REFERENCE: �' _ E Loamy Sand , 1. PLAN ENTITLED " DEFINITIVE SUBDIVISION PLAN "OSTERVILLE WOODS SEC. II" ELECTRIC I� �l r" 9 10YR 6/2 BARNSTABLE, MASS., FOR THE LANZA CORPORATION", DATED APRIL 12, 1972, SCALED AT w - PROPOSED , p � ,� 60 FEET TO AN INCH., LOCATED IN BARNSTABLE COUNTY PLAN BOOK 262 PAGE 58. wpm_ DISTRIBUTION BOX I � ` ` EASEMENT �� 7. ' Loam,' Sand 3 PROPOSED 500-GALLON (�zz�T i �� ��" B 10YR 5/8 19. DEED REFERENCE: 1. BOOK 11535 PAGE 174 0 M s, oti0 p �� LEACHING CHAMBERS ) 55� p0� SHED : I 38" 96 08 MAP 12O ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. r' ly 1ik� 45 95 50 Y r 21. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY Perc 8" OAK 1­6 OAi�r' Y PARCEL 119 ;:: _ FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY '" 63 94 00 � � � ;, � FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. ~' M-C Sand � . # r ` $ C 2.5Y 6/4 do 5 10°/ MAP 120 12" OAK �1 _ _ w - 6", 0, '� _ o Gravel PARCEL 085 6 PINT NO GROUNDWATER LOCUS PLAN TP _ 132" 88.25' 6 DINE .;j. �- 7-w 66.0' 99. 10" PIN& SCALE: 1" = 1000' 12" OAK DECK ".. .. DESIGN DATA LEGEND EXISTING LEACHING PIT UL EXISTING SPOT GRADES I TO BE PUMPED AND FILLED � � w�f , Q ...~� �m 50 EXISTING CONTOUR WITH CLEAN SAND NUMBER OF BEDROOMS (ASSESSORS) 2 ��� I S0 PROPOSED SPOT GRADES �'' # 116 NUMBER OF BEDROOMS (DESIGN) 2 L V'"' 1000-GALLON EXISTING DEED RESTRICTION REQUIRED EXISTING i ;rq• 2-BEDROOM ✓1 n PROPOSED CONTOUR SEPTIC TANK � 1� DESIGN FLOW 1'1d GAUDAY/BEDROOM C�b ,ry DWELLING .�J ✓1 / � `, ccc���ttt so � I TOTAL DESIGN FLOW 220 GAUDAY 2 ------- EtT/C - - EXISTING ELECTRICAL UTILITIES a,� r l O� TOF = 100.38 , o _ 440 '��,..� 15 s DESIGN FLOW X 20Ci /o - GAL/DAY �1�T'`C r*r� C6,� --------- GAS ---�- EXISTING GAS LINE USE EXISTING 1000-GALLON SEPTIC TANK D r_el� w �- EXISTING WATER LINE B.M. Cor. Conc. Patio ��` Elev. = 100.00' I MAP 120 TEST PIT LOCATION Assumed \4- - INSTALL 2 - 500 GAL. CHAMBERS PARCEL 117 ` (p� (J�(�R� EXISTING 1000 GALLON SEPTIC TANK 15,000 ± SQ.FT. MAP 120 pPP SIDEWALL CAPACITY � 4" SOLID SCHEDULE 40 PVC PIPE PARCEL 115 I A(�� 3� P �1 (LENGTH + WIDTH) (2) (2' HIGH) (.74 GPD/S.F.) = GAUDAY :� 1 [� DISTRIBUTION BOX 10° (2) (2') (0.74 GPD/S.F.) = 88.5 GAL/DAY c`�6� o O " S 1 C) 500 GAL. LEACHING CHAMBER GAO BOTTOM CAPACITY (LENGTH x WIDTH ) (.74 GPD/S.F.) = GAUDAY G ' .9") (.74 GPD/S.F.) = 138.3 GAUDAY REV. DATE BY APP D DESCRIPTION PROPOSED SEPTIC SYSTEM UPGRADE I TOTALS. PREPARED FOR: ERIC AND ERIN CABRAL TOTAL NUMBER OF CHAMBERS: 2 -~-------- ~ -- ~ ~- TOTAL LEACHING AREA: 306.5 SQ.FT. LOCATED AT TOTAL LEACHING CAPACITY: � GAL./DAY 116 OLDHAM ROAD r ' s �vt.�"t_ � ,.-_ _..____. . _ OSTERVILLE, MA 02655 SCALE: 1 INCH = 20 FT. DATE: APRIL 22, 2003 0 10 20 40 80 FEET TH OF ._. PREPARED .. ENTIRE PROPERTY LOCATED IN A DEP CHUCRCHtLL ��� JC ENGINEERING, INC. APPROVED ZONE 2 JR w �'"L No 41807 5 ROUNDHILL BLVD. . EAST WAREHAM, MA 02538 SITE PLAN 508.273.0377_- SCALE: 1"=20' ' l 3 Y 9 y�� _ ry y: JLC JOB No.437 c,L J Drawn B JLC Designed B JLC Checked B � ���