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HomeMy WebLinkAbout0176 OLDHAM ROAD - Health 176 OLDHAM RD Osterville A 120 — 129 i 0 Commonwealth.of Massachusetts /0?0-/o?f Title 5 Officinal Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 176 OLDHAM ROAD Property Address EDWARD CONNOLLY- 1 LILY POND LANE COHASSET MA 02025 Owner Owner's Name information is required for every OSTERVILLE MA 02655 8/5/2020 page. City/Town State Zip Code Data of Inspection r,l 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 614P filling out forms on the computer, use only the tab Christopher Maki key to move your Name of Inspector cursor-do not Cape Cod Septic Services use the return Company Name key. 350 Main St. Q Company Address W Yarmouth MA' 02673 City/Town State Zip Code 508-775-2825 SI-14423 Telephone Number License Number B. Certification SFr I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (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-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4, ❑ Fails r 8/17/2020 Inspector's Sig— n e 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 in the future under the same or different conditions of use. i5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form - III Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 176 OLDHAM ROAD L Property Address EDWARD CONNOLLY- 1 LILY POND LANE COHASSET MA 02025 Owner Owner's Name information is OSTERVILLE MA _02655 8/5/2020 required for every - 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: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303.or in 310 CMR 15.3.04 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): t5insp.doe•rev.7/26/2018 Title 6 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 176 OLDHAM ROAD Property Address EDWARD CONNOLLY- 1 LILY POND LANE COHASSET MA 02025 Owner Owner's Name information is required for every OSTERVILLE MA 02655 8/5/2020 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 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): 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.7126/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 3 of 16 Commonwealth of Massachusetts ,�p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 176 OLDHAM ROAD Property Address EDWARD CONNOLLY- 1 LILY POND LANE COHASSET MA 02025 Owner Owner's Name information is required for every OSTERVILLE MA 02655- 8/5/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning.in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well*". Method used to determine distance: *`This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 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 t5insp.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 176 OLDHAM ROAD Property Address EDWARD CONNOLLY- 1 LILY POND LANE WHASSET MA 02025 Owner Owner's Name information is required for every OSTERVIL'LE MA 02655 8/5/2020 page. 6tyrrown 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. ❑ ® 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 fallurezriteria 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 falls. 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 ❑ ❑ 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 t5insp.doc•rev.7/2 612 0 1 8 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspect!: onForm F' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 176 OLDHAM ROAD Property Address EDWARD CONNOLLY- 1 LILY POND LANE COHASSET MA 02025 Owner Owner's Name information is required for every OSTERVILLE MA 02655 8/5/2020 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)] t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts -^�-- Title 5 Official Inspection Form I'o Subsurface Sewage Disposal System Form Not for Voluntary Assessments 176 OLDHAM ROAD Property Address EDWARD CONNOLLY- 1 LILY POND LANE COHASSET MA 02025 Owner Owner's Name information is required for every OSTERVILLE MA 02655 8/5/2020 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:• 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 ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): '19-84 GPD '18- 115 GPD Detail: Sump pump? Yes ❑ No_ Last date of occupancy: CURRENT Date t5insp.doc•rev.7/2612018 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 V,r 176 OLDHAM ROAD Property Address EDWARD CONNOLLY- 1 LILY POND LANE COHASSET MA 02025 Owner Owner's Name information is required for every OSTERVILLE MA 02655 8/5/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.d6c•rev.7126/2018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form l Subsurface Sewage Disposal-System Form-Not for Voluntary Assessments 176 OLDHAM ROAD Property Address EDWARD CONNOLLY- 1 LILY POND LANE COHASSET MA 02025 Owner Owner's Name information is OSTERVILLE MA 02655 8/5/2020 required for every 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: 2006 PER,PERMIT ON FILE AT BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 32"feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line. feet feet Comments (on condition of joints, venting, evidence of leakage, etc.): LINE CHECKED WITH SEWER CAMERA AND WAS FOUND TO BE CLEAN AND PROPERLY PITCHED 15insp.doc•rev.7/26/2018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Y Title 5 Official Inspection Form l Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °t 176 OLDHAM ROAD Property Address EDWARD CONNOLLY- 1 LILY POND LANE COHASSET MA 02025 Owner Owner's Name information is required for every OSTERVILLE MA 02655 8/5/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 26"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 Dimensions: 1000 GALLONS Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle 2" 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 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. PVC TEES-IN PLACE AND CLEAN, TANK AT NORMAL OPERATING LEVEL. COVERS 9" BELOW GRADE t5insp.doc•rev.7/2612018 Title 5 Official Inspection Form:Subsurface.Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts to Title 5 Official Inspection Form � I. <i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments !% 176 OLDHAM ROAD �J Property Address EDWARD CONNOLLY- 1 LILY POND LANE COHASSET MA 02025 Owner Owner's Name information is required.for every OSTERVILLE MA 02655 $/5/2020 page. City/Town 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): 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.): 8. 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts ,� Title 5 Official Inspection Form _ tl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 176 OLDHAM ROAD t.. Property Address EDWARD CONNOLLY- 1 LILY POND LANE COHASSET MA 02025 Owner Owner's Name information is _OSTERVILLE MA 02655 8/5/2020 required for every 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.): i *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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 176 OLDHAM ROAD Property Address EDWARD CONNOLLY- 1 LILY POND LANE COHASSET MA 02025 Owner Owner's Name information is required for every OSTERVILLE MA 02655 8/5/2020. 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.): 1000 GALLON PUMP CHAMBER IS WORKING CONDITION. PUMP AND ALARM FULLY FUNCTIONING 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: ® leaching chambers number: 5 INFILTRATORS ❑ leaching-galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ . innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �. ,.�.�,..� 176 OLDHAM ROAD. Property Address EDWARD CONNOLLY- 1 LILY POND LANE COHASSET MA 02025 Owner Owner's Name information is required for every OSTERVILLE MA 02655 8/5/2020 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.): 5-INFILTRATORS FOUND DRY DURING INSPECTION WITH VERY SMALL PUDDLING. 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 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.): 15insp.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 176 OLDHAM ROAD ' Property Address EDWARD CONNOLLY- 1 LILY POND LANE COHASSET MA 02025 Owner Owner's Name information is _OSTERVILLE MA 02655 8/5/2020 required for every _- 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.ponding, condition of vegetation, etc.): 15msp doc•rev.7/2 6120 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts � I Title 5 Official Inspection Form .h Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 176 OLDHAM ROAD Property Address EDWARD CONNOLLY- 1 LILY POND LANE COHASSET MA 02025 Owner Owner's Name information is required for every OSTERVILLE MA 02655 8/5/2020 page. City/Town 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 16 of 18 c Commonwealth of Massachusetts -- _- ,rp Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 176 OLDHAM ROAD Property Address EDWARD CONNOLLY- 1 LILY POND LANE COHASSET MA 02025 Owner Owner's Name information is required for every OSTERVILLE MA 02655 8/5/2020 page. City/Town 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: 2006 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: ADJUSTED GROUNDWATER INFORMATION ON ASBUILT CARD FROM SEPTIC INSTALLATION SHOWS NO GROUNDWATER AT 72" Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15insp doe•rev 7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth'of Massachusetts Title 5 Official Inspection form i� Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 176 OLDHAM ROAD Property Address EDWARD CONNOLLY- 1 LILY POND LANE COHAS.SET MA 02025 Owner Owner's Name information is required for every OSTERVILLE MA 02655 8/5/2020 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector.lnformation: 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 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 •At his AZ rA 04 C� - 63 114 w ass II TOWN OF BARNSTABLE �� LOCATION 76 0���)L M Pew SEWAGE # VILLAGE oS den vt G2 ASSESSOR'S MAP & LOT // aq INSTALLER'S NAME&PHONE NO. 04&4-- c, e Zyd V 2 8 qU 9-1 SEPTIC TANK CAPACITY k't0 1000 uvh,2 LEACHING FACILITY:(type) 5'.11 '(fY fur (size) /0 38 NO.OF BEDROOMS -� BUILDER OR OWNER Vvk.S V\ PERMIT DATE: 13. ✓ Q-- COMPLIANCE DATE: G Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 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 Pta • a9• S F c{ �S �`3•0 as ag. 3 '4 a Of i TOWN OF BA,JRNSTABLE LOCATION ��� d��ha 11 "�OCL u SEWAGE# VILLAGE QSd�`"'�+ A4, ASSESSOR'S MAP & LOT LJT7�T T A 7 i TT I(•1L 1.fL` 0. � r K ��� 1 ® �• P SEPTIC TANK CAPACITY r! ( PAP LEACHING FACILITY: (type) g_ � NO.OF BEDROOMS 3 �J size) � IN — OWNER -J o Sc �j�pier 5 O /y PERMITDATE: tloq. °,COMPLIANCE DATE: fi Separation Distance Between Maximum Adjusted Groundwater able 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 omcarharKS.LOeare all welts-wlullrl lUU leer..7l caw ware puuuu 1� O.N• i3, 1 2s' �0 L 0 C A T 10 SEWAGE PERMIT NO. VILLAGE IN�STA LER'S A 7E & A,DORESS _ Y l _V ® UILDE OR OWNER vffe- 'Two,�- � r --.1 4 DATE PERMIT ISSUED DATE COMPLIANCE ISSUED /5,��f � � � 13 �K at- tlo��� . � {' 7� V q(� V ^� �� �° /� � ., , � ;q � � �; . a �� . � � . �� :� � � � - _. Q Aj . _ .� ., �3�1 { Y �j �,, � ff` f t f No.. / s i f Fee 16 0 i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: _,Z�_ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0[pprication for Wgpogal 6p9tem Congtruction V.ermit Application for a Permit to Construct( ) RepairX Upgrade( ) Abandon( ) ❑ Complete System,Individual Components Location Address or Lot No. �� �G� ��' Owner's Name,Address,and Tel.No. �`J�S'�t,�e.. T©SCP� �' SJg�tJ eL1W�1✓Q-� Assessor's Map/parcel. 120 I Z9QchE Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. CAp�w`O�. CST• t.-\..0 ��-kfl4' E��, S�iC'"�� 4 2,b-t-ko 25 3cr-`}el ls� Type of Building: Dwelling No.of Bedrooms Lot Size f STO 06 sq.ft. Garbage Grinder (/J/ - Other Type of Building /1�DnrL No.of Persons 2 Showers( ✓) Cafeteria Other Fixtures 1 c�yc^ c`. : �c.�C�eve �ic>lccr(1cM� Design Flow(min.required) gpd Design flow provided 33�j Eq O gpd Plan Date 1"Z 10 Number of sheets 1 Revision Date Title 0m, ocz- -1b\ Size of Septic Tank "7,3: 1 r9YL-,,o (J(OL� Type of S.A.S. X 11 Description of Soil Nature of Repairs or Alterations(Answer when applicable) e —��Cl 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. / Sig,ne Date Application Approved by /� Date �D 0 Application Disapproved by. Date for the following reasons Permit No. �.o Date Issued 3 Zo No. G W Ds­ b' Fee 160 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplicatt"On for Migogal 6p.5temc Con.5tructionpermit { Application for a Permit to Construct O RepairX Upgrade O Abandon O ❑Complete System, Individual Components Isla O\c\� —Rc\ Location Address or Lot No. Owner's Name,Address,andTel.No. OS�c-.��\\e - SosrrPH � S�saN �w+a��sc�► Assessor's MapTarcel 1 Zo 1 Zq Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. t^APEw�OE C L jNAY E\WV SVCS. A, LwZB e of Building: �'P2 Dwelling No.of Bedrooms J Lot Size S1006 sq.ft. Garbage Grinder Other Type of Building Abrw, No.of Persons 2 Showers( ✓) Cafeteria( v) Other Fixtures 2 v Design Flow(min.required) 3 J gpd Design flow`provided 3��JIq n gpd r Plan Date ?} ZG Ow Number of sheets 1 Revision Date Title ��VD -__-ecl- S A` Gx c 1�ccv- c �� a Su��. j Size of Septic Tank 9--Vlt S-r 1 JEW O,O�• Type of S.A.S. /6 X _')_ X (' c Description of Soil p\cy-, Nature of Repairs or Alterations(Answer when applicable) N�-o \�C(1 Date last inspected: iAgreement: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 Healr . Signe Date Application Approved by hN. f^ Date 3L u Application Disapproved by: Date for the following reasons Permit No. a Date Issued 3 ?u THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CER/T�IFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (/V) Upgraded ( ) \Abandoned( )by ti at 1 6 �( � , c J '`✓� Q has been constructed in accordance ,l with the provisio/nsJof Title 5 the for Disposal System Construction Permit No. G(] —rl datedInstaller ( `� ;�d li- Designer i #bedrooms Approved dep'gn flo\ w`-- 3 U gpd The issuance of this permit s�hhaall/Ao b�construed as a guarantee that the system w/�funchWn as esigned. Date I'15 Inspector No. . � FeeTHE COMMONWEALTH OF MASSACHUSETTS ' PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS =i5po.5ar 6pgtemt Construction Permit Permission is hereby granted to Go struct ( ) . Repair K) . Upgrade ( ) Abandon ( ) System located at / h �r+t1,2 Cl 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: Construct io must be completed within three years of the date of thi�s�'e mit. Date f U Approved by ��, / Town of Barnstable Regulatory Services • Thomas F. Geiler, Director BAXMABL&MAW ; Public Health Division. Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form ]Date: 4 -4 b� Designer: Shav Environmental Services, Inc. Installer: Address: P.O. Box 627 _ Address: East Falmouth, MA 02536 fy� On �} 5 1 U� c ar,-r, LLC- was issued a permit to install a date) (installer) septic system at -I-to ,Ae based on a design drawn by (address) Shay Environmental Services. Lic. dated (designer) YZs1= I certify that the septic system referenced above was installed substantially according t the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow, Y � y�N OF NSA, 1 CARMEN (Installe Signature) SHAY E No. 1181 at8TS SgNITAR�P� (Designer's Signa re (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTA,BLE PUBLIC HEALTH DIVISION, CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTD THIS FORM AND AS- BUILT CART) ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q;Heahh/Septic/Designer Certification Form 9/16/03 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems. Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, ( +AeME� �• S4A V ,hereby certify that the engineered plan signed by me dated :.24 106 , concerning the property located at 0 5—Cali I k meets all of the following criteria: • This failed system is.connected to a residential dwelling only...There.are no.commercial or business uses associated with the.dwelling. • The.soil is.classified as.CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct deep test holes and percolation tests.at the site without a health agent present. 0 There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the. Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information). 2'2,�+D B) G.W.Elevation :,0 +adjustment for high G.W. 2,5 5D DIFFERENCE BETWEEN A and B SIGN$D : DATE: NOTICE Based upon the above information-, a repair permit will be issued for bedrooms maximum.. No additional bedrooms,are authorized in the future without engineered septic system plans. t NIi� Z9 Z-o C'a C leve.-N= i4P gASeptic\percexemp.doc Iwo 1�0 �0-Y-0 Iry �� G , t �T e ►"Spa,ez co���Y� �,5 �ol�- t, Town of Barnstable r , P�OFZME Tp�� Regulatory Services Thomas F. Geiler,Director * BARNSfABLE, 9� . ••� Public Health Division ,ejFO MA'S A Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 April 12, 2006 Mr. Joseph Anderson 176 Oldham Road Osterville, MA. 02655 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5 The septic system owned by you located 176 Oldham Road, Osterville,MA,was last inspected on March 30th, 2006 by, Brad J. White, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system has "Failed" under the guidelines of.1995 TITLE 5 (310 CMR 15.00) due to the following: System is in hydraulic failure You have 2 years from the date of the system failure to bring the system into compliance. If there are any questions about this reminder, please feel free to contact the Barnstable Health Department. BARN TABLE HEALTH DEP TMENT Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health COMMONWEALTH OF MASSACHUSETTS F EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION eW r � V �M See TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 176 Oldham Road Osterville,MA. 02655 �? 7 Owner's Name: Joseph Anderson Owner's Address: Same ; Date of Inspection: 3/20/2006 � a Name of Inspector: (please print) Brad J White Company Name: Windriver Enviromental Z_ Mailing Address: 107 N.Main Street V �> Carver,MA 02330 Telephone Number: (508)-866-2576co CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the info ion reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority X Fa* s Inspector's Signature: Dater 3/20/2006 The system inspector shall submit a copyispection. his inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this i If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Continents System is in hydraulic failure ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 I Page 3 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART A CERTIFICATION(continued) Property Address: 176 Oldham Road Osterville,MA. 02655 Owner: Joseph Anderson Date of Inspection: 3/20/2006 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 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 and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: f Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 176 Oldham Road Osterville,MA. 02655 Owner: Joseph Anderson Date of Inspection: 3/20/2006 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _X_ 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'/z day flow _X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _X_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen.and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] _YES_(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system 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• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—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. T;r�A c T--fi-R,.—All 4 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART C SYSTEM INFORMATION Property Address: 176 Oldham Road Osterville,MA. 02655 Owner: Joseph Anderson Date of Inspection: 3/20/2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual):3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):330gpd Number of current residents: 2 Does residence have a garbage grinder(yes or no):NO Is laundry on a separate sewage system(yes or no):NO [if yes separate inspection required] Laundry system inspected(yes or no):NO Seasonal use: (yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): N/A Sump pump(yes or no): NO Last date of occupancy: Current COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped 9/6/2005 our records Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _X_Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool _Privy No Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: System was installed approx 1981 per as built plan. Were sewage odors detected when arriving at the site(yes or no): NO -r:a,, c T. .. ., r.- 1 c/Innn 6 Page 8of11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 176 Oldham Road Osterville,MA.02655 Owner: Joseph Anderson Date of Inspection: 3/20/2006 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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): o Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 176 Oldham Road Osterville,MA. 02655 Owner: Joseph Anderson Date of Inspection: 3/20/2006 SOIL ABSORPTION SYSTEM(SAS):X (locate on site plan,excavation not required) If SAS not located explain why: Type _x_leaching pits,number:_1— 6' x 6' pit had 1"of available room in it leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: _overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): Soil is wet.Pit has riser.System is in hydraulic failure.Vegetation is grass. CESSPOOLS:_(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): l 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.): -Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 176 Oldham Road Osterville,MA.02655 Owner: Joseph Anderson Date of Inspection: 3/20/2006 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 ,n Page l l of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 176 Oldham Road Osterville,MA. 02655 Owner: Joseph Anderson Date of Inspection: 3/20/2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 5'+ feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: _X_Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation:No groundwater encountered @ 5 per local slope off across street. TOWN OF BARNSTABLE LOCATION 7Ce &m PLJ SEWAGE # d�Go`tiS ' YILLAGE t �S�¢"wc ASSESSOR'S MAP& LOT cZ INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1000 12 LEACHING FACILITY: (type) U - ,6 ! (size) NO. OF BEDROOMS -� BUILDER OR OWNER V Q/S 'f PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 7 a -Feat 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 K SJ LAA h Jd 9 8£ V i ' J . a 1 LS.6 No -- --- = THE COMMONWEALTH OF MASSACHUSETTS .� BOARD OF HEALTH - - -----OF.... --- j� ppliratinn for Mivogal 10orkii Tnnitrnrtion Vantit .` Appli on is hereby made for a Permit to Construct 0<) or Repair ( ) an Individual Sewage Disposal Sys at: f�< :. --• ..;.... ---•--•--• •---------•---------•---------•-----•-----------................... �y --^ �ocatiort Address or Lot No. ne Address ......K ••—e ... ..... ••---•-•--•-......••.............. ---••-••••••............•.................. Install Address / �^ Q Type of Building Size Lot__/-vj_.�®O.Sq. feet U Dwelling—No. of Bedrooms............................................Expansion ttic ( ) Garbage Grinder ( ) 'k Other—T e of Building No. of persons____________________________ Showers — Cafeteria a' Other fix res .___ --------------- W Design Flow............:......._........__gallons per person,per Slay: Total daily flow_._...sS._ ...........................gallons. WSeptic Tank—Liquid capacity/&40-.gallons Length.!....... Width_A;.......... Diameter________________ Depth--_--___-___-__. x Disposal Trench—No....../........... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing t k 7 Percolation Test Results Performed by------ -------- 7--------------_-- Date..... .. _-Z.l. �.._.. Test Pit No. 1....�'Z.minutes per inch Depth of Test Pit___-__1 ... Depth to ground water________________________ Test Pit N o. 2.......... ,�' minutes per inch Depth of Test Pit------/ ......... Depth to ground water_t___'- "-._____. �+ r e� --•P............ r....... ............................. Descr>ption of Soil Q.°'�. ✓- '` G1 �- -------------•-- 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'T':L p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance Aeeued by the�iQard iSign ` -----------•••--• •-••-•......•-•-.......... Date Application Approved By----_-�-� �=. �-;E� J Date Application Disapproved for the following reasons:................ .----- ._ --------------------__------------- .-•-•-•-•-•-••••---•--•-....-•-•----•..........................••--•---•••••--•••--•---•----•••--•----•-••••-----•---•-•-•••-•---•----•••-••---••----•--•-•--•-•-•-•-••----------------•--••-•----••••- Date PermitNo......................................................... Issued....................................................... Date 40 No......................... F> is. .................... !. THE COMMONWEALTH OF MASSACHUSETTS BOARD. DOE H EA TH . _.. `. '.�--'...--...... c.%::�s-'.f.l<.=.............�.... AVV irtttinn for Uhip al Works Tomitrnrtinn Prrutit Application is hereby made for a Permit to Construct K) or Repair ( ) an Individual Sewage Disposal System,ax• ............... �') ..!........i.!✓+' -. ----••--• ---- ..... -----I�l_t------`---------------7 ocation Address or Lot No. r..... --. .r. .........--•-•................................... 1r .� Own Address InstaI14' Address Type of Building Size Lot........,:.................Sq. feet Dwelling—No. of Bedrooms............................................Expansion.;;A ttic ( ) Garbage Grinder ( ) pa, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) PaOther fixtures,---- -•----•-••••--•-••......•-••-•. . = ................_.......-•----------. f`.• d W Design Flow................. '......................gallons per person per day. Total daily flow-------....................................gallons. WSeptic Tank—Liquid capacity://�'10..gallons LengthZ .......... Width__:' ............ Diameter---------------- Depth................ x Disposal Trench—No....../........... Width•................... Total Length.................... Total leaching area....................sq. ft. below inlet................... Total leaching area..................sq. ft. Other.Distribution box DosinV,Depth b l Z Seepage Pit No. ( _.) Diameter.................... � � V� !1,11 off / Percolation Test Results �) Performed by Date.............................---........ 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........................ ---------------- ------•-••--•.. .. �a ---• QSoil... - Description of Soil ----------'------------ -•••--....------------........--•--...--•'-------•----------------------------------•-•----------•------------------------.........•.•.__. x c, w UNature of Repairs or Alterations—Answer when applicable............................................................................................... ----------•-----------------•--------•--------------------••----------------------------'-------••-•----•---••------------------------•--•----......................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with f^,T�'1'�'• the provisions of 'i: of the State Sanitary Code—The undersigne further agrees not to place the system in operation until a Certificate of Compliance has bee i sued by the boand�li Sined..... .� ....1... . �._. _. ........................ ......................_...._. y Dat Application Approved BY-'-•-"•• `- -- '• ... /9 tSs s Date Application Disapproved for the following reasons:----'--••••---- -----•--••- --•-----•--•......-••----•-•••--•----•---------•--'-••--•-•-•••-•'..._------•... ...,s... Date PermitNo.'.............'--'-'--'--'---•'-•--'--'-----•--....... Issued..................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD ,OF HEA.L 7 ' L:YL4_ra t ....:f! ...........................OF........ ..r. ..:........... .............. ................................ (�rrtiirtttr ,af f�,ant �inrr THLS Y That the Individu age Dis ys constructed ( ) or Repaired ( ) by �.../J��.�I'r✓�� -jI ' ('.V//�T\�/.J I V +Wf✓�`j(j JL.Y/'�-./--{-•'/•'.L ........'-•'•...._....•••••---•-••--•-'•....-••--".............. Inj alA f at ... .I .................................................................................... ................................................... has been installed in accordance with the provisions of TI?O�!) o T./he State Sanitary Code as described in the application for Disposal Works Construction Permit No.... ______________ dated_.............................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SAT4S A: TORY. DATE.............•................•"......--'''• ,. ----•••......... Inspector......_...---.�ijft - -------------------------------------------•--..------ THE COMMONWEALTH OF MASSACHUSETTS '"��~�✓� BOARD Of HEALTH�/OF.......j�.............. No......................... FEE.....-�1 Disposal nrk� ��antrnrtuan rrntit _._.e_..1--A,r_ f ,. to Consmi on is hereby T nted ian Ind al Se, .e FD v = 6 ----- •--- ---------- }� -( �o � ( ) ;�� � g �VoOQ em !' -° at No. `'``f art./.......... .......................•--•.-•--------- Street as shown on the application for Disposal Works Construction- /P err,i}j. No.:............... v Da d_._._.... . _..__.....-_-__•-_-__------.--._ DATE. 5 's/ �dofHealth ..............--•----- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS ,-� 1 CR 7We. .5. 7 Ow MORe A.ofr ID Orr--./W IAI A A. SWAL F-Z ff 400004NT, -r-O '*Mo4 CONCRETE V Y CA 5 7 . ... :, 1,0='1,oV DoolFIVEWA)" C AM co P 27 MIN. c)�-,—,olr cr M,4 4p ff c CLEAN -5*A A1,0 Al a LAYER 4" CAST 7 93 IRON PIJPPE t 1450 L 441 WA5H,-=O 57-ON eprlC TANK M At jP1 7CH CrA L. 4 0 .0 off BOX WASHED PRECAST SEEPAGE P17 -OR EQZIIV-- , IMMER7 AT ff4/1L-,D1tVCy '9 7,0 Fr PIAM. lv4E-r SEPTIC-IC TANK 9FT. VA C;o F ,96 ,3 Fr OUTLET SEA;1T/C TANK GROUND WATER TABLE UPON BOX 9- 6.-01 0=7 SECT/O/V OF In-' 5-rwaarlolv-Box ym. r .5 EWA Gs.6. AVISPOSAL SYSTEM -rA ACHING. C-.,-r LEA CH//V ev PITviMEws/oN 3 FT. SCALE. y's 10A, , a- FT. F 77, NUMBER OF&EIDMOOMS Re,4GE0/SPOSA"L.UN/T SOIL -LOG: '7 - - A�-LS3 L)-GAi./0AY SOI.L.74-sr S77 . A/ . $OIL -4,707AL & SOIL.'7E.S77- _7 '*YMO"0.4W Z4�q 0 cowve, 0 'Y�. � .- , ,I—.- � " - �11 : �,OA AVI 7-"Z 5SAED y __T07 7 65W.775 46 s4g 5/s%=_ 4a_ACA4hVCr PER dw :� z woN jeA re S MJ A�olj-M' CH 400T-rOM LAACNIA'Cr PERA7. -)tco4A-r1a"v P. RATE-REA so., �Wrv, 5VO z C) Sip. P 7: ve z.,s4 clN I mer,AREA '7 aV 71- LVF 4D),0 OF-Al V . - 4,p VI.A_A_ Utjt . p t:r-,BVNIKI FA wa Co. INC. v A 2162' !4, ........... "�''..':�, - r 4 � _,r � ta'n • � ..A �"7�.,Q� ( S� i �,� 't J � � ,��a &-,t �r�` �,__ • 4 *A 'ffc4 2 to t ' 1 f r L A a it /.ttJ�L�,` -,� �'�-r•�C - � ci Tfu F' f F S t a_1�y- .tl �` r t Y a n r 7 ra /-^) / : /ICJ fj.4 �^''[�� /�q.).//� �j/gyp y{ BUNW LEGEND ' k: EXIOTING .SPAT ELEVATION Ox0 � -- -CERTIFIED,':,, t9TtN0 CONTOUR 0'-- - <—�r ►lNI$HtD SPOT ELEVATION 10. �.- F1H,tSII�EO CONTOUR. . 0 r�.,Z, i, �ARovED BOARD :: of HEALTH A. A ,L �. OAT AGENT SCALE= �l" 30 °'DATE; ;+ , ENGiNE'ERONG CO. IN CLIENT ;i�cJs� 1 `CERTIFY THAT. THE: ` 1:®ISTERE REGISTERED g626-i w ,doe No. GurLpING. SHOWN oN tol � . CIVIL LAND _ ��� CONFORId TO THE Y GINEER SURVEYOR QR.i3Y OF BARNS' . `BIE, ► . ; r �', r CH. BY= 712 MAIN ST. i HYANNIS, MASS. SHEET_,L b :-' jj° DA LAN® $ 77, PERCOLATION TEST Kitchen [Both Bath Bedroom Date of Percolation Test: MARCH 28, 2006 3-24-REMOVABLE COVERS /Dining Test Performed By. CARMEN E. SHAY, R.S., C.S.E. 3-u•DIAM. ACCESS MANHOLES ` Results Witnessed By. WAIVER ( per BARNSTABLE B.O.H.) B'-o• Excavator: Shay Environmental Services, Inc. ' " '"'''` "' ' 4" ' " .b• •:r .,•1 i.�".'t:d.�...�'.h�•.�t.::il • 'o'•J : n,kf.d.Or�IC. ''t � '1T, INEf' Percolation Rate: Less Than 2 MPI ® 8 INLET s•mM -�x_min. Inlet to outlet e.,,,I,, Living Room Bedroom Bedroom �j r '•�"I I:: �' ' '` ,o•�. I Lqf uTdTiwl 1°. .2 OUTLET � .a ,� to S_o" _ INLET r °' 0- Test Hole Test Hole INLET , ou r uquw e:Pth No. 1 No. 2 �!r, DEPTH SOILS ELEV. `J DEPTH SOILS ELEV. 0 98.00 0 98.00 eT„�^%'•"'�,"Tw•-•.y..,.,^�+„r r ' ;• •�' f •; •� 3 BR HOUSE FLOOR SCHEMATIC Loamy Loamy STEEL REINFORCED PRECAST CONCRETE Sand Sand PLAN VIEW CROSS SECTION END-SECTION 10 YR 3/2 10 YR 3/2 Ar 97.33 0"-8" A„ 97.33 MSand Medium ACCESS THE CCE COVERS FOR THE SEPTIC TANK, 7.5 YR e/, Sand TYPICAL (EXIST.)1000 GALLON SEPTIC TANK DISTRIBUTIONEACSS Box AND LEACHING COMPONENT 'OO.oo+ i 7.5 YR 8/1 SHALL BE RAISED TO WITHIN 8" OF 8"-120' C' 88.00 8"-120" C' 88.00 NOT TO SCALE FINISHED GRADE. �� �. (H-10 LOADING) INSTALL TUF-TITE GAS BAFFLES OR EQUALS -ell ON ALL OUTLET TEE ENDS O - ��� Note: Remove soil down to el. 99.00 o C-1 Layer & replace ith ---- SHALL BE �� clean coarse sand w/perc. rate less NO B LAYER FOUND os RwunON PIPES FROM 7HE ELEVATION CUT DOWN WHEN HOUSE WAS CONSTRUCTE SET LEVEL FOR AT LEAST Z FT. 12 CONCRETE COVER TEST HOLE #1--- or equal to 2 min./in. before & after placement ELEV.- 9f3. ,.. . 3- 6"OUTLET y •"• •+•"• KNOCKOUTS 100\ k may.B$r- \�Q' s - 5.V ouTUlr ,Y INLET \\` TEST HOLE2 y � , ,r►;ti k .: '�ti•7ti \\ ELEV.= 98.00/ i'' � � / I, � i�; "e e e , .. e N• (D-BOX\\ ,es 4" - SCH. 40 To 1.75• rY t r \\ /' 41.v�riT ' i r'1�i.., '�ai�`P1eY'i �' PLAN-SECTION CROSS SECTION `\ .- - - .- J `yo b 3 HOLE H-10 DISTRIBUTION BOX Failed O Perc #1(® Test Hole #2) „� �U cwt� - LEACH PIT Depth to Perc: 20" to 38" �, 3° NOT TO SCALE - --------- -- ,100 Perc Rate= Less Than 2 MPI r,il :-so•oueN Aoa,e wu.,aEs MIW29/ZONE C - INDEX 7.6 for 0/06 Lut �c,�Tr PROJECT BENCH MARK EXIST. , 0 34 , 2-20• REMOVEABLE O 98 ADJUSTMENT - 2.5 FEET 2' MANHOLE COVERS WITHIN ELOEV.OF 100 OO FOUNDATION Assumed , OBSERVED H2O Elev. _ 90" or 7.5' below Grade �'<"' � °•�FINS RESTORE TO FINISHEo GRADE ELEv. Nr-r 1 (Assumed) ADJUSTED H2O Elev. 60 Inches or 5 below Grade ;t , a�• j,,,S"1JuP'TJIC""W`4JK', 98 1000 GALLON per Cape Cod Commission AdjustmentDECK Pump Chambe BUOANCY CALCULA TIONS LFr DIT ai4N THE ACCESS COVERS FOR THE SEP11C TANK, LOT #55 INLET INVM • 41DISTRIBUTION Box AND LEACHING COMPONENT SET DEEPER THAN B-BELOW FINISHED f �Jli _ OUTLET INVERT ELEV.- 00.00 GRADE SHALL BE RAISED TO WITHIN e" OF Weight of Septic Tank(Exist): N7,240 lbs. 3�cFREQE PPAM CHECK VALVE �r '.yT..�'yam• flNISHED GRADE' LOT #51 \ ' % Weight of Soil Above Tank 2,220 lbs. r SWING CHECK VALVE-P.Y.C. STEEL MWORCED PRECAST CONCRETE �`�\ EXISTINC �98 Total Weight Down: 10,460 lbs. °1* • PLAN VIEW \\ .� 3 BEDROOM r------, �� 2 a-W 1117M CLAM r _ � 1 HOUSE i I r Weight of Water Displaced. 2,520 lbs. °'`.- :,�� ,,, • ' \ #f 76 1B• 01M sNn. _Lr ant►Not to,vast $ * No Ballast Required For Septic Tank _ PL►� CHAMBER ELEv._ 92.00 'e.,,.,, I-i-�M - ,' °"'�' Y \\ i -- 0 20 X Ito 40 5o Weight of Pump Chamber(H- 10: 8,250 lbs. 12 w 3/4 - 11/2 sten. { f r 601, dolh 100, - Weight of Soil Above Tank 2,750 lbs. `• - -'' I I PUMP DETAIL ` Total Weight Down: 11,000 lbs. , ,, ,f0e,, -SECTION C SCALE: 1 =20 CROSS Weight of Water Displaced: 2,520 lbs. LOT #53 I RAVEL I PUMP NOTES & SPECIRCA TONS 1000 GALLON H-10 SEPTIC oT TATO NK K USED AS PUMP CHAMBER 16,000, Square Fast +/- � GRAVEL * No Ballast Required For Pump Chamber I I f. PUMP SHALL BE livAALLED /N STRICT COA1PLi NCE NOTE: PUMP CHAMBER TO BE FACTORY WATERPROFFED PRIOR TO SHIPPING. _�Z� `� I I WITH MANUFACTURERS SPECIFICA710NS. 1 I ?,sign n CO(C u I a t I On S 2. ALARM SN4LL CONSIST OF AUDIBLE SIGNAL # T _- I I RED wARN/Nc ucHr TO BE INSTALLED IN WILDING O�, AND POWERED BY SEPARATE CIRCUIT nZoif PUMP SPECIFICA 77ON ;CALCULA 770NS CIRCUITS Ti9 PUMP., �00.00, j � J. DOSING SCHEDULE; 13XNumber of Bedrooms: 3 Equivalent to 330 Gal./Day (330 Gal./Day Min. per Title V) 330 GALLONS/4 DOSES-82.5 "-IOAS/oo.SE yTA?hc fffAD CALC-ULA77ON J Ad `� Garbage Grinder: No --------------- Ching Capacity Proposed: 330 Gal./Day Minimum (Min. Per Title V) 99.17' - Bev of D-Box In `\ ��---i -- Septic Tank - 2 x 330 Gal./Day = 660 USE EXIST. 1,000 GAL. Septic Tank. i2.00' - Elevation of Bottom of Pump Chamber \ FLOA T LOCA 77ON CALCULA 77ONS -------------=------------- ----- I e ABSORPTION AREA: Using percolation rote of C7 min./inch I Bottom Area: 0.74 al s ft. x 372.5 s ft. - 275.65 gallons ag.17 - Ni2.00' • 7 t7" Statio Head •`+ g / q• 4 g 825 Gallons/ 7.48 GAG/Cu � - 11 Cu fY.r Sidewall Area: 0.74 gal./sq. ft. x 78.72 sq. ft. = 58.25 gallons Area of Bottom-of Chamber 8'x s' 40 Sq. R. DYNAMIC HEAD p Providing: - 333.90 gallons Height of wafer for One Dose,(H) - 11 Cu. Ft. /40 Sq. Ft.H - 0.28 Ft. - 3.4" Friction Hood For J'SCH 40 PVC Pips TT TT11 L �1 7� T� C ®L l./r L��31►/I R 0-,.4L Use: (5) INFILTRATOR HIGH CAPACITY H-20 UNITS, HAVING A 0.83' (10 INCHES) EFFECTIVE DEPTH, e/0 GPM - 0.005 lit./too Ft. TO BE USED WITH 3.5' OF WASHED STONE ON THE SIDES, AND 3.5' OF WASHED STONE Pump On - 10:5" 050 GPM - 0.01 Ft/100 n. Use Gould Model J887(M50511BF) Pump ON THE ENDS. NO STONE UNDER. Pump Off - 7.1- 0100 GPM - 0.40 FL/100 Ft. 230 Volt Phase l (40 FOOT RIGHT OF WAY) 1/2 HP 2"Solids Handling Alarm - 14.0" rota/ Dynamic Hood - 7.57' 0 100 GPM OR EQUIVALENT EXISTING SAS TO BE PUMPED DRY & THE PROPERTY LINES ARE APPROXIMATE AND PUMP PERFORMANCE DATA COMPILED FROM THE SURVEY PLAN ENTITLED FILLED IN PLACE CERTIFIED PLOT PLAN OF LOT 53 OLDHAM ROAD GENERAL NOTES NOTE: THE STRIPPED OUT SOIL CONTAINING LEACHATE BY E ELDRLDRID MA, DATED MAY 27, 1981 BY ID GE ENGINEERING of YARMOUTH, MA FROM THE EXISTING SEPTIC SYSTEM TO BE DISPOSED AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN 40 1. Contractor is responsible for Digsafe notification IT SHOULD BE USED FOR NO PURPOSE OTHER THAN and protection of all underground utilities and pipes. OF AS PER 'BOARD OF HEALTH SPECIFICATIONS. THE SEPTIC SYSTEM INSTALLATION. 2. The septic tank / l distri¢L{ion box shall be set level on 6" of 3 4 -1 1 2 stone. 3. Backfill should be clean sand or gravel with no !►HAND * stones over 3" in size. r ' LEGEND i 40 4. This system is subject to inspection during installation PROFILE OF SEPTIC SYSTEM + 166 by CARMEN E. SHAY - Environmental ' 1 5. The contractor shall Install this system in accordance 8X0 DENOTES PROPOSED c with Title V of the Massachusetts state code, the approved plan er and Local Regulations. SPOT GRADE = 6. If, during installation the contractor encounters any a ! ` DENOTES EXISTING E 20 soil conditions or site conditions that are different 104X46 o from those shown on the soil log or in our design / SPOT GRADE a installation must halt & immediate notification be *NOTE.- INSTALL TUF-T/TE CAS BAFFLES OR EQUALS ON ALL OUTLET TEE ENDS. Finished grade over system-2X slope away A M PL PROPERTY LINE .0 made to CARMEN E. SHAY - Environmental ,"� N°- 10 7. No vehicle or heavy machinery shall drive over the / septic system unless noted as H-20 septic components. Provide Risen if necessary Finished rode over system- 100.33 � � ` '�' / to briny D-Box cover g y r A PROPOSED CONTOUR 8. Install Tuf-Tate gas baffles or equals on all outlet tee ends. within 6" of finished grade 10' min. from Provide Risers 97- - - - - -97 DBOX EXISTING CONTOUR 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. +� � `� EXIST. House house to septic tank Provide Risers it necessary to brin INLET Pump Chamber cover yy ,� 10. All solid piping, tees & fittings shall be 4" diameter to briny Septic tank covers to grode and outlet cover to within 4 within 8" of finished grade 6" of finished grade DEEP TEST HOLE & Schedule 40 NSF PVC pipes with water tight joints. 1/B Per foot Top of System- Ow.-sees kwA 0 20 40 60 80 100 120 140 11. Municipal Water is Available And All Houses Within 150 Feet 3' Maximum r. f PERCOLATION TEST LOCATION Level for 2 o Effective oepthkfpNs �. ,� are Connected. s. 1/4. �N 5, eo* -. STOCKADE FENCE ► Per foot S. i/e-Per foo FORCE MA g {M BNaedYe!tat7tOwylerflE7 Q ti Capacity - US G.P.M. EXIST, PIPE pp 0.83' (10 inches) FROM EXIST. C 8 10' to 50 obi � FaikNDATION rr X/ST. 1000 GALLO 5'u7 p II g 14" 8o& 40 � SEPTIC TANK �j KV 1000 GALLON s" soh 40 P > � � � v; PUMP CHAM A PROPOSED CONCRETE FOUNDATON 'a II 03 H-10 (6 > > 3.5' 3.5' II REVISIO N S FULL FauNOAT1DN it 3; PREPARED FOR : c 8" OF 3/4"-11/2" STONE 3�i y 6" OF 3/4"-11/2" STONE Effectiv0e Vldth c c 6" OF 3/4'-111P/2" STONE 9 $ SUBSURFACE SEWAGE DISPOSAL SYSTEM PUMSYSTEM PROFILE CHAMBER W Adjusted Groundwater - Elev. 93. 0 N O. DATE: DEFINITION OF - Observed Groundwater - Elev. 90.50 Bottom ofTe�t Foie-=lf-ev."$S13b---'"- SECTION A --4J O S E P H 8c S U S A N A N D E R S O N # 1 7 6 O LD HA M ROAD PROFILE VIEW OF ADDITION TO LEACHING SYSTEM OSTERVILLE, MA 3" of 1/8' - 1/2" Washed Peastone /4" to 1 1/2 ' Washed C shed Stone ASSESSORS MAP - I2-1, PARCEL - f Z,9l Note: Remove soil down to med - coarse sand layer & replace with # 176 OLD HAM ROAD PREPARED BY: %0,�, (elev. 9.00 Estimated) & replace with clean coarse sand w/perc. I PVC(CAPPED)INSPECTION PORT TO 9E INSTALLED AND TO BE 1M1WN 0•OF GRADE NOTE: PUMP CHAMBER TO BE FACTORY WATERPROFFED PRIOR TO SHIPPING. rate less than or equal to 2 min./in. before & after placement O ST E RV I L L E MAC j?ff �A OF A EV E. SHA Y • 5 Units 2 6.25' 30' ENVIRONMENTAL SERVICES, INC. rT 7 AY > . a' 31.25 3' o P.O. BOX 627 Effect e2Lengtn STI EAST FALMOUTH, MA 02536 SOIL ABSORPTION SYSTEM (SAS) SAAV/ITAR N INFILTATROR HIGH CAPACITY (H-20 LOADING)/ GEORGE O'BRIEN TEL/FAX 508-548-0796 (OR EQUIVALENT) Not to Scale SCALE: 1 "=20' DRAWN BY: CES DATE: MARCH 29, 2006 NOTE: OVERALL HEIGHT OF INFILTRATOR IS 18" /EFFECTIVE HEIGHT IS 10" PROJECT#SD-885 FILENAME: SD885PP.DWG SHEET 1 OF 1