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HomeMy WebLinkAbout0221 OLDHAM ROAD - Health 221 L ldha m,Road e45 016 ter F 0 i 0 J /yam o«- Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 221 Oldham Road -" Property Address Marla Myers Owner Owner's Name information is required for every Osterville Ma 02655 4-26-19 } page. City/Town State Zip Code Date of Inspection " Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information �� a� filling out forms ( 9 Z on the computer, Brett Hickey use only the tab key to move your Name of Inspector cursor-do not B&B Excavation use the return Company Name key. 374 Route 130 m Company Address Sandwich Ma 02563 City/Town State Zip Code (508)477-0653 S113747 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 ry, --i;`':'MR 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 Brett Hickey -26-19 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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. t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 • .`1 c Commonwealth of Massachusetts Title 5 Official Inspection Form ' 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments l; 221 Oldham Road V Property Address Marla Myers Owner Owner's Name information is Osterville Ma 02655 4-26-19 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 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system was in working order at the time of inspection. y 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.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 221 Oldham Road v" Property Address Marla Myers Owner Owner's Name information is Osterville Ma 02655 4-26-19 required for every 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 221 Oldham Road v Property Address Marla Myers Owner Owner's Name information is Osterville Ma 02655 4-26-19 required for every page. City/Town 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: r1 **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 ❑ O Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ondin of effluent t h surface f o the su ace o the round or surface waters ❑ 0 9 P 9 9 due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts �s Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 221 Oldham Road Property Address Marla Myers Owner Owner's Name information is Osterville Ma 02655 4-26-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ Q Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ O Liquid depth in cesspool is less than 6" below invert or available volume is less than '/day flow El O Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ l Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ 0 Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ❑ 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. ❑ El 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.] ❑ El The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ 0 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 ❑ ❑ 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 r c Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 221 Oldham Road Property Address Marla Myers Owner Owner's Name information is Osterville Ma 02655 4-26-19 required for every 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 El ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ El Were any of the system components pumped out in the previous two weeks? 0 ❑ Has the system received normal flows in the previous two week period? i ❑ 0 Have large volumes of water been introduced to the system recently or as part of this inspection? El ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ 0 Was the facility or dwelling inspected for signs of sewage back up? 0 ❑ Was the site inspected for signs of break out? 0 ❑ Were all system components, excluding the SAS, located on site? El ❑ 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: El ❑ Existing information. For example, a plan at the Board of Health. ❑ Q 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.7/2 612 0 1 8 Title 5 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 221 Oldham Road v Property Address Marla Myers Owner Owner's Name information is Osterville Ma 02655 4-26-19 required for every State page. City/Town St Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: 2 Number of bedrooms(design): Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 345/GPD Description: 1 Number of current residents: Does residence have a garbage grinder? ❑ Yes Q 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 E] No Seasonaluse? ❑ Yes [g No Water meter readings, if available(last 2 years usage(gpd)): See below Detail: 2018- 74,000gallons 2017- 59,000gallons Sump pump? ❑ Yes ❑■ No current Last date of occupancy: Date t5insp.doc-rev.7/26/2018 Tile 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 r c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments (F' 221 Oldham Road V Property Address Marla Myers Owner Owner's Name information is Osterville Ma. 02655 4-26-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: NA 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: Owner- last pumped 5 years Was system pumped as part of the inspection? ❑ Yes ❑■ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 �_ 1 I Commonwealth of Massachusetts �s Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �t J� 221 Oldham Road Property Address Marla Myers Owner Owner's Name information is Osterville Ma 02655 4-26-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: E 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: 2005 Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No 5. Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ❑■ 40 PVC ❑ other(explain): Town water Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 i�+- Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 221 Oldham Road v� Property Address Marla Myers Owner Owner's Name information is Osterville Ma 02655 4-26-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 1' Depth below grade: feet Material of construction: ❑■ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No 1 Dimensions: 500gallons 6" Sludge depth: 3091 Distance from top of sludge to bottom of outlet tee or baffle On Scum thickness NS Distance from top of scum to top of outlet tee or baffle NS Distance from bottom of scum to bottom of outlet tee or baffle measured How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank was in working order at the time of inspection. The tank is not in need of pumping at this time but should be pumped every two years for maintenance. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 c Commonwealth of Massachusetts i. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 221 Oldham Road v� Property Address Marla Myers Owner Owner's Name information is Osterville Ma 02655 4-26-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): NA 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 i 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): NA Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: I 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 c Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 221 Oldham Road Property Address Marla Myers Owner Owner's Name information is Osterville Ma 02655 4-26-19 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.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): 0" 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.): The d-box was in working order at the time of inspection. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 c Commonwealth of Massachusetts +n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t 221 Oldham Road Property Address Marla Myers Owner Owner's Name information is Osterville Ma 02655 4-26-19 required for every 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.): NA * 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: ❑ leaching galleries number: 10'x41' 0 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 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 221 Oldham Road V Property Address Marla Myers Owner Owner's Name information is Osterville Ma 02655 4-26-19 required for every 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.): The SAS was in workingorder at the time of inspection. Infiltrators were d when viewed. p dry 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA 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.): t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 c Commonwealth of Massachusetts �9 ,lp Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 221 Oldham Road Property Address Marla Myers Owner Owner's Name information is Osterville Ma 02655 4-26-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): NA Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): r t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 c , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 221 Oldham Road V Property Address Marla Myers Owner Owner's Name information is Osterville Ma 02655 4-26-19 required for every 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 tA �lvr' 7 �7f> sewAE vu UA ,ass ssOtx s -LOT _ .Va� NANffi_&PHONE NO, rry 4 LEACKNb FACILtUY. NO3 otz BLL3koom S ' Separation Dissanee Between the'a tvfaxirl iota Ati(cited GrmndiAiatv,Table,io the[3etzbm crf Le c'1'an ,F c lrty Prat ihrava*Water Suppty,Wil-1 and Zxaclsing Facility <7f any'well s ezi"st uw,site or wit61,6 2t>0 feet ofleaching f 6tity? Feet Edge of wetland and Leaehiii&F..acaity:ar"any-Wetlands exist a it3un 3tdCi feet of le tsars tac ttcty) Feet' Furnished bye � . Z 4 7 3"': C� = ` sus Pzw t5insp.doc•rev.7/262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 221 Oldham Road Property Address Marla Myers Owner Owner's Name information is Osterville Ma 02655 4-26-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: © Check Slope ■❑ Surface water ❑■ Check cellar W Shallow wells F below SAS Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans on record 7-7-05 If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) "' ! t; ❑ 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: A plan on file at the local Board of Health was used to determine high groundwater. Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Y Commonwealth of Massachusetts +n ,lp Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 221 Oldham Road Property Address Marla Myers Owner Owner's Name information is Osterville Ma 02655 4-26-19 required for every 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 0 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 No. �31 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS y , 0[pplication for �Dizponl *pztem Con0truction Permit Application for a Permit to Construct( )Repair Grade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Zj 0 ICA k+R Wj Owner's Name,Address and Tel.No. Inh-IV _ ��� Assessor'sMap/Parcel /q5/1� �" Installer's Name,Address,and Tel.No. R Q-o/s't Designer's Name,Address and Tel.No. 60. 6Gt t-v1.S?W_R le_ fi-WSS (10 U3 N< L Af�-C_CE!N d f�i�S Type of Building: Dwelling No. of Bedrooms Z Lot Size ( 5�sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 2-7- gallons per day. Calculated daily flow 3 gallons. Plan Date S Number of sheets r Revision Date, F Title Size of Septic Tank / AQ�9 Type of S.A.S. Description of Soil Nature o irs or to ations(A nswer when applicable) %/U S f (� f SC O Date last inspected: Agreement: The undersign es to ens a cons tru tion a inten a of the afore described on-site sewage disposal system in accordance with the provis'e s of Title 5 of the A n ntal Co nd not to place the system in operatio7unfita Ce h- sate of Compliance h en s d by oar o eSigned Date �4 d"s Application Approved by ` Date F13ckr Application Disapproved fog&followlng reasons Permit No. 2Q0 _q3 f Date Issued e v R h Vol No. tl — s� b Fee .] THE COMMONWEALTH OF MASSACHUSETTS. Entered in computer: !_ PUBLIC HEALTH DIVISION - TOWN`OF BARNSTABLES MASSACHUSETTS Yes _ 12l'"plicatfon for Mi5pogal *p,5tem Con!tructfnn Permit Application for a Permit to Construct( . )Re air( V ) rade ' Abandon D Com lete System ❑Individual Components - Location Address or Lot No.?-7-1 018 k+A m Owner's Name,Address and Tel.No. • Assessor's Map/Parcel / ,< S AA' 5 ` Installer's Name,Addr ss,and Tel.No. R C•,o mst Designer's Name,Address and Te1.�No. 1 Type of Building: ' Dwelling No.of Bedrooms Lot Size ( S sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures f Design.Flow 2-Z 0, gallons per day. Calculated daily flow 7�gallons. Plan Date �j S zd Number of sheets Revision Date Title Size of Septic Tank /5Q:�, Type of S.A.S. Description of Soil Nature LR airs or to ations( nswer when applicable) Date last inspected: Agreement: The undersignkdFagrfees tolensuce-the cons �tion ad,rid- inten e of the=afore described on-site sewage disposal system in accordance with the provisio' ofTitle5ofthe nvi nmental Co e and not to place the system in operation until a Ce ifi- cate of Compliance has-been i d by is'B0 1 of e lth. Signed a Date �, 30 a Application App roved;byl - r S . s Date l3, v Application Disapproved foRhe•:.following reasons „ Permit No. v2 U�{5 �. �3 Date Issued ' ?C, d ——— —————————————————————————————————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE MASSACHUSETTS Certificate of (Compliance THIS IS TO CERnTIF1Y�, that the On-site Sewage Disposal System Constructed Repaired( )Upgraded( ) Abandoned( , )by K 1 Cl cur at I ��, )(I L1 M r)r �P/ti l�/o has been constructed 'n accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.,? Uo 5-- V 31 dated 36 u Installer Designer The issuance of this pe i sha�l no be construed as a guarantee that%tthhe stem w'l nction as designed. Date �:7 1 ��w Inspecto'r�-- i - - — � � -------------------------- No. �Ob ,.Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS ® li5po5ar 6p.5tem Congtructfon Permit Permission is hereby granted to Xa_- andtruct( � BRepair( )Upgrade( )Abandon( ) System located at2! 6 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 thisp76t0w-_r-<&, Date: � Approved by I ""--� FRAM :down cape engineering inc FAX NO. :15093629990 Aug. 31 2005 09:33AM P2 k COMMONWEALTH OF MASSACHUSETrS ]EXECUTIVE, OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER s,rREET, BOSTON, MA 02109 G17.292-5600 ROD DURAND JANF SWIFT Secretary Governor LAUREN A.LISS CiornmisaioneI k MODIFIED CERTIFICATION FOR GENERAL USE Pursuant to Title 5, 310 CMR 15.000 Name and Address of Applicant:, Infiltrator Systems,Inc. P.O.Box 768 6 Business Park Road Old Saybrook,CT 06475 Trade name of technology and model: High Capacity Infiltrator Chamber, Standard Infiltrator, Infiltrator 3050 and Equalizer 24 (hereinafter the "System" or the"Infiltrator System"). Transmittal Number: W007800 Date of Issuance: May 31, 2000 - Date of Modification: December 10, 2001 and March 19, 2002 and July 17,2002 Date of Expiration: May 31, 2005 Authority for Issuance Pursuant to Title 5 of the State Environmental Code,.. 310 CMR 15.000, the Department of Environmental Protection hereby issues this Certification to: Infiltrator Systems,Inc., P.O. Box 768, 6 Business Park Road, Old Saybrook, CT 06475 (hereinafter"the Company"),for General Use of the System described herein. Sale and use of the System are conditioned,on and subject to compliance by the Company and the System owner with the terms and conditions set forth below. Any noncompliance with the terms or conditions of this Certification constitutes a violation of 310 CMR 15.000. �7 OZ Date Gle Haas, toi Division of Watershed Management Department of Environmental Protection Tbb bramedM b ayWbbb im slarsme fMM9 br r201K oe ADA OEP on ft Wald Wlde Web: to JAwaw.sb6&=.ueh19P DRi�Aed on Racyded Paper r FROM :down cape engineering inc FAX NO. : 15083629880 Aug. 31 2005 09:33AM P3 Infiltrator General t.Jse Certification Page 2 of 5 I. Purpose 1. The purpose of this Certification is to allow use of the System in Massachusetts, on a General Use basis. 2. With the necessary permits and approvals required by 310 CMR 15.000, this Certification authorizes the use of the System in Massachusetts. 3. The System may be installed on all facilities where a system in compliance with 310 CMR 15.000 exists on site or could be built and for which a site evaluation in compliance with 310 CMR 15.000 has been approved by the local approving authority,or by DpP if DEP approval is required by 310 CMR 15.000. U. Design Standards 1. Design Notes for each Certified Infiltrator System are attached to this Certification. The below models are covered under this Certification. Dimensions Invert Model WxLxH Height Inches Inches Equalizer 24 l 5x 101 x 11 9.25/6/3* Standard Infiltrator 34x75xl2 7 Infiltrator 3050 50x85A**x30 24 Hi Eh Capacity 34x75x16 10 *3 and 6 inch inverts may be used only in bed or field configuration **nominal length,does not reflect effective length 2. The 'Infiltrator System is an open-bottom leaching unit molded fi-om high-density polyethylene. It can be installed without aggregate or distribution pipe as a soil absorption trench as described in 310 CMR 15.251. 3. 310 CMR I5.247(1) and (2): The use of aggregate is not necessary with the System when installed as a trench,bed or field. 4. 310 CMR 15.251(1)(e): The Infiltrator System, in a'trench configuration without aggregate, shall be sized as follows: Model Leaching Area SF/LF Equalizer 24 2.8 Standard Infiltrator 4.0 Infiltrator 3050 8.2 High Capacity 4•5 7 \ r ' - Design, Nc�t�s � Mass�chus��ts� f� s f ? J r LOAD RATING: H-10 or H-20 The Standard Infiltrator® Chamber MADEP TRANSMITTAL NUMBER: 126298, April 2, 1998 APPROVED FOR: General use in Septic leachfleld applications (new construction and replacement) as a trench, bed or gallery configuration. INVERT: 6.5" and 6.5"-24" (gallery) Mound for Establish Mound for Establish proper drainage J ` I —vegetative cover proper drainage vegetative cover Topsoil :Topsoil . . Native backfill or select fill Pe CMR 00 R Native backfill or select fill : Per CMR 15.00 (Title 5 sand) r to I code (Title 5 sand) or local code 12" ` 11 " T 1'"4 '1 3 =:: �. 6.5" . Number and layout of chambers per design 36" { 6.5"to 24"Sidewall Height(increase height by adding stone below chamber) GALLERY CONFIGURATION 'TRENCH CONFIGURATION Mound for proper drainage Establish vegetative cover Topsoil Native backfill or select fill`.' : Per CMR 15.00 :. :. : :,•, ;:.... (Title 5 sand) al code orloc 5. -Number and layout of chambers per design,` BED CONFIGURATION EFFECTIVE LEACHING AREA • Distribution Pipe not required_ Chamber Type Trench Bed/Field Gallery+endwall area • 20' inlet intervals not required High Capacity Infiltrator® 4.5 sf/If 18.0 ftz/chamber 14.83.sf/If+ 21.66 ft2 • Aggregate not required Standard Infiltrator® 3.83 sf/If 18.0 ft2/chamber 14.83 sf/If+ 21.66 ftz • Filter fabric not required Equalizer®24 2.8 sf/If 10.4 ft2/chamber 13.25 sf/If+ 18.5 ft2 Infiltrator®3050 8.2 sf/If 26.1 ft2/chamber 16.2 sf/If+ 24.3 ft2 The Standard Sidewinder® Chamber The Standard SideWinder Chamber 1'Overlap at Latching Mechanism 12' ❑ 71 > z_tO M� L 75" - Effective Length Size (WxLxH) ........34" x75l'x12" - Storage Capacity.....::.76 gal/10.1 ft3 Weight ......................... .:29`Ibs Lduvered Sdewall Height... INFILTRATOR SYSTEMS INC STANDARD LIMITED WARRANTY INFILTRATOR SYSTEMS,INC.,rinfiffratorl STANDARD LIMITED WARRANTY FOR SEPTIC PRODUCTS (a)The structural integrity of each chamber and end plate manufactured by Infiltrator(collectively referred to as'Unitsl,when installed and operated in a leachfield of an onsite septic system in accordance with Infiltrator's installation instructions,is warranted to the original purchaser('Holden against defec- tive materials and workmanship for one(1)year from the date upon which a septic permit is issued for the septic system containing the Units;provided, - / • - however,that If a septic permit is not required for the septic system by applicable law,the one(1)year warranty period will begin upon the date that instal- lation of the septic system commences. In order to exercise warranty rights.Holder must notify Infiltrator in writing at its corporate headquarters in Old Saybrook,Connecticut,within fifteen If S days of the alleged defect.Infiltrator will supply replacement Units for those Units determined by Infiltrator to be detective and covered by this Limited R Warranty. InSUBPA liability H(a)A RE excludes the cost R removal and/or OTT installation of the Units. - SYSTE M�5 I N C (b)THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH(a)ARE IXCLUSNE.THERE ARE NO OTHER WARRANTIES WITH RESPECT TO THE UNITS,INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE (c)The Limited Warranty does rot extend to incidental,consequential,special or indirect damages. Infiltrator shall not be liable for penalfies or liquidated sly damages,including loss of production and profits,labor and materials,overhead costs or other losses or expenses incurred by the Holder or any third Environmental Onsite Wastewater Solutions party.Specifically excluded from Limited Warranty coverage is damage to the Units due to ordinary wear and tear,alteration,accident,misuse,abuse or neglect of the Units;the Units being subjected to veNde traffic or other conditions which are not permitted by the installation instructions;failure to main- 6 Business Park Road P.O. Box 768 fain the minimum ground coves set forth in the installation instructions;the placement of improper materials into the system containing the Units;failure of the Units or the septic system due to improper siting,improper smug,excessive water usage,improper grease disposal or improper operation or any Old Saybrook, CT 06475 other event not caused by Infiltrator.This United Warranty shag be void if the Holder falls to comply with all of the terms set forth in this Limited Warranty. Y"' Further,in no event shall Infiltrator be responsible for any loss or damage to the Holder,the Units,or any third party resulting from installation or shipment. 800-221-4436 860-577-7000 or from any product lability claims of Holder or any third party. For this Limited Warranty to appy the Units must be installed in accordance with all site conditions required by state and local codes,all other applicable laws and Infiltrators installation instructions. FAX 860-577-7001 (d)No representative of Infiltrator has the authority to flange this Limited Warranty in any manner whatsoever,or to extend this Limited Warranty.No war- rantYapplies to arty parry other than the original Holder.- www.infiltratorsystems.com The above represents the standard Limited Wartarriy offered by Infiltrator•A limited number of states and counties have different warranty requirements. 1-800-221—4436 Any purchaser of Units should contact Infiltrators corporate headquarters in Old Saybrook,Connecticut,prior to such purchase,to obtain a copy of the applicable warranty and should carefully read that warranty prior to the purchase of Units. ` Infiltrator Systems does not recommend installing onsite systems under pavement. Chambers must be installed according to manufacturers instructions.Failure to install according to manufacturers instructions will void warranty. Infiltrator Systems recommends the use of septic tank fitters and laundry fitters with all onsite septic systems. For technical assistance, installation instructions or customer service, call Infiltrator Systems at 1-800-221-4436. U.S.Patents:4,759,661;5,017,041;5,166,488;5,336,017;5,401,116;5,401,459;5,511,903;5,716,163;5,588,778;5,839,844 Canadian Patents:1,329,959;2,004,564 Other patents pending. Infiltrator,Equalizer and SideWinder are registered trademarks of Infiftrator Systems Inc.Infiltrator is a registered trademark in France. Infiltrator Systems Inc.is a registered trademark in Mexico. Contour,MicroLeaching,PoyTuff,SnapLock,Chambeispacer,PosiLock and OuickPlay are trademarks of Infiltrator Systems Inc. 0 2001 Infiltrator Systems Inc. Printed in U.S.A. C730301 FNL-1 i The Standard Sideffinder Ilk ' ' • ' Chamber SYSTEMS INC Environmental Onsite Wastewater Solutions' F � r1 �0 I!4 IIt tW� IF "?` � �7t e St ridard SidelifFm.deRIO,K5 , INOi a to, �o�i n� ifs` z�ft feature s the e of ionar5t�p�atentRaw- v1'V Iflier te$hnofo0111�g deli ,er additional infiltrative su:rface�area erskin are oo ri ior ' easeF cktarnbersw�thasrinallefao prJUntgare�ctesird off eas sp handling and storage..V1/ ti�l2�of�.cp n� acte¢ cov�r;.�Gt�supports if6r,�00 � Ib axle, equivalent�to ab.RIIM S The Standard Sidewinder Tested and Proven with More Chamber System Offers You than 600,000 Installed These Unique Benefits: • Infiltrator is the number-one septic • Optimum infiltrative efficiency in a leachfield chamber system in the compact design onsite industry. • Easy assembly and installation with • More than 600,000 systems (and count- as few as two people ing) have been installed, with more than • Lightweight chambers that can be 20 million units in-ground in all 50 states delivered in one pickup truck load and 13 countries. and hand-carried into position • Infiltrator's established history of per- • Inspection port option for easy formance and reliability began in 1987. access to leachfield with no site • Field surveys of septic system disruption performance and failure rates show • Solid-topped chambers that need Infiltrator chamber systems are measur- i no geotextile ably more resistant to hydraulic failure • OVERALL REDUCED COST than stone and pipe systems. Approved in f FROM :d.ov:n cape: engineering inc FAX NO. :e1508 .829088 Dec. 15 2005 12:21PM P? '' Town. of Barnstable 4:s W rip eg latory Service: Thom.as F. Geiler,Director 1 f Public: Health. Division 'i'hof�&ii6 McKean,Director 200 Main Street,Hyannis, NIA 02601: Office: 508-962 4644 _,,,.. 'Fax: 548-79U-6304 installer&Deligrcer Certification Form Date: � `" v Sewage perm!0* AV,4 r-,° �JTJ Assessor's MapTarcel Designer, .,m Installer: ��i`�� y�-��� ,fx«.�-.r,a..J Address: On was issueda 1 ennit to install a date` W. `instaaliez� t based on a design drawn septic systerra at w b`� - — ---- � Y (addtess} .... I-certify that the septic system refs r vua'enced above s installed.substantlally according to w� the design, wtjch may include rni.a rgproved, c11anges such as lateral relocation of the .distributicrt box and/or septic tank. - ire ter dun 10'elateral relocation of the SAS or any Y'micai relocation of any component of, he septic system) but in accordance with Sta`e,& Local R-egulatiov;. Plan revision or c #led as- uit by des,g to follbW y -- s� DJAi A t. CIVII No. 3C%97 s (�f'tix mp Here) LEASE C!)t�F'LIA>�i6 WILL NCl'i�l�! D'tr,N� IL , H THjt� x�_ ,�tv17�o1�>I1tI.t �ax� ARE 1EtEC:�iV L) TIfiIE ld�i1�l �t E Plrli3lv)CC.HEALTH QtV13iON,_THANK YOU. ;Hea19YQemic1Dc3igncr Cert flcatio!i Form 3-`".4:d4fc ' COMMONWEALTH OF MASSACHUSETTS Z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF EN�ik6 'Mi"I'4�I'''hiAPkfOTECTION h 71005 IMAY I I A" 10: 27 FAILED INSPECTION niVISIoI TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 221 Oldham Road Osterville MA 02655 14� Owner's Name: Estate of Barbara F.Widmayer Owner's Address: 308 Shearwater Drive Hampstead NC 28443 Date of Inspection: April 11,2005 Job#05-94 Name of Inspector: PATRICK M. O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: 00"llfFr11111zkk s � Passes Conditionally Passes TRI N s Needs Further Evaluation by the Local Approving Authority = 1 :M _X_ Fails / L :Co- Inspector's Signature: Date: 4/11/05 ��. �' 1:1�•'0 •� �F6 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of HeaiI'or t„ DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments: Flowdifussors previously full to top. ' ` ****This report only describes conditions at the time of inspection and under the conditions of use at that I 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 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 221 Oldham Road,Osterville Owner: Estate of Barbara F.Widmayer Date of Inspection: April 11,2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available.. ND explain: Observation of sewage backup or breakout or high static water.level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Tit1P G Tnanaptinn Rnr 411 v')nnn 2 Page 3 of I 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 221 Oldham Road,Osterville Owner: Estate of Barbara F.Widmayer Date of Inspection: April 11,2005 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: Titlra C incnontinn iFnrm Ail;i)nnn 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) . Property Address: 221 Oldham Road,Osterville Owner: Estate of Barbara F.Widmayer Date of Inspection: April 11,2005 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 _ _X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than Yz day flow 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. Tifla f T"anaofinn Pf%rm All siInnn 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B f CHECKLIST Property Address: 221 Oldham Road,_Osterville Owner: Estate of Barbara F.Widmayer Date of Inspection: April 11,2005 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No _X_ Pumping information was provided by the owner,occupant;or Board of Health _ _X_ Were any of the system components pumped out in the previous two weeks _X_ Has the system received normal flows in the previous two week period? _X_ Have large volumes of water been introduced to the system recently or as part of this inspection? _X_ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ Was the facility or dwelling inspected for signs of sewage back up? _X_ _ Was the site inspected for signs of break out,? - _X_ _ Were all system components,excluding the SAS,located on site? _X_ Were the septic tank manholes uncovered,opened,and`the interior of the-tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of,, scum? - _X Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage'disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no. _X_ Existing information. For example,a plan at the Board of Health. _X_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] Tit1A Iq inem-ptinn Rnrm k/1 5/7M/1 5 Page 6 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 221 Oldham Road,Osterville Owner: Estate of Barbara F:Widmayer Date of Inspection: April 11,2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):330 Number of current residents: 0 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): Seasonal use:(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): 2003—36,000 gal.2004—75,000 gal.=152 gpd. Sump pump(yes or no): No Last date of occupancy: November 2004 l COMMERCIAL/INDUSTRIAL 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: Tank pumped 1999 Source of information: Owner 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 _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): A Approximate age of all components,date installed(if known)and source of information: 1980 Were sewage odors detected when arriving at the site(yes or no): No Title C inenortinn 17nrm 4/1 MAMA 6 4 l Page 7 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 221 Oldham Road,Osterville Owner: Estate of Barbara F. Widmayer Date of Inspection: April 11,2005 BUILDING SEWER: XX (locate on site plan) Depth below grade: 2' Materials of construction:_cast iron _X_40 PVC_other(explain): Distance from private water supply well or suction line: - Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: 16" Material of construction:_X_concrete_metal_fiberglass,polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions:8.5' long x 5.2'wide—1000 gal. Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle: 27" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 7" Distance from bottom of scum to bottom of outlet tee or baffle: 11" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Baffles intact,tank does not appear to be leaking. GREASE TRAP: No (locate on site plan) Depth below grade: 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: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): I Titles G Tnenartinn Rnrm All VIMA 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 221 Oldham Road,Osterville Owner: Estate of Barbara F.Widmayer Date of Inspection: April 11,2005 TIGHT or HOLDING TANK: No (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: XX (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: 0" 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.): Liquid level currently at bottom of single outlet pipe. PUMP CHAMBER: No (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.): T41A C incnon}inn Fnrm 4/1 C/100A 8 I Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 221 Oldham Road,Osterville Owner: Estate of Barbara F.Widmayer Date of Inspection: April 11,2005 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: _X leaching chambers,number: Two Flowdifussors. 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.): Previously full to top. CESSPOOLS: No (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.): PRIVY: No (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.):. Tifla C Tncnarfinn Rnrm lii ciinnn 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 221 Oldham Road,Osterville Owner: Estate of Barbara F. Widmayer Date of Inspection: April 11,2005 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. Oldham Road #221 35 19 36 43 Titla G Tnenartinn Fnrm ril annnn 10 Page I 1 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 221 Oldham Road,Osterville Owner: Estate of Barbara F.Widmayer Date of Inspection: April 11,2005 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water 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: 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: A perc test will be performed prior to repair to determine groundwater elevation. Tifla Iq Tnanae finn T:nrm All v')nnn 11 r Fimic............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD F HE /'r- .* .........OF.. e --------------------------- .......... . ..... . ........... Appfir,aftlan for Bispaaal Works Tonstrurtion ranfit Application is hereby made f r Permit to Construct or Repair an Individual Sewage Disposal, c;:2 at System ....... .... ....... ...... ....... ... . ...... . .......................... % Loc n 4jd&@ss orLot-No. --- ___:Oz------------------------------- ------------- ow or A ...................... . .................. . ................ .............. ns ler Address e of Building Size Lot____- feet U Dwellingt-No. of Bedrooms....... --_............................Expansion Attic Garbage Grinder V_V'11- Other—Type of Building ............................ No. of persons............................ Showers Cafeteria PL4 Other fixtures ----------- ..................................................... ..... e� ------------ ---- ------------ Design Flow.....1.........sTX...............gallons per person per d . Total 4Y daily flow---- GM-D 1:4 Cr7_ ;0 Septic Tank-Liqui&capacity/X0%j-;Vt5ns Len fth------ ----------�V idth...... ....* ... Diameter................ .Depth...._.. ....... r Disposal Trench—No. c2----------yXiFth LA�kZ1_AT_4F/Wa1 leaching area---Z.AEsq. ft. Seepage Pit No._.__._....._._._.__.. Diameter____________________ Depth below i*_ t.... Total lea ing aX.&............sq. ft. Z Other Distribution box Dosin to 7- ---- --- ........... Date----- . _�a.z Ar........ Percolation Test Resu?'?X:_..minutes Performed by.-X t �IF Test Pit No. 1_ perinch Depth of Test Pit.................... Depth to ground water_._._.._.__._...._...__. Test Pit No. 2................minutes per inch Depth of Test Pit..............._.... Depth to ground water.___...___..._.....____. ................................ - -- - I---------/........X...j..n' . . .. 0 Description of Soil.......en.A.......1 .4, ....... M.e U ....................................................................................................................................................................................................... ----------------------------------------------- ........................................................................................................................................................ 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 TI ITI 11 5 of the State Sanitary Code—'The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the board of health. ned.. ... ... .. .. ..... ..... ....... ... .. ............... ................................ D t Application Approved By----.--- ...... ._X------Yn--- Date Application Disapproved for the following reasons:................................................................................................................ ......................................................................................................................................................................................................... Date PermitNo ... .......... ...... --- ISSU4....................................................... d k1 No._..:..`..... ..... Fxs............................... THE COMMONWEALTH`OF MASSACHUSETTS BOARD OF HEALT ............. `"" ......OF...... �1 +?:..... mod- Appliration for Bhipooal Works Tonirurtion thrutit Application is hereby made foi a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at ,�•; /� ..... ... Location Address " ff or Lot No. / Y .: 'ran i-.s,•'s, n...t� ' .�''-�.�+.4�' .�€"lt�"" .................-=-.• -,w7_i •--•-••.................................... ' '-_3 Owner t Address s� a •-----•----•----- �' `•-*---•----'- '- ................................... e� '�Cr+���„�%r'��i......._. nstal�ier Address d Type of Building Size Lot..... .....` :.�q. feet Dwelling No. of Bedrooms...... ..................._.............Expansion Attic ( ) Garbage Grinder (/I) aa, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures ------ ... --------------•••--• --. -- �...., ----- ------- W Design Flow.................`.......................gallons per person per day. Total daily flow..... _. s"' .._...gallons. GG Septic Tank 1 Liquid'capacityli��allons Length............"... idth........... Diameter______ --- Depth...... ....... Disposal Trench—No.., -------�-- � -Lei 1 a��tal leaching area___....._.T.:_....sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area.-...............sq. ft. Z Other Distribution box ( ) Dosing tank Percolation Test Results Performed b �_' ..._.__.. �_____ _____ _ _ Date...... , :. __* ........ a Y fi --------------i-- =----.- ,.� Test Pit No. 1.._ ':e...-...minutes per inch Depth of Test Pit.................•.. Depth to ground water.................... (T Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •----•-••--•................... ------..........--•---........_.. ... ' --••--•----............................................. --- O x; Description of Soil = =......•-----......-•-----------------------••---•---•--------•-------------------------••............--••--------.............................. -•-•----••••-- 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed .---••----...... ...........•••• -••-•-----•---•••-•-------- Date Application Approved B `'/ _ �' f''J°e < R ...................................f PP PP Y .. . -------•----•... .............. .------ s Date Application Disapproved for the following reasons:............................................... ..---...-••--•........................•• ....._..___.._ -------•---------------------------•------------.....---•--•----•---------------•••......-----....•..••. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTHY Trriifiratr of Tomplianrr THIS IS ) CERTIFY, That..the Indi vidvdial,Sewage Disposal System constructed ( or Repaired ( ) by ........ : . .....­ '. ----• ..._.. .. f ` ......._ Znstauer fs�f e at.........-•-••• p . � -E�"df" sk-6." "��' - has been installed in accordance with the provisions of TITLE , 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.�`:r-----------el".4_.1.__...... dated-----�:------'/.. ' THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..................�����....---._...--••------.....--•- Inspector - .7(. �%---•I,,: ........................ THE COMMONWEALTH OF MASSACHUSETTS f BOARD OF HEALT _& ..... ... 1�+.w,,.. .OF...... ?' r? ✓�.... ................................. T . NO......................... FEE......... ............ Disposal orko Tonoir io-tt..Errant Permission is y granted.,�,���4. '"� r ,r. to Construct (, f; r Repair ( )Fan Individual, ewage Dtsposal`System f r at No........ .. ----_... � -ll --------- "r Street as shown on the application for Disposal Works Construction Permit No......r-........... Dated.•_fig..___._"......... ... a ................................................. -- G Board of Healthth DATE................................................................................. FORM 1255 HOBBS & WARREN. INC., PUBLISHERS Q'JG- -DA t L t=L-0u1 - 3 i I a 330 rit Tl�, TA 4L,- �'�� tC 1 yp=M. . + nti. A '1 /Gft T°act'=i�„.. . (?-A +4Y, t ,{,�(r1Y � t �-I 4- G-r ✓ /VTTOAA AQE+�tME yLF ZB6 5 v- �c +aV lua5 AIVA.58 f oo cad. 4 c4' D � LraT • �!L �Sr %►� �i l �S .spy fitm l Pit. i Z BD 10'; toco , Sam:, � Sox =' ' _ '.• 1 SrcN At,( A twut7, W F�S4*,Y 'L,q'�j 'G'"O! VJAStikc'l7 7l�ASTt ti3 t1c(?• ?POP�L.L. CE IRt 0PQS�`� at R' s f ,0 S i { . l IT, _ A 5 e - Gl fr �x�Y✓'.'t'✓` /n,rG� l '�-G' G j'�..5 :n /n L cl L✓/:.2 / i ) i d / [:' �iYJEIsS��sS ,v� �iye✓iu✓ s��,c� Fva � p,,Ie oo �✓�oy/z✓� 5�+��✓�5 4eG�nctvi1,6 � O O � "tie LA) �/ G s Y-1 S13 IV dL 07 o-7 Cz 3 c 36 n 3 v SYSTEM PROFILE TEST HOLE LOGS TOP FNDN. AT EL. 27.7' -'- ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT To SCALE) PROVIDE INSPECTION PORT WITHIN ACCESS COVER (WATERTIGHT) TO f 6' OF FINISH GRADE ENGINEER: BAXTER & NYE (A. JON'ES) 56A' MINIMUM .75' OF COVER OVER PRE-CAST F WITHIN 6" OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM // - r� v 25.0' 26.0' WITNESS: PAUL MURRAY (BOH) OLD 2" DOUBLE WASHED PEASTONE DATE: 7/22/80 A 0 24.7 * RUN PIPE LEVEL a ` ar LOCUS : (PROPOSED) FOR FIRST 2' '* 23.7' PERC. RATE _ < 2 MIN INCH BONNIE: BRIAR PROPOSED 1500 I _, } i 24.0 GALLON SEPTIC t "� o �j CLASS SOILS REF: PERMIT #80'-404 / o K H- 10 0 23.28' o d tc o cr o TAN ( _0 GAS -' BAFFLE2. o000 0.58' 0000 cx�oo 00 00000 - oo25S _ oo� 22.7' NER RD. 2% MIN. SLOPE 6' CRUSHED STONE OR MECHANICAL 4 ELEV. Q ELEV. COMPACTION. (15.221 121) a" 24.3' O" 25.8' DEPTH OF FLOW = 4' ( 1 % SLOPE) 3/4" TO 1 1/2" DOUBLE WASHED STONE FILL FILL TEE SIZES: INLET DEPTH 10 12" 36" " A A LOCATION MAP NTS OUTLET DEPTH = 0 LS LS LEACHING 51 1 OYR 3/2 48" /2 1 OYR 3 ' FOUNDATION 10' SEPTIC TANK 8 D FACILf� r BOX 2 -a 18" ASSESSORS MAP 145 PARCEL 15 B *NOTE: THIS IS A PROPOSED INVERT ELEVATION OUT B GROUNDWATER ADJUSTMENT DATA: (PLUMBING TO BE RE-ROUTED FROM REAR TO FRONT OF ZON LS WELL: 29 HOUSE TO POSITION SHOWN), PLUMBER TO CONFIRM t_S 72" 10YR 6/6 1 g•8° ADJ: C ADJ: 2.4' FEASIBILITY PRIOR TO INSTALLATION OF ANY PORTION OF - - - SYSTEM (MIN. INVERT ELEVATION OUT ALLOWED = 24.20" 1OYR 6/6 C1 USEADJ:.WATER AT EL. 17.7' 4$" 20 3' PERC M/C SAND , C 1OYR 6,/4 PROP. RE-ROUTED WATERIJ!,IE PERC 108" BENCHMARK: USE JUNCTION OF PAVED i C2 DRIVEWAY AT EDGE OF PAVE. OF OLDHAM + i M/C SAND ROAD AT ELEV. 25.2' 2:r13 108" MS o 15.3' 132" OBS WATER _ 14.8' P► � 4 2.5Y 7/4 �� / i 00 126" 13.8' 144" 10YR 6/6 13.8' 5.16 n } +=�3.11 _... NOTES:_ NOT ALLOWED 1. DATUM IS APPROX, NGVD EXISTING WATERLINE SEPTIC DESIGN: ) � �•�5.43 : \ (GARBAGE DISPOSER IS (RE-ROUTE) �' - 4 ��� \ Dt _ r 2.._Iu UN!C1` AL WATER IS EXISTING (F:E-ROUTE OR .SLEEVE) .,_A :�� - �` s• i. C:.E:SiGN FLOW: . BEDROOMS (11 GFu� - 22u GFD PROVfDE APPROX. 5'3' OF0FF /I ---.' • - , t lc� 220 ^n� Dc i / -I-25,. d -� \ � z A ��r� -S�G�J FLOW 3. .'Vi!N11%!UM PIPE PITCH TO BE 1 8°' PER F(007. 40 MIL LINER A }-25.4r .�( \ BE AASH H SAS IN AREA, SHOWN: TOP l \ ,,�' 4. DESIGN, LOADING FOR ALL PRECAST `UNITS "l.O - 0 - +} .47 + 5• 25.7 ,� s�, ' EPTIC TANK: 220 GPD, ( 2 ) 440 10 AT ELEV.� 23.7. BOTTOM AT / rd \ ,` ht� \ +. 4. .. - __._ 5. PIPE J�.?INTS TO BE MADE WATERTIGHT. EL. 19.7 /r +2�t4B \ 9s- \+ 7.01 USE A 1500 GALLON SEPTIC TANK 6. CONSTRUCTION DETAILS TO BE Il,l ACCORDANCE WITH MASS. i 10, 1 ,,.� \ ENVIRONMENTAL CODE TITLE V. i ' 'I p� 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT looli 25. 3� 2 �' �+ 04 SIDES: - (41.5 + 9-83) (.74) (� - �� TiO BE USED FOR ANY OTHER PURPOSE. p �..ham / - 5.86 4 869 �ifl 41.5 x 9.83 (.74) = 3 �a� '"8. PIPE FOR SEPTIC SYSTEM TO SC-I. 40-4" PVC. 130TTOM: +25.90 i 24 33& TS 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT +2 ' +26.38 TOTAL: 466 S.F. 3 GPD l INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED 4.28 �5 +2 2 ExiSr. DWELL.. 3 � •88 LSE 6 STANDARD INFILTRATORS TH 3.5' STONE AT FROM BOARD OF HEALTH. I-24.71 �S TOP Fr«�rw s 27.T+ 23,5B�� ^�,,���,Q,.2� ' S6 SIDES AND 2' AT ENDS ` 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) EXISTING SEPTIC SYSTEM c'q 23.59 1- 2.5 .51 3.77 +2 40 2.90 SILL ELEV. 20.6' mcx GdYA 5' REMOVAL OF U ITAB SOIL 2 ' S SHEDR . REQUIRED AROUND P ME OF 1. +22. •47 T5 N _i_EGEND S ° Lj Tc n /��/ LEA CHIN FACILITY. LAYER.DO TO 2 9 O 6" EVER REE _ ! {. ! �I 7l SUITABLEc� OLD WIH CLEAN MED. SAND. +2 TH -}-22.1 0 + 100.0 PROPOSED SPOT ELEVATION S I / OF ti 44 DUSTING 'SEPTIC L L 1 O L D A M ROAD +27. -22.46 p SYSTEM100x0 EXISTING SPOT ELEVATION +22,1 / IN 71E TOWN OF: +21 +22. 100 PROPOSED CONTOUR -7 2 e (OSTERVILLE)_ BARN STABLE 22.94 � '11, "' 100 EXISTING CONTOUR, I MARLS MYE�;S +22.35 RH00`I y PF'EF',�RED Ft:iR: +21.49 QT 64 20 0 20 40 60 BOARD OF HEALTH +21.33 ry'b`23.9 MA SCALE: 1 _== 20' DATE: JULY 7, 2005 NN Ob` APPROVED DATE RE`,' 8/5/05 (NEW THs) �' ,ADO• off 508-362-4541 fox 508 362-9880 I � t , down cape engrneerzng Inc. �S OF� �ZH OF 1 " S'9C 'iN OF!$gS�C ARNE CIVIL ENGINEERS tJJALA o H. JALA LAND SURVEYORS Qi7 N� 0.26348� uY� 939 vain st. yarmouth, rya 02675 F 05- 120 �� Ar,A, gay .��. DATE