HomeMy WebLinkAbout0096 PARKER ROAD - Health 96 parker Road
Osterville
A= 117— 129
,1
Commonwealth of Massachusetts
Title 5 Official Inspection Form
1;1
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '
m 1
96 Parker Road rs
`. Property Address
Michael Domenica
ern?
Owner Owner's.Name
information is every Osterville ✓
required for eve MA 02655 1-19-18
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 filling out forms A. General Information
1�1p1unllrydrr
on the computer, OF Mgss
use only the tab
1, Inspector:
key to move your y
cursor-do not ,lames D.Sears :' JAMES N
use the return =z m=
key. Name of Inspector 9 SEARSn
Capewide Enterprises *'
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Company
I SP�
Commercial Street 1N
153
Company Address
m� Mashpee MA 02649
City/Town State Zip Code
508-477-8877 S1623
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5 (310 CMR 15.000).The system:
E Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
n 1-22-18
nspector'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 should be sent to the system owner and copies sent to the
buyer, if applicable, and the approving authority.
""This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins,doc•rev.6116 Tine 5 official Inspection Form:Subsurface Sewage Disposal System•Pape 1 of 17
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
s 96 Parker Road
Property Address
Michael Domenica
Owner Owner's Name
information is required for every Osterville MA 02655 1-19-18
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E 1 always complete all of Section D .
A) System Passes:
® 1 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 is a 1000 Gal.Tank D Box and 25 chamber's.
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes","no"or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
"A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND(Explain below):
t8ins.doc rev.6116 Title 6 Official Inapecticn Form:Subsurface Sewage Disposal System-Page 2 of 17
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Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
96 Parker Road
Property Address
Michael Domenica
Owner Owner's Name
information is required for every Osterville MA 02655 1-19-18
page, CityrTown State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumpslaiarms are repaired.
B) System Conditionally Passes (cunt.):
❑ 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):
n x' leveled r replaced Y ND lain below):
❑ distribution box is eve ed o ep ❑ ❑ N ❑ (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 ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
Wns.doc•rev.W 6 Title 5 Official Inspection Form:Subsurface Sawage Disposal System-Page 3 of W
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c Commonwealth of Massachusetts
Title 5 official Inspection Form
klv.fz.,
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
96 Parker Road
Property Address
Michael Domenica
Owner Owner's Name
information is
required for every Osterville MA 02655 1-19-18
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
This system passes if the well water analysis, performed at a DEP certified laboratory, for 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.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
'S N
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
El ® Liquid depth in is less than 6" below invert or available volume is less
than day flow 4 t? #lp C
t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurtace Sewage Disposal System•Page 4 of 17
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
96 Parker Road
Property Address
Michael Domenica
Owner Owner's Name
information is required for every Osterville MA 02655 1-19-18
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis,performed at a DEP certif led
laboratory,for fecal colifonn bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails.I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303,therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection
Area—IWPA)or a mapped Zone II of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered"yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15,304. The system owner should contact the appropriate
regional office of the Department.
t5ins.doc-ray.Bite Title 5 Oflldal Inspectior form:Subsurface Sewage Disposal System•Page 5 of 17
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< e, Commonwealth of Massachusetts
Title 5 Official Inspection Form
p
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
96 Parker Road
Property Address
Michael Domenica
Owner Owner's Name
information is required for every Osterville MA 02655 1-19-18
page. Cityr7own State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no"as to each of the following:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as NIA)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
❑ ® Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms(design): 4 Number of bedrooms (actual): 4
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440
t5ins.doc rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
uz, 2.
�" Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
96 Parker Road
Property Address
Michael Domenica
Owner Owner's Name
information is required for every Osterville MA 02655 1-19-18
page. Cityrown State Zip Code Date of Inspection
D. System Information
Description:
1000 Gal. Tank D Box and 25 chamber's.
Number of current residents: 2
Does residence have a garbage grinder? ❑ Yes ® No
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 ears usage NA
9 ( Y 9 (9Pd))�
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: Present
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 or 17
5Z a5ed xe:1 dH 60:EZ 9602 EE uer
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
96 Parker Road
`-' Property Address
Michael Domenica
Owner Owner's Name
Information is required for every Osterville MA 02655 1-19-18
page. City/rown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancyluse: Date
Other(describe below):
General Information
Pumping Records:
Source of information: NA
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped:
gallons
How was quantity pumped determined?
Reason for pumping:
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 DE approval.
❑ Other(describe):
Mns.doc-rev.6116 Tito 5 Official Inspection Form:Subs zfeoe Sewage Disposal System-Page 8 of 17
9Z a5ed xe� dH UEZ ME ZZ Uef
Commonwealth of Massachusetts
Title 5 official Inspection Form
- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
96 Parker Road
Nope rty Address
Michael Domenica
Owner Owner's Name
information is required for every Cisterville MA 02655 1-19-18
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont,)
Approximate age of all components, date installed (if known)and source of information:
Tank 1992 I D Box and chamber's 2011 permit #2011 -280.
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
6"
Depth below grade: ft4
Material of construction:
❑ cast iron ®40 PVC ❑ other (explain):
Distance from private water supply well or suction line: feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
Pipeing is 4" PVC SCH 40.
Septic Tank (locate on site plan):
Depth below grade:
3'
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 Gala Precast H-10
Sludge depth:
t5ins.doc-rev.6116 Title 5 Officlal Inspection Forrn:Subsurface Sewage Disposal System•Page 9 of 17
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Commonwealth of Massachusetts
: Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
96 Parker Road
Property Address
Michael Domenica
Owner Owner's Name
information is required for every Osterville MA 02655 1-19-18
page. city/rown State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle 29
Scum thickness 0
Distance from top scum of to to of outlet tee or baffle 8,
P
Distance from bottom of scum to bottom of outlet tee or baffle
18"
How were dimensions determined? Asbuilt- Plan
Sludge Judge
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tank at working level. Tank at 3' below grade wlboth cover's at 4". Inlet baffle,outlet tee. No sign of
leakage or over loading.
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
15ins.doc-rev.6116 Title 5 Official Inspectlon Form,Subsurface Sewage Disposal System-Page 10 of 17
8Z a5ed xezl dH 0 VEZ 8 60Z ZZ Uef
Commonwealth of Massachusetts
Title 5 Official Inspection Form
�t Subsurface Sewage Disposal System Form• Not for Voluntary Assessments
96 Parker Road
Property Address
Michael Domenica
Owner Owner's Name
information is required for every Cisterville MA 02655 1-19-18
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.);
Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity:
gallons
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
'Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 91 or 17
6Z a5ed dH 6 VEZ 91,OZ ZZ Uef
Commonwealth of Massachusetts
Title 5 Official Inspection Form
fa'. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
96 Parker Road
`J Property Address
Michael Domenica
Owner Owner's Name
information is required for every Osterville MA 02655 1-19-18
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert 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.):
D Box is 16"x2l"-46" below grade w/cover at 22". Box is clean and solid w/five lines out. No sign of
over loading or carry over.
ry
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No'
Alarms in working order: ❑ Yes ❑ No"
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System(SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
l5ins.doc•rev.WIS Title 5 Official Inspedion Form:Subsurface Sewage Disposal System-Page 12 of 17
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c `y Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
96 Parker Road
Property Address
Michael Domenica
Owner Owner's Name
information is
required for every Osterville MA 02655 1-19-18
page. CityfTown state zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number.
® leaching chambers number: 25
❑ 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.),
Leaching is twenty five Biodiffuser chambers. Ck D Box and camera out. Wet Bottom. No sign of
over loading or holding water.
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
t5ns.4doc-rev.W6 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 13 of 17
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
E,
Vc � 96 Parker Road
Property Address
Michael Domenica
Owner Owner's Name
information is required for every Osterville MA 02655 1-19-18
page. CityfTown State Zip Code Date of Inspection
D. System Information (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,
etc.):
Privy (locate on site plan);
I
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc,):
l5ins.doc•rev.W16 Title 5 Official Inspection form:SuDsurface Sewage Disposal System-Page 14 of 17
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
eI; Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
96 Parker Road
Property Address
Michael Domenica
Owner Owner's Name
information is required for every Csterviile MA 02655 1-19-18
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
A
0
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3
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#3
151ns.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17
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Commonwealth of Massachusetts
RI
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
96 Parker Road
Property Address
Michael Domenica
Owner Owner's Name
requinform
r on is Osterville MA 02655 1-19-18
requiredd for every
page. Cilyrrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
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
If checked, date of design plan reviewed: 8-1-11
Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
T.H.on Design Plan 8-1-11 1V-6" no G.K. Bottom of chamabers at4'-6"below grade. Bottom of
chambers at&+ above T.H. Depth.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t&ns.doc•rev.6116 TIte 5 Of6Uel Inspealon Form:Subsurface Sewage Disposal System-Page 16 of 17
abed
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cN, Commonwealth of Massachusetts
Title 5 Official Inspection Form
b� Subsurface Sewage Disposal System Form •Not for Voluntary Assessments
F�
u
95 Parker Road
Property Address
Michael Domenica
Owner Owner's Name
information is required for every Osterville MA 02655 1-19-18
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B. C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
15ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
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TOWN OF BARNSTABLE
LOCATION 9&c l XA �2-3 SEWAGE#
VILLAGE OS c,t L(f ASSESSOR'S MAPP&PARCEL a
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY /(JQ ) /-1/0 ZnYCJ �wt
LEACHING FACILITY.(type) lZ S'� ,/ C v7(�t(P t/Zv (size) /5!S-X Z J'-'
NO.OF BEDROOMS
OWNER v l,\
PERMIT DATE: 2 d I I COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ✓tld 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 CAetW-Je c4 " fln -e-
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No.
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
Rpplitation for Bisposal Opstem Construction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade Y� Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. `(b P4(wne, jacp Owner's Name,Address,and Tel.No.,RO3 4 45+-,A3g
�S zVlt (>e&"1AVk A06va- ri
Assessor's Map/Parcel 1 I ( 0 1 , Wt5r6rkKr C-r
Installer's Name,Address,and Tel.No. SZ)Z-071�.0171 Designer's Name,Address,and Tel.No. 5710�9-a'736�?71
L6(-PVVJt4(5 6__Vr vd a 14 G tXtZ, %
5
Type of Building:
Dwelling No.of Bedrooms Lot Size Z101�3 )6" sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date 9-((;- Number of sheets Revision Date
Title ci6 P : 0>
Size of Septic Tank l®oa Type of S.A.S. AWC- tA^.>C1 lXCUOLt�'UJaC(
Description of Soil 6ae kit t�.-d.-eA Q 6? 3e--. �
Nature of Repairs or Alterations(Answer when applicable)
Mc UQ lkG 14-;Lo R to'PctrtySd�-'6
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 Hea
nih-ed Date
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. Date Issued
Fee
MO THE COMNWEALTH OF MASSACHUSETTS Entered in co puter: '
y, Yes
X PUBLIC HEALTH DIVISION -TOWN,OF BARNSTABLE, MASSACHUSETTS
2pprication for Misposal �&pstrmf'Co nei truction 3dermit
Application for a Permit to Construct( ) ,Repair( ) Upgrade)� Abandon( ) ❑Complete System ❑Individual Components
x
Location Address or Lot No. '�6 p ¢� Owner's Name,Address,and Tel.No.a?0'3 t� 3� o•
o OSTt�aVlc h�,�u1 A►J+C oWi
Assessor's`iMap/Parcel 1 Lb CXr T
Installer's Name Address and Tel.No. Designer's Name Address,and Tel.No. �..
$77ff �f77•p'�7y �
C�a9�r1,c1tbJ6 F� P,�SL`S G �1 t�/�.k+,a`b—
Type of Building:
Dwelling No.of Bedrooms Lot Size •1dl. j �— sq.ft. Garbage Grinder( )
Other Type of Building a5r No.of Persons Showers( ) Cafeteria( )
Other Fixtures s
Design Flow(min.required) `LI, gpd Design flow provided gpd
Plan Date ( ( Number of sheets Revision Date
Title ����
Size of Septic Tank 1 non 1 Type of S A Sa 2.1 dk(g ^.�o
Description of Soil ,G/
ti .
Nature of Repairs or Alterations(Answer when applicable)
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 t
Compliance has been issued by this Board of Heal
j Y ned Date
t
t 9
Application Approved by f !qN Date
Application Disapproved by Date
for the following reasons
Permit No. '� v Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded(� )
c Abandoned( )byA�
at has been cons cted in accor ance
All
with the provisions of Title 5 and th for Disposal System Construction Permit No " ated
Installer Designer_T
#bedrooms ' C�^ Approved design flow and
gpd
The issuance of this permit shall not be construed as a guarantee that the system will f coon as esi ed.
Date 9- Inspector
------------ --------- ------------ ----------------- ---------------- --------- - - - 11rV
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Disposal &pstem Construction J)ermit
Permission is hereby granted to Construct( ) Repair( ) Upgrade(�) Abandon
System located at
�j and as described in the above Application for Disposal System Construction Permit; The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions. '
Provided:Constru tion st completed within three years of the date of this permit.
Date Approved by
f
Town of Barnstable
Regulatory Services
Thomas F. Geller,Director
N Public Health Division
►
�� Thomas McKean,Director
yen r
200 Main Street, Hyannis, MA 02601
Office, 508-862-4644 Fax: 508.790.6304
Date: Sewage Permit# 20 tl- z00 Assessor's Map/Parcel ill /
Installer & Designer Certification Form
Designer: '3"C Engtnee(foa`TnC, Installer: CQ(�e�;;,d� ( nfe�Pr(se�5, 4. -C
Address: 2,.5y CconLO.ccV l�i�Hw� Address: lZ
East ruC,rehQrn H A' 02536
On $ " t 'Z e t 1 i (` Ong a was issued a permit to install a
(date) (installer)
septic system at °Ilo Po�Ke� (Load based on a design drawn by
(address)
-3,G E(lntneee(Ac 7ygG. dated S-11- It C�w.1
(designer)
1 certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Stripout (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with m-tjur changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation -)f,'any component
of the septic system) but in accordance with State & Local Regulations,. flan revision or
certified as-built by designer to follow. Stripout (if req nspe,.�ted and the soils
r were found satisfactory, �r�°"�cs,
JOHN I..
cMuKC!•ILL 1,
J fZ
(Ins 1er's SI natur t;l�!Il. 1r
g No sdG7 / 11
esigner's Sibnatur (Affiti esi er's ' ,utii,i-tere)
LEASE RETURN O BARNSTABLE PUBLIC HEALTH DIVISION CERTIFICATE
OF COMPLIANCE WILL NOT 8E ISSUED UNTIL BOTH THIS F)ItM AND AS-
RUIIJ CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEA II'H DIVISION.
THANK YOU.
q\ol'I'iie fnrins\dvsignorccrliliiuliun ro m diw
Town of Barnstable Pit 13 3 '7 3
Department of Regulatory Services
Public Health Division Date
200 Main Street,Hyannis MA 02601
Date Scheduled` 1( Time I 0 AM Fee Pd.
Soil Suitability Assessment for Sewage Disposal
Perf.rm d By: �t�U ZI ei 1M k1,C -T.Ca C Witnessed By: DM Old d72SYVKl«t S
..�. p LOCATION&:GENERAL INFORMATION
Location Address 96 it
Owner's iVame pQ60 �. �d1� 1
,
Oske vI'M N A 1 Address i o Ic( H�tl (td weskeu i 1 LT.
Assessor's Map/Parcel: Engineer's Name TC E n�lP7 Ca'fi tlS,Tox w
NEW CONSTRUCTION REPAIR Telephone# 308'2 73-0 3 77
Land Use 5 t tPL S O'nli It/A WCQI t(C Slopes(%) 6-1 Surface Stones
Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well It
Drainage Way It Property Line 7 1 V ft Other ft
r I
SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes)
See �tTIACY►c�l �1�a✓1 � '. �
r'�e 0
Parent material(geologic) WA 1,0:05�% Depth to Bedrock
Depth to Groundwater: Standing Water in Hole: ,Weeping from Pit Face
Estimated Seasonal High Groundwater
DETERMINATION FOR SEASONAL HIGHWATER TABLE',. ,..
Method Used: Viiec 1 6(D6ko 6Atcv l _ _ _ _..
Depth Observed standing in obs hole: 7 t 2,16 in. Depth to soil mottles: in.
Depth to weeping from side of obs.hole: in. Groundwater Adjustment - - ft. _
Index Well# - Reading Date: Index Well level _ Adj.factor - Adj.Groundwater Level—
PERCOLATION TEST Date' J I (�Vine Sc'A
_.. .. _. .,._v<..
Observation _
Hole# Time at 9" '
Depth of Perc " �6 Time at 6"
Start Pre-soak Time @ I0:.3 O P hI Time(9"-6")
End Pre-soak 1oqq A `
r Rate MinAnch L f..!
Site Suitability Assessment: Site Passed �/ZS Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100'of wetland,you must first notify the
Barnstable Conservation Division at least one(1)week prior to beginning.
Q:\SEPTICVERCFORM.DOC
_ __ DEEP OBSERVATION HOLE LOG- __r Hole# .�
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Graven
ilo-30 Ls 10yr518
36- 12.6 C H-FS 2_5 6A - < 5% gravel
A DEEP OBSERVATION HOLE LOG i Hole#. 2
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel)
o-Ib
Ib'30 LS /oyrs/�
30'12(o C t4- S 2,5 y V16 _ Z 5% 'gav4
DEEV OBSERVATION HOLE LOG `� Hole#.
Depth from Soil Horizon Soil Texture Soil Color Soil Other. "
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel)
_Y DEEP OBSERVATION-HOLE LOG;` Hole#•
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel)
Flood Insurance Rate Man:
Above 500 year flood boundary No_ Yes
Within 500 year boundary No Yes
Within 100 year flood boundary No ✓Yes_ c
Depth of Naturally Occurrine Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system? Y aS
If not,what is the depth of naturally occurring pervious material?
Certification '
I certify that on 10 27'9 (date)I have passed the soil evaluator examination approved by the `
Department of Environmental Protection and that the above analysis was performed by me consistent with
the required training,expertise rd el ence described in 310 CMR 15.017.
Signature• Date
Q-.\S EPTIC)P ERCFORM.D OC
TOWN OF BARNSTABLE
Ae4Z�VQ40*LOCATION �6 SEWAGE
�f
VILLAGE ASSESSOR'S MAP 6 LOT- a
INSTALLER'S NAME & PHONE NO. Car-f-A 1
SEPTIC TANK CAPACITY b 000 6 t1I,
LEACHING FACILITY:(type).- (size) Z`X a/'
NO. OF BEDROOMS PRIVATE WELL .OR PUBLIC WATER
BUILDER OR OWNER 'hQ r�,i-t (� ����y
DATE PERMIT ISSUED: 7�ix f -!CJ a
DATE COMPLIANCE ISSUED: ( D - �-
VARIANCE GRANTED: Yes . No p
�1
� v o 01%
F - I
o
0
` A
r
o ,
X
1
I � /
No... ...,� «l Fx$. �j.................
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
TOWN OF BARNSTABLE
Appliration for Uiipuiial Workii Totm rttrtion Vamit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
.....................(�_...........1zhc�............. :....�::5....... ../Z -------------------___________-.--____----------_-_---------------------_---_-- ----__
....1 P�f1�.E�f�1 .<..C����ocat. ..Address ........................••.......Lot No...-•---.-•----...........................
Owne Address
Installer Address
d Type of Building Size Lot___________________________S q. feet
U Dwelling 7o. of Bedrooms___....................................Expansion Attic ( ) Garbage Grinder ( )
'4 Other—Type T e of Building _______________ No. of ersons___.______.______________._. Showers — Cafeteria
Aa � YP g ------------- P ( ) ( )
44 Other fixtures _______________________________ __
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity;MO__gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No_____________________ Width..........._........ Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No-------------------_ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
0.4 Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
0-4
fT4 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................
9 •----------------•-----------------------•------•--------•••••-••-..._._........•-•---••••-•................................................................
0 Description of Soil........................................................................................................................................................................
x
U .................................--•---•-------•----•----------•-------•--•-•----•-----------------------------------------...-------------•----•---------------••----------.._...-----•-••-•-••---•....
---------------------------------------------------------------------------------------•-•------------------------------------------- �
U Nature of Repairs or Alterations—Answerhen applicable...___ ag_v 6g/f--��%C ��
---------------------------------------------------- ------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been - sued by board of health. q q
I` igned ... %� - ------ - `` ..... / / ...... ...
Date
Application Approved By ---------- ------ -- � i -----
---- -.. ..... ...... . .: .. ..... ................................ ..-----------..Date...................................
Application Disapproved for the following reasons: --- ------------------------------------------------------------------------------------ -------------------- -----
Date
PermitNo. 'r ..... ............ Issued ......................................
�.- Date
No..... .... ..A. Fx$............_..............
THE COMMONWEALTH OF MASSACHUSETTS
F BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Dispauaf Workii Tomitrurtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
.?� .. .......---•..............................................••--.•-=••-..----.---.--............-----
Locatio'�;Address , or Lot No.
............................................... ......................... ....----•--................................
Own Address
a ...............c7f P�f-�. e:1.�n� ._.............----•----..................... ..........----------........:. ....---••-....................-----------......
Installer Address
Type of Buildin� Size Lot................"'_.........Sq. feet
Dwelling T No. of Bedrooms...3...................................Expansion Attic ( ) Garbage Grinder ( )
`4 Other—T e of Building .... No. of persons............................ Showers — Cafeteria
P4Other fixtures -----•-----------•--•---•------------------•----•-••--•-------...-•-•---------•------------------...--•--.................----.............---•------•
W Design Flow............................................gallons per person per day. Total daily flow..........................................:.gallons.
WSeptic Tank—Liquid,capacity/7oco gallons Length................ Width................ Diameter................ Depth.....__.._......
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No---------_--------_ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
04 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P ---.----•-••------•----------•..............•-•-----------.........-----................•----.------.........................................................
0 Description of Soil........................................................................................................................................................................
x
U -----------------------------------
•------------------
.-----------
.....----------------
..... •-------...--------------------------------------
•-----------------
.--------------------------
-•----------
UW ----•---------- ...................................................................................................................... ....................... ..... . . ....................
Nature of Repairs or Alterations—Answer when applicable.-._/10 v...�1A.--. rr,! �--......................
....................................................... .........................-------•--------------•-------•-----•---•--•--..........................--•---.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by t e board of health.
Signed -.^ >+ / c�
--- .....-. ..........`..... � ../.................
I/ � Dace
Application Approved By .........4......--.i��.7�... .. ........///f/.> ... .. - �- ............. -
• � ' Dace
Application Disapproved for the following reasons: .......................................................................................................................................
. . .. ................: n...........................------.---------...............------------------------------------.................-- .
Dace
Permit No. '�
......... ............:........................... Issued A..................................................................
Dace
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
(g.e>r#ifirate of Compliance
THIS IS TO CERTIFY, That, the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by............ �7 �.: �.�.... /Nf.(1 .) � 11. . l ..............�....
��.>
........................ s. ..:
has been installed in accordance with the provisions-of TITLE 5/off The Stte Environmental 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 SATISFACTORY.
DATE ...... l..r�.. 1..... ....---•--------------------- Inspector .......................... t.._ ......... ------..................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
L.(7 I TOWN OF BARNSTABLE ���
No....�.. ........ FEE........................
Disposal Works Tern #r io/nyy �eJrndt,.
Permission is hereby gran ed1-•••--.0 01 7.. .. ..... l,l.J..A ,, t ...........................................
to Construc(t')�. ) or ai ( ) an Indivi`�ual Sewage Dispos �Syst
at No.------ "1-1 _:. ? �'�......--f� )� � e . ....I :/
V u ��, -•
et
as shown on the ap lication for Disposal Works Construction er�'t I..
id e ted...............................�....:...
/ Board of"Hlalth
DATE............`- ...............................................................
'
FORM 36508 HOBBS&WARREN.INC..PUBLISHERS s
AsBuilt Page 1 of 1
TOWN OF BARNSTABLE
LOCATION ����}2I-�e:2 iOF}p SEWAGE a - 1
VILLAGE_ SrFL 9��lr ASSESSOR'S MAP C, LOT
INSTALLER'S NAME 8i PHONE NO. QC EAA/ (395yE/c�
SEPTIC TANK CAPACITY 40006,11
LEACHING-FACIL'ITY:{ty� //;2�%d�.� (size)3— 7
NO. OF BEI
ROOMS IVATE WELL OR PUBLIC WATER
BUILDER OR NER._-- i=h o�A r�c; c 1 t l- —
DATE PERMIT ISSUED: Tex%, 9961
DATE COMPLIANCE ISSUED- �-
VARIANCE GRANTED: Yes No
117
ITAY e,. V UOX
yeor`
yo�F' (►�
A 3
t .
1
http://issgl2/intranet/propdata/prebuilt.aspx?mappar=l 17129&seq=1 8/15/2011
T.O.F. EL.= 31 .5'± PROVIDE EXTENSION RISER WITH INISH GRADE OVER D-BOX= 30.3'± 4"SCHEDULE 40 PVC MIN. SLOPE 1 % PROPOSED PVC VENT FINISHED GRADE OVER BIODIFFUSERS= 30,7' - 31 .0- GENERAL NOTES
f CONCRETE COVER TO WITHIN 6"OF SLOPE @ 2/o MIN.
INSPECTION PORT WITH
FINISH GRADE OVER INLET 8�OUTLET REMOVABLE WATER-TIGHT COVER OVER 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION
RISER TO WITHIN 6"OF FINISHED GRADE ACCESS BOX TO WITHIN 3"OF METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL
FINISH GRADE w F.G. (ONE PER OUTER ROW)
@ FND. EL.= 31 •0 '+ F.G. OVER TANK EL. = 30,4 ± 5 DIA. OUTLET(S)
CODE AND ANY APPLICABLE LOCAL RULES.
2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE
DESIGN ENGINEER.
PROPOSED 4" 9"MIN. SEE NOTE 21
EXIT i iNV 4•
PVC SEWER PIPE 36"MAX. 4.27' MAX. TOP OF SAS/B.O. = 26.73' <
3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL
--
SEWER PIPE --��- SYSTEM UNLESS OTHERWISE NOTED.
��w 3"DROP MAX 114"
! _ PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN
6 3 2"DROP MIN 3 L - 10± JOINTS (TYP.) ELEVATION =26.73' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A
MIN.SLOPE @ 1% 410" 4" PVC IN FROM 1.33' r10.
" 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF
�.` *26 $f} SEPTIC TANK 4"PVC OUT TO 0 90, (TYP.) -(TYP) 16 THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION.
• LEACHING FACILITY 1 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM.
1
iiw w
CONTRACTOR CONTRACTOR SHALL 112 6 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL.
I OUTLET TEE 26.57' MIN. 26.40' 26.30' 25.40' (laid flat) 2.875'(34.5")
SHALL VERIFY SIZE 48" VERIFY CONDITION OF (TYP.) 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK
AND CONDITION OF EXISTING TEES GAS BAFFLE 5.0' FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS
6"CRUSHED STONE 14.375'
EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY (TYP.) REQ'D NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH
TANK NECESSARY COMPACTED BASE
25.0' AND DESIGN ENGINEER.
5 OUTLET DISTRIBUTION BOX (TYP.) 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 31.00' ESTABLISHED
TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV.= < 18,90' ON A NAIL SET IN A 36" MAPLE TREE AS SHOWN ON PLAN.
BIODIFFUSERS END VIEW
- BASE. FIRST TWO FEET OF OUTLET )
BIODIFFUSERS (PROFILE) 9• CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION
EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT
CROSS SECTION VIEW (BY ADVANCED DRAINAGE SYSTEMS, INC.) 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES
*CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL ARC 36HC (#3616BD) BIODIFFUSERS (H-20) TO THE DESIGN ENGINEER.
10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT.
TO ANY WORK & NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE
11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING
tt�W low TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM
a # PERC NO. 13373 ! APPROPRIATE AUTHORITY.
4
` . INSPECTOR: Donald Desmarais, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS
(4 • . ' ` ' LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE
(3 c) o . • EVALUATOR: Michael Pimentel E.I.T.
"- 10.0 ' • • _ Oct 1999 THEY SHALL WITHSTAND H-20 LOADING.
10.4' • ; ' • + C.S.E.APPROVAL DATE:
EXISTING GC-1 �"`' • •' • • ' } August 1 2011 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES.
• • DATE: 9
/ GARAGE � � - . -�
ZONE 2 • • 0 TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE
GC-2 to • MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY.
I 01 , ELEV TOP= 29.40' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY,
MAP 117 p . .• • , •• ELEV WATER= < 18.90' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3).
15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN
U / (1 --14.4' ' • • PERC RATE _ <2 min./inch SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK.
PARCEL 128 -
cw 30" 48". n r `+ DEPTH OF PERC= -
I / >�* . . • • ` a ti 16. PROPOSED PROJECT IS LOCATED WITHIN:
z PROPOSED 4" PVC VENT PIPE; LOCUS . t �► • TEXTURAL CLASS: 1 ASSESSOR'S MAP 117 PARCEL 129
IL S86°15'13"E� EXACT LOCATION PER OWNER J �
/ - - j�i • � ,�� •' • «` , -- OWNER OF RECORD: DEBORAH MATTISON ANGOTTI
MAP 117 141.65'
SWING-TIES SCALE: 1"=20' ` •; �• . • • • + ADDRESS: 1 OLD HILL ROAD
Z 'c 31 • i.• ,.' + s 0" 29.40'
,.n,. / �1. . C? a •
� \ PARCEL 129 -� .. � DESCRIPTION GC-1 GC-2
• ti 4, + • • WESTPORT, CT 06880
C .01
20,732 S.F.± r31 ♦ f • . ' i/ I� " >\\• it •• 0 i• a r • s Fill
aQ / BIODIFFUSER CORNER(1) 27.4 13.7 • . . • �• . + ,1
' I� 1\ F• ,� • • • • �11 16 28.07 FEMA FLOOD ZONE C
� k W \� I EXISTING • . ` '-'t ! \1 • � . • • �� w
W/ W W ��T J GARAGE BIODIFFUSER CORNER(2) 35.3' 27.7' b
, l • +� a
Loamy Sand COMMUNITY PANEL# 250001 0016 D
[) p \ PROPOSED INSPECTION PORT WITH BIODIFFUSER CORNER(3) 24.4' 34.2' I • U • ' ' • s r • lt' B 10Yr 5/8
Q W C!O ACCESS BOX (TYP OF 2) CSf� * / !I ' • : • l "
k On ` r 11 30 26.90, 17. DEED REFERENCE: L.C.C.#98014
/ ; _ BIODIFFUSER CORNER(4) 10.0' 24.3 % t •� • • r • • r r
O x t
it x #96 �' o Perc 18. PLAN REFERENCES:
�``'4�>>__ �'`•-��, � ,.�,.-�. •• . "' • 48" 25.40' 1. L.C. PLAN 12538-C
7-- 31 EXISTING - PROPOSED TOTAL 25 ARC 36HC (#3616BD) J r 's )
LL/ k 4-BEDROOM a 0 n > BIODIFFUSERS (H-20) IN A FIELD CONFIGURA'i ION �Y �/ - ' F "'- 2.) PLAN BK.40, PG. 111
" ',"! �� 1'VeC�{I; 3.) PLAN BK.41, PG. 143
k DWELLING, J '['9"k13y
TOF = 31.5'± tj+ _
Q W -4/ e '4 Medium-Fine Sand 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION.
`o k \ B.H PROPOSED DISTRIBUTION BOX i~ C (<2.5 gravel)
o /
k c ¢ �; x s.�..c� ,.. .a 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY
�s /� FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY
Z k BIT. DRIVE EXIST. 3 INFILTRATORS (SIZE Tx 21') FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE.
vP f \30\ PER AS-BUILT CARD LOCUS PLAN 21. IN ACCORDANCE WITH 310 CMR 15.401 -15.405,THE FOLLOWING LOCAL UPGRADE
x a GAS APPROVAL IS REQUESTED FROM 310 CMR 15.221 (7):
SCALE: 1"= 1000' (1.) A 1.27'WAIVER(3.0'-4.27') FOR THE MAXIMUM COVER OVER THE LEACHING SYSTEM.
EXIST. 1,000 GAL. SEPTIC TANK /
ui 126 18.90
/ C) TO BE UTILIZED IN THIS DESIGN \ / Z No Mottling, Standing or Weeping Observed
w MAP 117 ---------------------- --
i _3 TREE �� DESIGN DATA TEST PIT DATA LEGEND
(TYP) PARCEL 131 PERC NO.
/ 30 4 13373
l Benchmark r' {)
� ; � \ NUMBER OF BEDROOMS(DESIGN) 4 INSPECTOR: Donald Desmarais, R.S.
_ Nail in 36"Tree 50x0 EXISTING SPOT GRADE
1?0EVALUATOR: Michael Pimentel, E.I.T. - 50 - - EXISTING CONTOUR
Elev. = 31.00' I` / DESIGN FLOW 110 GAUDAY/BEDROOM
S77°33,2 pw Approx. M.S.L. o � C.S.E. APPROVAL DATE: Oct. 1999 50 PROPOSED SPOT GRADE
X _ _ E ro 3 \ TOTAL DESIGN FLOW 440 GAUDAY
DATE: August 1, 2011
880 50 PROPOSED CONTOUR
X X X X51 TP 2 �c`ci \ DESIGN FLOW X 200 % = GAUDAY ��
TEST PIT#: 2 �-
29x4'
o USE EXISTING 1,000 GALLON SEPTIC TANK ELEV TOP= 29.40
' E/T/C - EXISTING UNDERGROUND UTILITIES
MAP 117 (n_ T11 V ELEV WATER= < 18.90' w W----_ EXISTING WATER LINE
N 0 29x4' PERC RATE _
PARCEL 195 P I.
a' % GAS EXISTING GAS LINE
C? o ' INSTALL 25 - ARC 36HC (#3616BD) BIODIFFUSERS (H-20) DEPTH OF PERC=
m g14
TEXTURAL CLASS: 1 TEST PIT LOCATION
SYSTEM CAPACITY
(TOTAL L.F. OF BIOS)(4.8 SF/LF)(0.74 GPD/SQ.FT.)=GPD
EXISTING 1,000 GALLON SEPTIC TANK
(125.0')(4.8 SF/LF)(0.74 GAUSQ.FT.)= 444.0 GAL. LEACHING!DAY
MAP 117 zc� 0" 29.40' PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE
/ PARCEL 130 rn 0 Fill
w TOTALS:
cn Q PROPOSED DISTRIBUTION BOX
°'- o TOTAL NUMBER OF BIODIFFUSERS: 25 16" 28.07'
TOTAL NUMBER OF COUPLINGS: 0 Loamy Sand
TOTAL LEACHING AREA: 600.0 B 0 PROPOSED ARC 36HC(#3616BD)BIODIFFUSER(H-20)
10Yr 5/8
TOTAL LEACHING CAPACITY: 444.0 30" 26.90' 1 8-16-11 MCP JLC CHANGED SAS DESIGN FROM 3 BEDS TO 4
REV. _ DATE BY APP'D. DESCRIPTION
29- -
PROPOSED SEPTIC SYSTEM UPGRADE
-y
NOTE:
EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE PREPARED FOR:
DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER Medium- Fine Sand
3046��%N MODIFIED CERTIFICATION FOR GENERAL USE ISSUED TO ADVANCED C CAPEWIDE ENTERPRISES
DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003 (LAST MODIFIED (<2.5Y
r gravel)
1 EOc'EOF PP ��, JANUARY 11, 2011). TRANSMITTAL NUMBER=W000052. LOCATED AT
p,Y ROPE 96 PARKER ROAD
OSTERVILLE, MA
NOTES: -
/� 126" 18.90' SCALE: 1 INCH = 20 FT. DATE: AUGUST 11, 2011
1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF SH OF A.1 0 10 20 40 80 FEET
EACH SEPTIC SYSTEM COMPONENT. No Mottling, Standing or Weeping Observed �a� ` �ssa��
- J HN L P, PREPARED BY:
2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF RESERVED FOR BOARD OF HEALTH USE CHu cHi JC ENGINEERING, INC.
THE PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST ivi
' .41 0 2854 CRANBERRY HIGHWAY
PIT DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL :1 •
BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. �'� cr,
� EAST WAREHAM, MA 02538
SITE PLAN 3.) LOCUS PROPERTY IS LOCATED WITHIN THE ESTUARINE WATERSHEDS. _
SCALE: 1"=20' Drawn By: MCP Designed By:MCP Checked By: JLC JOB No.2040