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HomeMy WebLinkAbout0233 PARKER ROAD - Health 233 Parker koad ' Osterville —i r A= 116-078 4 a 7 i Commonwealth of Massachusetts Title 5 Official Inspection Form _ a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 233 PARKER ROAD Property Address GEORGE ALLIEGRO Owner Owner's Name information is required for every OSTERVILLE MA 02655 02/14/2014 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. Imng out forms A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not JOHN GRACI use the return Name of Inspector key. GRACI SEPTIC INSPECTIONS, LLC r� Company Name PO BOX 2119 Company Address TEATICKET MA 02536 City/Town State Zip Code J 508-641-6694 S1468 Telephone Number License Number ; .I 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 M, i d np was serf.ormed based on my training and experience in the proper function and maintenance of on site sewage:.dlsposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of 4. Title 1:�:10 CMR 15.000). The system: t-- ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Furthejaation by the Local Approving Authority 02/14/2014 Inspector's Signature Date The system inspe for shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Offoial Inspectio :Subsurface Sewage Disp/salystem•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 233 PARKER ROAD Property Address GEORGE ALLIEGRO Owner Owner's Name information is required for every OSTERVILLE MA 02655 02/14/2014 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM PASSES TITLE V INSPECTION SYSTEM APPEARS TO BE STRUCTUARLLY SOUND AND FUCTIONING PROPERLY AT TIME OF INSPECTION RECOMMED NOT TO DRIVE ON SYSTEM 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): NA t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 233 PARKER ROAD Property Address GEORGE ALLIEGRO Owner Owner's Name information is required for every OSTERVILLE MA 02655 02/14/2014 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due .to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): NA ❑ 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): NA C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not.functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 233 PARKER ROAD Property Address GEORGE ALLIEGRO Owner Owner's Name information is required for every OSTERVILLE MA 02655 02/14/2014 page. Citylrown 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: NA D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 233 PARKER ROAD Property Address GEORGE ALLIEGRO Owner Owner's Name information is required for every OSTERVILLE MA 02655 02/14/2014 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. ❑ N Any portion of a cesspool or privy is within 50 feet of a private water,supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El El Area 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•3/13 Titie 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 I Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 233 PARKER ROAD Property Address GEORGE ALLIEGRO Owner Owner's Name information is required for every OSTERVILLE MA 02655 02/14/2014 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) . ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 233 PARKER ROAD Property Address GEORGE ALLIEGRO Owner Owner's Name information is required for every OSTERVILLE MA 02655 02/14/2014 page. City/Town State Zip Code Date of Inspection D. System Information Description: H-10 1500 GALLON SEPTIC TANK, DISTRIBUTION BOX&4-500 GALLON CHAMBERS 4 FEET OF STONE Number of current residents: SEASONAL 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 Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage d TOWN 9 ( Y 9 (gp ))� Detail: 2012- 155,000 2013-109,000 Sump pump? ❑ Yes ® No Last date of occupancy: SEASONAL Y Date Commercial/Industrial Flow Conditions: NA Type of Establishment: NA Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): NA 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: NA t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 233 PARKER ROAD Property Address GEORGE ALLIEGRO Owner Owners Name information is OSTERVILLE MA 02655 02/14/2014 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): NA General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: NA gallons How was quantity pumped determined? NA Reason for pumping: NA Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. 4 ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 233 PARKER ROAD Property Address GEORGE ALLIEGRO Owner Owner's Name information is required for every OSTERVILLE MA 02655 02/14/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 01/20/2011 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 38"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: GREATER THAN 10+ FEET feet Comments (on condition of joints, venting, evidence of leakage,etc.): NO COMMENT Septic Tank(locate on site plan): Depth below grade: 32"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: NA years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No. Dimensions: 1500 GALLON Sludge depth: 3" t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 233 PARKER ROAD Property Address GEORGE ALLIEGRO Owner Owner's Name information is required for every OSTERVILLE MA 02655 02/14/2014 page. City/Town 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 ,34" Scum thickness 0 Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): SYSTEM APPEARS TO BE STRUCTUARLLY SOUND AND FUCTIONING PROPERLY AT TIME OF INSPECTION RECOMMEND PUMPING EVERY TWO YEARS RECOMMEND NOT TO DRIVE ON SYSTEM Grease Trap (locate on site plan): Depth below grade: NA p g feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑.other(explain): Dimensions: NA Scum thickness NA Distance from top of scum to top of outlet tee or baffle NA Distance from bottom of scum to bottom of outlet tee or baffle NA NA Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 233 PARKER ROAD _ Property Address GEORGE ALLIEGRO Owner Owner's Name information is required for every OSTERVILLE MA 02655 02/14/2014 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.): NA Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: NA Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): NA Dimensions: NA Capacity: NA gallons Design Flow: NA gallons per day Alarm present: ❑ Yes ❑ No Alarm level: NA Alarm in working order: ❑ .Yes ❑. No Date of last pumping: NA Date Comments (condition of alarm and float switches, etc.): NA I Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 233 PARKER ROAD Property Address GEORGE ALLEGRO Owner Owner's Name information is required for every OSTERVILLE MA 02655 02/14/2014 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 BOTTOM OF PIPE 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.): NA 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. Soil Absorption System.(SAS) (locate on site plan, excavation not required): If SAS not located,explain why: NA t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 233 PARKER ROAD Property Address GEORGE ALLIEGRO Owner Owner's Name information is required for every OSTERVILLE MA 02655 02/14/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 4-500 GALLON LC ❑ 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.): 4-500 GALLON 12.83'W X 421 X 2' DLEACHING CHAMBERS APPEAR TO BE FUNCTIONING PROPERLY AND STRUCTURALLY SOUND AT TIME OF INSPECTION Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA Depth—top of liquid to inlet invert NA Depth of solids layer NA Depth of scum layer NA Dimensions of cesspool NA Materials of construction NA Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 233 PARKER ROAD Property Address GEORGE ALLIEGRO Owner Owner's Name information is OSTERVILLE MA 02655 02/14/2014 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments note condition of soil, signs of hydraulic failure, level of ondin , condition of vegetation, ( 9 Y P 9 etc.): NA Privy(locate on site plan): Materials of construction: NA Dimensions NA Depth of solids NA Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , 233 PARKER ROAD Property Address GEORGE ALLIEGRO Owner Owner's Name information is OST MA 02655 02/14/2014 ERVILLE required for every OS TER State Zip Code Date of Inspection page. own 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 t 32 91254 17 +4 4(o E 4$ A5 44-S 95 102. F RbNT,4 Pf�R1�E,R �Gf�D Title 5 Offidd;Inspection rm Fo :Subsurface Sewage Disposal System•Page 15 of 17 t5ins•3/13 S f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 233 PARKER ROAD Property Address GEORGE ALLIEGRO Owner Owner's Name information is required for every OSTERVILLE MA 02655 02/14/2014 page. Cityrrown 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: GREATER THE-10+ FEET feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: BOH FILES ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins 3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 L f Commonwealth of Massachusetts f W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 233 PARKER ROAD Property Address GEORGE ALLIEGRO Owner Owner's Name information is required for every OSTERVILLE MA 02655 02/14/2014 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 TOWN OF BARNSTABLE LOCATION 1 3 3 SEWAGE.# 2011 004 VILLAGE OSfery 111,e ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY.(type 5-00, (size) /d�N3 x�a xa NO.OF BEDROOMS j OWNER G9Po� e Nli,f ✓o PERMIT DATE: COMPLIANCE DATE: f Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY � a33 A A af, 34' a 3 37 3 `l poll o No: ''^!� ,6 a. Fee '✓--- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftpiication for disposal Opstem Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.a33 Pi/ler /Qi/ pf� Owner's Name,Address,and Tel.No. i A//,Bgim Assessor's Map/Parcel //(o p 7,5 Installer's Name,Address and Tel.No. Designer's Name,Address,and Tel.No. J,L. Ati /s3o CV.I.; e74,`", st�l�., Lby/t *4A*f,,C 33 9 mw sto�t -,4•YAf �q 0Wyf Type of Building: `So 8 a 9'/ to Dwelling No.of Bedrooms Lot Size /T o?�'-t sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) _02 gpd Design flow provided__ �`� gpd Plan Date �"'3 a Df Number of sheets / Revision Date Title -Size of Septic Tank Type of S.A.S. Description of Soil Xee / ,.7 Nature of Repairs or Alterations(Answer when applicable) 5�ee 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 ea h. I % Q Date / W Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued Em - .�.. Oct Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS YeS applicatlolC for Disposal 6pstpe'Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No..733 /,-,x-,, Rai osr Owner's Name,Address,and Tel.No. A///N yr� Assessor's Map/Parcel //(, D Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. J.C. Fria /Ao Coh571rve-}/ 57'�Oe. Aejy4- A 331 44,//f 11�iq �WV Type of Building: (4-0 6,V'!t/ 5 o ya 1:2 S 3 y e Dwelling No.of Bedrooms Lot Size �l, y �" sq.ft. Garbage Grinder(_ ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) S 5 r7 gpd Design flow provided gpd Plan Date /—3-_-2�7// Number of sheets / Revision Date) "Title Size of Septic Tank Type of S.A.S. Description of Soil t,- Nature of Repairs or Alterations(Answer when applicable) Sr, ,O/ , a Date last inspected: t 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 opera t.ion until z Certificate of Compliance has been issued by this Board owealth. f ' t signed C Date 'AtApplication Approved.by , r (/ r' �% Date - ... ?` !,' Application Disapproved'by l i " Date for the following reasons Permit No. Date Issued a — ----- ------- - - ----------- -- - - = THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS ; ' 4 Certificate of Compliance' THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by ), C. P . //o at 273 /�r4 , go4 r� has been constructed in accordance with the provisions ofTitle 5 and the for Disposal System Construction Permit No `ed Installer 3 C. Designer S>T #bedrooms Approved design flow -�'y gpd The issuance o this permit shall not be construed as a_ guarantee that the system will n tion�s designed. Date /��o / a u (� Inspector YY ---- - - - �/J- -- --= ---- ----- ---_-- - --/---- No. l/ / �}v THE COMMONWEALTH OF MASSACHUSETTS Fee PUBLIC HEALTH DIVISION -BARNSTABLE, MASSACHUSETTS ;Disposal *pstem Construction permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( Abandon( ) System located at a 33 Ar'fT« -- 1 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction mu. t be c in eted within three years of the date of this permit. ! / l Date Approved by EXISTING DECK 101 00 II I II • EXISTING EXISTING DINING KITCHEN ®® EXISTING ® BEROOM II II II II OI1 EXISTING EXISTING HALLWAY BATH EXISTING LINEN O LIVING PANTRY II EXISTING EXISTING II MUDROOM BEDROOM II EXISTING FIRST FLOOR FLAN EXISTING STORAGE AREA i N , EXISTING BEDROOM EXISTING �TYP. CEILING LINE .-, BEDROOM ----------- ------------ - - EXISTING BEDROOM ----------------------- ------- EXISTING SECOND FLOOR FLAN 77 low- a o l I ( ' / a .Soil!Suitabilit Assessment for Sewage csposat Perform=ed Uy ' "r..: { ::r r ,.... a.,"•�' Witnessed By. LOCATION& GENERAL INI+ORMATIUN` {' Location Address Owner's Name 4I 1 . z 3 3 eA exeir .��• • .. - ,�, Address Assessor'sMep/Parcel: Engineer's Name l4JCLL� 0'J8 NEW CONSTRUCTION _,� REPAIR Telephone N•-a,.9 7 S Land Uset''SS/ �9-c_ Slopes(%) •Surface Stones. �� Distances from: Open Water Dody n Possible Wet Area ZSo n Drinking Water Well Drainage Way e �� n Property Line (1, Other It SKETCH:(Street nnme,dimensions of jot,exact locations of test holes&perc tests locate wetlands In proximity to holes) ��. t. r ';�>•, w. �C�i,.r a ,.q`*�`�rc%t'-t` x x`�v �•r '~ �. t",tir «.wk.; #.. *3 /fit , •_ Parent material(geologic) Depth to Bedrock ' A' Depth to Groundwater: Standing Water in I lole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATEMVABLV Method Used: r Depth Observed standing in obs.hole: __ in. Depth to$oil mottles: in Depth to weeping ftom side of obs.hotel in. amundwater Adjustment t� Index Well N Reading Date: Index Well level• Adj.factor _ Adj.Groundwater lrvel ERCOLMIDN TEST Observation Time at 9" Hole N —' Depth of Perc Time at 6" Start pre-soak Time Q`. ` :/$ Time(4"-6'7 End Pre•sonk Rate Min./Inch Site Suitability Assessment: Site Passed 4--' Slie Failed: Additional Testing Needed r Original: Public Health Division Observation Hole Data To Be Completed on Back---=-�" Copy: Applicant DEEP OBSERVATION HOLE LOG Hole#1_ rkpth from Soil I lorizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munseil) Mottling (Structure,Stones,Douldemo . '2(1 � . xg SZ/Z ci s�� Z•_S �. - �.,�c v z Az DEEP OBSERVATION HOLELOG: Hole# ` Depth from Soil I lorizon_ I Soil Texture Soil Color . Soil Other ' Surface(in.) (USDA) (Munseil) Mcilling (Structure,Stones,Boulderes.- ' Z` ,pcc> lam a boy s� DELI' OBSERVATION HOLE LOG Hole# rkpth from Soil I lorizon Soil Texture Soil Color Soil Other ' Surface(in.) (USDA) (Munseli) Mottling (Structure,Stones,Boulderes. fI u ZS----------- --------------- DEEP OBSERVATION HOLE LOG Hole# Depth from Soil i lorizon Soil Texture Soil Color Soil Other Surface(in.) (USDA). (Munsell) Mottling (Structure,Stones,Boulderes. ConsitleaM• Clijivell Flood Insurance Rate Man: Above 500 yen flood boundary No_ Yes ! Within 500 year boundary No Ywe Within 100 year flood boundary No A Yes Depth of Naturally Occurring Pervious Material ,.j Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? G!5 A If not,what is the depth:of naturally occurring pervious material? Certification • I t. certify that on` (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 and experience described in 310 CMR 15.017.0 ` . �I~own of Ba riai table . � ewe ram, R6g ltory Services Thomas F. Gc ler,Director +« �sa�uvb�rne�we, y Public Health Division puss. Fn hAA�a Thornas'McKian,Director 200 Maui Street, Hyannis,:VIA 02601 Office: 508.862-4644 Fax: 508-790-6304 Date: _/-7'"1/ Sewage Perrnit.4 / -QD( Assessor's Map/Parcel 7S Installer&Designer Certification Form , Designer: 5• �1. _. . fir Installer: J�C, ,��.TO C �RtlCTl�N Address: Address: +�.Ra�t�3S o Marstons Millv.. MA 0264 011 / 7�� °.� J. A;' 1 was issued a'permit to in'stalI a (date) (installer) septic systen-1 at based on a design drawn by (address) a_V_ 1 c fy that the septic systern referenced'above was installed substantially according to design, which may include minor approved changes such as lateral"relocation of the distrib�utiora box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. 1 certify that the septic system referenced above was 'installed with major changes (i.e. greater than 10' lateral relocation of the,SAS or any vertical relocation of any component of the septic system)but izx accordance with State & Local Regalations. Plan revisioll or certified-as-built;by designer to follow. Stripout(if required)was inspected anal the soils were found satisfactory. 4VIN OF o DAVID E. B' n {Ins Iler'SNIgEW , MASON No.7066 (D sz er's Sigflature) (Affix T mp Here) , PLEASE lU'lTURN TO BARNSTABLE PUBLIC HEALTH DIVISION.• CERT'IFICAT'E OF COIYIPLIAINCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-. BUILT CARD ARE RECEIVED BY THE BAR-NSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Y , c�aoflice fD�msWasignercer:'tTicat�on fUIY[;,duc � y , 10/Z0 3Jbd Z 99000Zb805_._ 61:E0 TZOZ/Z0/E0 i Commonwealth of Massachusetts w W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 233 Parker Road Property Address Sheila Murphy Owner Owner's Name information is Osterville MA 02655 February 22, 2010 required for ry every page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Whe n filling out X Wh General Information --� en forms on the computer,use 1. Inspector: only the tab key _, to move your Patrick M. O'Connell �r cursor-do not Name of Inspector use the return ..,�� key. Septic Inspection Services Co. r o Company Name r� 189 Cammett Road ) r. f� Company Address Marstons Mills MA 02648 City/Town State Zip Code 508-428-1779 S1 12855 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: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority February 22, 2010 Viecto7r�sSt�ignatuue Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""*This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 10 34 Murphy.doc 08/06 Title 5 Official Inspection Form:Subsurface Sew isposal stem• age t of 15 f Commonwealth of Massachusetts w F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 233 Parker Road Property Address Sheila Murphy Owner Owner's Name information is Osterville MA 02655 February 22, 2010 required for ry every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: 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 break out or high static water level in the distribution box due! to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed 10-34 Murphy.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Co mmonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 233 Parker Road Property Address Sheila Murphy Owner Owner's Name information is Osterville MA 02655 February 22, 2010 required for ry every page. Cityrrown State Zip Code Date of Inspection' B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of'a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 10-34 Murphy.doc-08/06 Title 5 Official Inspection Form.Subsurface Sewage Disposal System-Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 233 Parker Road Property Address Sheila Murphy Owner Owner's Name information is Osterville MA 02655 February 22, 2010 required for ry every page. City/town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *" This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates d Cates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or 9 9 4 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 El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 10-34 Murphy.doc•08/06 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 233 Parker Road Property Address Sheila Murphy Owner Owner's Name information is Osterville MA 02655 February 22, 2010 required for ry every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve 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 11 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. 10-34 Murphy.doc•08/06 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 233 Parker Road Property Address Sheila Murphy Owner Owner's Name information is Osterville MA 02655 February 22, 2010 required for ry every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as pail of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systerris? 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)] 10-34 Murphy.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 I` Commonwealth of Massachusetts R. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 233 Parker Road Property Address Sheila Murphy Owner Owners Name information is Osterville required for MA 02655 February 22, 2010 every page.. Cityfrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): N/A Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Unknown Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: Currently Occupied Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 10-34 Murphy.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 233 Parker Road Property Address Sheila Murphy Owner Owners Name information is Osterville required for MA 02655 February 22, 2010 every page. Cltyrrown State Zip Code Date of Inspection D. System Information (cons.) General Information Pumping Records: Source of information: Unknown Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ® Single cesspool ❑ Overflow cesspool. ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe),- Approximate age of all components, date installed (if known) and source of information: Unknown Were sewage odors detected when arriving at the site? ❑ Yes ® No 10-34 Mutphy.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 233 Parker Road Property Address Sheila Murphy Owner Owners Name information is OsteNille required for MA 02655 February 22, 2010 eve ry page. Cit /Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 1 feet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No ---------------------------------------------------------------------------- ----- Dimensions: — Sludge depth: — Distance from top of sludge to bottom of outlet tee or baffle — Scum thickness Distance from top of scum to top of outlet tee or baffle — Distance from bottom of scum to bottom of outlet tee or baffle — How were dimensions determined? — 10-34 Murphy.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 233 Parker e Ro ad Property Address Sheila Murphy Owner Owners Name information is required for Osterville MA 02655 February 22, 2010 every page. Citylrown 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.): Grease Trap (locate on site plan): Depth below grader feet Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene El other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: - — Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): 10-34 Murphy.doc•08106 Title 5 Official Inspection Form.Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 233 Parker Road Property Address Sheila Murphy Owner Owners Name information is psterville required for MA 02655 February 22, 2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ NIo Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 10-34 Murphy.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 233 Parker Road Property Address Sheila Murphy Owner Owners Name information is Osterville required for MA 02655 February 22, 2010 every page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) locate on site Ian excavation ( p on not required): If SAS not located, explain why: Type: ❑ leaching pits number. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: — ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 10-34 Murphy.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 i ` Commonwealth of Massachusetts r Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 233 Parker Road Property Address Sheila Murphy Owner Owners Name information is Osterville required for MA 02655 February 22, 2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration One Depth—top of liquid to inlet invert 8 Depth of solids layer 6" Depth of scum layer 2 Dimensions of cesspool 6x6 Materials of construction Block Indication of groundwater inflow ❑ Yes ® No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Single cesspool is an automatic fail by Town of Barnstable standards Privylocate on site plan): ( p ) Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 10-34 Murphy.doc-08106 Title 5 Official Inspection Form.Subsurface Sewage Disposal System-Page 13 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form h Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w� 233 Parker Road Property Address Sheila Murphy Owner — ---- -------------------------------------- Owner's Name information is Osterville MA 02655 February 22, 2010 required for _ _ ry every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Parker Road Water Service 43 20 r. ! • 1 / / • i ! f / ! r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 233 Parker Road Property Address Sheila Murphy Owner Owners Name information is Osterville required for MA 02655 February 22, 2010 every page. Cityfrown State Zip Code Date of Inspection 't D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to ground water: N/A feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: E 10-34 Murphy.doc•08/06 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 15 of 15 . 3'-0"x rn I I �n -TYP.CEILING LINE 20 2.6 w I b r C I , C �(� _-- LINEN N® V' rn x � 0 • I fry � I I � ' \ Y 11 � I I , , N _ r- ---------.. 0 e 070 °o uz I ' I i ------------' P 8 C J GS.. ----------• J i yr.. �S I �• I�I� .. 1 � ' Z z ; m 12'-0u 24'-O" r.' I` vW� �i .. QJ(T .fT� tf S90 oil Suitabilcti sp Assessment for'Sewage rosal Performed By. - witnessed By LOCATION & GENERAL INFORMATION Locelian Address' Address Owner's Name 4 t 's Mep/pi+rcel:.: Engineer's Name LL� Assesso NEW CONSTRUMON _ AF,PAIR' Telephone p 7:7 5-C 5S Land Use `��5�. i�-c_ Slopes.(%) SurfeceStones Distances from: Open Water Body P Possible Wet Arc 7 ZSfl n thinking Water Well Drainnge Way� /-�� n Properly Line �� n Other . 5KETCH;(Street name.dimensions or lot,exact locations ortesi holes&pert tests,locate wetlands In proximity to holes). l , Parent material(geologic) �uw e-'6•17w,f6.01 Depth to Bedrock Depth to Groundwater: Standing Water in I lole: —Iol ` Weeping l}om Pit Frace Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL.HIGH WATER TABLE P Method Used: soli ew ' Depth Observed standing In obs.hole: In. Depth to sttla: in. Depth to weeping Rom side orobs.hole: In. Oroundwater AdJustmatt ♦t. Index Well N Reading Date: Index Well level Ad).rector Adj.Groundwater lrvel,_„_ PERCOLATION TEST bates. =�o 111me %m. Observation me N/ Ti 9" Hole A / �----- Depth or Pere Time at 6" Start Pro-soak Time Q / :/s Time(9"-6') End Pro-soak Rate MlnAnch Site Suitability Assessment: Site Passed 1-� Site Failed: Additional Testing Needed(Y",_ Original: Public l{ealth Division Observation Hole Data To Be Completed on Back----=—�" Copy: Applicant I UELI'' 11SLRVATION MOLE LOG hole 0 r Jkpih rmm t.solfilorizon soil'rexture Soil Color Soil . Other Surface In ( ) (USDA), (Munsell) Moltling (Slructure;Stones;Dqulderesc 'r ''... ZG='33s No loye y At, w 5"2=/z" ci r�� Z•S � � DEEP-OBSERVATION HOLE LOG: Hole Depth rmm Soil Iforizon Soil Texture Sail Color Soll. Olher Sur foce(in.) (USDA)' (Munsell) Mc1111nd (Strucltrre,Stones,Boulderes.` ' 4 C2 6� •un Z,S . DEEL OBSERVATION HOLE LOG Hole# 3 Dcpth from Soil l lorizon Soil Texture Soil Color Soil Other ' Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Srr`-7 '�J s�oy 4, Z. s� 5 DEUP OBSERVATION HOLE LOG Hole I)Cpth from Soil I lorizon Soil Texture. Soil Color Soil Other . Surrece(in.) (USDA) (Munsell) Mottling• (Strudure,Stones,Bouldae>t. b Flood insurance Rate Man: Above 500 year flood boundary No_ Yes Within 500 year boundary No X Yes.� . -- i. Within 100 year(load boundary No A Yu } Depth of Naturallysj�urrjng Pervious Material tit Opt fow Aw ofto llp t h. i►le►s rmterlal#AM In#ll Smaa obter throUghoot the area proposed for the soil absorption system? a If not,what is the depth of naturally occurring pervious material? ',. ry �i ,. 1 certify that on 5 I (date).l have passed the soil evaluator examination approved by'the:. Department ment of Enviro nmental onmental Protection and that the above analysis was performed b me consistent with; pc _ Y . the required training,expertise and experience described in 310 CMR 13.017b Town of Barnstabte SHE Regulatory Services x Thomas F. Geiler, Director * BARNMBLE, 9`�prE16.19. ,0� Public Health Division Thomas McKean, Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 June 18, 2007 Mr Saul Gershkowitz 75 Marshview Lane Marstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIROMENTAL CODE, TITLE 5 The septic system located at 75 Marshview Lane,Marstons Mills, MA was last inspected on May 31St, 2007 By Shawn McElroy, a certified septic inspector for the State of Masshachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Single cesspools automatically fail in the Town of Barnstable You have 2 years from the date of the system failure to bring the system into compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. BARNSTABLE HEAL DEPARTMENT T omas A. McKean, R.S., C.H.O. Agent of the Board of Health Ci? Town of Barnstable �oFTHe r�� f MP o� Regulatory Services Thomas F. Geiler, Director . BARNSTABLE. 9$ MASS. Public Health Division ATED MP'�A Thomas McKean, Director 200 Main Street, Hyannis, MA.02601 Office: 508-862-4644 Fax: 508-790-6304 May 16, 2007 Mr. Herbert Ehlers c/o E. B.Norris 11 Cove Road Osterville,MA 02655 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 11 Cove Road,OsterwilW, MA was last inspected on April 24t", 20075 by Robert J. Bortolotti, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Single cesspools automatically fail in the Town of Barnstable You have 2 years from the date of the system failure to bring the system into compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. BARNSTABLE HEALTH DEPARTMENT Thomas A. McKeon, R.S., C.H.O. Agent of the Board of Health �0�7 .i077 U2- Town of Barnstable �QFTHE.Tp�� Regulatory Services Thomas F. Geiler, Director * I RN5TABLE. MASS. Public Health Division TFO MA'S�" Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 May 28, 2007 Ms Kathryn Silva P O Box 142 West Barnstable,MA 02668 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 41 Twickenham Crossing,Barnstable, MA was last inspected on February 21St, 2007,by James D. Sears,.a certified septic inspector for the The inspection of the septic.system showed that the system"Failed" under the guidelines of 1995 TITLE 5 ( 310 CMR 15.00).due to the following: Tank& Covers at 20'. Tank full to cover, there is a backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert. Liquid depth in leaching is less than 6"below invert or available volume is less than Y2 day flow. You have 1 year from the date of the system failure to bring the system into compliance. If there are any questions about this reminder, please feel free to contact the Barnstable Health Department. BARNSTABLE HEALTH DEP TMENT . Thomas A. McKean, R.S.,C.H.O. Agent of the Board of Health lcl'7 0 4- Town of Barnstable ♦ OF THE 1p Regulatory Services Thomas F. Geiler, Director * *QB,ARNSTABLE, 9vA 1639. •�� Public Health Division rfD MA'S A, Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 April 4, 2007 Ms Kathryn Silva 41 Twickenham Crossing Barnstable, MA 02668 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system owned by you located at 41 Twickenham Crossing, Barnstable, MA was last inspected February 21" , 2006,by James D. Sears, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system"Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Tank& covers at 20",Tank full to cover, there is a backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert. . Liquid depth in.leaching is less than 6"below invert or available volume is less than %Z day flow. You have 1 year from the date of the system failure to bring the system into compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. BARNSTABLE HEALTH DEPARTMENT (Zom�as VA:tMcKean, H.0. Agent of the Board of Health J - COMMONWEALTH OF MASSACHUSETTS Title 5 Official Inspection Form ,I Not for Voluntary Assessments Subsurface Sewage Disposal System Form Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information 1. Property Information: MAP 23 1—PARC 061 41 TWICKENHAM CROSSING — T BARNSTABLE, MA 02668 Property Address SILVA, KATHRYN Owner's Name 41 TWICKENHAM CROSSING Owner's Address WEST BARNSTABLE MA 02668 City/Town State Zip Code FEBRUARY 21, 2007 Date 2. Inspector: JAMES D. SEARS Name of Inspector A & B CANCO Company Name 350 MAIN STREET Company Address = � WEST YARMOUTH MA 02673 City/Town State Zip Code 508-775-2800 ` ' ~ Telephone Number B. Certification 47- I certify that I have personally inspected the sewage disposal system at this address and that the information re orted ` below is true, accurate and complete as of the time of the inspection. The inspection was performed based onny 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 16.000). The System: ® Passes ® Conditionally Passes ® Fails Ne ds Further Evaluation by e Local Approving Authority o� a 617 Vector'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 is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. *—This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. r Title Official inspection Form:Subsurface Sewage Disposal System Page 1 of 16 COMMONWEALTH OF MASSACHUSETTS u Title 5 Official Inspection Form o Not for Voluntary Assessments 41 y0�` Subsurface Sewage Disposal System Form D. Certification (coot.) 41 TWICKENHAM CROSSING Owner's Address WEST BARNSTABLE MA 02668, City/Town State Zip Code SILVA, KATHRYN Owner's Name FEBRUARY 21, 2007 Date of inspection Inspection Summary: Check A, B, C, D or E/always complete all of Section D A) System Passes: N/A 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: N/A , ® 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: Title$Official Inspection Form:Subsurface Sewage Disposal System Page 2 of]6 COMMONWEALTH OF MASSACHUSETTS w Title 5 Official Inspection Form d lG�M SJey`aW Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 41 TWICKENHAM CROSSING Owner's Address WEST BARNSTABLE MA 02668 City/Town State Zip Code, SILVA, KATHRYN Owner's Name FEBRUARY 21, 2007 Date of inspection B) System Conditionally Passes (cont.): N/A ® Observation of sewage backup or break out or high static water level in the distribution box due to f 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: C) Further Evaluation is Required by the Board of Health: NIA 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 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 1 COMMONWEALTH OF MASSACHUSETTS d Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 41 TWICKENHAM CROSSING Owner's Address WEST BARNSTABLE MA 02668 City/Town State Zip Code S I LVA, KATH RYN Owner's Name FEBRUARY 21, 2007 Date of inspection C) Further evaluation is required by the Board,of Health (cunt.): N/A 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. ElThe system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ® The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well** Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less that 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3.Other: Title`Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 COMMONWEALTH OF MASSACHUSETTS W Title 5 Official Inspection Form o a Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 41 TWICKENHAM CROSSING Owner's Address WEST BARNSTABLE MA 02668 City/Town State Zip Code SILVA, KATHRYN Owner's Name FEBRUARY 21, 2007 Date of inspection D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth inleaching is less than 6" below invert or available volume is less than '/�day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: _. ® ® Any portion of the SAS; cesspool or privy is below high ground surface water elevation. ® N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ® N/A Any portion of a cesspool or privy is within a Zone 1 of a public well. s N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well. N/A 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.] y YES -No The system is a cesspool serving a facility with a design flow of 2000 gpd—10,000 gpd. 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. Title 5 Official inspection Form:Subsurface Sewage Disposal System Page 5 of 16 f COMMONWEALTH OF MASSACHUSETTS, Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) k 41 TWICKENHAM CROSSING Property Address WEST BARNSTABLE MA 02668 City/Town State Zip Code SILVA, KATHRYN Owner's Name FEBRUARY 21, 2007 Date of inspection E) N/A-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 13 ® 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. Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 COMMONWEALTH OF MASSACHUSETTS d Title 5 Official Inspection Fora 1 !¢ Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. Checklist 41 TWICKENHAM CROSSING Property Address WEST BARNSTABLE MA 02668 City/Town State Zip Code SILVA, KATHRYN Owner's Name FEBRUARY 21, 2007 Date of inspection 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 f 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, including 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)]. 1 I Title 5 Official inspection Form:Subsurface Sewage Disposal System s Page 7 of 16. COMMONWEALTH OF MASSACHUSETTS p Title 5 Official Inspection Form v C Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information 41 TWICKENHAM CROSSING Property Address WEST BARNSTABLE MA 02668 City/Town State Zip Code SILVA, KATHRYN Owner's Name FEBRUARY 21, 2007 . Date of inspection Residential Flow Conditions:,/ NOTE: INLAW APARTMENT. 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 Number of current residents: 6 Does residence have a garbage grinder? ® Yes ® No Is laundry on a separate sewage system?[if yes separate inspection is required] El Yes ® No Laundry system inspected? ® Yes ® No Seasonal use? ® Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 2005—102,000 GAL. 2006—119,000 GAL. Sump pump? ® Yes . ® No Last date of occupancy: PRESENT Commercial/Industrial Flow Conditions: N/A Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.) Grease trap present? Yes ® No Industrial waste holding tank present? Yes ® No Non-sanitary waste discharged to the Title 5 'system? ® Yes ® No Water meter readings if available. Last date of occupancy/use: Date Other(describe): Title Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 16 COMMONWEALTH OF MASSACHUSETTS N s Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 41 TWICKENHAM CROSSING Property Address WEST BARNSTABLE MA 02668 City/Town State Zip Code SILVA, KATHRYN Owner's Name FEBRUARY 21, 2007 Date of inspection o General Information Pumping Records: Source of Information: N/A Was system pumped as part of the inspection? ® Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ® Single cesspool ® Overflow cesspool ® Privy ® Shared system(yes or no)(if yes, attach previous inspection records, if any) ® Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) ® Tight tank. Attach a copy ofthe DEP approval. ® Other(describe): Approximate age of all components, date installed (if known)and source of information: APPROXIMATE 1985—NEW LEACHING 1999—PERMIT 99-315. Were sewage odors detected when arriving at the site? ® Yes ® No Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 16 r - COMMONWEALTH OF MASSACHUSETTS N W Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) a 41 TWICKENHAM CROSSING Property Address WEST BARNSTABLE MA 02668 City/Town State Zip Code SILVA, KATHRYN Owner's Name FEBRUARY 21, 2007 Date of inspection Building Sewer(locate on site plan): Depth below grade: 16" feet Material of construction: ® cast iron [3 40 PVC ® other(explain) Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): GOOD — CLEAN Septic Tank(locate on site plan): J Depth below grade: 20" feet Material of construction: "I 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-GALLON Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle 26" Scum Thickness 3" Distance from top of scum to top of outlet tee or baffle FULL TANK Distance from bottom of scum to bottom of outlet tee or baffle FULL TANK Flow were dimensions determined? ASBUILT—PLAN—TAPE&SLUDGE JUDGE. title 5 Official Inspection Form:Subsurface Selvage Disposal System Page 10 of 16 COMMONWEALTH OF MASSACHUSETTS N Title 5 Official Inspection Fora Not for Voluntary Assessments 41 ye y� Subsurface Sewage Disposal System Form D. System Information (cont.) 41 TWICKENHAM CROSSING Property Address WEST BARNSTABLE MA 02668 City/Town State Zip Code SILVA, KATHRYN Owner's Name FEBRUARY 21, 2007 Date of inspection 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 & COVERS AT 20", TANK FULL TO COVER. OUTLET BAFFLE TWO INLET TEE'S. NOTE: PUMPED TANK AFTER INSPECTION. Grease Trap (locate on site plan): N/A Depth below grade: feet Material of construction: ® concrete ❑ metal fiberglass ® polyethylene other(explain) Dimensions: Scum Thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): N/A Depth below grade: Material of.construction: concrete 11 metal F] fiberglass polyethylene other(explain) Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 COMMONWEALTH OF MASSACHUSETTS Title 5 Official Inspection Form d Not for Voluntary Assessments , Subsurface Sewage Disposal System Form d D. System Information (cont.) 41 TWICKENHAM CROSSING Property Address WEST BARNSTABLE MA 02668 City/Town State Zip Code SILVA, KATHRYN Owner's Name FEBRUARY 21, 2007 Date of inspection Tight or Holding Tank (cont.) N/A t Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: Yes No Alarm Level: Alarm in working order: ® Yes F] No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach a copy of current pumping contract(required). Is copy attached? Yes ® No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert OVER 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 4' BELOW GRADE, FULL TO COVER. Pump Chamber(locate on site plan): N/A Pumps in working order: El Yes No Alarms in working order: Yes No Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 COMMONWEALTH OF MASSACHUSETTS N w Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form Do System Information (cont.) 41 TWICKENHAM CROSSING Property Address WEST BARNSTABLE MA 02668 City/Town State Zip Code SILVA, KATHRYN Owner's Name FEBRUARY 21, 2007 Date of inspection Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): R- Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: Elleaching pits number: ® leaching chambers number: 5 ® 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 FIVE HI CAP INFILTRATOR'S WITH 4' STONE. LEACHING IS FULL — NOT WORKING. NEED TO REPLACE LEACHING. Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 COMMONWEALTH OF BVIASSACHUSETTS H Title 5 Official Inspection Form 777 Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 41 TWICKENHAM CROSSING Property Address WEST BARNSTABLE MA 02668 City/Town State Zip Code SILVA, KATHRYN Owner's Name FEBRUARY 21, 2007 Date of inspection Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): N/A Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ® Yes No Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): privy (locate on site plan): N/A Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 16 COMMONWEALTH OF MASSACHUSETTS Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Fomi D. System Information (cont.) 41 TWICKENHAM CROSSING Property Address WEST BARNSTABLE MA 02668 City/Town State Zip Code SILVA, KATHRYN Owner's Name FEBRUARY 21, 2007 Date of inspection 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. r ,YIf � Fc k y 5 ao. a sTti 1. Tide 5 Official inspection Form:Subsurface Sewage Disposal System Page 15 of 16 COMMONWEALTH OF MASSACHUSETTS y Title 5 official Inspection Form Not for Voluntary Assessments N Vev` Subsurface Sewage Disposal System Form D. System Information (cont.) 41 TWICKENHAM CROSSING Property Address WEST BARNSTABLE MA 02668 City/Town State Zip Code SILVA, KATHRYN Owner's Name FEBRUARY 21, 2007 Date of inspection Site (Exam: Slope Surface water Check cellar Shallow wells Estimated depth to NO ground water: 11' 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: 10/04 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: NO GROUND WATER 11' PER PLAN 10/04. NEW ( �-`C Z f 1 W EXISTING DECK ((ZZo DECK w I 12'X12' / 22'XI2" 4'10" 24'O" .—TING \ . RAt iP II'0" 2.2" 15'4" 24XI6-2 3068------------------- 5+ �e" 30685 p - I o tl o I l—J�J ®p 24X24 EXISTING -"--- ---_-" EXISTING v NEW , rc a rc KETCHEN ® A - BEDROOM - KITCHEN 00 �� EXISTING1i - - I x DINING rc� AREA :5/8 F.G.DRYWALL I U I - BEROOM _ _ m BEDR 9 ® rc •------- --------- ^' AREA N O o WALLS e CEILING. U s - _________________ ____ w - 3 6 l" m , o� - Q W - ; ------- --------- ADD 4X4 POST . a . _NBA�-0•-� __ ________ -M m 4 - N .®,. ® __ - WIOBEAMABOVE - O _ —_�—___—_—___ O d HALL X 4X6 POST NEW 6X6 PT P05T _ _____________ c� N X MASTER GARAGE - EXISTING EXISTING ». a, q°'S X BATH - HALLWAY BATH Wr, v� � T111 n Q - BATH o CONC45L4B O w 0 EXISTING uNEN ® i � EXISTING z„ S > LIVING LIVING W/Ff6ERN 5N O OR EQu4L. ° (O d"Y, 3 4 uo " 4Fl i 3 `N NEW _ ____ MASTER 24X24 24X24 i Exr N- EXISTING E%ISTING1174 DRoon BEDROOM _ nuDRoo BEDROOM 24X24 24X24 AREA 6'-6" W-O" 24'O" 24X24 24X24 EXISTING FIRST EXISTING 4 NEW FLOOR PLAN FIRST FLOOR PLAN 32'O" 24'-0" 2'0" 5 l° 9'01. 9'-I° 6'-4" W-O" 4 II'o" 2'O" 11 m - EXISTING - 29X22 29X22 24X20 suowER 29X22 29X22 STORAGE 6'8"WALL II'-1'h° 8'-&,., m ARA /\ g S 4X22 24X22 24X22 _____ 1YP.CELNG LINE v _ _ __ __ __ _________ __________�\ _ _.__LINE m OI -______________ 11________ ______ 1 - ........... m__ _ _ .__ ®___ _ _ ___ �_ _ _ °-APROX. l 2'WALL HEIGHT__ _ NEW z U U 4 : ADJUST TO MAIN HOUSE O r BATH a m DORMER. '� ,z ___ _______. ______VE __ ___ _ t U �0 AREA - °u � n EXISTING ;w I} ,u U q � ® rc I � ° BEDROOM - r• r . m9 n ° 2-3<' U I FUTURE m� �� EXISTING 1 cv _ r uNF�, O 1 _ LI °' BEDROOM RAILING n EXISTING '0 EXISTING X - ` 5,2" I 3'6" x n BEDROOM h - �rYP,cEIUNG LINE BEDROOM -0' NEW _�\_P _._FLUE__. _________ _______SITTING - +• TING III II' Q ROOM NEW WALLS AREA E-2X6 J, mXl6 0.�. ___________ ____ _ EXISTING WALLS 24X2 i "\ 24X20 n\ 24X22 .0 .9 24X22 24X22 6_6'� 1 II'-O" 24'-0" .0 { EXIk TING 4 NEW SECOND FLOOR PLAN EXISTING SECOND FLOOR PLAN BUILDER JOB ADDRESS DESIGN n n qn n.p��p n2�-�q �ON� �l {� //� com DATE REVISION DRAWN BY PAGE SCALE KENDALL 8 WELCH I ALLEIC�RO RESIDENCE RENOVATE ,ADD DORMER /l�✓//111/�✓/l//oN///�j/BUJ/{' , O l//��7J(///�\V// 02-22-11 a JB 2 or2 1,4"=1'-O" �� �esighS 233 PARKER ROAD AND TWO CAR GARAGE, w "I PURCHASE OF ORAW— PR LEAVES PURCH AS ER RE51'1— LE FOR—LIANCE WITH ILL 12)EXACT 51ZE AND REINFORC—T OF ALL CONCRETE FOOTINGS ALL FOOTINGS SHALL EXTEND BELOW FROSTLINE VERI DEPTH. OO LOCA SITE CONDITIONS OR FOR THE L BUILDING CODES AND ORDINANCES,JB DESIGNS nAY NOT BE HELD RESPONSIBLE nU5T BE DETERI I NEO BY LOCAL SOIL CONDITION5 AND ACCEPTABLE l 1 VERIFY 5TRUCTURAL EL—ENTS FOR DESIGN.51ZE P.1 Box 1 (508J 494-9534 OSTERYILLE MA. Z FOR USE OF THE5E DR�WINGS DURING CCYS RUCTION. ACTICES OF CONSTRUCTION.VERIFY DESIGN WITH LOCAL ENGINEER. WITH LOCAL ENGINEER AND BUILDING OFFICIALS E9Z BAR,V9 ZAHLE,Yd.OI669 30'-"" r 24'-3✓s" , 14•-214" C•-6IG" G>'-6• -11'-3yi" - 6'-6" t. - I 1 1 - - NEW WALLS NEW !�i LL W - _. - ......._ .. _ .. -.. ... n GARAGE I _ 2•-0" �I ;a Ixto C.J.—. EXISTING WALLS 16"O.C. Q ! 4I m DECK N AREA _... _. ,O L > r 9 - O I Q 1I I T.v�:• - ° 5L40 EIIJ -tom a m i 4I _QI� m _--� IQ11 f rI� I mill .-�:• -j- _ +RSr...E%45nRG Doors _ �i\�' �C)4 1m1 _• -------------._.. S/8"F.C.DRYWALL� i - u I WALLS E CEILING.----------------------- . _ �I 11 —CUSTOM 24"HIGH RAILING i �I I U 1 u �• I iI O I NEW O wNEW 1 S i 51TTING >- � � 1 a I I �I NEW .AREA r O KITCHEN �-2X8 G.J _ I 111 VIEW a Q F AREA _ _ 9 a I6.O' �1 COURTYARD .—.—.—._ _.—.—.—. - ' - —(B)51ZED W14 OR WI&BEAM.ABOVE kl i VIP.51ZED 5TEEL COLUMN - ' i / `.. NEW 1 .,•` .: - EXIST. \. Fm ... .. -- J 9 <, Oi i MUDROOH v /I W ' BATH •— '�. S EXISTING' a• DINING � AREA EXISTING - ' EXISTING BEDROOM - EXIST. BEDROOM - -a "';.- WIC S " �i•� aJ.— BATH a NEIU PANTRY '? _ ___ _ _ _ ___ •.,. eD _. __ _ EXISTING ---. ! '� � ` e' NEW -- BEDROOM MASTER t iY BEDROOM I' I lip AREA EXI5TING r. T B•-0. AREA. C..� ... ._....... ...... _..___- S HALF EXISTING 'I y`} ., BATH j MASTER p - LIVING - BATH Jtill . 8 9y, POST-- w* I 9 EXISTING DEN I� I . POST-- - - . nmaoon _ _ It 3 S5 3 215" EXISTING 4 NEW EXISTING 4 NEW ,o. R FIRST FLOOR PLAN — SECOND FLOOR PLAN NEW� • ER RT 1 BUILDER JOB ADDRESS DESIGN DATE REVISION DRAWN BY PAGE SCALE KENDALL 4 WELCH PARISt AND JENKINS EXTEND EXISTING LIVING, L' w' '� �� , : —�/ — JB Designs /G, 1 1 03-21-14 • JB 233 PARKER ROAD KITCHEN NEW MUDROOM W N PURfyuSE a pRgyRdb9�EAVF9 WRGWgi RFyppri9®l.E TOR COnT11pRCE JrtR at1 %-T SZE I nrm RE➢60RCET4'Hi O<<li tLM%E iOT�Ya9 N1 FOOto,�S 5wgy p�rE�9Elqu�R05TLog vHasl' iw. OSTERV ILLE, MA. AND NEW TWO CAR GARAGE. 5T aE of ""�a,_«u 5oa <m nCf�nnB E ERA 5 R ci R �r5 TaR OE5 R."g P-o bx (50BJ 494-9934 Z TOR SATE CO•DRiOvS aR TOR lig WE OE MEY OR/•YMGS pR+INGSiRUCnOR. PRnCTKES aF CO.LSiRUCTprt v93s�O£9�GR aura IOC.oL ERG�RE92. wTw�0�4 ENGwEB+nNG Bu[DNG 6ECue.L_9. uEDT 9dRMTABIE n4 OY.M 0 cn � Ld O J � O U N O No pVt: V) w w TOP DWELLING FOUNDATION EL. 32.0' r SECO p pVE N LOCUS THIR U ® Z ' Q FINISHED GRADE EL. 30.1'f 12.83 -I v� w Co a N DWELLING 8 �S 34" 'dd p 24 WEST BAY Li : of 27.8 MIN. RISER 1/8" TO 1/2" DOUBLE WASHED STONE 3" THICK OR UEOTEXTILE FABRIC '� 58,. 48' NECK O zz = 4 PROVIDE TWO RISERS TO WITHIN POND U D PARKER 00 3" OF FINISHED GRADE. POND dam- 0 FINISHED GRADE EL. 30.1't FINISHED GRADE EL. 30.0't NUMBER of TRENCHES = ONE o IIIII IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIII l IIIIIIIIII IIIII NUMBER OF UNITS = FOUR 6 W tai t,J PROPOSED LEACH TRENCH-END VIEW INV EL INVO EL RISER I-■-- 8.5' -1 EL.�27.0' llll i wsTALL FouR soo GALLON uwrs zo 27.29' GAS OOO ADO ll WITH FOUR FEET OF DOUBLE WASHED STONE 9� �O W Q O_ INV EL a s e v e e e m 24.17' so w P� J Liquid Level 48" BAFFLE a 'd a AT ENDS AND AT SIDES �% w d INV EL slums" INV EL 26.17' 4s" 3/4„ - 1 1/2.. a 2 L SEANE �� w 26.77' 26.57' DOUBLE WASHED STONE �� G S0� ~ 6" STONE 6" STONE BED PROPOSED 1500 GALLON TANK 42' iv REMOVE ALL UNSUITABLE MATERIAL FIVE FEET SEAVIEW A aP�w DISTRIBUTION BOX PROPOSED CHAMBER TRENCH u-;, AROUND THE,S.A.S. DOWN TO THE Cl HORIZON (EL.24.1't) REQUIRED TANK CAPACITY: AND REPLACE WITH CLEAN COURSE SAND PER 310 CMR 550 GPD DESIGNED @ 200% 1500 GAL/MINIMUM 15.255 - AS REQUIRED. L,O C' U,S MAF SEPTIC TANK NOTES: BOTTOM OF TEST PIT EL. 18.^�' INSTALL ON A STABLE COMPACTED BASE ONTO PRECAST DISTRIBUTION BOX NOTES: No GROUND WATER FOUND WHICH 6" OF CRUSHED STONE HAS BEEN PLACED INSTALL ON A STABLE COMPACTED BASE ONTO ASSESSORS MAP 116 PARCEL 078 WHICH 6" OF CRUSHED STONE HAS BEEN PLACED REFERENCE DEED: 2339-77 TEES SHALL BE CONSTRUCTED OF SCHEDULE 40 PVC AND SHALL EXTEND A ZONING DISTRICT: RF-1 MINIMUM OF 6" ABOVE THE FLOW LINE OF THE SEPTIC TANK AND BE ON COVER SHALL BE WATERTIGHT OVERLAY DISTRICT: AP, RPOD AND MA ESTUARY THE CENTERLINE OF THE SEPTIC TANK LOCATED DIRECTLY UNDER THE LOCUS DOES NOT LIE IN A FLOOD HAZARD ZONE. CLEAN-OUT MANHOLE. MINIMUM WALL THICKNESS 2" THE INLET PIPE ELEVATION SHALL BE NO LESS THAN 2" NOR MORE THAN S' MINIMUM INSIDE DIM. = 12" ABOVE THE INVERT ELEVATION OF THE OUTLET PIPE. OUTLET INVERTS SHALL BE EQUAL TO EACH OTHER AND AT THE SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 12", WITH TWO 2" MINIMUM BELOW INLET INVERT. a 20" MANHOLES HAVING READILY REMOVABLE IMPERMEABLE COVERS N OF DURABLE MATERIAL SHALL BE PROVIDED WITH ACCESS PORTS. THE DISTRIBUTION LINES FROM THE DISTRIBUTION BOX SHALL W ALL HAVE EQUAL INVERTS AS DETERMINED BY FLOODING THECC THE TANK OUTLET TEE SHALL BE EQUIPPED WITH A` GAS BAFFLE. DISTRIBUTION BOX TO THE HEIGHT OF THE DISTRIBUTION LINE SAS I INVERT AFTER ALL LINES HAVE BEEN SEALED IN PLACE. PR MgER D RFNCH x _ ip FND It CA 'I SYSTEM DESIGN DATA: INVERT ADJUSTMENTS SHALL BE MADE BY FILLING WITH CHA 30.1 (OFF) i o o FIVE BEDROOMS = 5 x-110 GPD = 550 GPD REQUIRED FLOW DURABLE AND NONDEFORMABLE MATERIAL PERMANENTLY USE CHAMBER TRENCH 12.83'W x 421 x 2' EFF. DEPTH FASTENED TO THE LINE OR RECONSTRUCTING THE LINES 172.05 I 3+12.831 x 2.0 = 219 SF UNTIL ALL INVERTS ARE OF EQUAL ELEVATION. T x SIDE WALL: [42+42+12.8 ro as It z BOTTOM: 12.83 x 42 = 538 SF SOIL STRIPOU 30.0 757 x 0.74 = '560 .GPD :.TOTAL DESIGN FLOW PROVIDED _ _ __ -__ NO GARBAGE DISPOSAL ALLOWED 30.2 ° y Xtt 30.1 PARCEL 78 x _ p- �t GENERAL NOTES: 30.6 ° 16,928± S.F. a Zs 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO DEP AND X a gip'( a P 2 I o THE TOWN OF BOURNE RULES AND REGULATIONS FOR THE SUBSURFACE 30.6 QR\ tl 1 'i 100 I DISPOSAL OF SEWAGE. EXISTING ' 2. ACCESS PORTS OVER TANK TEES SHALL BE ACCESSIBLE WITHIN 6" GARAGE ° x �t ii 0 I t OF FINISHED GRADE. / '` � p�.- 30.1 v ^� o t1 tt o 3.- ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF 308 �� �P ° 30.1 �' ''1, o It I t WITHSTANDING H-10 LOADING UNLESS OTHERWISE NOTED. n "� ° "RPM%' i X PROPOSED ► W t w Q ° ° a C �•'. . GAL- c�, ' I O I 4. THE EXCAVATOR CONTRACTOR SHALL CALL DIG SAFE AND VERIFY THE LOCATION a �� 1500 rn D/B I *so N ► w _j >- / Cia TANK 0 A I I z Q 2 OF SITE UTILITIES PRIOR TO ANY EXCAVATION, AND SHALL BE RESPONSIBLE FOR EXISSIN ,-- I "' I W I � o- > ALL MATTERS RELATING TO ELECTRIC AND/OR GAS EASEMENTS. X a a /" 19' 0 �' w' 0 0' It I o 5. SEWER PIPES SHALL BE SCHEDULE 40 PVC. (4" DIA. UNLESS OTHERWISE NOTED) 0 29.4 / --W 4 �I I a ti O ii w g Q o 6. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL BE O 10, I I w U- o N TIN . MORTARED IN PLACE. 'o � -� EXISTING � I a n Q o � o - DWELLING 30.1 59.9 ____- t c,� I O z _j � a 7. FINISH GRADE SHALL HAVE A MINIMUM SLOPE OF 0.02 FT. PER FOOT. - x o 8 o b I � ¢ w � 8. EXISTING SYSTEM COMPONENTS - IF ANY SHALL BE ABANDONED PER / �' / ► o IILij TITLE 5 REQUIREMENTS. j / - PW N p� t t 0 z w 9. THE EXCAVATOR/CONTRACTOR SHALL BE RESPONSIBLE TO CONTACT DOYLE x J / Pw I' o o Uj,Y o AND ASSOCIATES 24 HOURS PRIOR TO ANY REQUIRED INSPECTIONS. X 30.3 % 30.1 I ' �' 0 0 CO 0 10. ALL COMPONENTS SHALL BE MARKED WITH MAGNETIC TAPE OR 29.7 I Of COMPARABLE MEANS IN ORDER TO LOCATE THEM ONCE BURIED. ' I . CB 11. WHERE WATER SERVICE IS LOCATED CLOSER THAN 10 FEET FROM X FND SEWAGE COMPONENTS, SERVICE LINE SHALL BE SLEEVED IN PVC. 30.6 BM: C/BASIN RIM 12. ALL AT-GRADE COVERS SHALL BE SECURED TO UNAUTHORIZED ACCESS. 29'3 166.98 b 28.4 x EL. 30.2' pF�gs' � N \ X 30.7 DATUM: ASSIGNED �tcQ� 1 O II SOIL DATA: 4 DAVID �'y\; TEST DATE: 05-20-10 - EXISTING AND c� B. Co a Q SOIL EVALUATOR: M. O'LOUGHLIN PROPOSED GRADE MASON m SPOT ELEVATION (TYP.) � N0.1066 �„ � O � a WITNESSED BY: DAVID STANTON, HEALTH AGENT O Q Uj U) J PERC RATE:-5 MIN/INCH 9 ¢t�� Ld O_ _ U DEEP OBSERVATION HOLE #1 DEEP OBSERVATION HOLE #2 DEEP OBSERVATION HOLE #3 SST Q Q � N EL. 29.9 „ EL. 30.3 „ EL. 30.3 „ z cn - FILL ° FILL ° FILL ° GRAPHIC SCALE J � < s 26" 48" 48" I= I_ A N L-1= G = hJ I� pj d _j Q d, 04 20 0 10 20 40 80 n w A LS 10YR 4/2 A LS 1OYR 4/2 A LS 1OYR 4/2 EXISTING WATER SERVICE , �P OTMA .t%ycF�d O J cfl 33" 56" 56" w SCR r `°! 2 M BOTTOM w LS 10YR 5 6 w LS 10YR 5 6 ¢ M W < B / B / B w LS 10YR 5/6 ° P ` J N Uj Q 52" EL25.57 72' EL24.30 74' ( ) -I"N PROPOSED WATER SERVICE STEpHEN N �� o � z PERC ( ) EL.24.14 o J. ( ) IN FEET ) v N 67„ C LS 2.5Y 6/3 v f' DOYLE � O Q 1 C 1 LS 10YR 5/6 C 1 LS 1OYR 5/6 e> F- 102" 93" 801, �, o #37559 s 1 inch = 20 ft. I ABANDON EXISTING SEPTIC COMPONENTS �, LLj FINE FINE FINE ® GIESS O O`� MED. 1OYR 6/8 MED. 2.5Y 6/4 MED. 2.5Y 6/4 ®®�41 swoI y�� Q C2 SAND C2 SAND C2 SAND 0 EL. 18.9 132" EL. 19.6 128" EL. 19.6 128' NO GROUND WATER FOUND NO GROUND WATER FOUND NO GROUND WATER FOUND I