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HomeMy WebLinkAbout0137 PINE LANE - Health 437,Pirie;Lane Ostervillc , { =A 1.18 , 076 i /18- 07 Commonwealth of Massachusetts Title 5 Official Inspection Form ISubsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Pine Lane Property Address Robert Beals P Owner Owner's Name q.w information is Osterville Ma 02655 6-24-2019 " required for every page. City/Town State Zip Code Date of Inspection r Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information s(# 393S on the computer, Brett Hickey use only the tab key to move your Name of Inspector cursor-do not B&B Excavation use the return Company Name key. 374 Route 130 ss Company Address Sandwich Ma 02563 (508)City/Town7 ZIP Code 7-0653 S113747 I Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ❑■ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails uen,iro.e�a�r aren H�a� Brett Hickey. o� ���,.,.n.uo.e d. m@Oe­­ . US 6-24-19 Oae:20tB 0].d20:5231-01W Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts �m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Pine Lane V� Property Address Robert Beals Owner Owner's Name information is Osterville Ma 02655 6-24-2019 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ❑� I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: The system was in working order at the time of inspection. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 ears old or the septic tank whether metal or not is structural) P Y P ( ) Y unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5insp.doc•rev.7/26/2018 Title 5 Offidal Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 c Commonwealth of Massachusetts ,ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v 137 Pine Lane Property Address Robert Beals Owner Owner's Name information is Osterville Ma 02655 6-24-2019 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 c� Commonwealth of Massachusetts Im Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Pine Lane V Property Address Robert Beals Owner Owner's Name information is Osterville Ma 02655 6-24-2019 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form 1.l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Pine Lane Property Address Robert Beals Owner Owner's Name information is Osterville Ma 02655 6-24-2019 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ o Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow ❑ ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ 0 Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ 0 Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ❑ Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ El Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ El Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ Q The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ 0 The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 c Commonwealth of Massachusetts +m ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Pine Lane Property Address Robert Beals Owner Owner's Name information is Osterville Ma 02655 6-24-2019 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed.The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no" for each of the following for all inspections: Yes No 0 ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ El Were any of the system components pumped out in the previous two weeks? E ❑ Has the system received normal flows in the previous two week period? ❑ 0 Have large volumes of water been introduced to the system recently or as part of this inspection? 0 ❑ Were as built plans of the system obtained and examined?(If they were not available note.as N/A) ❑ 0 Was the facility or dwelling inspected for signs of sewage back up? 0 ❑ Was the site inspected for signs of break out? El ❑ Were all system components;excluding the SAS, located on site? 0 ❑ 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? ❑ 0 Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: El ❑ Existing information. For example, a plan at the Board of Health. ❑ 0 Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts �o Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v 137 Pine Lane Property Address Robert Beals Owner Owner's Name information is Osterville Ma 02655 6-24-2019 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: 2 2 Number of bedrooms(design): Number of bedrooms(actual): " DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 349/GPD Description: 2 Number of current residents: Does residence have a garbage grinder? ❑ Yes E] No Does residence have a water treatment unit? ❑ Yes R No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes 0 No information in this report.) Laundry system inspected? ❑ Yes FEI No Seasonal use? ❑ Yes [g No See below Water meter readings, if available(last 2 years usage(gpd)): Detail ***2017- 34,000gallons 2018- 33,000gallons*** Sump pump? ❑ Yes ❑■ No current Last date of occupancy: Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 c Commonwealth of Massachusetts I�p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Pine Lane Property Address Robert Beals Owner Owner's Name information is Osterville Ma 02655 6-24-2019 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: NA Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Owner- last pumped 7 months ago Was system pumped as part of the inspection? ❑ Yes X No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 I - Commonwealth of Massachusetts �A Title 5 Official Inspection Form ±= I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v 137 Pine Lane Property Address Robert Beals Owner Owner's Name information is Osterville Ma 02655 6-24-2019 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: El Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 2016 per Board of Health information Were sewage odors detected when arriving at the site? ❑ Yes ❑N No 5. Building Sewer(locate on site plan): 2'3" Depth below grade: feet Material of construction: ❑ cast iron ❑■ 40 PVC ❑ other(explain): Town water Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments (f' 137 Pine Lane Property Address Robert Beals Owner Owner's Name information is Osterville Ma 02655 6-24-2019 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): .11311 Depth below grade: feet Material of construction: M concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No 1 Dimensions: 500gallons 3„ Sludge depth: 3311 Distance from top of sludge to bottom of outlet tee or baffle 0 Scum thickness Distance from top of scum to top of outlet tee or baffle NS NS Distance from bottom of scum to bottom of outlet tee or baffle measured How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank was in working order at the time of inspection. The tank is not in need of pumping at this time but should be pumped every two years for maintenance. 15insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form ; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Pine Lane Property Address Robert Beals Owner Owner's Name information is Osterville Ma 02655 6-24-2019 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): NA Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness i • I 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.): i 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): NA Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Pine Lane Property Address Robert Beals Owner Owner's Name information is Osterville Ma 02655 6-24-2019 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): o„ Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The d-box was in working order at the time of inspection. t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Pine Lane Property Address Robert Beals Owner Owner's Name information is Osterville Ma 02655 6-24-2019 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): NA * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: „ (2)500 gallon chambers 0 leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 c Commonwealth of Massachusetts �. Title 5 Official Inspection Form 1al Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I 137 Pine Lane V� Property Address Robert Beals Owner Owner's Name information is Osterville Ma 02655 6-24-2019 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The SAS was in working order at the time of inspection. Chambers were dry when viewed. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): NA Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 X.. Commonwealth of Massachusetts �a ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Pine Lane Property Address Robert Beals Owner Owner's Name information is Osterville Ma 02655 6-24-2019 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): NA Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form �a I;o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Pine Lane L Property Address Robert Beals Owner Owner's Name information is Osterville Ma 02655 6-24-2019 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: K hand-sketch in the area below ❑ drawing attached separately �3 n •dam.. Y 3 <. i U v4.. g. Al t1 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 c Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments lF' 137 Pine Lane u Property Address Robert Beals Owner Owner's Name information is Osterville Ma 02655 6-24-2019 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ■❑ Check Slope On Surface water ■❑ Check cellar ■❑ Shallow wells -Estimated depth to high ground water: No GW @ 152"feet Please indicate all methods used to determine the high ground water elevation: 0 Obtained from system design plans on record 9-01-16 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: A plan on file at the local Board of Health was used to determine high groundwater. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Pine Lane u Property Address Robert Beals Owner Owner's Name information is Osterville Ma 02655 6-24-2019 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: F■ A. Inspector Information: Complete all fields in this section. B. Certification: Signed& Dated and 1, 2, 3, or 4 checked C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist)completed ■❑ D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 TOWN OF BARNSTABLE LOCATION 137 Pi SEWAGE# ZD/G -3 ZO VILLAGE ©saLT L;11L ASSESSOR'S MAP&PARCEL J INSTALLER'S NAME&PHONE NO. -4�iB E'Xcal�, t 1 On TO 06S3 SEPTIC TANK CAPACITY /so na.) LEACHING FACILITY: (type) TQ05?oJ LIC CT (size) 13 X ZS X Z NO.OF BEDROOMS 3 OWNER CoLr©1 RcCJ S PERMIT DATE: 9-L- [, COMPLIANCE DATE: - Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching cility(I any wetlands exist within 300 feet of leachin ' a ity�ef Feet (� FURNISHED BY � ` Al^SZ' 3 " le ' Zg 9 ' REAR , A3 33'6 ' 23' fay- y3 3 x- No. � 1V � Fee J THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitation for 30isposal 6pstpm Construction pertuit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 87 p/ram.LA 0S"r O er's Name,Address,and Tel.No. Assessor's Map/Parcel Q_44C f F'C��Le� �p ���R�,S 61 7 —6 d '-(—I 7 GP D Installer's Name,Address,and Tel.No. Desi n is ame,Address,and Tel.No. Af C 3w 6oTUc reD rxu�c �- �XLQWa fto n ,609 - -7 7 3- r Type of Building: Dwelling No.of Bedrooms C� Lot Size -� sq.8. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required)ii 2- gpd Design flow provided 34q, gpd Plan Date q- I ' Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 15 06 Aral io ST N z�, &hnOv 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 Bo of h. nn Signed Date! Application Approved by Q/ Date [{1 Application Disapproved by Date for the following reasons Permit No. Date Issued No. �/ o Fee „rc THE COMMONWEALTH OF MASSACHUSETTS -Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 21ppiication fort Disposal *pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. )37 pl f1Q t4iF-��05 O }er's Name,Address,and Tell..No. Assessor's Map/Parcel �`'I ( 91 rGi(Le.� -7 �j O��G l�j 61 7 S k' k�`r 76, 0 Installer's Name,Address,and Tel.No. Desi Cnyr's ame,Address,and Tel.No. X �-�O .5 �1Y�15.� �— V a 0 �f 7 7 D�5 33- ur Type of Building: Dwelling No.of Bedrooms O( Lot Size q sq.ft. Garbage Grinder( ) Other Type of Building ';w. No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 2 2 gpd Design flow provided -714 q, -7 gpd Plan Date q~ � Number of sheets Revision Date Title '1 / Size of Septic Tank --f�;�}-d Kj� Type of S.A.S. - jC� G7G-t Description of Soil rp/( C( CV 5,4. '�G� ✓V/t t i Nature of Repairs or Alterations(Answer when applicable) i 5 0 aril IV t0 5T cL kDV (z) la =nj Date last inspected: Agreement: \ The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of *g1th. Signed l Date Application Approved by )NM Date Application Disapproved by Date for the following reasons i ! Permit No. (� ^�j Date Issued ----------------------------------------------------------------------------------------------------------------- --------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) j Abandoned O by T X c(-i\/ t o n at V 3 1 P1 (� I.j(--L Qee Qjr has been constructed in accordance {{ with the prod 'ons of Title 5 and the for Disposal System Construction Permit No. ated b _ Installer Designer #bedrooms Approved design flow gpd The issuanc f t1i s permit shall of be c ed as atuarIntee that the system will funcfio!as desT d. Date �� / I 0 ' Inspector ,IV- S i No. n 04 pC 0 Fee nC/THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Veposal 6pstem Construction J)ermit Permission is hereby granted to Co�struct( ) Repair( ) Upgrade( ) Abandon( ) System located at '4 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 must be completed within three years of the date of this permit. G Date ent Approved by U `' Town of Barnstable .� To Regulatory Services Richard V.Scali,Interim Director • BMWSPABLE. MA.% Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: �� �I Sewage Permit# Assessor's Map\Parcel (7 Designer: �- vw Installer: 16 ] Address: � � Address: �1 ., On6L � I ► was issued a permit'to install a (date) (installer) � � �� 14 septic system at sed on a design drawn by (address A �. VO OW6 v12 Z1 dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution'box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or-any vertical relocation of any component of the septic system)but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was-inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in co T J'ance with the terms of the IAA approval letters (if applicable) OF ;S�rir {)AVIU �y r (Instal s Signature) MASONrTi No.10ss IVITAR\ , (Desi 's ign e) (Affix Des1 Here) r PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\.Septic\Designer Certification Form Rev 8-14-13.doc • . ..ram ... ♦ � "�t auo mat w a4�l�Eff we' ammsurng and 3o&OI P St�aq a4 st e[oand a All1V MORRUPSUPWROY k� - / 't.�" �� -Y /.�,s h ,,fir.- •, � ,4 j.. //n�� 4WDOMPUR . mol3 rloa2I3d 71 •�9a�a Iia� ' 'SA&item lrojosm 110Ax1ol .. Q MOB t E - �'Wmolg IPAi� a - p e��ea u own � pn d �8 #awe �— m"�' coon 4 Ln lz ,�vso�a acia5 do�'�uair. 09 1op+tpS opa pd i — J IS/ a ;q gJo 1POLL j)EEP OBSExVTOM HOLLOG ,��. sOR sal DqOfmm SM*=cam.) (UW (M M I tlt»lt�s, u y DEEP OBSERVATION HOLE LOG Hole# DepW tmm Shc Ho�isan SaiYt�nrta sal Qo1or soil Odw. SUM=am) (�A) (Munkll) MotNinB (Stmm*Sim&B wws. 2-- DEEP OBSERVATION HOLE LOG Hole# DgAb from' sou Hod= Safi 7bxMo soil cww Sail Omw Su�se(in.) MEW (MimsrlQ MotttluS Mnmm SMM eauldas. DEEP OBSERVATION HOLE LOG Hole#�_ Depth dram Sail l a� sal Self Color _ &�i! s surf (in.) ([1DA}, '(M0isall): . M nB (sOrtnery.. .. , Abavm=yea Owdbogodory No,:.. Ysa., - - MWn SW you booty No Vie'Yes�--- WRn 100 year flood bmmfty No✓ Yes nth of N�� lail,Mm NO Dow at Ioaet fWr feet of> xwring sous cxiat.in afl arras obaa-Ved dmugtont the area proposed for tho sofl absorption symm? If tot.what is Me depth of naW"Y Mwft this mauaW? I dw on 4 hy4 fjdaW)I have pamed-tlro soH evaluaw examination approved by the Dgrartment OfBnvtro ntat won ate dlat the above SmOysis was ruled by a�i °w&h the mquihrvdtrain n$, and " to ribed,iii 15.017. she. DO. �(� Commonwealth of Massachusetts- Ili W, Title 5 Official -Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 137 Pine Lane Property Address Nora Ordway Trust , Owner Owner's Name `s information is required for every Osterville Ma 02655 6-15-16 page. City[Town. State Zip Code Date of Inspection :. Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:when A. General Information filling out forms (�"on the computer, use only the tab 1. Inspector: key to move your cursor-do not Matthew Gilfoy use the return Name of Inspector key. B&B Excavation rab Company Name 374 Route 130 Company Address, Sandwich . Ma 02563: Citylrown " State Zip Code (508)477-0653 S113640 - 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 6-15-16 Inspector's Signature Date The system inspector shall submit a copyof 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 DER 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•3113 5 Inspection F Sewage System .Page 1 Title Official Form:Subsurface S m• of 1'7/ Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 137 Pine Lane _ Property Address Nora Ordway Trust Owner Owner's Name information is Osterville Ma 02655 6-15-16 required for every _ -- page. Cityfrown 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: ® 1 have not found any information which indicates that any of the failure criteria;described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System was inspected VIA camera from interior plumbing as no asbuilt or records were obtained due to age of home. A cesspool was found with an inlet pipe and one outlet pipe to an unidentified leaching. Cesspool was not opened as it could not be located. The cesspool was dry and passes Barnstable BOH regulations per discussion with Board Of Health agents 6-15-16. Additions or renovations to dwelling may result in system needing to be replaced. i 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): t5ins-3113 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 ,M 137 Pine Lane Property Address Nora Ordway Trust Owner Owner's Name information is required for every Osterville Ma 02655 6-15-16 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 F pass inspection if(with approval of Board of Health): ❑ broken pipes)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N '❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: 0 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments cwM 137 Pine Lane Property Address Nora Ordway Trust Owner Owner's Name information is Osterville Ma 02655 6-15-16 required for every page. City/Town 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 supplyF ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. ° 3. Other: ~ D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No [IBackup 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 /2 day flow t5ins•3/13 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 137 Pine Lane Property Address Nora Ordway Trust Owner Owner's Name information is required for every Osterville Ma 02655 6-15-16 page. CityTTown State Zip Code Date of Inspection B. Certification (cont.) Yes No El ® 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. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® " Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP 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 ❑ ❑ 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. a t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . °M 137 Pine Lane Property Address Nora Ordway Trust Owner Owner's Name information is required for every Osterville _ Ma 02655 6-15-16 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? ❑NA ❑ 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): No design Number of bedrooms(Actual) 2 plans DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): NA t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts L Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 137 Pine Lane _ Property Address Nora Ordway Trust Owner Owner's Name information is required for every Osterville Ma 02655 6-15-16 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 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.) El Laundry system inspected? r ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: ' 2014- 1,000gallons 2015- 1,000gallons Sump pump? ❑ Yes ® No Last date of occupancy: Last fall Date Commercial/Industrial Fiow Conditions: 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): Grease trap present? ❑. Yes ❑ No Industrial waste holding tank present? ❑, Yes ❑• No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 137 Pine Lane Property Address Nora Ordway Trust Owner Owner's Name information is required for every Osterville Ma 02655 6-15-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: No information Was system pumped as part of the inspection? ❑ Yes E No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) Innovative/Alternative technology..Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ® Other(describe): Cesspool and unidentified leaching facility 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 137 Pine Lane Property Address Nora Ordway Trust Owner Owner's Name information is required for every Osterville Ma 02655 6-15-16 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: Dwelling built 1958 per town records Were sewage odors detected when arriving at the site? _ ❑ Yes ® No Building Sewer(locate on site plan): 2,6„ Depth below grade: feet Material of construction: ® cast iron ❑ 40 PVC ® other,(explain): Orangeburg 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: NA 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: t5ins•3/13 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 °M 137 Pine Lane - Property Address Nora Ordway Trust Owner Owner's Name information is required for every Osterville Ma 02655 6-15-16 page. Cityrrown 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 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?. f' Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): t.. I Grease Trap (locate on site p Ian). 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 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 ' Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 137 Pine Lane Property Address Nora Ordway Trust Owner Owner's Name + information is Osterville Ma 02655 6-15-16 required for every 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, evidenc&of leakage, etc.): 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): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 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 . ^M 137 Pine Lane Property Address Nora Ordway Trust Owner Owner's Name information is required for every Osterville Ma 02655 6-15-16 page. Cityrrown 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 NA 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* 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: t5ins•3113 Title 5 Official Irispection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 137 Pine Lane Property Address Nora Ordway Trust _ Owner Owner's Name information is required for every Osterville Ma 02655 6-15-16 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: 4 , ❑ innovative/alternative system Type/name of technology: Unidentified Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching not found due to lack of records and depth.,. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): k Number and configuration Approximately 6'x8' Depth—top of liquid to inlet invert Dry R 0„ Depth of solids layer 0„ Depth of scum layer' Dimensions of cesspool 6'x8' Materials of construction Cesspool Indication of groundwater inflow ❑ Yes ® No t5ins•3113 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 °M 137 Pine Lane Property Address Nora Ordway Trust Owner Owner's Name information is required for every Osterville Ma 02655 6-15-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Cesspool was dry and appeared to be in good condition. Privy(locate on site plan): Materials of construction: NA Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)-. t5ins•3/13 r Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts - W Title 5 Official Inspection Form _) Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Pine Lane Property Address Nora Ordway Trust Owner Owner's Name information is required for every Osterville Ma 02655 6-15-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately READ' PATIO � , of cess obt Pipe exiting cesspool t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form =Not for Voluntary Assessments ,M 137 Pine Lane Property Address Nora Ordway Trust Owner Owner's Name information is required for every Osterville Ma, 02655 6-15-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ; ® Shallow wells >20' Estimated depth to high groundwater: 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: pate ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Viewed Town charts with BOH agent ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database —explain,- . You must describe how you established the high ground water elevation: Topo maps viewed with BOH agent show a greater than 20' separation between bottom of SAS and ground water elevation. Before filing this Inspection Report, please see Report Completeness Checklist on next page. . t5ins•3/13 r Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 , Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 137 Pine Lane Property Address Nora Ordway Trust Owner Owner's Name information is required for every Osterville Ma _ 02655 6-15-16 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist E Inspection Summary: A, B, C, D, or E checked E Inspection Summary D (System Failure Criteria Applicable to All Systems)completed E System Information—Estimated depth to high groundwater E Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file s t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 LOCUS ASSESSOR'S MAP: 118 GENERAL NOTES: o. Maximum Feasible Compliance: ee PARCEL: 76 Title: 5 15.405: � ��c 1. VERTICAL DATUM: _ Assun-ied------ ___ REFERENCE: PL. BK. 97 PG. 17 2. MUNICIPAL WATER __I __ AVAILABLE. co Q°tea �� o �,,� FLOOD ZONE: X Town of Barnstable 1. 3' variance, proposed 17' 3. SCHEDULE 40 PVC PIPE TO BE USED THROUGHOUT \00y ° #25001 C0544J(07/16/14) i separation between leach facility SYSTEM UNLESS OTHERWISE NOTED. and foundation 4. ALL PRECAST UNITS TO CONFORM TO a m AASHTO: H_10 & H_20 r Oa 5• PIPE PITCH-1/4" PER FOOT UNLESS OTHERWISE NOTED. s St fin• 6• ALL CONSTRUCTION DETAILS TO BE IN CONFORMANCE g�os 0Uth Je. WITH MA ENVIR. CODE (TITLE 5) AND LOCAL REGULATIONS. LOCUS MAP N.T.S. 7 CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR TO CONSTRUCTION. LEGEND: 1 1 $ad1�1 ,E�,�1. SPLIT RAIL FENCE ��:r 40.20 �—99,--�— PROPOSED CONTOUR w `40?5 z 97.1 7 ss` PROPOSED SPOT GRADE LA_ 41.31 LOT 10 — 40 EXISTING -CONTOUR SHED 9858t SF I X 30.23 EXISTING SPOT GRADE xQ (ON ' e�ocKs) 41.0 41 p°'� 5 40.00 TEST PIT 6 41.18 2 12 8 ' — ;40*17 - ® EXISTING WATER SERVICE 10 17°—• 1 PAVED.: ::." '::: o X�--� WORK LIMIT LINE DRIVEWAY :".c,'. A x I� GARAGE ` 40.61 + D�' i J����� OF Mq f fq� 40.79 0000000 yy 4 019.59AM L. yG tPAT10a�I WATERLINE I Z VON HONE �. on 0o O 4 98,0000 0 " O I ' I No. 1068 o Q 21 oop000000al z EXIST. DWELL. Q I ,p 00 000aaoo c� ° 000°000l TOP FNDN. I P ISTER�s ° o �0�9'1,000 w ELEV. 41.3' - �u000❑ O x 40.58 �. o' 10 I l 36" OAK CESSPOOL x 4 .08 AREA+/— r i FTI N T This plan i t b f septic O E s a s o e used for P 40.54 system purposes only and is not to be 0.48 , used for any other purpose. G off' G .17J 7_40_'�6'6 39.10 0.54 � 1.37 PINE LANE x 40.63. " ; X 139.03" 41 0.35 CB .31. V OSTERVILLE, MA 9 9 . 9 99 FNDA� 39I68 PREassociates FOR: O STOCKADE FENCE 4Q.05 nc SYSTEM DESIGNS 139.31 B & B Excavation 320 Cotuit Road BENCHMARK: USE Sandwich, MA 02563 a n d COR. (WOOD) BH (o)508.833.0041 AT EL. 40.8' (c)508.274.0074 Ordway Su-eying by. Kennebunk, ME AH Ojala Surveying Arne H. Ojala,P.L.S. DATE REVISED SCALE SHEET NO. 211 a w4d 8.matable,StrMA 02668 09/01/2016 1" = 20' 1 of 2 T.O.F. (Full) Provide Riser over D-box NOTE: All components to be marked with °� magnetic toe or similar nor NOTE: To prevent breakout, final EL. 41.3 to within 6 of final grade 9 p p to final cover. grade of EL. 94.6 to be carried (Cover to be watertight) out a minimum 15' beyond edge F.G. EL: 40.6-40.9 F.G. EL: 40.7 F.G. EL: 40.8 Maintain Min. 2% slope over leach facility to of leach facility. Existin revent ondin F.G. EL: 40.5-41.0 Install risers w/covers over inlet and Min. 2" of 1/8" - 3/4" Washed Stone or - Ins ection Port within 6" to grade Exist. Invert outlet to within 6" of final grade Geotextile Fabric L=15' (Access Covers min. 20" diam. per Code) , EL. 38.13 ° 4" SCH 40 P . 4" SCH 40 PVC L=10' 3/4 - 1 1/2' Double Washed Stone Cast Iron Pipe Top of Peastone or Geotextile Fabric EL. 38.0 ( P ) ®S=2% 2% to• ta• 1.15% 1.0%MI 44 SCH 40 PVC a® as 6 CADS=2.3% 0.5%MIN a13W 24 Eff. Depth aa®®aa® EL. 37.55 EL 37.23 ®e®ease EL. 37.8 Install Gas Baffle EL. 37.4 35.0 PROPOSED DB-3 EL. 37.0 Use 2 - 500 Gallon Precast Chambers H-20 DISTRIBUTION BOX{ (H-10) with Double Washed Stone 6.6' Am Watertest for levelness 4 Ends, 4' Sides (Install PVC Inlet & Outlet Tees) 25' x 12.83' x 2' PROPOSED 1500 GALLON if more than one c c�/c ( )_ H-10 SEPTIC TANK outlet SEPTIC SYSTEM S TE M PROFILE EC 28.4 Bottom of TH-1 & 2 1 N.T.S: SOIL 1OG ADDITIONAL NOTES DESIGN CRITERIA Number of Bedrooms: Existing n 3 Bedrooms SOIL EVALUATOR: AMY VON HONE, R.S. S.E. #2517 ,` 1. Contractor to confim soil suitability prior to installation. Contact g 2, Min. Design INSPECTOR: DAVID STANTON, R.S., BOH BOH and Design Sanitarian in the event of varying soils from original (Lot located in Zone II) DATE: SEPTEMBER 1, 2016 10:00 AM Soil Type: Class PERMIT: 15145 soil test. Percolation Rate: <2 min/Inch PERCOLATION RATE: <<2 MIN/INCH IN C1 2. Pump and' remove/backfill Failed Cesspools. -Any-contaminated Daily Flow: materials-,.within 5' of proposed Leach Facility to be removed. Design Flow: 110 G.P.D./Bedrm x 3 =330G.P.D. TH -t 1 _ TH - .2 w 330 G.P.D. (Min. Required) . EL. 41.1 EL. 41.1 3. Water line to be sleeved at any sewerline crossings and within 10 ✓Garbage Grinder- of any septic components, as needed.; per Water Department Loamy Sand Loamy Sand requirements. Contractor to verify location of .water line prior to Leaching Area 10YR3/2 10YR3/2 construction. Required: (330)/0.74 = 445.9 S.F. 7" 40.52 T° 40.52 B g 4• Septic Tank and Distribution Box to be placed on 6" crushed stone Septic Tank Required: 330 G.P.D. x 200% _' 660 G.P.D Loamy Sand Loamy Sand or compacted, level base. Minimum 1000 Gallon (Existing) 10YR5/8 10YR5/8 26" 38.93 27" 38.85: Use 2 500 Gallon Precast Chambers H-10 with C1 C1 17' Double Washed Stone: 25' x 12.83' x 2' ed.-Coarse Sand ed.-Coarse Sand 12.8 ' 2.5Y6/4 2.5Y6/4 4, 2(25' + 12.83')2= 151.32 S.F. SEPTIC i Sidewall Area: Perc J E R TI C TIES ch ;. �� 25' x 12.83'= 321.25 S.F. e Bottom Area: v' Im Total Area: 472.57 S.F. 50" Bottom (� 34aaoaaa Desi n Flow _Provided: 0.74(472.57 S.F.)= 349.7 G.P.D. aooaa000 ° °°°°° 137 PINE LANE - - 000000°°❑ao�� oo¢aoaooacd � apa°°aaoaa o OSTER VI LLE MA a000aoa000l .0 aaaaaaaaa❑ Oaaaaaaaa❑ � � � aaaaaaaaa = EXIST. DWELL. O ° �$oaoao r TOP FNDN. = CISSOCICIt@S PREPARED cacao.acoo' ELEV. 41.3' FOR: 152" 28.4 152" 28.4 O 00000a °0 °D nc SYSTEM DESIGNS ,°°°°°° B & B Excavation No Groundwater Observed o" 320 Cotuit Rood 1 6, Sandwich, MA 02563 a n d <9" ® 7:00 minutes PERC RATE: <2 C1 Horizon MIN INCH (o)508.833.0041 / (c)508.274.0074 Ordway I, Amy.L. von Hone, R.S., hereby certify that I am currently approved by Surveying by: Kenn ebu n k, ME the DEP pursuant to 310 CMR 15.017 to conduct soil evaluations and AHOjala Surveying that the above analysis has been performed by me consistent with the Arne FL Ojala,P.L.S. DATE REVISED SCALE SHEET N0. requirements of 310 CMR 15.017. 1 further certify that I have 211 Maas Street successfully passed the Soil Evaluator's Exam on November, 1994. west Barnstable, MA 02668 09/01/2016 1" = 20' 2 of 2 k Locus ASSESSOR'S MAP: 118 GENERAL NOTES: o• Maximum Feasible Compliance: e PARCEL: 76 e Title 5 15.405: _ C REFERENCE: PL. BK. 97 PG. 17 1. VERTICAL DATUM: __Assumed_________ d 2. MUNICIPAL WATER �S __ AVAILABLE. CD Q°� �� n ���,p FLOOD ZONE: X Town of Barnstable% 1. 3" variance, proposed 17' 3. SCHEDULE 40 PVC PIPE TO BE USED THROUGHOUT Wo`J • % o #25001 C0544J(07/1 f/14) separation between leach facility SYSTEM UNLESS OTHERWISE NOTED. a and foundation 4. ALL PRECAST UNITS TO CONFORM TO a AASHTO: _H_10_& H_20 \ r -)a 00 5• PIPE PITCH-1/4" PER FOOT UNLESS OTHERWISE NOTED. \o5sott� nth 6• ALL CONSTRUCTION DETAILS TO BE IN CONFORMANCE z. g Je oU WITH MA ENVIR. CODE (TITLE 5) AND LOCAL REGULATIONS. . Locus MAP N.Ts. 7• CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR TO CONSTRUCTION. LEGEND: ��A� 4�1�1 1 40.20 �--gg�- PROPOSED CONTOUR. SPLIT RAIL FENCE x �40195 v 9 7.17' gg PROPOSED SPOT GRADE r Z. t` SHED 41.31 LOT 10 k i 40 — EXISTING CONTOUR - 9858t SF ; x 30.23 EXISTING SPOT GRADE xQ (ON I BLOCKS) ��, l 40.00 TEST PIT o x 41.18 41.08�, ,�41 p0 .., q08� % . J G — 40;17 ® EXISTING WATER SERVICE 12.8 , of 17 , •< ' X o WORK LIMIT LINE 1 i PAVED GARAGE DRIVEWAY t N y I� { 0 CJ1 j WBF 40.61 40.79 �Q\� Aff9l' 000aoaa W 4�0•0 .59 ?� AMYL yl/ a�CONC=' WATERLINE l VON HONE O ao aoaoaoc j!. ']aOaG� O i!_ _ I 1T I U No. 10ER6L� 8�=p 21 EXIST. DWELL. O P�O ° TOP•FNDN. O T �eoo9ooc D O ' ELEV. 41.3 to o * 40.58 �`• j D o � _...g°67 36" OAK i CESSPOOL x 408 AREA+/- j I NOTE: This plan is to be used for septic t 40.54 system purposes only and Is not o b e 0•48 used for any other purpose. G ap G 17 9h3 39.10 `0 J�0.54 40.66 _ x40.63 C 37 PINE LANE OS'° xP9.03 43F. 'Q v , MA F31 OLLY03 CBOSTERVILLE FND 9 99.99 PREPARED (. associates' FOR: "0 STOCKADE FENCE 0.05 nC sY51EM DESIGNS, B & B Excavation 320 Cotuit Road BENCHMARK: USE Sandwich, MA 02563 a n d COR. (WOOD) SH (o)508.833.0041 AT EL. 40.8' (c)508.274.0074 Ordway Surveying by: K en n e b u n k, ME AH Ojala Surveying ArneH Ojala,P.L.S. DATE REVISED SCALE SHEET N0. 211 Maple street West Barnstable. MA 02668 09/01/2016 1" = 2.0' 1 of 2 , Provide Riser over D-box NOTE: All components to be marked with NOTE: To prevent breakout, final T.O.F. (Full) „ magnetic toe or similar prior EL. 41.3 to within 6 of final grade 9 p p 'or to final cover. grade of EL. 94.6 to be carried (Cover to be watertight) out a minimum 15' beyond edge F.G. EL: 40.6-40.9 F.G. EL: 40.7 F.G. EL: 40.8 Maintain Min. 2% slope over leach facility to of leach facility. Existin prevent ondin F.G. EL: 40.5-41.0 Install risers w/covers over inlet and Min. 2' of 1/8 - 3/4 Washed Stone or Ins ection Port within 6" to grade outlet to Exist. Invert L=15' (Access Covers i inn. 20'of final diamrader Code z' Geotextile Fabric EL. 38.13 4" SCH 40 P p „) 13 1 L=10' 3/4 - 1 1/2 Double Washed Stone Top of Peastone or Geotextile Fabric EL. 38.0 4 SCH 40 PVC (Cast on Pipe) ::.OS=2% 27..M1 lo. 14, 1.15% 1.0%MI '4" SCH 40 PVC ®e B® „ s @S=2.3% 0.5%MIN Baa�aBB 24 Eff. Depth EL. 37.55- ®eaaaee EL. 37:23 35.0 EL. 37.8 Install Gas Baffle EL. 37.4 EL. 37.0 Use 2 - 500 Gallon Precast Chambers - PROPOSED OB-3 H-20 DISTRIBUTION BOX; (H-10) with Double Washed Stone 6 6' Watertest for levelness 4 Ends, 4'. Sides (InsPROPOSED Inlet15 0 GALLON Tees) if more than one (25' x 12.83' x 2') H-10 SEPTIC TANK outlet SEPTIC SYSTEM PROFILE EL. 28.4 -- _ Bottom of TH-1 & 2 N.T.S. SOIL LOG . ADDITIONAL NOTES DESIGN CRITERIA Number of Bedrooms: Exi sting 2, Min. Design 3 Bedrooms SOIL EVALUATOR: AMY VON. HONE, 'R.S. S.E. #2517 1 Contractor to confim soil suitability prior to installation. Contact g g INSPECTOR: DAVID STANTON' R.S., BOH BOH and Design. Sanitarian in the event of varying soils from original Sil Type: (Lot located in Zone IL) DATE: SEPTEMBER 1, 2016 10:00 AM Class PERMIT: #15145 soil. test. _ o YP .Percolation Rate: <2 min/inch PERCOLATION RATE: <2 MIN/INCH IN Cll - m 2. Pump re ove/backfill Failed Cesspools. Any contaminated Daily Flow: materials within 5' of proposed Leach Facility to be' removed. Design Flow'. 110 .G.P.D./Bedrm x 3 =330G.P.D. TH - 1 TH - 2 330 G.P.D. (Min. Required) EL. 41.1 EL. 41.1 3- Water line to be sleeved at any sewerline crossings and within 10' Garbage Grinder.: Not Allowed of any septic components, as needed, per Water Department - requirements. Contractor to verify Location of water line prior to Leaching Area Loamy Sand Loamy Sand - 9 - • construction. 330 0.74 - 445.9 S.F. 10YR3/2 10YR3/2 Required: ( )/ - 7" 40.52 7" - 40.52 B B 4• Septic Tank and Distribution Box to be placed on 6 . crushed stone Septic Tank Required: 330 G.P.D. x 200% = 660 G.P.D Loamy Sand Loamy Sand or compacted, level base. - Minimum 1000 Gallon (Existing) 26" 10YR5/8 38 93 27" 10YR5/8 38.85 Use 2 - 500 Gallon Precast Chambers H-10 with C1 C1 17 Double Washed_ Stone: 25' x 12.83' x 2' Med.-Coarse Sand Med.7Coarse Sand 12.8 ' 2.5Y6/4 2.5Y6/4 Sidewall Area: 2(25' + 12.83')2= 151.32 S.F. Perc N i� 25' x 1.2.83'- -321.25 S.F. Bottom Area: "TI ES U'- 34' i� ; Total_ Area: 472.57 S.F. 50" Bottom Desi n Flow Provided: 0.74(472.57 S.F.)= 349.7 G.P.D. °°°°°°°°° 137 PINE LANE ❑°° �.� °O°°°Op°°°� ❑°°°°°°°° - OSTER VI LLE MA ❑ n 0 0 ��°°°°R An T EXIST. DWELL. PREPARED 152" 28.4 152 28.4 p °00°°°°°°°°�,oDo ELEV. 41.3' associates PEPc SYSTEM ESIGNS FOR: ao°°° °° . °°°O°° B BC B Excavation No Groundwater Observed O 320 Cotuit Road 16, Sandwich, MA 02563 a n d /INCH C1 Horizon<9" 7: 00 minutes PERC RATE: <2 MIN (o>5os.a33.0041 (a)506 27a.007a Ordway I, Amy L. von Hone, R.S., hereby certify that I am currently approved by Surveying by: K en n eb U n k, ME the DEP pursuant to 310 CMR 15.017 to conduct soil evaluations and AHOjala Surveying that the above analysis.has been performed by me consistent with the ArneH. Ojala,P.L.S. DATE REVISED SCALE SHEET N0. requirements of 310 CMR 15.017. 1 further certify that I have successfully passed the Soil Evaluator's Exam on November, 1994. west 90 Mople,StreO 68 09/01/2016 1" .= 20' 2 of 2