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HomeMy WebLinkAbout0099 REBECCA LANE - Health 99 Rebecca Lane Osterville A= 146-058 r� I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Rebecca Lane Property Address , Earl Range Owner Owner's Name information is every Osterville required for eve MA 02655 4-1-19 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered In any way.Please see completeness checklist at the end of the form. ` ttOF f Uhii1��i Important:When A. Inspector Information tilling out forms p S�#F f� .08 a�y1 "gym usehonlythe ab James D.Sears 1 .JAMES y�,= -+ key to move your Name of Inspector ti cursor•do not Ca ewide Enterprises c* use the return ,- 'A [+ O;'� key. Company Name " - y 153 Commercial Street �,,,� 'SiNSP� r n6 Company Address , Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 16.340 of Title 5 (310 CMR 15.000); I 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 4-2-19 nspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection: If the system has a design flow of 10,000 gpd or greater,the Inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original 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. 15insp.doc•rev,7/26,'2015 Title 5 Ofrrclal Inspection Form:Subsurface Sewage Disposal System•Page 1 of 1s 6l• a5ed xed dH LVU 6602 £0 add r Commonwealth of Massachusetts \ Title 5 Official Inspection Form E Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v 99 Rebecca Lane Property Address Ead Range Owner Owners Name Information Is required for every Ostervllle MA 02655 4-1-19 page. City/Town State Ap 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 CM 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are Indicated below. Comments: The system Is a 1000 Gal. Tank D Box and twenty chambers. 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 forges","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 exftltration 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): Wnsp.doc•rev.7126=14 Title 5 010dal Inspecilon Form:subaurfeoe Sewage Disposal system•Page 2 of 18 02 abed xed dH 8U46 6602 £0 A commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for VoluntaryAssessments sessments 99 Rebecca Lane PrDPerty Address Earl Ran e Owner Owner's Name information is required for every Osterville MA 02655 4-1-19 page. City/Town State Yip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(conl.): ❑ 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: tip-doc•rev.7126R016 Title 5 l Inspection Form:Subsurlace Sewage Disposal System•Page 3 of 18 6Z a6ed xed dH 8t74 6 61,02 £0 jdd Commonwealth of Massachusetts Title 5 Official Inspection Form w Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Rebecca Lane Property Address Earl Range Owner Owners ti ame information Is required for every Osterville MA o2655 4-1-19 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 prlvate 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 inspection$. 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.7/26t2016 Title 60fEdal Inspection Form:Subsurface Sew age Oispasel System•Page 4 of 16 t ZZ a5ed xeJ dH 8VU 6 60Z £0 idy I , Commonwealth of Massachusetts ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 99 Rebecca Lane Property Address Earl Range Owner Owner's Name information Is required for every Osterville MA 02655 4-1-19 page. CltylTown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in is less than 6"below invert or available volume is less than day flow well_19 ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool ❑ ® ' or privy Is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy,is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than P Y 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 2000 gpd- 10,000 gpd. ❑ ® The system its. I have determined that one or more of the above failure criteria exist as described in 31,0 CM 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 15insp.doc-rev.7126/2018 Title 5 Official Inspection Forrm Subsurface Sewage Disposal System-Pepe 5 or 1e EZ a5ed XeJ dH 8VU 61,0Z £0 add Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Rebecca Lane Property Address Owner Earl Range Owner's name information is required for every Osterville MA 02655 Page, City/Town 4-1-19 state Zip Code ate ofInspection C. Inspection Summary (cunt.) 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 an Inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant,or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components,excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction, dimensions,depth of liquid,depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on; ® ❑ Existing information.For example,a plan at the Board of Health. ® Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)) 15insp.doc rev.7W2016 Title 5Official Inspection Farm:subsurface Sewage Disposat system•page s of 15 bZ a5ed xeJ dH 6t7:6 6 61,02 £0 add Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �.; 99 Rebecca Lane Property Address Earl Ran e Owner Owners Name information is required for every Osterville MA 02655 page. Cityfrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 Description: 1000 Gal Tank D Box and twenty Chamber's. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes,discharges to: Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, If available(last 2 years usage(gpd)): 2017-47,000Ga1s Detail: 2018-33,000Gal's Sump pump? ❑ Yes ® No Last date of occupancy: NA Date tSlnap.doc rev.712612018 - Title 5Official Inspection Forth;Subsurface Sewage Disposal System-.Page 7 of is 5Z a5ed XU dH 6VU 61.02 E0 Jdy Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 99 Rebecca Lane Property Address Earl Range Owner Owners Name information is required for every Osterville MA 02655 4-1-19 page. City/Town State Zip Code Date of inspection D. system information (cont) 2. CommerciaUlndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings,if available: Last date of occupancyluse: Date Other(describe below): 3. Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: Gallons How was quantity pumped determined? Reason for pumping: Mnsp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 92 a5ed xeJ dH 6VU 602 £0 add Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 99 Rebecca Lane Property Address wner Earl Range information is Owner's Name inform required for every Osterville page. City/Town MA 02655 4-1-19 State Zip Code Date of Inspection D. System Information (cont.). 4. Type of System: ® Septic tank,distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous Inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the UA 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: Tank NA Leaching 2010 Permit # 2010-487. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 31" 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.): Pipeing is 4r' PVC SCH -40. c5insp.doc•rev.7126=18 Title 5 Omsi Inspeclon Farts;Subsurface Sewage Disposal System.Page 9 of 1B J LZ a5ed xeJ dH 6b46 61.02 £0 add Commonwealth of Massachusetts > Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Rebecca Lane ' L! Property Address Earl Range Owner Owner's Name information is required for every Osterville MA 02655 4-1-19 page. Cityfrown State 21p Code Date of Inspection D. System Information (Cont.) 6. Septic Tank(locate on site plan): Depth below grade: 21" feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal,list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gal. Precast H-10 Sludge depth: V. Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 0" Distance from top of scum to top of outlet tee or baffle B" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Aspuilt Tape Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tank at working level.Tank at 21"below grade wlinlet cover at 1"and outlet at 16". Inlet old type wall baffle w/out let tee. No sign of leakage or over loading. 151nsp.doc•rev.712612018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 9Z a5ed xeJ dH 6V41, 6602 £0 A Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Rebecca Lane Property Address Earl Range Owner Owner's Name information is required for every Osterville MA 02655 page. City/Town 4-1-19 State Zip Code Date of Inspection D. System Information (cont. 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑metal ❑fiberglass ❑Polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade.- Material of construction: concrete ❑metal ❑fiberglass ❑Polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5lnsp.doc•rev.W2612018 TIU9 5 Official.nspeclion Form:Subsurface sewage Disposal System•page 11 or 18 U a5ed xed dH 0941, 6102 £0 AV Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 99 Rebecca Lane Property Address Earl Range Owner Owner's Name information is required far every Osterville MA 02655 4-1-19 per. 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): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover,any evidence of leakage into or out of box, etc.): D Box Is 16"x21"-40"below grade w/cover at 14". Box Is clean and solid w/no sign of over loading or solid carry over. J Minsp.doc-rev.712&2018 me S Of6dal Inspecdon Form:Suhsurfeos Sewage D*osel System-Page 12 of 19 0£ a5ed xed dH 0566 660Z £0 JdV Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments s 99 Rebecca Lane Property Address Earl Range Owner Owner's Name Information Is required for every Osterville MA 02655 4-1-19 page. City/Town State Zi p Code Date of Inspection D. System Information (cunt.) 10. Rump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No' Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS)(locate on site plan,excavation not required): If SAS not located,explain why: Type: ❑ leaching pits number. ® leaching chambers number 20 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: •t5insp.doc•rev.7l26/2010 - TMIe 5 Official Inspecdon Form:SUbeuface Sewege Disposal System-Page 13 of 1B 6£ abed xed' dH 09:t 6 6 lOF £0 jdd jApr 03.2019 12:10 HP Fax page 1 Commonwealth of Massachusetts F Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 99 Rebecca Lane Property Address . Earl Range Owner Owners Name information is required for every Osterville MA 02655 4-1-19 page. City/To" State Yip 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.): Leaching is Twenty Biodiffusers.Check area and D Box.Camera out to chamber's. No sign of over loading or solid carry over. No sign of holding water. 12. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): tsinap.doc•rev.V28J2018 TIVe 5 011dal Inspedlon Form:Subsurface Sewage Disposal Sysi m•Page 14 of 18 ',Apr 03. 2019 12:10 HP Fax page 2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Rebecca Lane Property Address Earl Range Owner Owner's Name information is required for every Osterville MA 02655 4-1-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): Wnsp.doc•rev.WHM18 Title 5 Official Inspeclion Form:Subsurface sewage oisposal system•page 15 of 1 s Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form•Not for Voluntary Assessments F. O 99 Rebecca Lane Property Address Earl Range Owner Owner's Name information is required for every Osterville MA 02655 4-1-19 pap. Citylrown State Zip Code Date of Inspection D. System Information (Cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately C � n B efMfNT' Tfck PATa 3j, A.P ��� C 3 - 3 � LSinsp.doc raw.712MOI8 Title S Official Inapecton Farm:Subsurface Sewage Disposal System•Page 18 of 18 b£ 96ed xed dH 0941, 6 60Z £0 �dV a, Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 99 Rebecca Lane Property Address Earl Range Owner Owners Name information is required for every OStervflle MA 02655 4-1-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Na Estimated depth t 10'-10" p high ground water: feet Please Indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 12-8-10 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: T.H.on Design plan 12-8-10 10'- 10"no G.W.. Bottom of chambers at 4'below grade.Bottom of chamber's at 6'+above T.H. Depth. Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5lnsp.doc-rev.7/26/2018 Title 5 Official Inspection Form,Subsurface Sewage Disposal System-Page 17 of 10 5£ a6ed xeJ dH 09:66 61,02 £0 Jd'd -9—\, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Rebecca Lane Property Address Earl Range Owner Owner's Name Information is required for every Osterville MA 02655 4-1-19 page. CitylTown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form Inclusive of: ® A. Inspector Information:Complete all fields in this section. ® B. Certification:Signed&Dated and 1,2,3,or 4 checked ® 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 y' L Nr'1/Y}B f rtij b j`ON t5insp.doc-ra,712612018 Title 5 Official Inspection Form:Subsurface Sewage Dispo"Syslem-Page 18 or 1d gE 96ed xed dH 1,941 61,02 £0 A 1 . No. o 0 I F1 Fee V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2ppliLAtion for MisposaY bpstem Construrti®n VPrtnit Application for a Permit to Construct( ) Repair(4 Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address pr Lot No. 99 Jb b e c­ Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel /Y(P - S— gq YLc eec� awc o S vt Installer's Name,Address,and Tel.No. Sa Designer's Name,Address,and Tel.No. SUS a 7 3 6 3 7"7 r�a�10 w.� fin(-uPn 5r ) J-C cns 1­0-k�.�p Type of Building: Dwelling No.of Bedrooms d` Lot Size 1'9 , X'? S_sq.ft. Garbage Grinder( ) Other Type of Building Re S No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 U gpd Design flow provided Z gpd Plan Date \2 — & — 1 o Number of sheets Revision Date Title Size of Septic Tank 1000 l{ Type of S.A.S. o?U /}v- 3(0 1 3 Description of Soil YVOL8 Sir v.c� 4� y O ' Nature of Repairs or Alterations(Answer-when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to;place the system in operation until a Certificate of Compliance has been issued by this Board of H th. Signed Date Application Approved by Date (� n Application Disapproved by Date for the following reasons Permit No. ao Date Issued v THE COMMONWEALTHWOF!MASSACHUSETTS Entered in cpmputer: PUBLIC HEALTH DIVISION - TO WOOF BARNSTABLE, MASSACHUSETTS 1V� application for disposal Opstem Construction Permit Application for a Permit to Construct( ) Repair(✓f Upgrade(� ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. `P 9 ev b e cr a c Owner's Name,Address,and Tel,No. uSLe. Assessor's Map/Parcel /y(p - S 4 t2< <c c a e n 5 Le, j 7� Installer's Name,Address,and Tel.No. So k Li z F <r o a it Designer's Name,Address,and Tel.No. Su S 7 3 6 3 -7-7 �0.f,L—, ).V- f- %-"(rust ) C -Cn� i .a4vt�/y d�5SK C ✓cn v+✓� w� ,. C/ c tom, t' G.1 l ct �1 Type of Building: Dwelling No.of Bedrooms M 01 -Lot Size 1 a,q,Ssq.ft. Garbage Grinder( ) Other Type of Building p,g '" r No.of Persons Showers yp g 2 ( Cafeteria( ) Other Fixtures . 1 Design Flow(min.required) 3 U gpd` Design flow provided 2 gpd Plan Date - - Number of sheets .. Revision Date Title 9 Size of Septic Tank 1 np y ). ,r, Type of S.A.S. o?u Description of Soil n.K_A Nature of Repairs or Alterations(Answer jjwhen applic b e),z r i f Date last inspected: Agreement: 4. The undersigned agrees to ensure the construction and maintenance of the afore described on-site'sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by it '* ? Date k `f Application Disapproved by f Date for the following reasons. Permit No. 7 Date Issued — — C2 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by �'a41 w,,cue 1. at 9 ni 0� �e c �a (r r, has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.-2 j) jd ed Installer Designer #bedrooms Approved design flow gpd The issuance of this pe it sha11 not be construed as a guarantee that the system will ctiop , designed. Date o Inspector 'l 1 No. , C>((J - `'/ .. Fee ( THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS Bisposal 6pstem construction Permit Permission is hereby granted to Construct( ) Repair(/f Upgrade( ) Abandon( ) System located at 92 2 a /,e 4 /c ry te o f 1.e, L. (u 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. r�,, / Date �� � � � — � ( / Approved by � � Y l C �( (,- f/�'�C�� � _�S, � , s x '71 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL H -��----------------- Apphration -for 43hi oottl Works Toxto#rnrtion Pumit Application is hereby`made for a Permit to Construct or Re air an Individual Sewage Disposal PP �� P ( ) a P Sys t ----•--•---- / -• c-J L;�Zk2tem l�Cf1 ................. =........... l.. Xoca on-Address - or Lot No. o / Address --•-- Own WW1 -� s�f�`=S' Gf 1'19.0 f._. .............. -- . •...... ......... .............................. Installer / Address UType of Building .�r Size Lot....&.. ..Sq. feet Dwelling—No. of Bedrooms.-___--_-.�.............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) Outerfixtures . e✓ i17�`- —'---------------------------------------------------------------------------------------------------------------- W Design Flow........... L`l--------------------.gallons per person per day. Total daily flow------&W-......................gallons. ' W Septic Tank—Liquid capaciv _x�g'ilons Length---------------- Width---------------. Diameter----- .......... Depth..___.__-_--. x Disposal Trench—No_ ____________________ VVidt ----------------- =Tofth__........_..__..... tal le ping area.._ _.�_.sq. ft. Seepage Pit No..__�' Diaz-:._ Iy- .._.' a ling area__-__--_.-.-----sq. ft. z Other Distribution box ( ) / Dosing tank 97 -t-7 aPercolation Test Results Performed bY.......................................................................... Date------------------------- -------------- ,� Test Pit No. 1------_---------minutes per inch Depth of Test Pit.................... Depth to ground water-----------_-.---.----- fZ4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water.-.--.___-_._--._-.-___. O Description of Soil--------= ----�,`�i v ----------------------- -i - --------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------ ----------------------------------------------------- -- .--------•----- -.----••----------------------------•--•-----------------------------------.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the bo rd of h alth. �~ Ligne - �?!L.. ��`1------ -- --- -- - - � .... ----�Yf / Dat Application Approved BY .... PP PP F= ' � ---------------- --•-/10._ �%.--. _�..... A -7 Date Application Disapproved for the following reasons------------------------------------------------------------------------------------------------------------••--- -------------------------------------------------------------------- Date PermitNo......................................................... Issued........................................................ Date •L THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH_71Z - ........................... , ; Appliration -for Ui,ipoiitt1 Workii Towitrurtion Vrrotit Application is hereby made for a Permit to Construct�(�)or Repair ( } an Individual Sewage Disposal Syst�at: r ..Location-Address /r or Lot No. Owner/, Address � Installer ��f Address Q Type of Building U Size Lot.,...... ...Sq. feet Dwelling—No. of Bedrooms----------v`_--_____________________________Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) 0.' Other fixtures ------------------------- W Design Flow------------- KZ....................gallons per person per day. Total daily flow------t�_�J_0 ---- ---------------------------gallons. piSeptic Tank—Liquid capac44!� 60allons Length---------------- Width................ Diameter................ Depth.__.-----.---.-. x Disposal Trench—No_ ____________________ Widtht------------------ Totai;,'L-ength--------------------3,6tal leaching area.._3 ,_.sq. ft. Seepage Pit -�o ....... D'el3th'zbel �i>rl'�et� To eaching area------------------sq. it. z Other Distribution box ( ) Dosing tank ( ) _ 7 _ aPercolation Test Results Performed by-------------------------------------------------------------------------- Date--------------------------------------- Test Pit No. 1................minutes per inch Depth of "Pest Pit-..-_-_-______-___- Depth to ground water..._-._--.-_-_-._------- (14 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ Ix ---------------------------=-- _ r ... O Description of Soil .-p�.. )i(? ._ 'rLka._ +�.cf_ _s-t.tr_ __- - /--..--._. -� r`'�!'?-f ra`�- ---------------- ------------------------------- ------------------------------------------------------------------------- w x -•-•------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable.-.------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------- .. ------------------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of healt4e4,� igned -'`r!r'! = = ------------- 1�r � Die•------ Application Approved By------- -r:. r21- i�r :--`------'----•--------- ---�D - `�'t ----- Application Disapproved for the following reasons:......................................... easons:......................................... --•--•--------------------------------------------Date ----------- ^_ ---------------------------------------------- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH a :, -..... 101rrtifiratr of 0111uivIt-a irr THIS-IS TO CERTIFY, That. the Individual Sewage Disposal System constructed C( )� or Repaired ( ) /---------------------------------------•------------••-•-------•-•••---•-------- � Installer at.. -------------=------- --='�-`-� ct-�t-C-........... _ ��r ----------------------------•-•-•---•-•.........---- has been installed in accordance with the provisions of A ` I XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No. ..__ � 7 ..----..�.----------- dated---1//-•-••G-/-'---7-4................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............. o.............. Zeer-------_-- Inspector_..._.. . 1. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 6 �I.c f✓�''.�?................O F/�, �!G �?�'—''� �+�= ':..`��.................. / No.-----1•r3 . --•----•- FEE._.__:.................. Dinvolia zduvrkii, C11mitrurtion f rru it Permission is hereby granted_ _ _ ._ _--______-,: � `-__..___ ----- to Construct�( Repair ( ).,an Individual Sewage Disposal System v ,,i ._.. -� .�,...... !� � Street as shown on the application for Disposal Works Construction A�rmit No.____._. Dated.......................................... �!��. t� ---------------------------------- DATE-------------------------------------------------------------------------------- Board of FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 1� r r�#•:-fet"Ft.'Ii`3+' t R t f ,ti-.ti_..F'.•.R_ ; n Ky f (f p A 'j,iy9"fi, y4i• `4,.tiq� Sck �FY VA d • � i.4 4 ��r p - .. i 1F.p r5 f3...0 it Mipa YS 'd ` ^Ai sx:t 74 i s �� e s•�alt rat, ) s ix wl f 1\\\ •is .,�R^ r / ���. t ML s s R x 1 i." - •. A / l fm/I'7 I` 1 �7 V��/�M. J �i��5.+ -�.y t .��;s ��""r .� § 7 r7• �O" r.T:. �/�ro�,• �'O G//r`� /� 1` _ +,yr4' p E f,,,, .�,'x{,,,. �g3. y._' ,rr'•1.���ry� ell. .4,� i` � s..t ',.� i .f fLt .2 �a � C eTJFY,, ,Ti�d/4T 7-AIE ®u/LD/VG L0'4C.497-Ea ON THE �G/it/Z' Au �Si/OW.V Fs� �BOitJ 6i.Vdfl TNRiT /T i B y „',!77j0* %St ®•c. ,7</E 73�NY�/'OF'l�f7i P�c.ZS CSC / ,V"2NE Gcl 1.nM H. 3ALA L6348 ,k ' COP- 7 A Q55. k Y Town of Barnstable -'� Regulatory Services '.fhomas F. Geiler, Director FIAM"AHLE, Public Health Division HAM T° 61 Thomas McKean, Director `` 200 Main Street, Hyannis, MA 02601 (:)Puce: 508-862-4644 F av 508• 'Q( -(0,)4 I)attc; ► _i .'' ( t✓ - Sewage Permit# �'fo��y�7 Assessor's Map/Parcel _!y�� -✓ Irj tam ller &c Designer Certification Form Designer: SG_�r�Jity7.�e,r"�.`1__...t_�'�_:._ Installer: C;c��w;dc'_ � �Eerpcta� a Address, 2 b?`I (ccwt'r)ei r Address; l.�m �v�`.._.7 i'"3.._..,.�_._.....,.. ra`a\ 'l)G;(CVlvvyi I_ 0 Ly .5o b l 13 0� 1 7 CZU 3j 2 On _ 0 10 : 2oto Qn)r>_ was issued a permit to install a (date) (installer) 1 septic system at, 9 c1 (i��O c_��i} "'�- based on a design drawn by (address) :2i C F'r\G�it1C..e.t ire<- .., "'1:v1C dated Dec:�WAO�( b 2L i0 V „ 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 sand/or septic tank. Stripout (if required) was inspected and the soils %ere found satisfactory. 1 certify that the septic system referenced above was installed with major changes (i.c. greater than 10! lateral relocation ol'the SAS or any vertical relocatic.)n of any component oCthe septic system) but in accordance with State& Local Regulations. Plan revision or certified as-built by designer to follow. Stripout (if`required) N , ' s)ectod and the s0iI:, were found saatisfactory. 1vt Or CrIURLt1!L;_ ... ..,, .. �..,.. .. . ........ JR. (I st der s Si6na r e) IV 41150 0 ----- esigner s 51jnEUre� Y (Affix I?e gn i-lcrc)_ P ASE TLJRN T( ARNSTABLE 'VB-UC HEALI DIVIS (. N. C:ERTIFICA E OF CC) IIL I I. NOT BE ISSUED UNTIL TH THIS 1+ RM ALVD AS. I1I :' CARD AIU RECEIVED BY 'THE BARNS AB.I.E P LI( XL>!;ALTH DIVI$10N, THANIJ I UK,, —.-. q\office 1bTm8\di'-SIp,nCtCertii'icul.ioir ionn.tiou \\ Z0 d 2-95�0 5 'I. 7 Sot-- T T T 0T27—bT —'l�rr Town of Barnstable P,#-j!Lik Department of Regulatory Services a � Public Health Division Date I-2 2- v h'o ��'� 200 Main Street,Hyannis MA 02601 Date Scheduled 0 Time Fee Pd. UU Soil Suitabili .Asses •ty sment ,for Sewage Disposal Performed By:_ M i c�o e j j Al 0 t Z( E T T, GSA ` + Witnessed By: Av, LOCATION& GENERAL FORMATION Location Address n Owner's Name�CCu �� + `K,�b:�rlez �awsGc�l Address S V M C Assessor's Map/Parcel H q I y(G + PGrct § i Engineer's Name W�? +(� In OP fi'3G Fn�i►�eert �reC NEW CONSTRUCTION REPAIR ✓ Telephone# 50c� 273 -0-77 7 Land Use Si ie_Fcmi( Ai p-if n Slopes(%) 5 `10 Surface Stones Distances from: Open Water Body ft Possible Wet Area — ft Drinking Water Well ft Drainage Way ft Property Line -7 t_ ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands f'n proximity to holes) See. a Aa clr J e Ion Parent material(geologic) -ta'Vwaskn Depth to Bedrockt3 0 b5s Depth to Groundwater. Standing Water in Hole: 7 l 3 0 CS Weeping from Pit Fnce 7 i 3 0 1oJ5 Estimated Seasonal High Groundwater 7 1110 c s DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: V'Ta6 01ose:i)a{i cn Depth Observed standing in obs.hole: 7 1 3 O in. Depth to soil mottles: 13 0 Depth to weeping from side of obs.hole: > 1 30 in. Groundwater Adjustment Index Well# Reading Date: ,index.Well level__.,_ Adj.,factor., a Adj.(3rttufldwnter Level, PERCOLATION TEST Dnia /2- "-' Ttme iC R,�-I Observation Hole# Time at 4" Depth of Perc y0 -.5 '- Time at 6 Start Pre-soak Time Time(9"-6") — End Pre-soak )6,16 R Rate MinJlnch 2 Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) N Original: Public Health Division Observation Hole Data To Be Completed on Back------ ***If percolation percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. o i tencY,_%Gravel) l��i�f 3 A L S /� Y� /, 1 k- Yo _ �0-1 3 0 c. tj 5 2.5 l IA DEEP OBSERVATION HOLE LOG Hole# 2- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. o sisten % ravel ID«31, /0 1/0-13 0 C S 25 1 "/6 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consiste DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones',Boulders. o i tenGravel) Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes ._. Within 500 year boundary No Yes Within 100 year flood boundary No._ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? des If not,what is the depth of naturally occurring pervious material? Certification I certify that on �Q'Z7" 5 (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 erience described in 310 CMR 15.017. Signature Date J_ Q:\SSEPTIOPERCFORKDOC TOWN OF BARNST ABLE LOCATION SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER PERMIT DATE: 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 Facility(If any wetlands exist within 300 feet of leaching facility) Feet ;%�URNISJIED BY �; _ TOWN OF BARNSTABLE LOCATION �g >� �� C C n �G� SEWAGE# 'ZO 60 - TCZ VILLAGE 4 ASSESSOR'S MAP&PARCEL �Y(,f - S� INSTALLER'S NAME&PHONE NO. CCw0e cclIA [ leA r,r L Ya Y cd SEPTIC TANK CAPACITY to oo l+ , u �L- X t O ill LEACHING FACILITY: (type) ZO A C01 3i, 3 (size) NO.OF BEDROOMS 3 OWNER �w� �` �Z o�tiv�S 0-1N PERMIT DATE: -1 'Z°i° COMPLIANCE DATE: Separation Distance Between,the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility /V u ic cl 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 '*'1&1FURNiSHED BY�� ,t�.z I � L-c c— v Fl Z 31•`( 3 314 9 t32 ;Lc? • � LOC&T1�0NI 5EW/J,GEERMIT IJO. VILLAGE �Fl INS LLER 5 kid A-F, % ADDRESS BUILD 2 5 Q &MF— ADD E SS D47E PER"VT 155UED .-DATE COMPLI &MC'F- ISSUED : ° � � a ItA' i - _ - _ T.O.F. EL.= 61 .4'± FINISH GRADE OVER D-BOX= 57.5 '± 4"SCHEDULE 40 PVC MIN. SLOPE 1 % FINISHED GRADE OVER BIODIFFUSERS= 56.8' - 57.3' GENERAL NOTES PROVIDE EXTENSION RISER INSPECTION PORT WITH SLOPE @ 2% MIN. 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION WITH COVER OVER INLET& REMOVABLE WATER-TIGHT COVER OVER ACCESS BOX TO WITHIN FINISH GRADE OUTLET TO WITHIN 6"OF F.G. RISER TO WITHIN 6"OF FINISHED GRADE 3"OF F.G. (ONE PER ROW) METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FND. EL.= 60.0 '±' F.G. OVER TANK EL = 59.7 ± 5" DIA. OUTLET(S) CODE AND ANY APPLICABLE LOCAL RULES. 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. --EXIS I iNG 4" PROPOSED 4" 39"MIN. 36"MAX. TOP OF SAS/B.O. = 54,30' 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEWER PIPE PVC SEWER PIPE SYSTEM UNLESS OTHERWISE NOTED. 6�3" 3" DROP MAX 4._ PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 2"DROP MIN 3 9 MIN.SLOPED 1% L - 80# JOINTS(TYP.) ELEVATION =54.30' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 10" T4" PVC IN FROM 1.08' Q 13„ i40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 14" �*57.2'± EPTIC TANK 4" PVC OUT TO (TYP.) t THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. • LEACHING FACILITY 0.59' 7.13+(n'P) I ° i 5. SLOPE ALL SOLID PIPE AT 1.0 /o MINIMUM. CONTRACTOR CONTRACTOR SHALL 12" 6" 53.81' �-- 53.22' laid flat 2.875' (34.5")--I 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. SHALL VERIFY SIZE 48" VERIFY CONDITION OF OUTLET TEE 56.00 MIN. 555.83 ( ) (TYP.) 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK EXISTINGAND SEPT CTION OF AND REXISTIEPLAC AS GAS BAFFLE 6NG TEES "CRUSHED STONE (TYP.) 5'MIN. 14.375'5.0' FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS OVER MECHANICALLY REQ'D NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE 20.0' AND DESIGN ENGINEER. I I 5 OUTLET DISTRIBUTION BOX (TYP.) 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 53.77'(BENCHMARK#1) TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV.= < 46.37' BIODIFFUSERS (END VIEW) ESTABLISHED ON A NAIL SET IN ROAD AND DATUM OF 60.00'(BENCHMARK#2)ESTABLISHED BASE. FIRST TWO FEET OF OUTLET ON A NAIL SET IN TREE AS SHOWN ON PLAN. EXISTING 1,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. 20 - BIODIFFUSERS (PROFILE) 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION CROSS SECTION VIEW (BY ADVANCED DRAINAGE SYSTEMS, INC.) I THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT SEPTIC TANK PROFILE 20 - ARG36 #3613 B D 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES *CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR DISTRIBUTION BOX DETAIL ) BIODIFFUSERS O D I F F U S E RS TO THE DESIGN ENGINEER. TO ANY WORK & NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. TEST PIT DATA 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING PERC NO. 13156 REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM �� •� APPROPRIATE AUTHORITY. INSPECTOR: David W. Stanton, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS O U • �� , '• �� EVALUATOR: Michael Pimentel, E.I.T. LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE C.S.E. APPROVAL DATE: Oct. 1999 THEY SHALL WITHSTAND H-20 LOADING. " December 8, 2010 - 1 DATE: 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE ELEV TOP = 57.20' MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. .� � y ELEV WATER= <46.3T REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY Q _ ZONE 2 FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). ca ZONE 2 PERC RATE _ < 2 min./inchLO 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN cC14 q q SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. M -' of DEPTH OF PERC = 40 -58 z OINI Benchmark#2 �� i1 f 1" o + i m O TEXTURAL CLASS: 1 16. PROPOSED PROJECT IS LOCATED WITHIN: z LANE Nail Set in Road REBECCA L �/� / - ASSESSOR'S MAP 146 PARCEL 58 CL Elev. =53.77' WID J (40' E LAYOUT) � Approx. M.S.L. 11 OWNER OF RECORD: KIMBERLEE N. ROBINSON pl NI / 1 LOCUS on 57.20' ADDRESS: 99 REBECCA LANE - Fill OSTERVILLE, MA 02655 EM�N w w 'W`_W��` c/�`;�EXIST. CBN 4 © A16" 55.87' v / f GRATE=54.0'± `�� Loamy 10Yr 3/1 d �OF PP � W `� �'��j 8-_� �+ o � � 18" 55.70' FEMA FLOOD ZONE C �pG W MAP 146 6� sZ Loam Sand COMMUNITY PANEL# 250001 0015 C B y 17. DEED REFERENCE: LAND COURT CERTIFICATE 141200 PARCEL 58 10Yr 5/6 J.P.#7 18,295 S.F.± __ 40" �r 53.8T 18. PLAN REFERENCE: LAND COURT PLAN#32225-B 5b'' - \ `* " ALL DISTURBED AREAS SHALL BRESTORED TORIGINAL o \ TP 2 �--- \ �� Perc .,.h f 19. E O CONDITION. 57.0 �O �' 58" 52.37' 1 20 PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY F~ , ` �' • * Medium Sand FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY Al i C 2.5Y 6/6 FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. c� y A \ PROP. D- OX \ �„ .4 �� . fir` ,`" . �._�_� .... (loose) rnVt RIP0 23 5 cP � U #99 LOCUS PLAN /6 EXISTING _ 2-BEDROOM I SCALE: 1"= 1000' 130"1 46.37' DWELLING X TOF = 61.4'± x � ' No Mottling, Standing or Weeping Observed x DESIGN DATA TEST PIT DATA LEGEND 7; B H. ` X / PROPOSED INSPECTION PORT WITH PERC NO. 13156 MAP 146 PATIO DECK , ! X / ACCESS BOX TO GRADE (TYP OF 5) PARCEL 57 ' J / NUMBER OF BEDROOMS (ASSESSOR) 2 INSPECTOR: David W.Stanton, R.S. 50x0 EXISTING SPOT GRADE J EVALUATOR: Michael Pimentel, E.I.T.J PROPOSED TOTAL 20 ARC 36 BD) NUMBER OF BEDROOMS (DESIGN) 3 (MIN. PER TITLE 5) - - 50 - -- EXISTING CONTOUR J � _ BIODIFFUSERS IN A FIELD CONFIGURATION C.S.E.APPROVAL DATE: Oct. 1999 x flp/ 56 DESIGN FLOW 110 GAUDAY/BEDROOM DATE: December 8, 2010 50 PROPOSED CONTOUR TOTAL DESIGN FLOW 330 GAUDAY TEST PIT#: 2 � \ � �t MAP 146 ( DESIGN FLOW X 200 % = 660 GAUDAY ELEV TOP= 57.20' ELEC EXISTING UNDERGROUND UTILITIES EXIST. DISTRIBUTION BOX TO BE ABANDONED f LP / �'/ PARCEL 59 USE EXISTING 1,000 GALLON SEPTIC TANK ELEV WATER= <46.37' E/H/W - EXISTING OVERHEAD UTILITIES EXIST. 1,000 GAL. SEPTIC PERC RATE = -W-W- EXISTING WATER LINE EXIST. LEACHING PIT TO BE PUMPED, -7� TANK TO BE UTILIZED AS FILLED WITH CLEAN COARSE SAND f - 58- - PART OF THIS DESIGN INSTALL 20 - ARC 36 (#3613BD) BIODIFFUSERS DEPTH OF PERC = TEST PIT LOCATION PER 310 CMR 15.255(3) & ABANDONED -- O /ro TEXTURAL CLASS: 1 Q� � Benchmark#1 EXISTING 1,000 GALLON SEPTIC TANK Nail Set in Tree SYSTEM CAPACITY o36c�D� Elev. =60.00' SWING-TIES SCALE: 1"=20' (TOTAL L.F. OF BIO'S)(4.8 SF/LF)(0.74 GPD/SQ.FT.)=GPD 0° 57.20' PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE S60 Approx. M.S.L. (100.0')(4.8 SF/LF)(0.74 GAUSQ.FT.)= 355.2 GAL. LEACHING/DAY� DESCRIPTION HC-1 HC-2 FIII p PROPOSED DISTRIBUTION BOX BIODIFFUSER CORNER(1) 29.4' 26.6' TOTALS: A 16 Loamy Sand 55.87 10Yr 3/1 � PROPOSED ARC 36 (#3613BD)BIODIFFUSER MAP 146 TOTAL NUMBER OF BIODIFFUSERS: 20 18" 55.70' PARCEL 60 BIODIFFUSER CORNER(2) 38.4' 23.6' TOTAL NUMBER OF COUPLINGS: 0 BIODIFFUSER CORNER(3) 53.9' 43.5' TOTAL LEACHING AREA: 480.0 B Loamy Sand TOTAL LEACHING CAPACITY: 355.2 10Yr 5/6 REV. DATE BY APP'D. DESCRIPTION BIODIFFUSER CORNER(4) 48.0' 45.2' - 40" 53.87' PROPOSED SEPTIC SYSTEM UPGRADE �► NOTE: >Va of r� PREPARED FOR: EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE ` '�`� ENTERPRISES WIDE CAP 3) DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER Medium Sand JOHN L. E R SES (2 20-0' "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO ADVANCED C 2.5Y 6/6 CHU C HILL R. HC-2 DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003 (LAST MODIFIED (loose) N ^soy FEBRUARY 18, 2010). TRANSMITTAL NUMBER=W000052. LOCATED AT S. 7' 99 REBECCA LANE NOTES: #99 4) OSTERVILLE, MA 02655 EXISTING 1. MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF (1 -- _-- ----- 2-BEDROOM 130" 46.3T i SCALE: 1 INCH =2� �20 FT. ao DATE: DECEMBER 8, FEET EACH SEPTIC SYSTEM COMPONENT. DWELLING { TOF = 61 A'± No Mottling, Standing or Weeping Observed 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE HC-1 - PREPARED BY: PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT RESERVED FOR BOARD OF HEALTH USE JC ENGINEERING, INC. B.H. DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF 2854 CRANBERRY HIGHWAY HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. EAST WAREHAM, MA 02538 3.) PROPERTY IS LOCATED WITHIN A DEP APPROVED ZONE 2 AND THE SITE PLAN _ 508.273.0377 JOB No.1915 ESTUARINE ZONE WATERSHED. SCALE: 1"=20' Drawn By: MCP Designed By:MCP Checked By:JLC