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0191 ROBBINS STREET - Health
�a 191 ROBBINS STREET^ OSTERVILLE. A= 142- 129. r C�. No. b ) `' _ ,4` Fee 'l:`(✓THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION -'TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for Misposal *pstem Construction 3permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) [600mplete System ❑Individual Components 4 Location Address or Lot No. 116bbi,-i-Y Gs,+envy l Ic Owner's Name,Address,and Tel.No..A 10,4cce, Assessor's Map/Parcel f 2,, 1 Z S I*P 1A 4 ' Installer's Name,Address,and Tel.No. jo hl% 40A Designer's Name,Address,and Tel.No.FAe `j'Ca. rlayc,Ice.trcu�.� , 5csq -7'7 6 Pi k E3 Type of Building: Dwelling No.of Bedrooms 3 Lot Size i 2 q 4''L sq.ft. Garbage Grinder( ) Other Type of Building of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 gpd Design flow provided 3y 'l gpd Plan Date (✓Zo bw Number of sheets 1 Revision Date Title Size of Septic Tank JT"©® Type of S.A.S. '2 5-0o (y IA ( ym Idea Description of Soil C 1 @146� s iA t d Nature of Repairs or Alterations(Answer when applicable) V\ L0 -9}o S KA V1 e U-s rs'®c � 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 It Signed „ Date 2 Application Approved by Date 7 Application Disapproved by Date for the following reasons Permit No. ✓- " l Date Issued I. -,n4;;,,fk... ':r...»JF. ,u- " r . t ` .Vf"..,.+. St! n ; "' ..,.r.^.ti!'T"'' L7• .r4r7r,. n, K .,.��n. -'at .t.v... '+, r fr..r h ' G g Fee-,S.' ....— ' THE,COMMONWEAL.TH OF MASSACHUSETTS Entered in computer: Yes rM �� � PUBLIC HEALTH DIVISION`- TOWN,OF BARNSTABLE-, MASSACHUSETTS Application for Zispo$ar *stem ConMrUction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( .): ❑g<!omplete System ❑Individual Components 3 X Location Address or Lot No. 191 116bb►�1s 13D QS+ecvttc Owner,'s Name,Address,and Tel.No. 141 Fei•,q Assessor's Map/Parcel .1 12,j S A MA rq Installer's Name,Address,and Tel.No. kh C OH GM Designer's Name;Address,and Tel.No.F Ar le I W k , �U 'Nkr ce► rvA� SV\ l�+lc1� } Type of Building: Dwelling No.of Bedrooms Lot Size 12 q141 sq.ft. 'Garbage Grinder( ) Other, Type of Building , o'of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided y gpd Plan Date (? 20 2G Number of sheets Revision Date- Title Size of Septic Tank Type of S.A.S. 's co q w i. C 'A h r►1 Oe rs Description of Soil yAoo C evA,h S LA 1+ E Nature of Repairs or Alterations(Answer when applicable) "e W sy S K'W► V1 e "tn k 2: S06 iy 14 Ctitva ZQC- s rt�d 13 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`ystem in operation until a Certificate of Compliance has been issued by this Board of H71V�#41 Signed _, Date Application Approved by lit 4 Date -Q- a y� VW '� Application Disapproved by 0 Date ;t for the following reasons r Permit No. ,, ice-fl Date Issued "� { s 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 of 1151 &6 Le � ,6 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No01Q -O Xdated . Installer _-�;L px Designer �•`t+r le I ► wkc-v #bedrooms . Approved design flow gpd• lam. ./' The issuance of this permit shall not be construed as a guarantee that the system will��Ydesigenn Date /!LAI Inspector � ��i C:I THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Bisposal Epstein Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade Abandon.( ) System located at - R O B�I H r V) � r 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. Date . / / Approved by. Town of Barnstable YFIE tn,. tiO Inspectional Services "- Public Health Division • inntvsrast.e. • ,- '"" Thomas McKean, Director '° cNu►'�A 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 3�,./& 2.1 Sewage Permit# OZ i U2(J Assessor's Map\Parcel Designer: N I ,E'R� P L Installer: Gd yM_ay� S &C Ai/n -tom Address: Address: .�� l V�t C C�-l• c�� MA ©CSL3 On 2. 2.1 _ Q0`JS & G{7(` was issued a permit to install a (da e) (installer) septic system at N-5 5T_ based on a design drawn by (address) E. L L RN , L-P\i P,&ted (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 wa eoQ ructed in compliance with the to rms of the M approval letters(if applicable) �ZN Of qF4s l � HARRY G� EARL "+ LA E�Y. JR. �. . No 265 (Desi ne ' iginVur `' .�"" (Affix amp Here PLEASE RETU ARNSTABL IC 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. Woa\depts\HEALTH\SEWER connecASEPTIODesigner Certification Form Rev&14-13.DOC i TOWN OF BARNSTABLE 2 -.�,_ 02-0 LOCATION SEWAGE# VI rT 1 VILLAGE Q ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO.Ccs-ao!,5 �cwv A4 kM -5D&77G 9 g(6 SEPTIC TANK CAPACITY I�G® LEACHING'FACILITY. (type) "bo Cdg46 C:VP0 my(size) 13 X 2 5 NO.OF BEDROOMS OWNER �'nnt 4 4 d 1 / PERMIT DATE: , ( `Zrj 2( 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 FURNISHED BY J l 1 to 1c,.,&, W T5- rz� w � -. Q-3 l9 S Its- � tl { KWE i�altUblic a l�!9 �ioo)n"//f�if��f Public Health rv�sion � BARMS=BLE.Q 200 Main Street _ prED MP� Hyannis,MA 02601 r' ZIP 02601 $ 00fi 02 4R 7015 1730 000.1 4988 1692 00003.73143A11c. 20. PACELLI,ALFRED J 01S NRE 1 ,19IGWO'$/20/20 FORWARD TIME E`XP RTN To SEND R ACEL't I 1 ANDERSON WAY B AKEVILLE 'MA 02 3 47 -1886 RETURN TO SENDER �:� � ��:.� I,s111�II�I�II��iIB'I'11°!�9'i�II�°I�9��lii'°�I�°.►,��.I����1°��1'.� © , \ ■.Complete items 1,2,and 3. �Agenf Print your name and address on the reverse E3 Addresseeso that we can return the card to t�7 ou (Printed Name) C. Date of Delivery■ Attach this card to theback of tor on the front if space permits. +dress different from Item 1? ❑Yes delivery address below: I'No ( I I � x PACELLI,ALFRED J I 191 ROBBINS STREET OSTERVILLE, MA 02655 j -- - - - - - -; OervIcn-iypa, ❑priority Mail Express® III0111�1181118111111IIIIIIIIIIf Illillllllllll� ❑Adult Signature ❑Registered Mail"" /,. Adult Signature Restricted Delivery ❑Registered Mail Restricted� Certified Mall® DIs'lignature livery I 9590 9402 5745 0003 5534 10 Certified Mail Restricted Delivery turn Receipt for j I ❑Collect on Delivery erchandise❑Collect onDelivery Restricted Delivery Confirmation j p_,_n.+hm_N,.,mtec_fTransfer_from service 1abe1) ❑Signature Confirmation 1 r,�.' Restricted Delivery 7 015 1730 0001 4988 16 9 2 „ - ill Restricted Delivery i III'•' I! I ' PS Form 3811,July 2015 PSN 7530-02-000.9053 Domestic Return Receipt V ii EVE r Town of Barnstable Inspectional Services Department r r �A MASS. ` Public Health Division 9 MASS. �. i634. �� - A 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL47015 1730 0001 4988 1692 August 20, 2020 _PACELLI;ALFRED J- - - - - - -- 191 ROBBINS STREET OSTERVILLE, MA 02655 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The-septic system located at 191 Robbins Street, Osterville, MA was inspected,on 08/03/2020 by Thomas Roux,certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to.the following: • Leaching facility with standing liquid level at or above the invert pipe (per Town Code 360-20 h). You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. - .Failure to:repair/replace,the'septic system within the deadline period will result in future enforcement action. �R OF THE BOARD OF HEALTH omas cKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\I91 Robbins Street Osterville.doe Town of Barnstable Inspectional Services Department � r BA MASS Public Health Division 9 ASS. 039. 0►+,n+" 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO (Returned) CERTIFIED MAIL47015 1730 0001 4988 1692 (2"d Mailing) CERTIFIED MAIL# 7012 1010 0000 2847 9343 August 27, 2020 PACELLI, ALFRED J 1 ANDERSON WAY LAKEVILLE, MA 02347 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 191 Robbins Street, Osterville, MA was inspected on 08/03/2020 by Thomas Roux, certified Title V Septic Inspector for the State of Massachusetts. a The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching facility with standing liquid level at or above the invert pipe (per Town Code 360-20 h). You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. z DER OF;RS., ARD OF HEALTH c ean CHO Agent of the Board of Health C:\Users\mckeant\AppData\Local\Microsoft\Windows\INetCache\Content.Outlook\KQKJQ6SW\191 Robbins Street Osterville.doc � t Town of Barnstable OF TMF 1p� Inspectional Services Department BA MASS. Public Health Division y ASS. i659. 0+ " 200 Main Street, Hyannis MA 02601 Office: 568-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4988 1692 August 20, 2020 PACELLI, ALFRED J 191 ROBBINS STREET OSTERVILLE, MA 02655 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic stem located at 191 Robbins Street Osterville MA was inspected on p Y � p 08/03/2020 by Thomas Roux, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching facility with standing liquid level at or above the invert pipe (per Town Code 360-20 h). You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. R OF THE BOARD OF HEALTH C5om McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\191 Robbins Street Osterville.doc t Town of Barnstable • BAMAS : ,- 39, ,�� Inspectional Services Department Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An "x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box is above the outlet invert due to an overloaded or clogged SAS or cesspool ❑ A portion of the SAS, cesspool, or privy is below the high groundwater elevation ❑ A portion of the cesspool is located within a Zone 1 to a public well ❑ A portion of the cesspool is located within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) *01-0!eaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts jqa_ ld— �d Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 191 Robbins St. Property Address , Alfred & Margaret Pacelli Owner Owner's Name ' information is ' required for every Osterville ✓ Ma. 02655 August 3, 2020 °-, page. City/Town State Zip Code Date of Inspection , Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information 22 on the computer, use only the tab Thomas Roux key to move your Name of Inspector cursor-do not use the return Company Name key. 89 Mayflower Lane r� Company Address East Wareham Ma. 02538 Alf City/Town State Zip Code 774-678-9066 S14531 Telephone Number License Number B. Certification I certify that:l am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000);I have personally inspected the sewage disposal system at theproperty 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 -A L) o J �D 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 L , Commonwealth of Massachusetts Title 5 Official Inspection Form �- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 191 Robbins St. Property Address Alfred & Margaret Pacelli Owner Owner's Name information is Osterville Ma. 02655 August 3, 2020 required for every g page. Cityrrown 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: 2) System Conditionally Passes: ❑ One or more system components as described in the"ConditionalPass"section need to be replaced or repaired.The system, upon completion of the replacement or repair,.as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑N ❑ ND (Explain below): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 c` Commonwealth of Massachusetts Title 5 Official Inspection Form : Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 191 Robbins St. Property Address Alfred & Margaret Pacelli Owner Owner's Name information is required for every Osterville Ma. 02655 August 3, 2020 _ page. Cityrrown 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 ON ❑ 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 ON ❑ ND (Explain below): ❑ obstruction is removed ❑Y ON ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form f Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 191 Robbins St. Property Address Alfred & Margaret Pacelli Owner Owner's Name information is required for every Osterville Ma. 02655 August 3, 2020 page. Cityfrown. 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 1 f fsurface water supply or tributary to a surface water supply. 00 eet o a PP Y rY ❑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 ® El clogged 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 Commonwealth of Massachusetts �- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 191 Robbins St. Property Address Alfred & Margaret Pacelli Owner Owner's Name information is Osteryille Ma. 02655 Au ust 3 2020 required for every g page. Cityrrown 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 El ® or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. 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 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 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. ® O 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 16,000 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 cam, Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Forms-Not for Voluntary Assessments 191 Robbins St. Property Address Alfred& Margaret Pacelli Owner Owner's Name information is required for every Osterville Ma. 02655 August 3, 2020 page. Cityrrown 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 ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ Z 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? ® ❑ Wasthe 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)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1 4 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 191 Robbins St. Property Address Alfred & Margaret Pacelli Owner Owner's Name information is required for every Osterville Ma. 02655 August 3, 2020 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): No design Number of bedrooms (actual): 3 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): +330 gpd Description: 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 ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current - Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 191 Robbins St. Property Address Alfred &Margaret Pacelli Owner Owner's Name information is required for every Osterville Ma. 02655 August 3, 2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No 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 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 c � Commonwealth of Massachusetts - Title 5 Official Inspection Form C Subsurface Sewage Disposal System Form -Not for Voluntary Assessments -s 191 Robbins.St. Property Address Alfred&Margaret Pacelli Owner Owner's Name information is Osterville Ma. 02655 August 3, 2020 required for every 9 page. Cityrrown 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 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: 39 years, House was built in 1981. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2.5 feet Material of construction: ❑ cast iron ❑40 PVC ® other(explain): SCH-20 PVC Distance from private water supply well or suction line: +1 p'feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 191 Robbins St. Property Address Alfred & Margaret Pacelli Owner Owner's Name information is Osterville Ma. 02655 August 3, 2020 required for every g page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1.5' 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: 10.51 x 5.67'W x 5.67'H Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle 31" Scum thickness 0" Distance from top of scum to top of outlet tee or baffle 6-1 Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018. Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 191 Robbins St. Property Address Alfred & Margaret Pacelli Owner Owner's Name information is Osterville Ma. 02655 August 3, 2020 required for every 9 page. Cityrrown 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: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): 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 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .� 191 Robbins St. Property Address Alfred & Margaret Pacelli Owner Owner's Name information is Osterville Ma. 02655 August 3, 2020 required for every g page. Cityrrown 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 severly corroded. D-Box is in danger of collapsing. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 191 Robbins St. Property Address Alfred & Margaret Pacelli Owner Owner's Name information is Osterville Ma. 02655 August 3, 2020 required for every 9 page. Cityrrown 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.): * 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: The pit was located and inspected. The pit had about.6"of water in the bottom, along with a significant amount of solids. The side walls of the pit were black up to the top of the structure. This indicates that the pit has been filled to the top with water, for long peroiods of time. The pit is in hydraulic failure. Type. ® leaching pits number: 1 ❑ leaching chambers number: ❑ Teaching 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 191 Robbins St. Property Address Alfred & Margaret Pacelli Owner Owner's Name information is Osterville Ma. 02655 August 3, 2020 required for every g 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 pit was located and inspected. The pit had about 6"of water in the bottom, along with a significant amount of solids. The side walls of the pit were black up to the top of the structure. This indicates that the pit has been filled to the top with water, for long peroiods of time. The pit is in hydraulic failure. 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.): t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 191 Robbins St. Property Address Alfred & Margaret Pacelli Owner Owner's Name information is Osterville Ma. 02655 August 3, 2020 required for every 9 page. Cityrrown 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.): t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 191 Robbins St. Property Address Alfred & Margaret Pacelli Owner Owner's Name information is Osterville Ma. 02655 August 3 2020 required for every 9 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 3 I Na Sa o u i ® 00, 4 1 A fp b ex . 32 1 ' A t fo _ T t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 • r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 191 Robbins St. Property Address Alfred &Margaret Pacelli Owner . Owner's Name information is Osterville Ma. 02655 August 3, 2020 required for every 9 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ®`Shallow wells Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: 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: Would need to dig a test pit and do a soil evaluation, to determine the actual groundwater elevation. 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 t Commonwealth of Massachusetts 1n Title 5 Official Inspection Form < Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �. 191 Robbins St. Property Address Alfred & Margaret Pacelli Owner Owner's Name information is Osterville Ma. 02655 August 3, 2020 required for every 9 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Noo... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH � i ...........oF...., , .�5' .. 4r ......... for Uispwi al Works Toustrnrtiun Prrmit Application is hereby made for a Permit to Construct Oe) or Repair ( ) an Individual Sewage Disposal System at -------- ------------ ---------•...........-----........................ `��� ��-. L�pcati ddress B ,/ 6 .. G� '�l.f-------•............: ✓�/ii��' /�1%�r t,x. /'�`•� �e---• ......................_ ....... _... .. .. ...... .-- O ner Address a '� .�?. %_ '..... ....... ............ .................... Installer Address Type of Building 2�� %�'�� Size Lot..l_�?.......�.-�-__Sq. feet �. Dwelling—No. of Bedrooms.9p Expansion Attic Yj�f, Garbage Grinder ( ) 04 Other—T aype of Building ____________________________ No. of persons............................. Showers ( ) — Cafeteria ( ) Otherfixtures -----------------------------•---------------------------------••••------------------.---------------•.......... W Design Flow.............. ./ ...................gallons per person per day. Total daily flow__-_--_� 0....................._gallons. WSeptic Tank—Liquid capacity/ .gallons Length '_�:_ Width ... Diameter________________ Depth.`'�.... x Disposal Trench 'No..................... Width . ............. Total Length_...................Total leaching area................. ft. Seepage Pit No....../............. Diameter.._....��._..__.... Depth below inlet•-_��............. Total leaching are.--.--' ft. ft. Z Other Distribution box (Yp Dosing tank ) Percolation Test Results Performed b ._-•-•------ .t. e.. �°�. '0�_� Date..���0-.t/,.19X® zejTest Pit No. I...._-:X--_-minutes per inch Depth of Test Pit....-•.•---..._... De Depth to round water..__ P P P g <c���� f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... W ... .. ........... ....................................................................................................................................... O •- . Descriptionof Soil-------------.1��'9--•-•------..........------------....--•-----•---....------------------------------...-------- U ....................... ........•-----••----•--••---•••---•-•••---•--••--••-------•••......-------•------•••-•-----•-•••--•••--•-•--- W -•-••-----•-------------------------------•--------------------------------•-----------•-••---------------------------------------------------------------••-----------------......................... V 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 TITA U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu d by th boa of healt�h. 01 Signed.......... ......•--- •-- ---------• .,...%�.......--.--- Date Application Approved By.... ................................... .r .� � ••--•- Date Application Disapproved for the following reasons---------------------•---.._..-----------------...------------••----------------•----._.:__......-••-•--•------•- -----------------------•-•------...-------•------.••-----------------•---------------............................................. Date PermitNo---------------------------------------------------•----- Issued........................................................ Date No ................ Finc............................. THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH -------- ®- r /....._.....OF.... �� '.Ns.T ..f3L, ' ........................... Allp iri atilan for Elispo s al loorks Tonstrn.rtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .�• J/ G�1—V1 ........ ..._..__.f• s .................................................... � `:. Q_..7. ....................................................... /� /r catio ddress or L4 No. .................6 � i r�o.7..,.. !......... .. �cri�r W I`/j �� T�Oyvn� J f .....................................•----.Address Installer � Address Type of Building Size Lot../"�!_/q��.._Sq. feet Dwelling—No. of Bedrooms. aa.�r/0h/''--- ' Ex ansion Attic/ p A.)$ Garbage Grinder ( ) aa Other—T e of Building No. of persons............................ Showers YP g ---------------------------• P (.._->--- Cafeteria ( ) Otherfixtures .----•-------------------------------------•----------.--•••--•--•-----------•---•----------=----•--•-•-...--• ---_-••... W Design Flow..............Z6l ....................gallons per person per day. Total daily�ow__.____:�-30......................gallon. WSeptic Tank—Liquid capacity®�©.gallons Length' .�6.... Widths.- ..__. Diameter................ Depth-�'&.._. x Disposal Trench—No. .................... Width_ 'W-------------- Total Length.................... Total leaching area.......--....... sq. ft. Seepage Pit No...... ............ Diameter......��.......... Depth below inlet..._��.............. Total leaching area'.`IiG".Psq. ft. Z Other Distribution box (}Vials Dosing tank ) Percolation Test Results Performed by___________________ _ Date................_..._------_ -- / Test Pit No. I h�im nutes per inch Depth of Test Pit_!`.........._.. Depth to ground water..��,xe l-vd 0-4 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 •----•-•••----• ------------- ------------------ •---------- .-.---------------- ---_------------•--------------•------------.........--------- DDescription of Soil------------- ��ris?a ---------------------•--------•------------•--•-----------------------•-------------------------------------••----------...........----- W U -••----•----------•--•-----•--•-----------•---••--••-----•------•-----------••-----•----------------------•--------------------------------------...---•----------•---------........---•••---•-••. W --------------------------------------------------------•-----------------------------...------------------------------------------------------------------•--------•-------------------•--•-••-----•- V 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 TITI2 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by tha��oaf healthigned-••-•••---•- .......•--- • -••• ---• � ` Date Application Approved By.... ••-••• s. '--. -•-•--••---•--•-•----•-•••-•-- /2 P------. Date Application Disapproved for the following reasons:. ----------•-------------------------------------------------------------------•----•----. ............-•---- ........--•---•--------------•-------......--•-••---•••--._...----•-----.....-•---••--.......----••.........•-•-•--•-•--••••--------•--•.._..•---...•----•--••---•-•----•-----•-•----•----•-••••••---••-- Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH ....................O F.. :^.... ........................................................ Turdifiratr laf TourpliFanrle THIS IS TO CERTIFY, hat e Individual Sewage Disposal System constructed or Repaired g P �' ( P ( ) by �� ... '.l ........... ---------• ---•---------------------•-------.----------•------ ---------- staller has been installed in accordance with the provisions of TIT IF 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No. _�'�__. _X> ............. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTIONS TIS ACTORY. q / d �� 1-------------------- Inspector------. DATE.............................. �'=��.:�`�-�-.�--.Q`. ........................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No ...i°3 Z ............Z..........................OF.....- .�� .......................................... ............ . FEE........................ Disposal Works Tian-s/t_r ion rrmit Permissionisereby granted......./t r -�-----•-r- `-------------------------------------••-•-------.........-----...............------... to Constru t )—or Repair ( ) Individual Sevt age Deposal System, at No.------. -•---.....,. fit:._- .. ...................................................... Street as shown on the application for Disposal Works Constructions Permit N��o....../............. DAted.......................................... Vdeloof' `' .................•-•-•----...---........_ 7�� ealth DATE.........---•�-••--/��............................................. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS E1. 20.0 Profile of Sewage Disposal System PLOT PLAN No Scale 1 in.= 40 ft. 4" Cast Iron Pipe 1.2' + Pitch 1/2" Per. Ft. — EL.l _ — 4" Orangeburg Pipe Pitch 1/2" Per Ft. / 1.4 ± � 9.92 101.29` o .H. _- Precast 6' dia. Eh. 12.91 Leaching Pit EL.12.32 � - EL. 13.08 EL. 12.49 Dist. . with 2' of Box EL. I11.9 " Reserve �� ' 1500 Gal. 3/4 to 1 1/2" Septic Tank f ~�� <, washed stone Area 10 Ll El. 5.90 - 31' 10.0 '� o 36 Lot No. 79 SOIL LOG DESIGN..DATA CERTIFICATION 12,942 S.F. ,. Application No. : 81-432 No. of Bedrooms 3 0 I certify that the system Date: June 21, .1981 Total Est. Flow 330 gals./day . 110.00, g Y . ' shown on this plan .is located on i o f Time: 9:30 a.m. Garbage Disposal NO the ground as shown hereon and ' Witnessed by: J. Jacob, B of H No. of Leaching Pits (1) that it conforms to the set Approval by: R. Gifford, B of H Bottom Leaching Area 78.5 s.f, back requirements of the Town Engineer: A.J. Pacelli, P.E. Side Leaching Area 188.4 s,f, of Barnstable; Town Water Total Leaching Area 266.9 s.f. ROBRINS ST. Reserve Area 266.9 s.f � way- Percolation Rate Less than ` 2 min/inch Loam & EL.15.0 Leaching Area Per Registered Land Surveyor Sub Soil2� Percolation Rate 550. gals. ^ Course Date: PLOT PLAN & SANITARY SYSTEM 2tSand r..w:?»_•�K.,. Location: Lot No. 79 (LC. No. 18366J)f-, Et,!LtN OF�`��`" Robbins Street Fine ZN OF M Osterville, MA. Sand 8' ALFRED J. ALFRED �y Owner & -� P2�2�Io ,� G� Petitioner* Alfred J. Pacelli 9D �Q/ �0 4� v P16189 I ^ ' STER o Scale: As Noted NALEN��� �¢ a►5t6Q� OQ• Date: July 1, 1981 c EL.3.O SURvE Approved: e No Ground Water Board of Health Encountered Date: 7`77,777!-�!777 A iv '000/OU -AV 31A v V, A& ;.4,7 l000�� 7'.9 A/l 7V or -0 a N. 017 S�Zzl'Ic i :040"7 "00;;Oooe 4 'k, 7 17 N f 777' ef 47,0*7 V lo f,f '7 ,4 o 6: Y fv �7 ft, f3, ff tf ol�: T .......... 2 Z f: 4�1 A A: 7 CELLI fA 16, N:, IPAC "tt Yl, ;,4e f Wt- A i""A f_4, TT 41V`� 4 W`4 �1,7, A� 'A a, t?r, OF ;�4 le4Or.4 /Jr 'X: 7 A"'r or v 7s 4 4w� 77 ,6077 O.A- 7' 7.1 OA�Fl A e7C p1t, .4 A, A, 7 't 7777 41 "o 7 Ole/1�v a F,I F-_ MOVE `�1 ATE j 1�1. 5 �tSC`J1,�i3 f� ueTt>JCC1 _l 11 r{ 1 _ Sv5 7" tw 7 f --- ot`i�k 7 ..sit -;-ha 9.�',y' ABC S S w !, r �r 1 rJ_f MAX C oV r.I�., L t# LEVfit: If N ` - I�CtE5 5 �Pb>�7 S� G At N `1h0 � Fott • �-•--•• � ��� ;° r - G, ,rc7rrG. ; _y�,_•� '�.6 t�s,>v � ....,=-�.�:._...-.,.��.����- . <n,.,..� -tea �` `_..`-"'�°"_ .� c TAN Y -j 'At aF?cal, ACt7 s ty'u4 1 0? r ,.t A5V:1ez Fw•tE 1 OL U j y D E r i; � �+�.�y ..q ; _ _ t tit- ,— i a M ti tJ --- — - - Al NOTES: PROFS LE or D I UAL E N STE. K 1. Disposal System to be constructed in strict accordance with { (Nor--o 5f-_&LV} Commonwealth of Mass. Environmental Code -�Title V. i 2. This plan is for the sole purpose of construction of aseptic system. 3. Contractor to call Dig-Safe 72 hours prior to beginning of excavation. 1Uf"!P 4. Pump existing septic tank & pit, fill with sand and abandoned. �1i..t j (:p IT y„� -�''� 5. Use a new (H-10) 1,500 gal. septic tank. Install Tee's and gas baffle. I �, � i 6. Contractor to field check invert of outlet at foundation. } fI k 1" 7. Bench mark is top of foundation elev. 50..0. ' 1 r�1 8. APN is 142 / 129 for the Town of Barnstable. rJ �U�Y 4 - --- 9. Locus 1s served by Town water. r i 10. The plan view is based on site plan by Alfred J. Pacelli, RLS, License ,;r 1 3 �3cL���\ �� � � number 16,189. 7 _ _ ________-__�_ 11. Use 2-5'x8`x2` P.C.L.C. with 4' of double washed f " to 1 %Z'" stone all around and filter fabric on top. 12. Grade loam and seed all disturbed areas. y ' 1 ! y g�dd P y iIN _� � Y r G �n T fI P L AIN n •� Jr e-;#i'/ t1a.iss^ 2 . ] '✓ y,�j + tom i . .�° 15�M L_ ` f�F....3 � fS..J-t =..y'•wr "./ 1 ` .:�l."A t__ �� ; ` j m,.. f 9 4 r '�1 ' �i r L U �,' - i J 6 � 3 ���1-0- ts.1�%,�':.�. �' '� - (��� i]Aia�- _ LEIq A s�,l c i /R j 1tV rC i IJlrt�/ r - LJ 5 F_ X' r�Crj t✓ 1 � r' ! ) 'f j i µ 1 f l � /.: � 7� �'- 1C"-T _ ._ ` - "- rx!3nNG M- 16UP\ ..� l 1. JV€1 ! . f�11�J T r..� -�- --- _ _.._. 7 i t P�L �,'_ firt t' I f7 Aj. ,o `a?`1~ ' !t l} 11 ` t�1 t�is ; i l� r P, 3rLPUD,. Mrs c J ` 'i` } R 5. nA E t