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0058 SETH GOODSPEED'S WAY - Health
58 Seth Goodspeed's Way j Osterville P A = 146 063 u e o . 0 o ° e o.. //TOWN OF BARNSTABLE �,/LOCATION 52 ,5cTH lno®�S�EEDS WXY SEWAGE# VILLAGE ®STEP yt c ' ASSESSOR'S MAP&PARCEL �-- s o INSTALLER'S NAME&PHONE NO.QVEc�ca6 4U 477• 77 SEPTIC TANK CAPACITY I l 000 �S P LEACHING FACILITY:(type)��� j60nAim C.44AR''A&S(size) NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility N Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) N A Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) A/L14 Feet FURNISHED BY —iA�l A-1 A ( ; 3ff.61 1 g_yT zs.s - o 9.5; 33 ` 0 2 IC-3 = 38' C-`t; '� c /TOWN OF BARNSTABLE LOCATION %Y)OF SEWAGE# VILLAGE l ASSE SOR'S MAP&LOT � 44"=10 �N C -i�ti C G It'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS BUILDER OR OWNER —A T �O PST DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 � Eck i i YJ- ° .. ti � No. Fee oO, THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplitation for bispo8al *pstrm Construction jPrmit Application for a Permit to Construct( ) Repair(� Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.58 SE` 4Qx0CVSV4?��Y Owner's Name,Address,and Tel.No. Assessor's Map/Parcel j 6:3 59 5 eTI-4 t S Installer's Name,Address,and Tel.No. 47 7•-fig 7 7 Designer's Name,Address,and Tel.No. 5 p S-a,7 3 03-7'] CAPGLOiD9 7JTdXP4.iSSM I tZ5v J� E�C�eI'��ca¢-Jrv� nt� )-. mrl" WY el PEMM Type of Building: Dwelling No.of Bedrooms Lot Size Q 6&* sq.ft. Garbage Grinder( ) Other Type of Building P,6$t Q ISXJ i'l A-(_No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) oZ gpd Design flow provided :3 q ! Y gpd Plan Date 1 36 —1012 Number of sheets Revision Date Title Ss �Ef7Z-/ �'--r�� LIJ�� Size of Septic Tank 11,-,e) C,,dd40AJ_�_ Type of S.A.S. a� S©V 9+L Q44- 6" Description of Soil Nature of Repairs or Alterations(Answer when applicable)�1 S� G?fi Sa'lAJt� I;f�Dc� C->�-�,LOXJ �� /C, 'r4 J LC 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 Ith. Signed - Date a Application Approved by Date ! :� Application Disapproved by i Date for the following reasons Permit No. � Date Issued j i �oIs 1h0 No. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yew PUBLIC, DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 010pYication for V46 al *pstent Construction Vermit i Application for a Permit to Construct( ) Repair( `Upgrad�'e'(" )"wAbandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �. SyE/ WAY Owner's Name,Address,and Tel.No. ` Assessor's 6 Map/Parcel /® _MaP OST �p1Y RQS� SAr��., ! t Installer's Name,Address,and Tel.No.502••Y77 $$7 7 Designer's Name,Address,and Tel.No. 5o g_)7 3_C317 � CAPGWID& t7pt 058; I k0o Sc. CN69/J4jC1rX41jC arNc, 15 X c:r t�6 cxt �- lu Type of Building: Dwelling No.of Bedrooms Lot Size �6� sq.ft. Garbage Grinder r Other Type of Building AkCS/D E>_M14C No.of Persons Showers( ) Cafeteria( ) Other Fixtures " Design Flow(min.required) ;;�'A 0 gpd Design flow provided "9 UCI,U gpd Plant Date -�+»` 30 a� $�Number of sheets ( Reision Date ` Title 5956774 Size of Septic Tank Type of S.A.S. Oca L CJ-E,�t6l�R �L, 4 Description of Soil /1► .. (1 � ,��,/j / t l ]�/,(,� Nature of Repairs or Alterations(Answer when applicable) li�tyl3• D��T Q� �-C ���2,R±17tJlU /.�f� Date last inspected: Agreement: j 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 ` ,l Date " t Application Approved by �' e���,.,.t� �� Date Application Disapproved by Date for the following reasons ` a r 1 --" Permit No. "Z l��� d��( 1.� Date Issued J l 1 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 (20A P9LAJ(n t &j�(QPA,[ Pao at 5% Se?1•/ nSOtj=%lC W,a V ,- has been constructed in accordance with the provisions of Title 5��an-d the for Disposal System Construction Permit No.�(?► dated Installer��0,©e►yln,4 Cr J "�'A�fl(S14T' �� Designer _SC e,2j&jAJJFMWa �x1� r #bedrooms Approved design flow Z gpd The issuance of this permit shall nZ a construed as a guarantee that the syste K wil�;designed. Date J Inspecto�� ------------ No. tl1 ""' � Fee i "..,.. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposal *pstem (Construction 3permit Permission is hereby granted to Construct( ) Repair O Upgrade( ) Abandon( ) System located at $Q c•3E') �•�„ ;C�� —;ylC, (A..V VS'7"fx e z Z; and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. '"`!� (ti Date b' ! J � Approved by 1 ry /�_`i C Q A, Aug. 3, 2018 10,06AM No. 2484 P. 1 Town Of Barnstable Regulatory Services Richard V. Scali,Interim Director ' � Public,Health Division Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 Office! 508-862-4644 Fax: 508-790.6304 Installer& Designer Certification Form Date: 8--3-(8 Sewage Permit# )L0(2-,24q Assessor'sM.ap\Paccel iyfO fO3 Designer: --VC �n�c�tcurn _1 ,�� Installer; CR twide- EVil cQc[Se Address: 28S`/ Gcanl,ecc �i hwp Address: 1-5-3 Covyhm exct a l S4(ee f cask ��cJn�m NA 6Z53 }task��e, �4 02 6 y q On_ i CaQewid� EotQerPses was issued a permit to install a (date) (installer) septic system at 58 Se k�% (004 eel '5 i,v e "`I based on a design drawn by (address) -SC 4 C- dated �rQl 30 20I$ / (designer 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 and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i,e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required)was inspected and the soils were found satisfactory, I certify that the system referenced above was construe nee with the terms of the IAA approval letters(if applicable) JOHN L � cdi CHUR ILLJR 4ita-IlleVSigna 4t e) N 11L A 7 S signer's Signa (Af xigne s S rnp Here) JEf ASE HRE NSTABLE PUBLIC HEA b S N. (-P12TTVTCATJE COMPLIANCE WILL NOT BE ISSUED UNTIL BOT S FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE U C HEALTH DIVISION. THANK YOU, Q:1Septic\Designer Certification Form Rev 8-14-13.doc Is Town. of.'Barnstable P# ' Department of.Regulatory Services (2r ' i : Public Health Division Date •MAE9. _ ---- r639 A� 200 Main Street,Hyannis MA 02601 V / /-� c Date Scheduled Time `. / Fee Pd.--It0 •-r7 * X �- "' Soil Suitability Assessment for Sewage Disposal ` Performed-BY:!" t►4�QQI ,fl k,0I CS Witnessed By: '�•! O tl' �-_� LOCATION&.GENERAL INFORMATION Location Address Owner's Name Ak,-i PAS Cz S Address 55-�' 5e 7•-1 Gtc;,.0,SP6En S (,AY SST, 1 t0/d�O3 �ST <:!4pC—W tW E� —tc L1ScS R Assessor's Map/Parcel: ` Engineer's Name J-C NEW CONSTRUCf10N REPAIR _ Telephone# 509-. 213-631-7, 1 /� O Land Use �QS IQP►1 t�I Slopes(96) ��rr/C� Surface Stones_ !`� Distances from: Open Water Body f d ft Possible Wet Area �lJ� ft Drinking Watcr Well �I 0 ft Dralhaga Wa y >10 ft Property Line V ft Other ft � SKETCH:(Street name,dimensions of lot,exact locations of test holes&pare tests,locate wetlands-in proximity to holes) sp-e �t�C hQ� r`J1Cx Parent material(geologic) y U� � t t Depth to Bedrock Depth to Oroundwater. Standing Water In Hole: Q. ►J�� Weeping from Pit Faoe Estimated Seasonal High Oroundwater &G- e DETE VIINATIC�N FOR SEASONAL I�GH WATER TABLE Method Used: if ee .y ibn Depth Observed standing in obs.hole: 7 13 In, Depth to soil mottles: Dcdth to weeping from side of obs.hole: _ In, aruundwater Adjusltnent :AIA dexWell- ReadingDato: Index Well ldvol.� A�,fketor Adj.droundwater•Level,,_ PERCOLATION TEST Dfliv ;2 - nt d_uma Observation Hole# Tinto at 4" _ Depth of Para 3G 54 Time at 6" Start Pro-soak Time @ •1��„1 Tima(V-0) Ld Pro-soak Rate Min./loch Site Suitability Assessment. Site Passed SitF Failed: Additional Testing Needcd(Y/N) V f Original: Public Health Dlvision; Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:1S LPTICIPERCFORM.DOC DEEP OBSERVATION + : RVATION HOLE LOG Hole# , Depth from Soil Horizon Soil Texture Shcl Color Soil. Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stoned;Boulders. a rsistency.%'Gravel) 0 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sol]Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon . Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.. Consistency, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Sol[Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Co Flood Insurance Rate Man: / Above 500 year flood boundary No— Yes Within 500 year boundary No V Yes Within 100 year flood boundary No,•,i\-/ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed thrpughout the area proposed for the soil absorption system? Ye S If not,what is the depth of naturally occurring pervious material?,_�...�.. Certification �j�, I certify that on �a-�� - / / (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 d experience described in�10 CMR 15.017. Signature Datt; Q:\SEPTICkPHACPORM.DOC Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 58 Seth Goodspeed Way Property Address Jeanne Lane Owner Owner's Name information is required for Osterville Ma. 02655 3/4/2011 every 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: A. General Information When filling out forms on the I computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name t� P.O.Box 763 Company Address Centerville Ma. 02632 Cityrrown State Zip Code (508)477-8877 S14454 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that-the --9 information reported below is true, accurate and complete as of the time of the 'inspection. The inspection was performed based on my training and experience in the proper function and rmaintenance.of on,sate sewage disposal systems. 1 am a DEP approved system inspector pursuant`to Section 15.340S�f Title 5(310 CMR 15.000).The system: - D ® Passes ❑ Conditionally Passes ❑ Fails 1 4.q..Y •� Needs Further Evaluation b the Local Approving Authority W ❑ Y pP 9 Y cam ' ' 3/4/2011 Ins ector Sign a Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater„ the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 61 t,ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Dip sal Syste//agZ)of 17 Commonwealth of Massachusetts H Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments I ,M 58 Seth Goodspeed Way Property Address Jeanne Lane Owner Owner's Name information is required for Osteryllle Ma. 02655 3/4/2011 every page. Citylfown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 58 Seth Goodspeed Way Property Address Jeanne Lane Owner Owner's Name information is required for Osterville Ma. 02655 3/4/2011 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 58 Seth Goodspeed Way Property Address Jeanne Lane Owner Owner's Name information is required for Osterville Ma. 02655 3/4/2011 every page. City[Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 58 Seth Goodspeed Way Property Address Jeanne Lane Owner Owner's Name information is required for Osterville Ma. 02655 3/4/2011 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under,Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 58 Seth Goodspeed Way Property Address Jeanne Lane Owner Owner's Name information is required for Osterville Ma. 02655 3/4/2011 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ® ❑ information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 15ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 58 Seth Goodspeed Way Property Address Jeanne Lane Owner Owner's Name information is required for Osterville Ma. 02655 3/4/2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: 2 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): NA Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NA Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments c�M 58 Seth Goodspeed Way Property Address Jeanne Lane Owner Owner's Name information is required for Osterville Ma. 02655 3/4/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) I Last date of occupancy/use: Date Other (describe below): I General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 f . Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 58 Seth Goodspeed Way Property Address Jeanne Lane Owner Owner's Name information is required for Osterville Ma. 02655 3/4/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer (locate on site plan): Depth below grade: 18"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line. 10'+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank(locate on site plan): 11 Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: - 1000 gallon 4" Sludge depth: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ^M 58 Seth Goodspeed Way Property Address Jeanne Lane Owner Owner's Name information is required for Osteryille Ma. 02655 3/4/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 12" 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.): Pump tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ^M 58 Seth Goodspeed Way Property Address Jeanne Lane Owner Owner's Name information is required for Osteryille Ma. 02655 3/4/2011 every page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments °M 58 Seth Goodspeed Way Property Address Jeanne Lane Owner Owner's Name information is required for Osterville Ma. 02655 3/4/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 58 Seth Goodspeed Way Property Address Jeanne Lane Owner Owner's Name information is required for Osterville Ma. 02655 3/4/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy soil.No signs of hydraulic failure.Leaching Pit was dry at time of inspection.Stain line observed 14" below invert. 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 58 Seth Goodspeed Way Property Address Jeanne Lane Owner Owner's Name information is required for Osterville Ma. 02655 3/4/2011 every page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): f t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Map Page 1 of 2 Town of Barnstable Geographic Information System Map Size Zoom Out Parcel Viewer Custom.Map Abutters ® j jIn �A. �+may y r R r �.f"°•� Va, y y s 40 t d P W + l r A I� E Set Scale 1" = 20 I Aerial Photos 3 I MAP DISCLAIMER 1• r-n—inht 7nnr.7nln Tnufn of R—netohln KAA All rinhte rcennn http://66.203.95.236/arcims/appgeoapp/map.aspx?propertyID=146063&mapparback= 3n12011 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments °M 58 Seth Goodspeed Way Property Address Jeanne Lane Owner Owner's Name information is required for Osterville Ma. 02655 3/4/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of LP 36.8' 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: As-Built ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate #2 annual ranges of groundwater elevations. I Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 58 Seth Goodspeed Way Property Address Jeanne Lane Owner Owner's Name information is required for Osterville Ma. 02655 3/4/2011 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 COMMONWEALTH OF MASSACI .USETTS' Y EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a DEPARTMENT OF ENVIRONMENTAL PROTECTION 350 MAIN STREET WEST YARMOl.TTH;MA �CO 508-775-2800 - lye TITLE 5 OFFICIAL INSi ECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION3� MAP 140—PARC 063 Property Address: 58 SETH GOODSPEED WAY OSTERVfLLE,MA 02655 Owner's Name: ATS11'vOUDAS,ANGELO Owner's Address: 125 3ELMONT STREET BELMONT,MA 02478 Date of Inspection SEPTEMBER 12,2005 Name of Inspector:(please print) JAMES D.SEARS Company Name: A&B Canco Mailing Address: 350 Main Street We;t Yarmouth,MA 02673 Telephone Number: 508-775-2800 CERTIFICATION STA I EMENT I certify that I have personally v:.spected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection..The inspection was performed based on my, training and experience in the p )per function and maintenance of on site sewage disposal systems. I am a DEP' approved system inspector pt i suant to Section 15.340 of Title 5(310 CMR 15.6)00). The system: ./ Passes Conditionally Passes Needs Further Evaluation by the Local -approving Authority Fails 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 compl&'ng this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to th system owner and copies sent tot he buyer,if applicable,and the approving authority. Notes and Comments This report only describe, 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. Title 5 Inspection Form 61151.2000 1 r r COMMONWEALTH OF MASSACHUSETTS f EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS s - DEPARTMENT OF ENVIRONMENTAL PROTECTION tiq Y e� ! y 350 MAIN STREET WEST YARMOUTH,MA ra�O 508-775-2800 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION MAP 140—PARC 160 Property Address: 58 SETH GOODSPEED WAY OSTERVILLE,MA 02655 Owner's Name: ATSIKNOUDAS,ANGELO Owner's Address: 125 BEL_MONT STREET BELMONT,MA 02478 Date of Inspection SEPTEMBER 12,2005 Name of Inspector:(please print) JAMES D. SEARS Company Name: A&B Canco Mailing Address: 350_Main Street West Yarmouth,MA 02673 Telephone Number: 508-775-2800 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.00). The system: •/ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: The system inspector shaA submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completin this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent tot he buyer,if applicable,and the approving authority. Notes and Comments "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. Title 5 Inspection Form 6/15/2000 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: ATSIKNOUDAS,ANGELO 58 SETH GOODSPEED WAY Owner: ATSIKNOUDAS,ANGELO Date of Inspection:. SEPTEMBER 12,2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes:✓ I have not found any information which indicates that any of the failure criteria described in 310 CNM 15.303 or in 310 CNM 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: N/A One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of,the replacement or repair,as approved by the Board of Health;will pass. Answer yes,no or not determined(Y, N,ND)in the for the following statements. If"not determined' please explain. _ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health)" broken pipe(s)are replaced obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 2 i Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) `f Property Address: ATSIKNOUDAS,ANGELO 58 SETH GOODSPEED WAY Owner: ATSIKNOUDAS, ANGELO Date of Inspection: SEPTEMBER 12,2005 C. Further Evaluation is Required by the Board of Health:N/A I Conditions exist which require further evaluation by the Board of Health in`order to determine if the system is failing to protect public health,safety,or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(I)(b)that the system is not functioning in a manner which will protect public health safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or salt marsh. 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of 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 coliform bacteria and volatile organic compounds indicates that the well is'free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Title 5 Inspection Forni 611512.000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: ATSIKNOUDAS, ANGELO 58 SETH GOODSPEED WAY Owner: ATSIKNOUDAS, ANGELO Date of Inspection: SEPTEMBER 12,2005 D. System Failure Criteria applicable to all systems: N/A You must indicate"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in pit is less than 6"below invert or available volume is less than day flow 4— 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 N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water'supply N/A Any portion of a cesspool or privy is within a Zone 1 of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water •, analysis performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: N/A To be considered a large system the system must service a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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—fWPA)or a mapped Zone 11 of a public water supply well. If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system is failed. The owner or operator of.any'large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Title 5 Inspection Form 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: ATSIKNOUDAS, ANGELO 58 SETH GOODSPEED WAY Owner: ATSIKNOUDAS, ANGELO Date of Inspection: SEPTEMBER 12,2005 Check if the following have been done. You must indicate"yes"or no as to each of the following Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up`? ✓ Was the site inspected for signs of break out? ✓ Were all system components,including the SAS,located on site? ✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Pa:-t C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3Xb)] o� Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: ATSIKNOUDAS, ANGELO 58 SETH GOODSPEED WAY Owner: ATSIKNOUDAS, ANGELO Date of Inspection: SEPTEMBER 12.2005 FLOW CONDITIONS RESIDENTIAL,/ Number of Bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CNIR 15.203(for example: 110 gpd x#of bedrooms: 220 Number of current residents: 2 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): YES Seasonal use(yes or no): Water meter readings,if available(last 2 years usage(gpd)): 2004 29,000 GAL/2003—46,000 GAL/2002 48,000 GAL Sump pump(yes or no) NO Last date of occupancy: UNKNOWN C OMMERCIAL/INDUS TRIAL Type of establishment: Design flow(based on 310 CNM 15.203): Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): . Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: N/A Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: _ gallons—How was quantity pumped deterniined? Reason for pumping: TYPE OF SYSTEM Septic tank,,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no(if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank Attach,copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 1976 PERMIT#1976-625 Were sewage odors detected when arriving at the site(Cues or no): NO Title 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ATSIKNOUDAS, ANGELO 58 SETH GOODSPEED WAY Owner: ATSIKNOUDAS, ANGELO Date of Inspection: SEPTEMBER 12,2005 BUILDING SEWER(locate on site plan): ✓ Depth below grade: 10 Materials of constriction: Cast iron ✓ 40 PVC _ other(explain) Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): ✓ Depth below grade: 18" Material of construction: concrete metal fiberglass polyethylene _ other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000-GALLON PRE CAST Sludge depth: 4" Distance from top of sludge to the bottom of outlet tee or baffle: 26" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 16" How were dimensions determined: ASBUILT&TAPE Comrents(on pumping recormnendations,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&COVERS AT 18"INLET TEE—OUTLET TEE. NO SIGN OF LEAKAGE OR OVER LOADING. GREASE TRAP(located on site plan) N/A Depth below grade: 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: Continents(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/1 52000 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ATSIKNOUDAS, ANGELO 58 SETH GOODSPEED WAY Owner: ATSIKNOUDAS, ANGELO Date of Inspection: SEPTEMBER 12,2005 TIGHT or HOLDING TANK: N/A (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/day Alarm present(yes or no) Alarm level: Alarm in working order(yes or no): Date of last pumping Comments(condition of alarm and float switches,etc,): DISTRIBUTION BOX: N/A (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.,): PUMP CHAMBER: N/A (locate on site plan) Pumps in working order(yes'or;ito): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15/2000 8 a Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ATSIKNOUDAS, ANGELO 58 SETH GOODSPEED WAY Owner: ATSIKNOUDAS, ANGELO Date of Inspection: SEPTEMBER 12,2005 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type •/ leaching pits,number: 1 leaching chambers,number: leaching galleries,number leaching trenches,number,length leaching fields,number, dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) LEACHING IS ONE 1000-GALLON PRE CAST PIT. PIT&COVER AT 20",24"WATER STAIN LINE AT 3'. NO SIGN OF OVER LOADING OR SOLID CARRY OVER. CESSPOOLS: N/A ` .(cesspool must be pumped as part of inspectionXIocate 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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.): PRIVY: N/A (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.) Title 5 Inspection Form 6/1512000 9 r Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued). Property Address: ATSIKNOUDAS, ANGELO 58 SETH GOODSPEED WAY Owner: ATSIKNOUDAS, ANGELO Date of Inspection: SEPTEMBER 12,2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. G/ g2 3 `_ ck _ o�s 0 �d S o Title 5 Inspection Form 6/15/2000 10 1 Page 11 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ATSIKNOUDAS, ANGELO 58 SETH GOODSPEED WAY Owner: ATSIKNOUDAS, ANGELO Date of Inspection: SEPTEMBER 12.2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to groundwater 12' feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed` T Observation 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: TEST HOLE AT 12'NO WATER. TEST HOLE AT 4' BELOW BOTTOM OF PIT. BOTTOM OF PIT AT 8'BELOW GRADE. j6 o/7 44 PiT /V O V Title 5 Inspection Form 6/15/2000 11 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION d � 1 / ve TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE'SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 58 SETH GOODSPEED.OSTERVILLE, MA 02655 ,L4 O :J Lo ,51DECEIVED Owner's Name: LILLIAN REICHERS Owner's Address: 65 SCOONER LANE EASTHAM MA 02642 JUL 2 512002 Date of Inspection: 7/10/02 TOWN OF BARNSTABLE HEALTH DEPT. Name of Inspector: (please print),; T ,JOHN GRACI Company Name: SEPTIC INSPECTIONS It t, Mailing Address: P.O: BOX 2119 TEATICKET,MA.02536 Y Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT certify that 1 have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: I X'Pa'sAes• l _ Conditionally asses _ Needs/FuEvaluation by the Local Approving Authority Fails �, Date: 7/10/02Inspector's Signature: . , The system inspector shall subm.' a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. if the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shallisubaut the report to the appropriate regional office of sent DEP.The original should be sent to the system owner and copies,sent to the,,buyer, if applicable,and the approving authority. l'.., y !. Notes and Comments SYSTEM PASSED TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. ****This report only describes cond'ilions at the time of inspection and under the conditions of use at that (iulc. 'Phis inspection does not address how,the system will perform in the future under the same or different conditions of use. Title 5 tncnPrtinn Fnrm li/I 5/)6nn Page 2 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM E PART A CERTIFICATION (continued) Property Address: 58 SETH GO.,ODSPEED OSTERVILLE,MA 02655 Owner: LILLIAN REICHERS Date of Inspection: 7/10/02 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D r , A. System Passes: ? i P � X 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 c'r'iteria not evaluated are indicated below. Comments: SYSTEM PASSED TITLE V INSPECTION.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. k B. System Conditionally Passes:, _ One or more system components as'described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacemenvor.repai�,as approved by the Board of Health,will pass. , Answer yes,no or not determined(Y,N;ND) uhhe for the following statements. If"riot determined" please explain. n/a The septic tank is metal and over 20 years,old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it,is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: n/a n/a Observation of sewage backup,or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced _ obstruction is removed distribution box is leveled or replaced ND explain: n/a n/a The system required pumping morFthan 41imes a year due to broken or obstructed pipe(s). 1'he system will pass inspection if(with approval of the Board'of health): JL _brok6..pipe(s)are replaced _obstruction is removed V ` 1 ND explain: n/a ;I . QI ., rk ,, fz ;- Page 3 of 1 I ` OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 58 SETH'GOODSPEED OSTERVILLE, MA 02655 Owner: LILLIAN REICHERS Date of Inspection: 7/10/02 C. Further Evaluation is Requir`ed'by the Board of Health: _ Conditions exist which require further=evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment: 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner°whic,h will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier, if any)determines that the system is functioning:in a manner that protects the public health,safety and environment: _ The system has a septic tar k'and soil'absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. y,y t _ 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 tank1'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:deterinine distance n/a "This system passes if the well,water'analysis,performed at a DEP certified laboratory, for coliform bacteria and �i 'i volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this,form. 3. Other: n/a =. {.ti L - ;Mt ft, r q 4 141 Y t r:l ti.�T+ t; '" 'Page 4 of I I e- OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A j`. CERTIFICATION(continued) Property Address: 58 SETH GOODSPEED OSTERVILLE, MA 02655 Owner: LILLIAN REICHERS Date of Inspection: 7/10/02 • 4 ]r D. System Failure Criteria applicable to'all systems: You must indicate"yes"or`.`no"to each of-the following for alLinspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to:the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _ X Static liquid level in the distribution`box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow X Required pumping 'More than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped nLa. t.;,_`,i, X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspodo't privy-is within 100 feet of a surface water supply or tributary to a surface water supply. _ X Any portion of a cesspool-or;privy is within a Zone 1 of a public well. X Any portion of a cesspool or"pr'ivy is within 50 feet of a private water supply well. _ X 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that'faeility 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:j (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.T6'eysystem owner should contact the Board of Health to determine what will be necessary to correct the failure. 1, +i,J E. Large Systems: To be considered a large system:the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no.','to each of the following: (The following criteria apply to large systems in addition to the criteria above) 4- r t„ yes no i,F X the system is within 400 feet of a surface drinking water supply X the system is within 200 feel of a tributary to a surface drinking water supply _ X the system is located in;a nitrogen sensitive area(interim Wellhead Protection Area IWPA)or a mapped Zone 11 of a public water su'pply:well ti 1 " h if you have answered yes ;to any question in Section E the system is considered a significant threat,or answered "ves" in Section D above the large system,his failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. i. S.1. h. ' Page 5 of 1 a , OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B '. CHECKLIST Property Address: 58 SETH GOODSPEED OSTERVILLE,MA 02655 Owner: LILLIAN REICHERS Date of Inspection: 7/10/02 Check if the following have been done. You must indicate "yes"or"no"as to each of the following: Yes No , X _ Pumping information was`providediby the owner;occupant,or Board of Health �y I X Were any of the system comperients:pumped out in the previous two weeks? X Has the system received normal flows in the previous two week period ? X Have large volumes of water'been introduced to the system recently or as part of this inspection ? X _ Were as built plans of the system'obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? k ` ai X _ Was the site inspected for signs of break out t X _ Were all system components,excluding the SAS, located on site'? X _ 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 ? X _ Was the facility owner(and.occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems " t ' The size and location of the Soil Absorption System (SAS)on the site has been determined based on: w Yes no y X _ Existing information. For example`a plan at the Board of Health. X _ Determined in the field(if any of the failurecriteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] { �I :l 0" „ t41ti;. ' `�F k ' Page 6 of 1 9 x OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE'SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C =SYSTEM INFORMATION Property Address: 58 SETH GOODSPEED OSTERVILLE,MA 02655 Owner: LILLIAN REICHERS Date of Inspection: 7/10/02 y; FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 2` Number of bedrooms(actual): 2 DESIGN flow based on 310 CNIR EQ03-(for example: 110 gpd x#of bedrooms): 220 Number of current residents: 0 Does residence have a garbage grinder(yes or'no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes`or no):'NO', Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)):tea- 00 Sump pump(yes or no): NO " ' v i — 1 ?/060 Last date of occupancy: 6/1/02 COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CM13,15,.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank presenf(yes.or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records t �. Source of information: n/a Was system pumped as part of the inspecticn,(yes or no): NO If yes, volume pumped: n/agallons-;How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,.soil absorption system _Single cesspool _Overflow cesspool _Privy S _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 fi om system owner) ,xi _Tight tank Attach a copy of tl;e DEP approval Other(describe): n/a 3a, li Approximate age of all componedt's;!date installed(if known)and source of information: 25 YRS BY OWNER Were sewage odors detected when arriving at the site(yes or no): NO ,A A Page 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 58 SETHxGOODSPEED OSTERVILLE, MA 02655 Owner: LILLIAN REICHERS Date of Inspection: 7/10/02 s BUILDING SEWER(locate on site plan) , Depth below grade:20" Materials of construction:_cast iron —40 PVC Xother(explain): 20 PVC Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 14" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is ale confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 1000G L 8' V.H 5,7" W.4'.10"" Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: 0" Distance from bottom of scum to'bottom of outlet tee or baffle: n/a 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.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP:_(locate on site plan) Depth below grade: n/a ,Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a 1 Distance from top of scum to top ofoutle?tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a ''y Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, n/a Y 'Page 8 of l l + OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 58 SETH GOODSPEED OSTERVILLE,MA 02655 Owner: LILLIAN REICHERS Date of Inspection: 7/10/02 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day4f f Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX: _(ifgprgsent must be opened)(locate on site plan) Depth of liquid level above outlet invert: n/a . 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.): n/a w PUMP CHAMBER: _(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a 4w t sL , .. R Page 9 of OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 58 SETH GOODSPEED OSTERVILLE, MA 02655 Owner: LILLIAN REICHERS Date of Inspection: 7/10/02 SOIL ABSORPTION SYSTEM(SAS): X(locate on site plan,excavation not required) If SAS not located explain why: n/a YP 000 GAL 6' X 6' ` leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a ; leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a ' innovative/alternative system Type/name of technology: . n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. SYSTEM SHOWS NO SIGNS OF FAILURE. PIT HAD I' OF LIQUID IN IT AT TIME OF INSPECTION.STAIN LINES INDICATE PIT HAS NEVER HAD MORE THAN 2' OF LIQUID IN IT. BOTTOM IS AT 8 FT. CESSPOOLS: (cesspool rm1Wbe,pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a i N 1, Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of'hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a 4 Page 10 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART C SYSTEM INFORMATION(continued) Property Address: 58 SETH GOODSPEED OSTERVILLE,MA 02655 Owner: LILLIAN REICHERS 4: Date of Inspection: 7/10/02 SKETCH OF SEWAGE DISPO SAL,SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. .r Ark I S ;x a AC P y 4 {" 3 i' s to 4 , Page I I of I I ' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 58 SETH GOODSPEED OSTERVILLE,MA 02655 Owner: LILLIAN REICHERS Date of Inspection: 7/10/02 SITE EXAM _Slope _Surface water _Check cellar _Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record- If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavafors; installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: HAND AUGER- 12+ FT. 4\ r. _LO=CATI N SEWAGE PERMIT NO. C 2S +VILLAG4L J�kh A ®, INSTA LL R'S NA El & ADDRESS B U I-L D E R ORif07 N ER IAf DA E ERMIT ISSUED i2,- 30 DAT E COMPLIANCE ISSUED �� �� ~ i ` - ii .. .r, ��a. V v#:i�d e .r 'r��`'. -- s;. ^ � �l i;� ` '� .� �� THE COMMONWEALTH OF'MASSACHUSETTS BOARD 0 A - Application is hereby'made for a Permit to Construct e,<6_r _Repair an Individual Sewage is osal Syst. ... ...... .... .. ........... ... . .......... /41e ------------- Seepage Pit N( C4-------------------- Total leaching area------------------sq. ft. Other Distribution' box Dos ng tank Z eng tank 1) The undersigned agrees to install the aforedescribed Individual Sewage Disposal System iii'accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system.in een is operation until a Certificate of Compliance has been issued by the o rd f he�alth Date Date Date THE COMMONWEALTH mrMAssAc*uSsrrs BOARD --------------'--''--------'----'''------------------- No.•--•-------------•----•- FE, 6. �/.................. THE COMMONWEALTH OF MASSACHUSETTSBOARD OF HEALTH .....!` `. ' Appliration -for 11!ipoiiaf Workii C otmtriartion Vanift Application is hereby'made for a Permit to Construct (,) o�Repair ( } an Individual Sewage Disposal System at:� -�.�' ,/� �,.r'''• �,-sir' ` Location-Addresss ./ ,// or Lot No. /' f L "f+ i r s. Z.—t_lt!": . ....................................................---------------•............................................ ...................•-----•---•------.....-•-------••------------•..................--...•------- ��'� Owner i Address'/ f, Installer // Address d Type of Building Size Lot.... feet Dwelling—No. of Bedrooms--------!�--------------------------------Expansion Attic ( ) Garbage Grinder ( ) Gam, Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Other fixtures .! r --" -------------------------------------------------- --------------- -------------------------------------------------------------------- W Design Flow....._...._.`.._fC......................gallons per person per day. Total daily flow_.-_-_-______---_-.'__n_..�....--...gallons. WSeptic Tank—Liquid capacity'' . gallons Length---------------- Width-,---------- Diameter................ Depth._._----_--. x Disposal Trench—No- ---------------:=_Width------------- --a.- Total'Length-------------------- Total leaching area--------.-----------sq. ft. Seepage Pit No.Z_"__(Ar) :................... Total leaching area------------------sq. it. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by------------- ............................................................ Date---------------------------------------- Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water...----.---..--.--.----. G14 Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------ 9 -----------------------------------------------------------------------------------------------------•------•--------•---•----------------------------------- DDescription of Soil------------------•----••-•---•------------------- -•-------•-------------•-----------------------------•-•------•--•-------------- ----_---------------------- �4 U ---------------•---•------------•------••-•----------•-----------••--•----•--•-•--•---•-•-----------•-----------•------------------------------------- --•-•--•---•--------------------------------- W ----•-•-----------------------------------------------••---------.------•---------------------------------------------------------••--------•------------.----•-----------------------•---.-----•------ UNature 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 hoard of health. / � -------- T Dale ------- Application Approved By..._....��.__f�-------------------------------------------------�---------------------- - ��Date Application Disapproved for the following reasons-------------'--_--.---------_---.------------_--------.----.-•---------------------------- --•-----•----------- --•---••-•---•---••-------••-------------•------------------------------------------•--•---•-•---•------.............----•-•-------•---------------•--------------------•------------------------------- Date PermitNo...... ------------------------------------ Issued.- _---------------- ................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 61 . .................................... �rrt�f tr�tr of ITIOutplitturr THL&IS TO CERTIFY, That the Individual Sewage Disposal System constructed (-�`) or Repaired ( ) by..........f'-...... ";r ,. •,lam-^ _ = ' f ...................................�-•.r ' .-.--. __ . Installerat -- --=' :/, -- .•...r�.f��- has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No----- - _________________ dated..--....�. _f/-................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1 No...lrr.. ..�---- FEE.".. ................. �i����tt1_ �rk,� C���t�tr�trtilaitr�ler�ttt Permission is hereby granted_____ : s}.r... =- f to Construct ( )-or Repair ( ) an Individual Sewage Disposal System� ---------............................................ / " Street as shown on the application for Disposal Works Construction Permit NZ.l --------- Dated/—------3l-„----7--__-_--_----- 3 ---------------------------------------------------------------------------------•-----------......... r Board of Health DATE-----------�--- --�----- ------ /--1-------------------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS a i i 1j10 Q EGG.,4 v LA Taw i2. t or ^ A w I -1a 100 :k c.Ecz►��1�� PLo�T' P� /�,�, LOGAT'iU+-i T 1--i A i T i-1 i= u CA,-�PL-e'S W iTi4 Ti-1i_ Si DE Li'-1� At.,,--> SET13AC-4 �.'i-4t:i2cNic+�Ts Oi= Ti1i� G 'TOW►J or- -BA2K] AZLE-n i_AW:) 60v2T RllAW 3V-7 B IS.XT lr+Z �.. I�i Y i= t•�i G tZEGt5;LiZ D i_h."00 SUZvatiotLS T i-115 V L-A 1-1 I S Q 0T 13AS F---v Utz Ai,l US'TtQVZ L.LG a MA S5. IWSfv �Ni 'SU2�/ y' !�- Ti1C C:r=i=�ciS �ii1Ga.Jl:CJ A�'�LIG/�.1�1�" t c:. u,°(:- J Tac /Vl,uL Lo'T- L.tI-AiB, 7 ssoe Job: Amy Rose Sager 58 Seth Goodspeed's Wray TradeMark Professionals Osterville, MA 02655 Proposed i=inished Besemmnt Mike Baker 78 Bridle Path Marstons Mills, MA 02648 � 508-717-2982 trademarkprof@comcast.net seos oew� sesenn assvznaoo 00 Bees° =s sn ,-1Y D a Shower a �1v i9 M M �MM z ��Z/ £'� ssoe oe W N M r� - ..8/ 0-.9 m ' Bathroom r _ ..9 I./6 8-.£6 O00 u 8/ L L M 1st Floor Level Hallway from Kitchen to the Garage,Backyard&Basement 890E co Ncm ti r m N --10L 99011 Closet/Storage:. In sss£ Walls..2x4 w/.PT Plates R-13 FGL INS w/Vapor Barrier 1/2" Drywall'o•n Ceilings & Walls HRV Air Exchanger FanTech Model #VH704 Open Door way toEgress Window WellCraft Mo_det#2062 w/cover Egress Finished Area 1040sq. '- _ _ �. Window co Living Room Louvered Door& \ _ Open Vents For Furnace OO e— Office . .18/£ 9_ b 6 ti r. CD O CV . e- (V. lie0 _ Strorage/Utility Room a W Job: Amy Rose Sager - TradeMark Professionals - 58 Seth Goodspeed's Way EXISt111 Osterville, MA 02655 g First Floor Mike Baker 78 Bridle Path Marstons Mills, MA 02648 508-717-2982 trademarkprof@comcast.net 990E BATH M . 8'-8" x 8'-8" EIK Kitchen BEDROOM 11'-11" x 10'-7" o 999Z 999ZCo ` N a sCC _ w - 999Z 999E *. GARAG E BATH 19'-1Off x 13'-T' 9'-2" x 61-311 . BEDROOM FAMILY 13'-0�� x 15'-10" 13'-0" x 16'-6" I 00Co W N 0906 990E �-sue:-,•,�..,,_„r - - T.O.F.f EL.= 64.5'± FINISH GRADE OVER D-BOX= 62.8'f FINISH GRADE OVER CHAMBERS = 62 OVER SYSTEM .5' 3/4 TO 1-1/2 DOUBLE WASHED- 63.0' GENERAL NOTES � SLOPE @ 2% MIN.PROVIDE EXTENSION RISER ,-REMOVABLE WATER-TIGHT COVER OVER STONE TO CROWN OF PIPE 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION WITH COVER OVER INLET & RISER TO WITHIN 6"OF FINISHED GRADE 4" SCHEDULE 40 PVC INSPECTION PORT WI1 H ACCESS METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL FINISH GRADE OUTLET TO WITHIN 6" OF F.G I ° 2" OF 1/8"TO 1/2" DOUBLE WASHED F.G. OVER TANK EL. - 63.0't 5" DIA. OUTLETS) MIN SLOPE 1 /° BOX TO F.G. (SEE NOTE 21) STONE OR GEOTEXTILE FILTER FABRIC CODE AND ANY APPLICABLE LOCAL RULES. @ FND. EL.= 63.5 ± _ r 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE PLACE RISERS ON ALL DESIGN ENGINEER. 9" MIN. TOP OF SAS= 60.00, CHAMBERS WITH /-PROPOSED 4" V 9 MIN. �{ 3. 4" SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SCH 40 PVC 36" MAX. 59.00' 36" MAX. INLET PIPES TV 6 OF \ SYSTEM UNLESS OTHERWISE NOTED. 59 BREAKOUT EL= .50 I FINISHED GRADE SEWER PIPE -f _ PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT, THE PROPOSED FIINISHED GRADE SHALL NOT BE LESS THAN 6" 3 2" DROP MIN 3" DROP MAX 3„ 9„ MIN si.oNE r 19% L 60 t o ELEVATION = 59.50' FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE SAS. UNLESS A � o 0 13" � 4' PVC IN FROM �-JOINTS (TYP.) �w� 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF 14' SEPTIC TANK � 4" PVC OUT TO = = = O o oo O a THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. CONTRACTOR TO PROVIDE UJ LEACHING FACILITY O� r- r-� r-� o Q Qo c7 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. SPECIFIED DROP BETWEEN j 12" 6" I o00 �� I___J U �� L o o ✓/ 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. INLET AND OUTLET CONTRACTOR CONTRACTOR SHALL OUTLET TEE ! 59.37' MIN. 5j9.20' 2' °° o o 0 SHALL VERIFY SIZE 48' VERIFY CONDITION OF \ 00 o0 00 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION OF EXISTING TEES GAS BAFFLE 6" CRUSHED STONE o 0CD 0 0 0 o FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY o o 0 NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE 4 0 I AND DESIGN ENGINEER. ----_I 8.5' (TYP) _i 4.0' 1 1 4.0, ( 4 0. 3OUTLET DISTRIBUTION BOX 0 4.83' 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. BENCHMARK ELEVATION OF 63.01, TO BE INSTALLED ON A LEVEL STABLE 25.0' (TYP.) ESTABLISHED ON A NAIL SET IN UTILITY POLE AS SHOWN ON PLAN, BASE. FIRST TWO FEET OF OUTLET GROUNDWATER ELEV.= < 51 .50' 12.83 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION PIPES TO BE LAID LEVEL. /5700'. THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT EXISTING 1 ,000 GALLON (CONCRETE SEPTIC TANK 2 - 500 GALLON H-20 CHAMBERS 5' MIN. CHAMBER END VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES CROSS SECTION VIEW TYPICAL CHAMBER PROFILE TO THE DESIGN ENGINEER. P I I 1 t t"�-20 D RIP! 1 ( N� P COX DETAIL C H A E R D ET.A I LS 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. NOT TO SCALE NOT TO SCALE NOT TO SCALE �+ ! - 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING S T T P IT n A.TA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM MAP 146 PERC NO., y 15728 APPROPRIATE AUTHORITY. NOTES: LOT 55 � -or 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED t 0 INSPECTOR: Donald Desmarais, RS_ UNDER MORE THAN 3 FEET OF COVER OR LOCATED UNDER PAVEMENT, DRIVES, OR 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF 1 ' �r EVALUATOR: Michael Pimentei, EIT, CSE TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING. EACH SEPTIC SYSTEM COMPONENT. N890 24' 10"E �' ., C.S.E. APPROVAL DATE: Oct. 27, 1999 SOIL \\ � 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. 2.) CONTRACTOR SHALL VERIFY CONDITIONS IN THE LOCATION OF 120.00' / •� t ` _ _ uuu DATE: July 23, 2018 THE PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST p 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE PIT DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL ZONE 2 /f/ a I TEST PIT# 1 MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. SHED I � ELEV WATER < 51.50'?3 ELEV TOP = 63.00' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, 00, FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). = 3.) ENTIRE PROPERTY IS LOCATED WITHIN THE GROUNDWATER � r 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN PROTECTION OVERLAY DISTRICT & THE ESTUARINE ZONE WATERSHEDS. J I < 2 min./inch PERC RATE= SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. 4.) SWING TIES SHOWN ON THIS PLAN ARE PROVIDED ONLY AS A L? E 0 „_ t, '� I i DEPTH OF PERC= 36"- 54" 16. PROPOSED PROJECT IS LOCATED WITHIN: COURTESY FOR THE INSTALLER. INSTALLER SHALL VERIFY SWING TIE RCG1 INF - MEASUREMENTS IN THE FIELD PRIOR T O INS I ALLiNG THE SYSTEM. `c���' U �'/ - X < / iI _I ASSESSOR'S MAP 146 LOT 63 N _, ., f ��� � -�'-_° 1.,,, TEXTURAL CLASS. i - CONTRACTOR SHALL NOTIFY ENGINEER IF MEASUREMENTS APPEAR TO BE e/ ��'� -. (c - r� f ^ i; fj OWNER OF RECORD: AMY ROSE SAGER INCORRECT. / Q 22' OAK L • I 01' 63.00' ADDRESS: 58 SETH GOODSPEED'S WAY • ° LOC U - U _-., - Fill . � (1 ..--..- OSTERVILLE, MA 02655 •56 cf•f 6" 62.50' I ; - `� ,\ of A/E Loamy Sand FEMA FLOOD ZONE X 10Yr 5/1 62.00' COMMUNITY PANEL# 25001CO015C 12 I GENERI4TOR � ' North I 17. DEED REFERENCE: L.C.C. #1941138 `, �. F� Loamy Sand EXISTING LEACHING PIT TO BE PUMPED A" \ ; PPondg 18. PLAN REFERENCE: L.C. PLAN#32225-C `•..ram , 10Yr 5/6 `' FILLED WITH CLEAN SAND &ABANDONEr' ) 1 36" 60.00, 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. I EXISTING „ }• ;� 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY 2-BEDROOM - (• `� % ='� a 54" 58.50' FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY off DWELLING DECK +' • • �• off 'f.7- - k Wit FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. t \ t• •; %• 1 p t ! Med.-Coarse Sand 21. A 4" PERFORATED SCH. 40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A \ _ 2.5Y 6/6 DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A FFE =65.5' \ Loose REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. 1 \ � LOCUS PLAN 22. OWNER /APPLICANT I CONTRACTOR SHALL BE RESPONSIBLE TO OBTAIN ANY AND ALL REQUIRED PERMITS AND APPROVALS FOR THIS PROJECT. SCALE: 1" = 1000' 3 0 138" 51.50' w o cWr, No Mottling, Standing or Weeping Observed m Z TOF =64.5' m DESIGN DATA ` 1011 �' °� LEGEND m1-.01, � DECK ,� PERC NO. 15728 I MAP 146 HC-2 / 50xO' EXISTING SPOT GRADE "' o GARAGE I INSPECTOR: Donald Desmarais, RS o 0 1 , LOT 63 '�y NUMBER OF BEDROOMS 2 (3 MIN. PER TITLE 5) ./ 16,066 f S.F. �_' 1 SHED MAP 146 EVALUATOR. Michael Pimentel, EIT, CSE ------ 50 -- EXISTING CONTOUR W M \ SLAB =63.9' r';; DESIGN FLOW 110 GAUDAY/BEDROOM C.S.E. APPROVAL DATE: C PROPOSED CONTOUR ITl m �� / LOT 62 DATE: July 23, 201EOct. 27, 1999 M Z 1 1 I / TOTAL DESIGN FLOW 330 GAUD/AY 63 - DESIGN FLOW x 200 % = 660 GAUDAY TEST PIT#: 2 F501 PROPOSED SPOT GRADE o O \ (2) USE EXISTING 1,000 GALLON SEPTIC TANK ELEV TOP - 63.00' EXISTING OVERHEAD UTILITIES Q 2.8' -12.1' ELEV WATER = < 51 5D' EXISTING WATER LINE o ❑(n 1 l 1 I HC-1 --- - ; :..gyp 2;.. ..:' �; PERC RATE _ r PROP. H-20 ■ N -� "D-Box" INSTALL 2 - 500 GAL. CHAMBERS w/ AGGREGATE TEST' PIT LOCATION Rl I i G o DEPTH OF PERC = m I , I��_- 63 SIDEWALL CAPACITY � ❑ � I � i� � � TEXTURAL CLASS. 1 EXISTING 1,000 GALLON SEPTIC TANK O N PROPOSED 2-500 GALLON H-20 (LENGTH + WIDTH) (2 SIDES) (2' HIGH) (0.7.4 GPD/S.F.) = GAL/DAY 1 I \IN, �' I _ / °y� LEACHING CHAMBERS (25.0' + 12.83') ( 2 ) ( 2' ) ( 0.74 GPD/ S.F.) =112.0 GAUDAY PROPOSED 4" SOLID SCHEDULE 40 PVC PIPE Y \ - PROPOSED H-20 DISTRIBUTION BOX 17 OAK'- 0`< WOOD POST BOTTOM CAPACITY Fill 63.00' ❑ I DIRT DRIVEWAY ° iO O (TYP (LENGTH x WIDTH 0.74 GPD/S.F. = GAUIDAY I \ D y ( ) (LENG ) ( ) 6" 62.50' PROPOSED 500 GALLON H-20 LEACHING CHAMBER \ \ \ 1 �� (25.0' x 12.83') (0.74 GPD/S.F.) = 237.4 GAUDAY A/E Loamy Sand 1 BIT. DRIVEWAY / r I --� ✓ ` 10Yr 5/1 � ` l / ✓ � . ..o;. . - PROPOSED 4 PVC VENT PIPE; 12" 62.00' / - EXACT LOCATION PER OWNER TOTALS: r ` / 295 (4) -7 3 TOTAL NUMBER OF CHAMBERS 2 B Loamy Sand t � ) 10Yr 5/6 TOTAL LEACHING AREA 472.2 ;SQ.FT. REV. DATE BY APP'D. DESCRIPTION \ 1 \ \ i '14"/11" OAKS PROPOSED INSPECTION PORT TOTAL LEACHING CAPACITY 349.4 (GAL./DAY 36" 60.00 PROPOSED SEPTIC SYSTEM UPGRADE N BUSH (TYP) \ <\ \ \\ `6z- PREPARED FOR: �� _ _ _ _ CAPEWIDE ENTERPRISES !b Med.-Coarse Sand ` _ I , �y / C 2.5Y 6/6 LOCATED AT ` \ (TELEPHON Loose 95.00' _{_ 58 SETH GOODSPEED WAY S89' 24' 10 Benchmark "W OSTERVILLE, MA 02655 / Nail Set in U.P. - -- _ _ Elev. = 63.01' 138" SCALE: 1 INCH = 10 FT. DATE: J Approx. M.S.L. 51.50' SWING-TIES SCALE: 1"=20' \ / �61 _ 0 5 1020 40 FEET DESCRIPTION HC-1 HC-2 � -�___ No Mottling, Standing or Weeping Observed ��tH OF INgS. EDGE OF PAVFn>1FNr or JOHN L oyGN PREPARED BY: CORNER OF STONE (1) 24.5' 15.7' RESERVED FOR BOARD OF HEALTH USE CHURCHILLJR. IM4 JC ENGINEERING, INC. CORNER OF STONE (2) 37.2' 21.6' REBECCA LANE u CIVIL C .41807 2854 CRANBERRY HIGHWAY (40'WIDE LAYOUT) G1 EAST WAREHAM, MA 02538 CORNER OF STONE (3) 46.6' 43.3' SITE PLAN 508.273.0377 CORNER OF STONE (4) 37.3' 40 6' SCALE: 1" = 10' Drawn By SJI Designed By:SJI Checked By: MCP JOB No.4280