The URL can be used to link to this page

Home My WebLink About0047 SHARON CIRCLE - Health 47 SHARON CIRCLE OSTERVILLE A= 122 - 151 TOWN OF BARNSTABLE LOCATION '41 5"(A A;J� SEWAGE# A®(5 1 I y VILLAGE__dC ' 9/ASSESSOR'S MAP&PARCEL �6 INSTALLER'S NAME&PHONE NO.CAPEw%-DF— VZmAsr-i 17 SEPTIC TANK CAPACITY D o LEACHING FACILITY.(type) (size) ,30 e / r m NO.OF BEDROOMS OWNER R69M—C R asA-rA PERMIT DATE: (0 >)0( 5 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility £ -XA%4 a 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) Feet FURNISHED BY 10A&9jaz31D,6 i�d J SAc4r-,,. ce LVf RE0, 'F tloosC Y ,4°biC� � a� � n17 -b ;vt i `-e f - f yy 1 No. 4'� s L Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 010plitation for Disposal 6pstem Cunstrurtion Permit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. i4q 5t"kaj Owner's Name,Address,and Tel.No. F-4BeR-T +41,4JA) PLO SA-r Assessor's Map/Parcel 42 Nt4X4 dWJ4;Zj\j 41) Aft l JA-(A Installer's Name,Address,an e�,NNoo. — 'rZ e f%71 Designer's Name,Address,and Tel.No. 509-a73 Type of Building: Dwelling No.of Bedrooms 3 Lot Size 31,4�sq.ft. Garbage Grinder( ) Other Type of Building $ZCS'li)&7L;MA<,, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 y gpd Design flow provided `Tit►- gpd Plan Date 5 b 19— AO 15 Number of sheets Revision Date Title q•7 6kfA:R Q$) `U le Size of Septic Tank j r00 C—jolfL, Type of S.A.S. g5w) (W&tA,0*J Description of Soil (/�(E�1[[s;� S (0 i 7 e�f/!c C4+111j Nature of Repairs or Alterations(Answer when applicable) u6ee off. Isn't, I 000 dn�)-46ari, 17,100K TO Il)t.10 t4 --;Ly 0 -661C TM �� 4-are -TOO 60&L O.V L49"[VQ Ck_ 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 Health. t Signed Date .7 v ,)LO15 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued �No. V �" / Fee -M THE COMMONWEALTH-OF MASSACHUSETTS Entered in computer:1 Yes ' PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS f/ JtlYlcatIDYC�foC Mispsal 6pstem Construction Permit t Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) Complete System ❑Individual Components q.- Location Address or Lot No. C f j s'jk.'aj C,(��'j{,� 65T Owner's Name,Address,and Tel.No. k} PR6ee -T -t-4tj&) RO SA-+ A sessor's Map/Parcel �.'� ? [.f 8�1,( � p� �J es ,( 144A i f Installer's Name,Address,an el.No. 50%"4 T7-$'%7j Designer's Name,Address,and Tel.No. _50$-.1'7'3..p11-1 ' d4 EIIJIDE 1> Ef C.t✓C. 7L 6ctW� t LNG l Go ST Pam" �8 E C Type of Building: Dwelling No.of Bedrooms Lot Size 3 `t' 7 sq.ft. Garbage Grinder( ) Other Type of Building RCSI D&%.MA4. No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33 e) gpd Design flow provided 3 q-( 1 3 , gpd Plan Date J- 1 S A O 15 Number of sheets l Revision Date r Title 4'7 6jff,4mcwj 6fk 0,5 lse ¢ NSize of Septic Tank ( ,boo GOC r Type of S.A.S. �3 6go (Vk(Ao0*J Descriptionnpf Soil kk5ln u, �,.�, t / Se5 jP(,4-t Nature of Repairs or Alterations(Answer when applicable) U.5e 6)� J-CY'tA,<-, l 00[) dty(, LY 7-0 mtELt) R -ao b-$oK Th y 50 o 6epk L.0pi !.t`w%cAlQ Gg0.e � 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 Health. Signed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued ------------------- ----------------------------------------- -------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(X) Upgraded( ) Abandoned( )by C APEwm E a)TwA G&r t.L c. at 477 S44R-W &Q . DS7 DWI LLL6 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. Z U 15� dated Installer C�P� (b >�I'�Q��Q( GLL. — Designer 'TG aJ&(kX5aG&49;r! � #bedrooms Approved design flow A 320 gpd The issuance of this permit shall not be construed as a guarantee that the system will n'�c t'o`,�as designed. Date (p' I Inspector t/ Vi,- � O ---- -------- ---- --------- ----- ----- ---------------------- --- - -------------------------------------------------- No. V C /0 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstetn Construction Permit Permission is hereby granted to Construct( ) Repair(}C) Upgrade( ) Abandon( ) System located at q77 zd �n+� 61 -Rut Lt-445 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date (� Approved b r►'l��/ / '"� _ � PP Y 47didJ V. VV I/VVI Town of Barnstable F Regulatory Services , Thomas F. Geiler,Director ' BARNam Public Health Division 030. Thomas McKean,Director 200 Main Street, Hyannis,MA 0260.1 Office: 508.862-4644 Fax: 508-790-6304 Date: io"2-) Sewage Permit# 10 VS IK Assessor's Map/Parcel 12 Z 151 Installer& Designer Certification Form Designer: '3G E%1,gt0ee%,e0S. Tv-G_ Installer: Ca 00-wide. EnterPr("s e-5, L `C, Address: Z�5y Cronbe•;cv H(�hw� Address: 153 Go�nmeru'QI StCee+ Eas{ w6re.hAm Hft 62 3b HQsV►Pee, Nft 02.6 y q On,��- D GaQew�de- �rcterQ�c ses was issued a permit to install a (date) (installer) septic system at based on a design drawn by (address) �L L-O.J erinC) �'T'nG, dated Nay la, 2�(5 (designer) V 1 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. Stripout (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. Stripout(if req ' nspected and the soils were found satisfactory. � ,N OF �C �c Joh!N L, , CMURCrULL 3 , J R. W Installer's Sid Lure) ^^ No CIVIL 41537 AL esigner. s Signatur (Aix esi er s Wmp Here) PLEASE RETURN O BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. q'.11ir ii,im;klt+gicic.niliwtiun lunn.doc ` i Y. Town of Barnstable of Regulatory Services Bern ZHE T c Thomas F. Geiler,Director ,omerica'ity Public Health Division I I BARNSTABLE, 9� MASS. � Thomas McKean, Director 2007 1639. e,`0 200 Main Street iDtFp�( Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 April 18, 2014 Sent Via Certified Mail— 70121010 0000 28513528 Robert and Ann Rosata 48 Mary Chilton Rd. Needham, MA 02492 As of October 1, 2006 a new rental registration ordinance was put into affect requiring all property owners of rental units to register their rental units with the Town of Barnstable Health Division. According to our records, you own the rental property at 47 Sharon Circle, Marstons Mills, MA (Map-Parcel: 122-151). Enclosed is an application. Please use a separate application for each rental unit you own. Should you need more applications, they are available online at www.town.bamstable.ma.us. Go to the Health Division page by looking in the Department Menu. There is a link to the Rental Registration information on the Health Division page. You may print out as many as you need, and return them to the Health Division with the appropriate 2013 fee of$90 included. This must be completed within (14) fourteen days of your receipt of this letter. Failure to comply with this ordinance will result in the issuance of a non-criminal ticket citation in the amount of$100. Each day of non-compliance is considered a separate offense. Should you have any questions, please feel free to call 508-862-4644. Thank you in advance for your cooperation. Sarah Donnelly Division Assistant Public Health Division Direct#508-862-4072 I I Health Master Detail Page 1 of 1 Logged In As: TOWN\miorandd Health Master Detail Friday,April 18 2014 Application Center Parcel Lookup Selection Items } Parcel Septic Perc Well Fuel Tank Parcel: 122-151 Location: 47 SHARON CIRCLE, MARSTONS MILLS Owner: ROSATA, ROBERT M &ANN E Business name: Business phone: i IRental property: ❑ Deed restricted: ❑ Number of bedrooms : 0 Contaminant released: ❑ Fuel storage tank permit: ❑ Save Parcel Changes Return to Lookup Parcel Info Parcel ID: 122-151 Developer lot:LOT 45 i Location:47 SHARON CIRCLE Primary frontage: 125 Secondary road: Secondary frontage: Village:MARSTONS MILLS Fire district:C-O-MM Town sewer exists at this address:No Road index: 1474 Asbuilt Septic Scan: 122151_1 Interactive map: ' y3rl,�9 Town zone of contribution:GP (Groundwater Protection Overlay State zone of contribution:IN District) Owner Info Owner: ROSATA, ROBERT M & ANN E Co-Owner: Street1:48 MARY CHILTON ROAD Street2: City:NEEDHAM State:MA Zip: 02492-1138 Country: Deed date:3/11/2010 Deed reference:24413/340 Land Info Acres: 0.86 use: Single Fam MDL-01 Zoning:SPLIT RC;RF Neighborhood: 0105 Topography:Level Road:Paved Utilities:Public Water,Gas,Septic Location: Construction Info Building No Year Buil Gross Area Living Area Bedrooms Bathrooms i 1982 2588 1056 13 Bedroom 2 Full Buildings value:$83,200.00 Extra features: $33,700.00 Land value: $122,300.0 j 1. http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=122151 4/18/2014 �n , Town of Barnstable P# " Department of Regulatory Services M �Ag 'Public Health Division Date �; `� / Z 0 JTP Arfl6.39.A�a� 200 Main Street,Hyannis MA 02601 r t p L -Date Scheduled d e Q<) t4 Tith r °I 1 rsr Soil ,Suitability Assessment for Sew e D7k: ®s l Performed `pfMeek VCt e�I7 t CSE Witnessed By: kv• LOCATION& GENERAL INFORMATION Location Address i Lv� 5 ,I��N `{f��,�� Owner's Name Q©� -` Z Aotj _kp�TA -ITT l �l Address g (A,((A�.� C H(l.-i�b) �� C I Assessor's Map/Parcel: ' Engineers Name C°r4t�tzllDe— E�;fJ5 C Z G �► NEW CONSTRUCTION REPAIR _L`_ C r✓h <��`''(� i Telephone# 5og-4?7•-S217 5 land Use S nn`yi�.FGt�mi t�/ �(uQ,Lf� Slopes(%) � � Surface Stones . � 508'27J 0377 Distances from: Open Water Body ft Possible Wet Area - ft Drinking Water Well ft Drainage Way — ft Property Line f® ft Other ft SIMTCII:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Ste- Q-Rac�ed Plan Parent material(geologic) r,U� Depot to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit FuCe Estimated Seasonal High Groundwater 7 �. 7 �f�$ D]Ct TE NATION FOR SEASONAL HIGH WATER TABLE Method Used: bIfQG 6 Se(vci FiUrl Depth Observed standing in obs:hole: y 7 In. DeptJt Itl 5011 InUtth9: Itt,. Depth to weeping from side of obs.hole: in, Groundwater Adjustment t[. Index Well It — Reading Date: Index-Well levol_ � Adj.Ihetor �, P Adj.Groundwater Level PERCOLATION TEST Dole tve %U aver Observation Hole# ( Tinto at 9" Depth of Perc Time at G" ' Start Pre-soak Time @ I o b�aw Time(9"-6")" End Pre-soak l Q: 4 M Rate Min./Inch Z Site Suitability Assessment: Site Passed t5 Site Failed: Additional Testing Needed(Y/N) Original! Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 1091 of wetland,you must first notify the. Barnstable.Conse>rvation Division at least one(I) weelc prior to beginning. Q:\8 EPTICU'ERCFORM.DOC DEL'P.OBSERVATION MOLE LOG Dole# t f z Depth from Soil Horizon Soil Texture Shcl Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. onsi tency %Gravel) �- 56 -72- 6 L S 72 -14Y MS 2.5`l DEEP OBSERVATION HOLE LOG Dole# Depth from Soil Horizon Soil Texture Soil Color+ Soil Other Surface(in-) a (USDA) (Munsell) . rs. ( , dilsWtengy,'%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil . Other Surface(in-) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%O DEEP OBSERVATION DOLE LOG Bole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stoam Boulders. Consistency. Flood Insurance Rate Map: Above 500 year flood boundary No— Yes _V Within 500 year boundary No Yes Within 100 year flood boundary No.✓ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervio s material exist in all areas observed throughout the area proposed for the soil absorption system? TP-S If not,what is the depth of naturally occurring pervious malarial? Certification I certify that on "Z 7�9� (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 a d exper' a described in 10 CMR 15.017. Signature Date /6-13 Q:\S EPTiC\PERCPORM.DOC AsBuilt Page 1 of 1 LOCKI ON SEWAGE ' PERMIT NO. VILLAGE INSTALLER'S NAME i A0D It[5S . I! UIL OR O N DATE PERMIT. ISSUED DATE COMPLIANCE ' ISSUED /y zl- 1 . r6 7' z ,r http://issgl2/intranet/propdata/prebuilt.aspx?mappar=122151&seq=1 4/23/2015 r. Town of Barnstable Barnstable Regulatory Services Department KAM Public Health Division i639• ♦� 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Second Notice Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2851 4105 July 9, 2014, 2014 Mr. & Mrs. Robert Rosata 48 Mary Chilton Road Needham, MA 02492-113 8 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5. . The septic system located at 47 Sharon Circle, Osterville, MA, was last inspected on 3/13/2014 by Ricky L. Wright, a certified septic inspector for the State of Massachusetts. - The inspection of the septic system showed that the system "Fails"under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: 0 Backup of sewage into facility or system component.due to overloaded or r clogged Soil Absorption System, the system must be repaired. . You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. ER OF THE OARD OF HEALTH c t - Thomas McKean; R.S. CHO Agent of the Board of Health • Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\47 Sharon Cir Ost 2014.doc Town of Barnstable Barnstable Regulatory Services Department edcac'' 6A ASS.LE. .q MASS. public)Health Division T M 0 i639• �� , pTE°M"`a 200 Main Street,Hyannis MA 02601 2007 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2851 2590 U� April 10, 2014 Mr. &Mrs. Robert Rosata � 48 Mary Chilton Road Needham, MA 02492-113 8 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5. • The septic system located at 47.Sharon Circle, Osterville, MA, was last inspected on 3/13/2014 by Ricky L. Wright, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Fails"under the guidelines of the 1995 TITLE 5 (310-CMR 15.00) due to.the following: • Backup of sewage into facility or system component due to overloaded or clogged-Soil Absorption System, the system must be repaired. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification.' Failure to repair/replace the septic system within the deadline period will result in future enforcement action. RDER;OF TH BOARD OF HEALTH , L Thomas McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\47 Sharon Cir Ost 2014.doc �� F�,• ter- r Town of Barnstable Barnstable Epp THE Tp� , Regulatory Services Department 1 wiml1 + BARMASS.NSUAB . public :Health Division T MASS. �q. . i639• �e Prfa MAC b 200 Main Street, Hyannis MA 02601 zoos Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2851 2590 April 10, 2014 Mr. &Mrs. Robert Rosata 48 Mary Chilton Road Needham, MA 02492-113 8 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5. • The septic system located at 47 Sharon Circle, "axoiv MA, was last inspected on 3/13/2014 by Ricky L. Wright, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Fails"under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to overloaded or clogged Soil Absorption System, the system must be repaired. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. , Failure to repair/replace the septic system within the deadline period will result in f iture enforcement action. RDER OF TH BOARD OF HEALTH Thomas McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\47 Sharon Cir Ost 2014.doc 4/10/2014 Parcel Detail /o'�'fig �BMNSTAOI) �p�,� hti55 }*�.� I � t � � �, -•# ,yam.-,� i Logged in As: ar el Detail Thursday, April i0 201.4 Parcel Lookup Parcel Info Parcel ID j122-151 I Developer Lot O 45 I Location 47 SHARON CIRCLE ( Pri Frontage '1257-1 I Sec Road sec Frontage I village MARSTONS MILLS I Fire District GO-MM �I Town sewer exists at this address No Road Index '11474 Asbuilt Septic Scan: a Interactive Map �. 122151_1i Owner Info Co- Owner ROB SATA, ROBERT M &/� owner Streetl48 MARY CHILTON ROA� street2 g city NEEDHAM I state {MA Zip 702492-1138 country F I Land Info Acres 0.86 �f use [Single Fam MDL-01 � Zoning ;SPLITRC;RF � rughbd ,0105 Topography Level Road Pa\ted � _7. utilities Public Water,Gas,Septle I Location Construction Info _ Building 1 of 1 Year 11982 D Roof ----Wall Gable/Hip Ex Built Strct l Wood Shingle Living i Roof AC Area �1056 cover Asph/F GIs/Cmp Type±None Bed Style 'Ranch I wan ,Drywall Rooms 43 Bedrooms .� . Model'Residential Floor;CCarpet Rooms 2 Fuu Click for Building Detail Heatt_»�_•. - Total :. •.. d a.� �— Grade A erage I Type Hot Water Rooms ,5 Rooms Stories Heat Found- """��`"t"" 1 Story Fuel •Oii ation iTypical Gross `2588 Area _ Permit History Issue Date Purpose Permit# Amount Insp Date Comments Visit History http://i ssq l2/i ntranet/propdata/Parcel D etai l.aspx?l D=7778 1/3 � o ��. . �,r� ; 0 Commonwealth of Massachusetts . _ • F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-/Not for Voluntary Assessments M 8 47 Sharon Circle � /f"/ Q•D -�„adr O�' Property Address Robert&Ann Rosata //v A 0� - %/,✓ Owner Owner's Name information is Osterville Ma 02655 3/13/14 required for 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:When A. General Information- - - the out forms on n �I� on the computer, L.J use only the tab . I 1 Inspector: key to move your . cursor-do not... Ricky L. Wright use the return Name of Inspector ' key. B&B Excavation _. ,y Company Name - .14 Teaberry Lane., Company Address - Sandwich Ma :. ....02644.' City/Town State Zip Code (508)477-0653 S14595 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the:inspection: The inspection was performed based on my training and experience-in the proper function and maintenance of on site _.. sewage disposal systems. I am a:DEP approved system inspector pursuant to Section 15.340.of Title 5(310 CMR 15.000). Thesystem: . Passes- . . 0 Conditionally Passes ® _Fails Needs Further Evaluation by the LocalApprovingAuthority. 3/13/14 - .Inspector's Signature Date The:system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing,this inspection. If the system 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. - -- q vj t5ins•3/13_;: Title 5 Official Inspection Form:S surface Sewage.Disposal System Page 1 of 17. Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 47 Sharon Circle Property Address Robert&Ann Rosata Owner Owner's Name information is required for every Osterville Ma 02655 3/13/14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 47 Sharon Circle Property Address Robert&Ann Rosata Owner Owner's Name information is required for every Osterville Ma 02655 3/13/14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes.(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):. ❑ 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 47 Sharon Circle Property Address Robert&Ann Rosata ' Owner Owner's Name information is required for every Osterville Ma 02655 3/13/14 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 Y2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 47 Sharon Circle Property Address Robert&Ann Rosata Owner Owner's Name information is required for every Osterville Ma 02655 3/13/14 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•3/13 Titie 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts. .. _ f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form= Not for Voluntary Assessments °M 47 Sharon Circle Property Address:. ....... .... .. Robert &Ann Rosata Owner Owner's Name information is Osterville Ma 02655 3/1.3/14 required for every. page. City/Town State Zip Code Date oflnspectlon C. Checklist Check if-the following.have been done:.You must indicate":yes" or"no"as to each of the following: Yes. No El ® Pumping information was provided by the owner, occupant, or Board-of Health 0 0 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 1-1 ® this inspection? Z. 0..: Were:as built plans of the:system obtained and examined?(If they:were not.:,.:.. available note as N/A) N „ .Was the.facility or dwelling inspected for.signs of sewage back up? ® : ElWas the site inspected for signs of break out? ® 0. . Were all system components, excluding the SAS, located on site?. . ® 0 Were the septic tank manholes uncovered,:opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, - dimensions, depth of liquid, depth of sludge and depth of scum? 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: ® 0 Existing information. For example, a plan at the Board of Health.: 1:1 .. .Determined in the field(if any of the failure criteria related to Part C is at issue ® approximation of distance is unacceptable) [310 CM 15.302(5)] D. System Information . Residential.Flow Conditions: Number;of.bedrooms(design):;; 3;; - Number;of bedrooms (actual);; 3 DESIGN flow based on 310 CMR 15.203(for example: 1 10 gpd x#of bedrooms); 330 t5ins•3/13 ; ;;;; 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 �M 47 Sharon Circle Property Address Robert&Ann Rosata ` Owner Owner's Name information is required for every Osterville Ma 02655 3/13/14 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ®. No information in this report.) Laundry system inspected? ® Yes` ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 year usage d n/a 9 ( Y 9 (gP ))� Detail: Sump pump? F ❑ Yes ® No Last date of occupancy: current 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 47 Sharon Circle Property Address Robert&Ann Rosata 1 Owner Owner's Name information is required for every Osterville Ma 02655 3/13/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? El 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 47 Sharon Circle Property Address Robert&Ann Rosata Owner Owner's Name information is required for every Osterville Ma 02655 3/13/14 page. City/Town State Zip Code --Dat ection D. System Information (cont.) Approximate age of all components, date installed (if known nd:source of information: 1982 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >20feet Comments (on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in good working order no sign of leakage. Septic Tank(locate on site plan): 94. 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 gal. Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 47 Sharon Circle Property Address Robert&Ann Rosata Owner Owner's Name information is required for every Osterville Ma 02655 3/13/14 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 31" Scum thickness 1 Distance from top of scum to top of outlet tee or baffle over tee 2" Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? scours tick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appeared to be in working order,Tees present. Water level over outlet invert due to failed S.A.S. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene , ❑ other(explain): Dimensions: r 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-3/13 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 47 Sharon Circle Property Address Robert&Ann Rosata Owner Owner's Name information is required for every Osterville Ma 02655 3/13/14 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•3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 47 Sharon Circle Property Address Robert&Ann Rosata Owner Owner's Name information is required for every Osterville Ma 02655 3/13/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): 611 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-.- At time of inspection d-box is startin deterate it roo s roing to it. 0 O r 4��, '? Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ :No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): *if pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 47 Sharon Circle Property Address Robert&Ann Rosata Owner Owner's Name information is required for every Osterville Ma 02655 3/13/14 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.): At time of inspection leaching appears to be in hydraulic failure, water level is well above invert. ti Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to iniet'.invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 47 Sharon Circle Property Address Robert&Ann Rosata Owner Owner's Name information is required for every Osterville Ma 02655 3/13/14 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.): 4 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 assachusetts Commonwealth of M Title 5 Officia-1 n pecfiion Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M ' 4T.Sharqn Circle Property Address Robert :&Ann Rosata Owner Owner's:Name information is required for every Osteryille Ma 02655 3/13/14 page. Cltyfrown State Zip Code Date of Inspection, P. System Information.(cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage.disposal-system, including ties to at least-two permanent reference landmarks or benchmarks. Locate.all wells within 100,feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand.sketch in the area-below ❑. drawing attached separately . A } 0 . O 3 �,; f33',l, 3q .3 , t5ins•3/13 t Title 5 Official Inspection Form:Subsurface sewage Disposal system•Page 15'of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 47 Sharon Circle Property Address Robert&Ann Rosata Owner Owner's Name information is required for every Osterville Ma 02655 3/13/14 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: >12 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record j If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: . Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form . Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 47 Sharon Circle Property Address Robert&Ann Rosata Owner Owner's Name ` information is Osterville Ma 02655 3/13/14 required for every i page. CitylTown 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 r e y , t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION MAP PARCEL_.....b LOT � - TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A RECEIVED CERTIFICATION Property Address: 47 Sharon circle �,� (L5 MAR 2 3 2004 `, `" TOWN OF BARNSTABLE Owner's Name: Marion Bursaw HEALTH DEPT. Owner's Address: Date of Inspection: 3/16/2004 Name of Inspector: (please print) Patrick T.Sullivan Company Name: Ready Rooter Mailing Address: P.O.Box 371 Sandwich,MA 02563 Telephone Number: '-(508)88"055 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 15.000). The System: _Passes Conditionally Passes Needs Further Evaluation by the Local Authority Fails Inspector's Signature: �, Date: i c O y 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 DER The original should be sent to the system owner and copies sent to the 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. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 47 Sharon Circle Osterville Owner. Marion Bursaw Date of Inspection: 3/16/2004 Inspection Summary:Check A,B,C,D or E/ALWAYS complete all of Section D C. System Passes: have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the of Health,will pass. Answer yes,no or not determined (Y,N,ND)in the for the following .N"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank( metal or not)is structurally unsound,exhibits substantial m iltration or exfiltration or tank balm is' System will pass inspection if the existing tank is replaced with a complying septic tank as approval by Board of Health. *A metal septic tank will pass inspection if it is structurally sound, ' leaking and if a Certificate of Compliance, indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage badmp or break out or hi static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneve bution box System will pass inspection if(with approval of Board of Health): broken s)are replaced is removed on box is leveled or replaced ND explain: The system required pumping than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of Board of Health): broken pipes)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 47 Sharon Circle Osterville Owner. Marion Bursaw Date of Inspection: 3/16/2004 C. Farther Evaluation is Required by the Board of Health: Conditions exist which require finther evaluation by the of Health in order to determine if the system is failing to protect public health,safety or the7iprotect 1. System will pass unless Board of Hees in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manne public health,safety and the environment: _Cesspool or privy is within 50 feet a surface water _Cesspool or privy is within 50 of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Publi if any).determines that the system is functioning in a manner that protects the public he7Z(SAS) tbe nvironment: _The system has a septic tank and soil absorption systeAS is within 100 feet of a surftce water supply or tnbutary to a surface water supply. The system has a septic tank and SAS and the SAS is a public water supply. _The system has a septic tank and SAS and the ZISAS ' within 50 fat of a private water supply well. The system has a septic tank and SAS and the less than 100 feet but 50 feet or more from a private water supply well**. Method used tostance "This system passes if the well water analysis, ed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicateVihat the well is free from pollution from that facility and the presence of ammonia nitrogen and-'hate . is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the/ must be attached to this form. r 3. Other. Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 47 Sharon Circle Osterville Owner. Marion Bursaw Date of Inspection: 3/16/2004 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 effiuent 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 and overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than%Z day flow _ ✓ Required pumping more than 4 times in the last year TOOT,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. _ _Z Any portion of a cesspool or privy is 50 feet of a private water supply well. _ _,Z'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 N 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.] k I O(Yes/No)The system fails. I have determined that one or more of the above criteria exist as described in 310 CUR 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 a design flow of 10,000 gpd to 15,000 You must indicate either`des"or"no"to each of the following: (The following criteria apply to large systems in addition to criteria above) yes no the system is within 400 feet of a surface g water supply . the system is within 200 feet of a tnbntary a surface drinking water supply the system is looted in a nitrogen a area(Interim Wellhead Protection Area—IWPA)or a mapped Zone H of a public water supply well If you have answered W to any gacsti Section E the system is considered a significant threat,or answered `des"in Section D above the large has failed.The owner or operator of any large system considered a ' significant threat under Section E or 'ed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 47 Sharon Circle Osterville Owner: Marion Bursaw Date of Inspection: 3/16/2004 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? _,Z 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 bales or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? -V'-_, Was the facility owner(and occupants if different than 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: 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 Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOP.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 47 Sharon Circle Osterville Owner: Marion Bursaw Date of Inspection: 3/16/2004 , FLOW CONDITIONS , RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): —1,_ DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): -3 30 Number of current residents:_0 Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no):QD[if yes separate inspection required] Laundry system inspected(yes or no):_ �. O Seasonal use:(yes or no):nt:2 Water meter readings,if available(last 2 years usage(gpd)): QQP 3 = 1 Lf .�U Sump Pump(yes or no): Last date of occupancy: COMMERCIAUI DUSTRIAL Type of establishment: _ Design flow(based on 310 CMR 15.203): apd Basis of design flow(seats/persons/sgft, 76. Grease trap present(yes Industrial waste holding tank or no): Non-sanitary waste discharged to Title 5 system(yes or no):_ Water meter readings,if avaiLib Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of informiation: Was system pumped as part of the inspection(yes or no):&2e> If yes,volume pumped:_gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _/Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool _privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank ,Attach a copy of the DEP approval Other(dam): Approximate age of all components,date installed(if known)and source of information: A3 Were sewage odors detected when arriving at the site(yes or no): t—DCD Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 47 Sharon Circle Osterville Owner: Marion Bursaw Date of Inspection: 3/16/2004 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron ,'�PVC other(explain): Distance from private water supply well or suction line: �►//A Commends(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: (locate on site plan) Depth below grade: k i 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: g x x Sl• S 100� 6��s . Sludge depth: f'• Distance from the top of sludge to bottom of outlet tee or bale: 3 Scum thickness: ,o Distance from top of scam to top of outlet tee or bate: 6 " Distance from bottom of scum to bottom of outlet tee or baffle: / " How were dimensions determined::r, Vy\vos ,r• .i Comments(on pumping recommendations,inlet and outlet tee or bale condifion,amoral integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): xg�i T' w.t c�� i✓.� �c—C':bh � 1 v�ti —h a\��.l'^" �v� c�a�s t C �z.e • T.�:,,�.., S1..o.��.Q lac. p�,w,1'-z�L. v�a-� -�:c�c�— �l�.o,..�.� GREASE MAP:_(locate on site plan) Depth below grade:_ Material of construction: concrete iuetal _polyethylene_other (explain): — Dimensions: Scum thickness: Distance from top of scum to top of outlet or baffie: Distance from bottom of scum to bottom outlet tee or baffle: Date of last pumping: Comments(on pumping reoommen ns,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence eakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued.) ' Property Address: 47 Sharon Circle ' Osterville Owner: Marion Bursaw Date of Inspection: 3/16/2004 TIGHT or HOLDING TANK: (tank must be p at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass__-Polyethylene other(explain): Dimensions: Capacity: aallons Design Flow: sell day Alarm present(yes or no): Alarm level: Alarm in order(yes or no): Date of last pumping: x Comments(condition of alarm float switches,etc.): DISTRIBUTION BOX:_%ef(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: _ Comments(not if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): v PUMP CHAMBER (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber condition of pumps and appurtenances,etc.): Page 9 of 11 4 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 47 Sharon Circle Osterville Owner: Marion Bursaw Date of Inspection: 3/16/2004 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not r"Wred) " If SAS not located explain why: Type, lam,number:_1 leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Typetname of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): t GX C.C., w � ti7czrA 5 Svc. O �•(��l,h�.��\t �.A .�.�-+� . CESSPOOLS: (cesspool must be pumped as part of n)(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 or no): Comments(note condition of soil,signs of dranlic 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 by c failure,level of ponding,condition'of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 47 Sharon Circle Osterville Owner. Mahon Bursaw Date of Tnspecdon: 3/16/2004 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. a i Oa 3 Aa - :so � � _ 3I A3 - 14Q�' 133 = Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 47 Sharon Circle Osterville Owner: Marion Bursaw Date of Inspection: 3/16/2004 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water),1 O 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:I L2 Z-2 Observed site(abutting property/observation hole within 150 feet of SAS) Checked with the local Board of Health-explain: Checked with local excavators,installers-(attach documentation) wessed USGS database-explain: ten . You-m^ust describe how you established the high ground water elevation: LO`CA`T-I0N SEWAGE PERMIT NO. VILLAGE INSTA LLER'S NAME i ADDRESS B U I L OR 0 A DA T E PERMIT ISSUED DAT E COMPLIANCE ISSUED �y 3 t ,HC)V SL 9=k `4 L O 'C At !ON SEWAGE PERMIT NO. VILLAGE INST A LLER'S NAME i ADDRESS �. ic��I D U I L D E R 0a OWNER -b�-S t ►� l�t o r� DATE PERMIT ISSUED, ---- DAT E COMPLIANCE ISSUED A) 1-07 -A J 2--7 t f :.. ........ .586 THE COM MONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH O.wn.....---_ ....oF.1��.�X'-s.1`�R Apptiration for M-4pmaf Murky Tuutitrurtion ramit N J✓ Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: --. .�... `................... �.i� /�a l.. v/CT' Location' ��- 6 tl _e ... ... 1........... ... r ....... 1.....:. .------ ----•• - 1��„� •--_-(--........../--�---------------•---�� -`_.1,.��d/I ..----•- ----------------•---•---•--------.....-•--•- ---•---._.....-•------....-^-------•--•--- Installer Address dType of Building Size Lot----------------------------Sq. feet U ,..., Dwelling—No. of Bedrooms p� . _____________________________Expansion Attic ( ) Garbage Grinder Other—Type Type of Building w__;._.ZW*� No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures Design Flow_.....___. ._ ._ _ gallons per person per day. Total daily flrow.._..._..._�?__ ....................gallons. W V :. ,r Ra Septic Tank—Liquid capacity]t'OO.gallons Length.... _..... Width....... Diameter................ Depth................ Disposal Trench—No.......Z........... Width.................... Total Length.....:..... Total leaching area_._..,f _ _.sq. ft. Seepage Pit No._--.•______________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing*tnk ( ) Percolation Test Results Performed by....... .lT _. '. ............... Date........................................ ,4 Test Pit No. 1.1.`?2!..minutes per inch Depth of Test Pit.................... Depth to ground r3, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �+ :r------------ � < so/.............. I..............................:.................--- O Description of Soil ��...�=-.------•••1-a�7--•••••••-�GC_, �eJl -- 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 TITLE 5 of the State Sanitary Cod The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee sL.4......... y t ealth. n_ Si ne -�� 2 n J Dat Application Approved By �� .._.. h> '-----•..... Date Application Disapproved for the following reasons-------------------------------------------------------•----_------- ......................................... --••-•••-••.....---•••••--••••-•--••••-•••••---•-••••••-••-••••--•..........-•---•--------------•---••-••--•--•-•---•••.._..••-•-••-•••-•-•••----••-•-•••----•--•••••--••------•----•-------•-.......•-- Date PermitNo......................................................... Issued....................................................... Date y No. ' ' - �r-- Fps............._............_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................O F..............................-....................... .. ApplirFatiou for Dispoii al Works Tonstrurtion famit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................__.............................................................................. •--••-•-••--••••---••••---•-••......-•-...-----•-----•-•---------•-----•--...........::..--------• Location-Address or Lot No. .....--•-•-•--•--------.............................•-•---..._................................... ....................-•--•--••------...----------._............•--•--......--------.:............-- Owner Address W Installer Address 1 Q Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) ? Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) QOther fixtures = -----------------------------•••------------------------- WDesign Flow............................................gallons per person per day. Total daily flow__._..........__.._......_....._......._....gallons. Septic Tank—Liquid capacity............gallons Length................ Width_............. Diameter__._____-_____ Depth................ W Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... fZ, Test Pit No..2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -------------------------------------------------------------•-.....------------•-•------------••-•.•------•-•-••-••----•••-•••._........_•-----....---...•-- 0 Description of Soil.............................;__.. --------•-------------------------------•-----------------------•----------------------------=---------------------------------.••-•- x W M. ---••-----------•--------------•--------•-••----•••-•------•--------•••--•-••-.......-••-••-------•---•-•--••-•--------•---------••---•------••-•••••----•••-••--•••--•-------•---••-••---•---------•-- U Nature of Repairs or Alterations—Answer when applicable___________________________________________________•----____-____-_-_____---__---•-•--__---- ------------------------------------------------------------------•--------------------•-•----....------------------....---------------------------------------------------------------•-----•......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed.............................�......------------------. -----------•-------- -----------.---------- Application Approved By... `" ...... Q �'........... Date Application Disapproved for the following reasons--------------------------------------------------------------------------------•----------------------.....----- ..............•-•-•----••...........-••••-•••••-•-••-•---•-•---•-•-••........--•--•......-••-•-•---••••-•--••-•-•-------•-•--••-•-••-•--••-•------••-••--------•-------••-•---•-•---•-------•-•--------- Date PermitNo.......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF........;............................................................................ Tntifiratr of TontlrliFana THIS IS T H TIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by • • ----- ......................................................----................................................................................................. In4taller at....................... ............... -------�.*--------------...--------------...------------------------------------------••---•......•-•--•. E has been installed in accordance with the provisions of TIT I 5 f The State SanitaryCode as described in the application for Disposal Works Construction Permit No.___ ' ". + ............ dated------------------------------------------------ THE ISSUANCE OF`,THIS CERTIFICATE SHALL NOT BE CONSTRUED GUARANTEE THAT THE SYSTEM WILI;,,Ft IN ON SATISFACTORY. DATE...... ...... ................................................ Inspector........ ----- ........ ---------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF...................................•....---....----•-••--•-••....-•----••............ . N0. ?z, " mo d FEE: ................ ;Billpos a1 �r, v %T11notr iott rra�tii Permission is he eby granted........____...._.._... �.............._ to Construct r Rpair ( ) an Individual Sewage Disposal Sys atNo..............• ��' �...-- -' �� e---------------•--------------------------•------------................ Street as shown /thepli ion for Disposal Works Construction Permit No.................... t .._........____....._....._.._............ A....,. ----.rd of Health DATE------- ---•---------------------------------••-----•------...._... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS SI TE PL AN T YPICAL PROFIL E SCALE — / " = 3D' F[. eZ. 4-7 s NOT TO SCALE /8"STD. LT. WGT. C./. MH COVER / 4"C./. PIPE . , , 4"B/T. FIBER P/PIE TIGHT JOINTS ' O O O TO RSTT/ ✓DINT FLOW L INE —&.4 4;;.-.. er LEVEL ONEL L ING • a.•-� � ,C_.C�j• 4 D C./. T£E C./. TEE 43.7o STANDARD PRECAST CONCRETE/DooGALLON a SEPTIC TANK ' .. Box B" DOSB£I INS TA �ED ON r a LEVEL , STABLE BASE SEPTIC TANK " >yj / TO BE INSTALLED ON LEVEL , STABLE BASE " 7 � v ; 2"- //8" TO //2" WASHED PEA STONE EL• 3G O ALL AROUND FREE OF IRONS, FINES LEACH/ E PI AND DUST /N PLACE BASE TO BE LEVEL BRICK B MORTAR COUR£S AS R£OU/RED TO BRING 3/4 70 /-//Z WASHED CRUSHED STONE ALL AROUND FREE OF \ COVER TO GRADE. 24 C.I. MH COVER IRONS, FINES AND DUST /N PLACE. > AND FRAME _ N 4 LEACHING PIT SECTION- �+ INL E'T 8' FLOW L/NE - i I. CONCRETE TO BE 4000 PSI 28 DAYS 2. REINFORCED WITH 6" x 6" NO.6 GA. W.W.M. %'' sr�, iio,5C4sJrco,� . 3. 2' AND 4' SECTIONS ARE AVAILABLE FOR GREATER DEPTH REQUIREMENTS. OPENING W/TH 4-//9" 4. NUMBER OF PITS REQUIRED c'y� OUTER DIAMETER Q /-3/4"INS/DE DIAMETER :k NOTE EXCAVATE TO ELEVATION ,trQ014 LOWER AS a REQUIRED TO REMOVE ALL LOAM AND CLAY BENEATH , „ ( y PIT. REPLACE EXCAVATED MATERIAL WITH CLEAN GRAVEL TO DESIGNED GRADE . ��t 0 3f► AIt�C•osr � r v 41-0 h , " z cWZ• ~ by �:O•• 6'-6" E�.Z + FL r !31. 47 S 2 MIN. d� + � D^ LoT 44 (NOT O E EFFECT/VE DIAMET£R S EFFECTIVE DEPTHI XCEED 3 WATER TABLE SOIL AND P RC. DATA GENERAL T 4 E NOTES PERC. RATE 2 MIN. /IN . NO HEAVY EQUIPMENT TO RUN OVER SYSTEM. x:�' t►'' ��y•o� -�, �� 4� SEPTIC TANK, DISTRIBUTION BOX , LEACHING PITS TO BE STANDARD / TEST BY: �AxT�E .E �C/YE - ,4LSti'�/at/E.3 FEE• ^•N ,�,�g y�1 I / R PRECAST REINFORCED CONCRETE UNITS. WITNESSED BY: �a�./ ��<�'oQD 49eA ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE TO REVISED TITLE 5 OF THE STATE ENVIRONMENTAL CODE, kl TEST PIT GR.EL.: �G. DATE' 3��B1 MINIMUM REQUIREMENTS FOR THE SUBSUFACE DISPOSAL OF TEST PIT NO. I TEST PIT N0.2 SANITARY SEWAGE EFFECTIVE I JULY 1977. 0 0" 0" ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH. t4" AT COMPLETION OF CONSTRUCTION , PRIOR TO BACKFILLING, THE I7�E"O �F�wr� ✓y��E BOARD OF HEALTH SHALL BE NOTIFIED FOR INSPECTION. PITCH ALL SEWER LINES 1/4" /FT. UNLESS INDICATED \ OTHERWISE. ND G�/D W14 7 - DESIGN DATA 4 :; BEDROOMS 3 Dllye DISPOSAL /� EST. TOTAL DAILY EFF. ��D • �,. GALS. LEGEND SEPTIC TANK /DDd GAL. SIDEWALL AREA �•� GAL./SQ. FT. BOTTOM AREA V• o GAL./sa FT. SEI/t�AGE DISPOSAL SYSTEM d x Do EXISTING GRADE LEACHING REQUIRED •2/✓�' SQ.FT. ZONE �"/c ( o. oo FINISHED GRADE ACTUAL LEACHING AREA S SOFT. FOR O• oo INVERT ELEVATION ��tiyJGG�lsG /�'-4•;70 L � ; D.ST2',Q 1//L L N7:6 DOMESTIC WATER SOURCE: Toww k-,4rE� �__ . -� Go T 45 .jf�f9,COA/ C/�CGE PROPERTY LINE PLAN REFERENCE --" MEAN HIGH WATER / A' �: �' • �� .crM' ,�s SCALE: AS INDICATED DATE : . i9s3�m,�© .� � � � , • wax.• . _ x- BENCH MARK DATUM MARSH t WM. M. WARWICK B ASSOCIATES BOX 80/ - NORTH FALMOUTH ` MASSACHUSE T TS 02556 T.O.F. EL.= 41 .9'± FINISH GRADE OVER: D-BOX= 41 .0''F _ PROP.VENT WITH CHARCOAL FILTER TO ABOVE GRADE � FINISH GRADE OVER CHAMBERS = 41 .0' - 42.0' GENERAL NOTES PROVIDE EXTENSION RISER REMOVABLE WATER-TIGHT COVER OVER SLOPE @ 2% MIN. OVER SYSTEM 3/4"TO 1-1/2" DOUBLE WASHED WITH COVER OVER INLET& RISER'.TO WITHIN 6"OF FINISHED GRADE STONE TO CROWN OF PIPE 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISH GRADE OUTLET TO WITHIN 6"OF F.G. 4"SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FND. EL.= 40.9'± F.G. OVER TANK EL. = 40,9'± 5" DIA. OUTLET(S) MIN SLOPE 1% BOX TO F.G.. (SEE NOTE 21) 2"OF 1/8"TO 1/2" DOUBLE WASHED CODE AND ANY APPLICABLE LOCAL RULES. - -- - - - STONE OR GEOTEXTILE FILTER FABRIC 1 - - - - 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AN PLACE RISERS ON ALL DESIGN ENGINEER. EXISTING 4" PROPOSED 4" 4.60' MAX. ' TOP OF SAS= 36W50' 004a CHAMBERS WITH SEWER PIPE ---- -----T - 7- - SCH.40 PVC 4"PVC TEE 6.00 MAX. 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEE NOTE 22 35.00' SEE NOTE 22 INLET PIPES TO 6"OF -- SEWER PIPE BREAKOUT EL = FINISHED GRADE SYSTEM UNLESS OTHERWISE NOTED. 6�, 3" 3" DROP MAX 2" DROP MIN 3" 9" L=18�± 4. TO PREVENT BREAKOUT,THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN MIN.SLOPE(d 1% PROVIDE WATERTIGHT ELEVATION =35.50' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A �I 10" 4" PVC IN FROM JOINTS (TYP.) �w� 40 MIL GEOMEMBFRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF �L- -f 14" ` g 9'± SEPTIC TANK 4" PVC OUT TO 0 0 0 Q 0 0 0 Q 0 0 o THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. CONTRACTOR TO PROVIDE - LEACHING FACILITY o0 0 0 o SLOPE ALL SOLID (PIPE AT 1.0% MINIMUM. SPECIFIED DROP BETWEEN Tpo o o 5. INLET AND OUTLET f CONTRACTOR CONTRACTOR SHALL 12" 6" po 0 0 OUTLET TEE 35.40 MIN. 35,23' 0 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. SHALL VERIFY SIZE 48" VERIFY CONDITION OF 2 00 C>p o� 7. LOCAL BOARD OF (HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK i AND CONDITION OF EXISTING TEES GAS BAFFLE 00 o 0 0o FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY po 00 0 0 0 0 0 0 TANK NECESSARY COMPACTED BASE - NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH 5 2 5' 8 5'(TYP) 2 5' AND DESIGN ENGINEER. OUTLET DISTRIBUTION BOX 2'5� 4.83' 2.5 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. BENCHMARK ELEVATION OF 40.00, -"- TO BE INSTALLED ON A LEVEL STABLE 30.5' (NP•) - - ----- ESTABLISHED ON THE CORNER OF THE BULKHEAD, AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET GROUND WATER ELEV.= 28.001* PIPES TO BE LAID LEVEL. 33.00 9.83' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION EXISTING 1 , tii S MIN. CHAMBER END VIEW THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT 000 GALLON CONCRETE SEPTIC TANK 3 - 00 GALLON CHAMBERS 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES `CONTRACTOR TO VERIFY EXISTING SEPTIC TANK PROFILE CROSS s;ECTION VIEW TYPICAL CHAMBER PROFILE CONTRACTOR A VERIFY DEPTH LL TO THE DESIGN ENGINEER. ELEVATION PRIOR TO ANY WORK & GROUNDWATER AT TIME OF INSTALLATION. H-2 0 DISTRIBUTION BOX D E TA L H-2 0 CHAMBER DETAILS GROUNDWATER ELEVATION AT 27'± PER TOWN OF 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE BARNSTABLE 1992 GROUNDWATER COUNTOUR MAP =20' \1 , �1, II 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONI SWING-TIES SCALE: 1" NG T TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM DESCRIPTION HC-1 HC-2 PERC NO. 14669 APPROPRIATE AUTHORITY. II -4 +� f INSPECTOR: David W. Stanton, IRS 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS CORNER OF STONE (1) 55.0' 36.7' LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE EVALUATOR: Michael Pimentel, EIT CORNER OF STONE (2) 46.5' 31.1' �� r THEY SHALL WITHSTAND H-20 LOADING. C.S.E. APPROVAL DATE: Oct. 1999 + 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. CORNER OF STONE(3) 68.2' 14.9' ( DATE: April 24, 2015 J TEST PIT#: 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE 1 CORNER OF STONE(4) 74.3' 24.6' • fit `� MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. - - -- ZONE 2 ELEV TOP= 40.80' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, • !! ' FINES OR OTHER (UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). ELEV WATER= <28.80' 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN PERC RATE _ <2 min./inch SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. HC-1 CW� DEPTH OF PERC= 72"-90" 16. PROPOSED PROJECT IS LOCATED WITHIN: ASSESSOR'S MAP 122 LOT 151 TEXTURAL CLASS: 1 771 M D ,S� II P I _ OWNER OF RECORD: ROBERT M. ROSATA AND ANN E. ROSATA O m `� 0" 40.80' ADDRESS: 48 MARY CHILTON ROAD Z ° , g '0 p #47 1 � r LOCUS �.✓ NEEDHAM, MA 02492 a Fill EXISTING it � • • � \ 2) 3-BEDROOM • FEMA FLOOD ZONE X \ \ (1) 9 g3 DWELLING j o • h 42" 37.30' COMMUNITY PANEL# 25001CO544J \ TOE = 41.9'± \ \ J A Loamy 10 Yr 3/1 d 17. DEED REFERENCE: DEED BOOK 24413, PAGE 340 \ \ 0 j 0 �\ 50" 36.63' 18. PLAN REFERENCE:: PLAN BOOK 326, PAGE 71 \ \\ O 20 GARAGE + Loamy Sand 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. O B \ \ o HC-2 i ( 10 Yr 5/6 22 �! 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY MAP \\ \ 0! 0 14 6, G r Q o C 72" 34.80' FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME-ANY 11A.0UTi' go PARCEL 34 \ + . a Perc FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. � J \ \ 3) I • • 90" 33.30' 21. A 4"PERFORATED SCH.40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A \ MAP 122 (4 C Medium Sand DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A MAP O�� \ 6 0 \\ j 2.5Y 6/6 REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. 122 D� PARCEL 48 PARCEL 32 �p1 \ \ 22. IN ACCORDANCE WITH 310 CMR 15.401 -15.405,THE FOLLOWING LOCAL UPGRADE LOCUS PLAN- APPROVALS ARE (REQUESTED FROM 310 CMR 15.221 (7): \ \ (1.) A 3.00'WAIVER(3.00'-6.00') FOR THE MAXIMUM COVER OVER THE LEACHING FACILITY. \ Benchmark SCALE: 1" = 1000' (2.) A 1.60'WAIVER(3.00'-4.60') FOR THE MAXIMUM COVER OVER THE DISTRIBUTION BOX. \ 66'WIDE NEW BEDFORD GAS & EDISON \ Comer Bulkhead N6go 144" 28.80 \ LIGHT COMPANY EASEMENT \ Elev. =40.00' No Mottling, Standing or Weeping Observed \ Approx. M.S.L. 2822, \ \ DESIGN DA A TEST PIT DATA LEGEND \ \ PERC NO. 14669 500' EXISTING SPOT GRADE NUMBER OF BEDROOMS (DESIGN) 3 INSPECTOR: David W. Stanton, RS - 50 - - - EXISTING CONTOUR I - - \ EVALUATOR: Michael Pimentel, EIT \ EXISTING 1,000 GALLON SEPTIC TANK NE DESIGN FLOW 110 GAUDAY/BEDROOM O C.S.E.APPROVAL DATE; Oct. 1999 50 PROPOSED CONTOUR \ TO BE UTILIZED IN THIS DESIGN \ 12"PINE MAP 122 TOTAL DESIGN FLOW 330 GAUDAY \ I 10"OAK w PARCEL 151 I DATE: April 24, 2015 50 PROPOSED SPOT GRADE \ \ DESIGN FLOW x 200 % - 660 GAUDAY 31,467 S.F. TEST PIT#: 2 \ \ 131,PI E EXISTING OVERHEAD WIRES \ EXISTING DISTRIBUTION BOX \ _ USE EXISTING 1,000 GALLON SEPTIC TANK I ELEV TOP= 40.80' (Pk��,o \\ �` / ELEV WATER= <28.80' W -----W-- EXISTING WATER LINE 1 N PERC RATE _ 0o c0.1 \\ \ O 0 #47 �O / TEST PIT LOCATION \ \ , EXISTING titi INSTALL 3 - 500 GAL. CHAMBERS W/ AGGREGATE DEPTH OF PERC = MAP 122 \ L \ I 3-BEDROOM _ ! TEXTURAL CLASS: 1 FO Q1 EXISTING 1,000 GALLON SEPTIC TANK PARCEL 42 \ PROPOSED H-20 \ DWELLING - - -40 - - v w2 SIDEWALL CAPACITY TOE = 41.9'± - _ - \ DISTRIBUTION BOX I DECK � W-- �� _4 (LENGTH + WIDTH) (2 SIDES) (2' HIGH) (0.74 GPD/S.F.) = GAUDAY PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE \ w w- --W V (30.5'+9.83')(2 ) (2') (0.74 GPD/S.F.) = 119.4 GAUDAY \ PROPOSED 3 - 500 GALLON � J '�? 0" 40.80' p PROPOSED H-20 DISTRIBUTION BOX H-20 LEACHING CHAMBERS \ O 6 O BOTTOM CAPACITY \ WITH AGGREGATE O GARAGE O�v = v Fill �O PROPOSED 500 GALLON H-20 LEACHING CHAMBER \\ I \ (SLAB) �O O o4Q (LENGTH x WID'TH) (0.74 GPD/S.F.) = GAUDAY \PROPOSED INSPECTION PORT \ O ' BIT. DRIVE o (30.5'x 9.83') (0.7.4 GPD/S.F.) = 221.9 GAUDAY 42" 37.30' TP 1\ Loamy Sand/ 40x8 I A \ ` TP 2 17"PINE '�✓ TOTALS: 50" 10 Yr 3/1 36.63' IN 40x8 REV. DATE BY APP'D. DESCRIPTION 01. TOTAL NUMBER OF CHAMBERS 3 B Loamy Sand MAP 122 \ I 16' PINE ` _ _ - --40 - _ TOTAL LEACHING AREA 461.2 SQ.FT. 10 Yr 5/6 PROPOSED SEPTIC SYSTEM UPGRADE PARCEL 153 \\ _42 / O�ti TOTAL LEACHING CAPACITY 341.3 GAL./DAY 72„ 34.80' PREPARED FOR: CAPEWIDE ENTERPRISES PROPOSED 4" PVC VENT PIPE; S80° 10'36"E \ EXISTING LEACHING PIT TO BE PUMPED, \ EXACT LOCATION PER OWNER 231 , C Medium Sand LOCATED AT \\ FILLED WITH CLEAN COARSE SAND PER , \ 50 _ 2.5Y 6/6 NOTES: \ 310 CMR 255(3)& ABANDONED \ 47 SHARON CIRCLE \ OSTERVILLE, MA 02655 MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF SCALE: 1 INCH = 20 FT. DATE: MAY 18, 2015\EACH SEPTIC SYSTEM COMPONENT. 144" 28.80' o 10 20 ao BO FEET\ No Mottling, Standing or Weeping Observed , ,h OF ;ws 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF _ �� 9 PREPARED BY: THE PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST RESERVED FOR BOARD OF HEALTH USE JOHN L. ° JC ENGINEERING, INC. PIT c. a1R. cn DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL I�IL CHURCHILL; 2854 CRANBERRY HIGHWAY BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. 1 7 °;,, ,,� 3.) ENTIRE PROPERTY IS LOCATED WITHIN A DEP APPROVED ZONE II, THE EAST WAREHAM, MA 02538 SITE PLAN � rR ��`°w 508.273.0377 GROUNDWATER PROTECTION OVERLAY DISTRICT AND THE ESTUARINE WATERSHEDS. -- --- - -- - ---- --- SCALE: 1"=20' try ! Drawn By: BSM Designed By:BSM Checked By:JLC JOB No.3064