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Home My WebLink About0077 SPICE LANE - Health 77,Spice Lane Osterville A= 165-004 Commonwealth of Massachusetts I If Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 77 Spice Lane ' 1Og7q Property Address David Riley - Owner Owners Name ;z information is required for every Osterville Ma. 02655 06/08/2015 page. City/Town State Zip Code Date of Inspection }MSJ Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael T Bisienere use the return Name of Inspector key. Cape Septic Inspections Company Name 624 Old Barnstable Road Company Address Mashpee Ma. 02649 City/Town State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority �� `X1•�._ _ 68/2015 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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page t of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments •'° 77 Spice Lane Property Address David Riley Owner Owner's Name information is required for every Osterville Ma. 02655 06/08/2015 page. Cityrrown 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 *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 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 77 Spice Lane Property Address David Riley Owner Owner's Name information is required far every Osterville Ma. 02655 06/08/2015 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 W Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 77 Spice Lane Property Address David Riley Owner Owner's Name information is Osteryille Ma. 02655 06/08/2015 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water 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 %day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 f Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,•�' 77 Spice Lane Property Address David Riley Owner Owner's Name information is required for every Osterville Ma. 02655 06/08/2015 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 77 Spice Lane Property Address David Riley Owner Owner's Name information is required for every Osterville Ma. 02655 06/08/2015 page. Citylrown 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): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): >330 f ' 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 77 Spice Lane Property Address David Riley Owner Owner's Name information is required for every Osterville Ma. 02655 06/08/2015 page. Cityfrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 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 Seasonaluse? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: in 2014 99,000 gallons were used and in 2013 93,000 gallons were used Sump pump? ❑ Yes ® No Last date of occupancy: weekends 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 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 77 Spice Lane Property Address David Riley Owner Owner's Name information is required for every Osterville Ma. 02655 06/08/2015 page. Cityrrown 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? ❑ 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 77 Spice Lane Property Address David Riley Owner Owner's Name information is required for every Osterville Ma. 02655 06/08/2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 03/20/2013 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 12"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 4"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: Standard 1500 gallon septic tank Sludge depth: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 77 Spice Lane Property Address David Riley Owner Owners Name information is required for every Osteryille Ma. 02655 06/08/2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) . Distance from top of sludge to bottom of outlet tee or baffle 39" Scum thickness 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 11" How were dimensions determined? Field Instruments Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The septic tank is structuraly sound and has a pvc tee on the discharge side of the tank 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts u - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 77 Spice Lane Property Address David Riley Owner Owner's Name information is required for every Osteryille Ma. 02655 06/08/2015 page. Citylrown 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M •''� 77 Spice Lane Property Address David Riley Owner Owners Name information is required for every Osteryille Ma. 02655 06/08/2015 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 Oil 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.): *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 r Commonwealth of Massachusetts : Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,•�° 77 Spice Lane Property Address David Riley Owner Owner's Name information is required for every Osterville Ma. 02655 06/08/2015 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: one ap. 40 x 11 ❑ 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.): 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 or 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 77 Spice Lane Property Address David Riley Owner Owner's Name information is required for every Osterville Ma. 02655 06/08/2015 page. Cityrrown 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.): I t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 77 Spice Lane Property Address David Riley Owner Owner's Name information is required for every Osterville Ma. 02655 06/08/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately M t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 tYWl(I15 Assessing As-Built Card TOWN OF BARNSTAAU LOCATION •7? F7 iGrz� Lht. SEWAGE# �� •07�. VILLAGEOS^ ✓at 4. ASSESSOR'S MAP&PARCEL /6s•atsef INSTALLER'S NAME&PHONE NO.-U"X•�i CST ry'1 I•:1. SEPTIC TANK CAPACITY J 4— E.AL LEACHING FACILITY:(type) G . (size) NO.OF BEDROOMS OWNERAL [ T + td t PERMIT DATE: ' -L4-a COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility -f-A 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��1ri�e ryol 00 Commonwealth of Massachusetts 4 . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �Y 77 Spice Lane Property Address David Riley Owner Owner's Name information is required for every Osterville Ma. 02655 06/08/2015 page. Cityrrown 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: 10 plus feet feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: I augured a hole at a lower elevation and shot it with a transit to show five plus feet of seperation. 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 77 Spice Lane Property Address David Riley Owner Owner's Name information is required for every Osterville Ma. 02655 06/08/2015 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 /0 tJ0 N 20 k t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Town of Barnstable A P# Department of Regulatory Services Public Health Division A5 /) I ,r Date Main Street,Hyannis'MA 62601 Date Scheduled r ` Time Fee Pd. 4% • t Soil Suitability .A.ssessinent for SewW Disposal Performed By: Witnessed By: _ � S LOCATION& GENERAL INFORMATION Location Address"T 7 5 0 ,E , F.,V E Owner's Name DS rE�2-04-L E� M q 1 Address r Assessor's Map/Parcel: I(o 51664 Engineer's Name NEW CONSTRUCTION REPAIR F. w Telephone.#, Land Use: Slopes M_ Surface Stones Distances from: Open Water Body. �St7aft Odssiblc.WeLArea >Z g' Drinking Water Well � ft > z5v , Drainage Way_ ._ ft Property Line I l ft Other t2 100.6 v` N70'9'30 PIC ET F CEO`i SHE•TCH:(Street nazi 114.29' CB/DHPROPOSED 12W4' FOUNDi000'^!o holes) szINROew ON v v IBR/CK TO BE REMOlEO . //`��J99.7 SHED 9.5 T NANTUCKET. 100.2 ,.1 PA IER PAW - (TYPC/AL) GARAGE PAVED DRIVEWAY 99 -- _ __-- IREkO!£/REQPAOE/REPIACfJ '�c BRICK PA 9.B 99.6 Q I i BRICK STOOP TO 10 M/N —I of BE REMOlEO �O D 148.3 99. BULK 99.9 o No m 2 I _ HEAD rn 30.0' m EXISTING m 13 HOUSE#77 EX/SANG WATER SL7TNLE 0 F.F. 101.71 ws ws 99.5 LOT 9 O ® Z I 0 /a,MIN. 13,6 OtS.F. 1Tq#1 / t I OB_3 n 99.3 Z 99.4 ' I,Sao GALLON I 'Z' r" ' I' Ill' 2 TH#4 I` 5EP7IC TANK 1J• I o L J 1 m STOCKADE ,_FENCE._ -_N7 39'1 "E_ 9s.� Parent material(geologic) Depth to BerlrgeJt 0 l Depth to Groundwater. Standing Water in.Hole: Weeping from Plt Fnoe '� D Q R- Estimated Seasonal High Groundwater > CS %T-U. bw &;?A0tr_ DETERMINATION FOR SEASONAL HIGH WATER TABL Method Used: y Depth Observed standing in obs.hole: in. Depth to still mottles: Dcpth to weeping from side of obs.hole: In, Groundwater Adjustment +. ft. Index Well# Reading Date: Index Well level _ Adj,factor- Adj,Cltvundwnter level - PERCOLAT1.0N TEST Date- 11ma 4 Observation Hole# Time at 4" 0 h c 3 Depth of Pere - Time At 6" d ' tt � Start Pre-soak Time @ l Time(9"-611) (]End Pre-soak •i '' .1 ,, Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) Original: Public Health Division 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. g innin g Q:\SEPTIC\PERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# 1 Depth from Soil Horizon Soil Texture .Sdil Color Soil. Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. o i ten py,R6'(iravell O - 6 o �.o�rwl cfl� o•Yq- 7 z 14 A -4Z 1.-.. S io 7 /6 IA J �2=l2o G sd��g zS Z � • DEEP OBSERVATION HOLE LOG Hole# Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. o sis en %Grave S I ' DEEP OBSERVATION HOLE LOG Hole# 3 _ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, G c o- Cry d y4 t o14R -7 t o F- 746 N is 7 .� ' DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color soil .Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Cositn 'r V a Flood Insurance Rate Man: Above 500 year flood boundary No—//Yes Within 500 year boundary No V Yes ' Within 100 year flood boundary No.� Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all'al'exs observed throughout the area proposed for the soil absorption system? \ If not,what is ttie depth of naturally occurring pervtous material? Certification pipgLL9 5 I certify that on �'9 J(date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and exDe ien a described in�10 CMR 15.017. Signature Datb 2' , L3 Q:\SEPTICTERCFORM.DOC TOWN OF BARNSTABLE LOCATION -7-7 a7 40 L", SEWAGE# 4013.07 -, VILLAGES'; ✓I L-L-L ASSESSOR'S MAP&PARCEL JCS'da INSTALLER'S NAME&PHONE NO.�il��161-4 �'� SEPTIC TANK CAPACITY 1 506 i o r LEACHING FACILITY:(type) --t—Ken ii— (size) dl .x t NO.OF BEDROOMS .3 OWNER a Z,Af. a U _ PERMIT DATE: -4-1.*-1.3 COMPLIANCE DATE: vZ® f Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility -4-11(n 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) / IY Feet FURNISHED BY /��. rir�f L�iZc'➢ t�,r�i O O . S � 1 If 44tv- 1 I ( FW7 No. a l) 'V Fee. /� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppliLatlon for !Disposal *pstem Construrtion permit 7 Application for a Permit to Construct Repair( ) Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. -7 1 SP (I,-- de LA Owner's Name,Address,ai��Tel.No.� I VE 4 �}NAI 9d c Assessor's Map/Parcel 510 D o$ ��.�'f Qom{/Gc_ �N. 1�,(`//IifiTL�✓ lv,4 o?_q2 Ins ler's Name Address,and Tel.No. Designer's Name Address,and Tel.No. ' � 50�- -9399 ' crA:;1Vu C.is V) Type of Building: Dwelling No.of Bedrooms Lot Size /3 6 sq.ft. Garbage Grinder( ) Other Type of Building S No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 gpd Design flow provided gpd Plan Date �JS Number of sheets 'Y Revision Date Title 77 5 P/C6 Size of Septic Tank /Sbb Type of S.A.S. 4N^L� Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental n to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. f ffigqed Date 311- Application Approved by Y P Date tdf Application Disapproved by Date for the following reasons Permit No. a-a Date Issued No. V 0 -7 i" Fee /J THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es .. PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zipplicatlon for Disposal 6pstem Construction 3permit Application for a Permit to Construct( Repair j ) Upgrade( ) Abandon( ) [Complete System El Individual Components Location Address or Lot No. 7 -7 SP ( e LN de Owner's Name,Address,and Tel.No. Or0f) 3 G(o-60167 Assessor's Map/Parcel 5 Q P f ,((�2 evo e,c- LN• A F-,r11&6,7b v f7 0242 Installer's Name,Address,and Tel.No. 51 .7` Designer's Name,Address,and Tel.No. RdA�v vu-v1 CA yJS� ^ t` - 9 3��i t�i�mOV7W iA6/N r� Type of Building: Dwelling No.of Bedrooms 3 Lot Size /3 GG co sq.ft. Garbage Grinder( ) Other Type of Building /I S No;of Persons Showers( ) Cafeteria( ) Other Fixtures ' - Design Flow(min.required) 30 gpd Design flow provided Q� gpd Plan Date 2�5�/3 Number of sheets ?i Revision Date Title— Size of Septic Tank / �p p Type of S.A.S. A N G Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code t to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. ed Date Application Approved by U Date i Application Disapproved by Date for the following reasons �- i 1 I Permit No.' a b J 3 — o �- Date Issued --------------------------------------..------- _ _.°--_--_,,.-._-.:.-:.,.-:.- :_•_ _ ------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed X) Repaired( ) Upgraded( ) Abandoned( )by _ O/�'� u��t� ( n1 j` at 77—7 sd?/t' L has been constructed in accordance with the provisions of Title 5 and the for/Disposal System Construction Permit No. u/7-07 dated Installer -�6—/�/�i7 � Designer 41!'y/"771 f� , #bedrooms Approved design flow gpd The issuance of this perpit shall of be construed as a guarantee that the syste ill fun 'on as e ' ed. DateJ�� Inspect, •-------------- ----------------------- _-__ ___= _ _ = - - _ _------------------ ---- No. �"7) Fee r� _ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction 21ermit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at -7-7 �j P/C F P / e 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 ust be completed within three years of the date of this permit. Date Approved by r Town of Barnstable Op THE 1py, Regulatory Services Thomas F. Geiler,Director * BARNSTABLE,MASS. Public Health Division 1639.9 3S. '°lFp39.�61 Thomas McKean,Director 200 Main Street, Hyannis,MA 62601 Office: 508-862-4644 Fax: 508-790-6304 Date: 3-2 0-13 Sewage Permit#oL%T- O'72Assessor's Map/Parcel 16 5/0 0 4 Installer& Designer Certification Form Designer: Falmouth Engineering, Inc . Installer• Bortolotti Construction Address: 141 Locust Street, Unit A Address: 45 Industry Road Falmouth, MA 02540 Marstons Mills, MA 02648 On 3 1,3 Bortolotti construct ionivas issued apermit to install a (date) (installer) septic system at 77 Spice Lane based on a design drawn by (address) Falmouth Engineering, Inc .. dated Feb. 5, 2013 , revised Feb. 25, 2013 (designer) X 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. 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 required) was inspected and the soils were fou tisfactory. j H OF �jgsJ' MICHAEL J. 9�y BOHSELLI ':_� (Installer's Signature) � CIVIL. 1(,N0.35054 /S T EP��FQ FSS/ONAL ( e igner's Signature) (Affix Desi mp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice formsWesignercertification form.doc - 7' N Commonwealth of Massachusetts loom W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 77 Spice Ln Property Address Mike Jonsberg Owner Owner's Name f information is required for every Osterville MA 02655 .12/9/12 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, J14- V V use only the tab 1. Inspector: v key to move your cursor-do not Michael DiBuono use the return Name of Inspector key. Company Name Company Address Pocasset ma 02559 City/Town State Zip Code 508-364-9587 s , 1 3 S 2-2- Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑. Conditionally Passes ❑ Fails ❑ Needs Further Evaluation a cal Approving Authority 12/10/12 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. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Poo M 77 Spice Ln Property Address Mike Jonsberg Owner Owner's Name information is required for every Osterville MA 02655 12/9/12 page. CityTTown 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: System consists of one Cesspool and an overflow Cesspool, Both of wich are in good working condition. 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 77 Spice Ln Property Address Mike Jonsberg Owner Owner's Name information is required for every Osterville MA 02655 12/9/12 page. CityTTown 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 c,M 77 Spice Ln Property Address Mike Jonsberg Owner Owner's Name information is required for every Osterville MA 02655 12/9/12 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 '/z 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 ,M 77 Spice Ln Property Address Mike Jonsberg Owner Owner's Name information is required for every Osterville MA 02655 12/9/12 page. City/Town 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 ;M 77 Spice Ln Property Address Mike Jonsberg Owner Owner's Name information is required for every Osteryille MA 02655 12/9/12 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'iif 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): 2 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 t5ins•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 M 77 Spice Ln Property Address Mike Jonsberg Owner Owner's Name information is required for every Osterville MA 02655 12/9/12 page. CitylTown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonaluse? ® Yes ❑ No Water meter readings, if available last 2 ears usage d 2011 32 Gpd g ( y g (gp �)' 2012 33 Gpd Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Summer 2012 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 Commonwealth of Massachusetts z Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 77 Spice Ln Property Address Mike Jonsberg Owner Owner's Name information is required for every Osterville MA 02655 12/9/12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: August 2012 Date Other(describe below): General Information Pumping Records: Source of information: Unavailable 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 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 77 Spice Ln Property Address Mike Jonsberg Owner Owner's Name information is required for every Osterville MA 02655 12/9/12 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: 1965 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2.5 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Building sewer is intact and of newer construction Septic Tank(locate on site plan): Depth below grade: 6 Inches feet Material of construction: ❑ concrete ❑metal ❑ fiberglass ❑ polyethylene ® other(explain) Block cesspool If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins-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 77 Spice Ln Property Address Mike Jonsberg Owner Owner's Name information is required for every. Osterville MA 02655 12/9/12 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 4 ft Scum thickness na Distance from top of scum to top of outlet tee or baffle 8ft Distance from bottom of scum to bottom of outlet tee or baffle 8ft How were dimensions determined? open inspection and measures Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Both cesspools were empty and dry at time of inspection. Sludge and Scum Stain levels were measured and noted. 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 77 Spice Ln Property Address Mike Jonsberg Owner Owner's Name information is required for every Osterville MA 02655 12/9/12 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM 77 Spice Ln Property Address Mike Jonsberg Owner Owner's Name information is Osterville MA 02655 12/9/12 required for 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 w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments <° 77 Spice Ln �M Property Address Mike Jonsberg Owner Owner's Name information is required for every Osterville MA 02655 1219/12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: 1 ❑ 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.): Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 2 Honey comb Block Depth—top of liquid to inlet invert 8ft Depth of solids layer 8ft Depth of scum layer 8ft Dimensions of cesspool 5 ft wide and 8ft deep Materials of construction block 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 . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 77 Spice Ln Property Address Mike Jonsberg Owner Owner's Name information is required for every Osterville MA 02655 12/9/12 page. City/Town State Zip Code Date of Inspection D. System Information 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.): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 77 Spice Ln Property Address Mike Jonsberg Owner Owner's Name information is required for every Osterville MA 02655 12/9/12 page. CityTTown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately A S3 13- 2 32. LA. 5e 2 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 77 Spice Ln Property Address Mike Jonsberg Owner Owner's Name information is required for every Osterville MA 02655 12/9/12 page. Cityrrown 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: 35 +ft feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Topagraphical Maps And Town Records 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 77 Spice Ln Property Address Mike Jonsberg Owner Owner's Name information is required for every Osterville MA 02655 12/9/12 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS t DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT.FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 77 Spice Lane Osterville, MA 02655 C Owner's Name: Mike Jonsberg' Owner's Address: Date of Inspection:. October 14. 2009 Name of Inspector: (Please Print)James M. Ford Company Name: James M. Ford Mailing Address:, P.O.Box.49 Osterville,MA 02655-0049 Telephone Number:` (508)'862-9400 CERTIFICATION STATEMENT I certify that 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 Approving Authority Fails Inspector's Signature:,: Date: October M, 2009 The system inspector shall submit a copy `f 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. Notes and Comments` ****This report only describes conditions at the time of inspectionand-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 page 1 U V Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 77 Spice Lane Osterville, MA Owner: Mike Jonsberg Date of Inspection: October 14, 2009 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: I I B. System Conditionally Passes: One or more system components as described in the"Conditional Pass".section need to be replaced or repaired. The system,upon completion of the-replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not detennined(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 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: 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:. 2 i Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 77 Spice Lane Osterville,MA Owner: Mike Jonsber g Date of Inspection: October 14, 2009 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 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. -of a public water supply. The system has aseptic 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 10.0 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: 3 Page 4 of 11 OFFICIAL INSPECTION.FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 77 Spice Lane Osterville, MA Owner: Mike Jonsbery Date of Inspection: October 14, 2009 D. System Failure Criteria applicable:to all systems: _ You must indicate either"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 '/z day flow ✓ Required pumping more than 4 times in.the last year NOT due to clogged or obstructed pipe(s). Number of times pumped ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ 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'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.] 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 System: 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) Yes No the system is within 400 feet of a surface drinking water supply. _ the system is within 200,feet of atributary to a surface drinking water supply the system is located in a:nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone Il 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. 4 i Page 5 of 1 i OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 77 Spice Lane Osterville, MA Owner: Mike Jonsberz Date of Inspection: October 14, 2009 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: i Yes No ✓ Pumping information was provided by the owner occupant,or Board of Health ✓ Were any of the system coinponents 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 infornation 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 Cis at issue approximation of distance is unacceptable) [310 CMR 15302(3)(b)J. • 5 ; Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 77 Spice Lane Osterville, MA Owner: Mike JonsberQ Date of Inspection: October 14, 2009 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n/a Number of bedrooms(actual): 2 ' DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): ' 220 Number of current residents: 2 Does residence have a garbage grinder(yes.'or no): Yes 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)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currenth) COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd 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: .Unavailable Was system pumped as part of the inspection'(yes or no): No If yes,volume pumped: gallons-=How was quantity pumped detennined? 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(describe): Approximate age of all components,date installed(if known)and source of infonnation: original per owner-.1965 Were sewage odors detected when arriving at the site(yes or no): No ( 6 Page 7 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 77 Spice Lane Osterville, MA Owner: Mike Jonsberg Date of Inspection: October 14, 2009 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: 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 on site plan) (Cesspool acting as a septic tank) Depth below grade: 6" Material of construction: concrete metal fiberglass _polyethylene ✓ other(explain). 'cesspool block If tank is metal list age: Is age confinued by a Certificate of Compliance(yes or,no): (attach a copy of certificate) Dimensions: 5'W x 4'T x 8'bottom to grade Sludge depth: 1' Distance from top of sludge to bottom of outlet.tee or baffler -- Scum thickness: -- Distance from top of scum to top of outlet tee or baffle- Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Measuring stick Cormnents(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage;etc.): The cesspool had]'of watu on the bottom..An outlet tee was present. GREASE TRAP: None_ (locate on site plan) 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: Comments(on pu nping recominendations,'inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 t. Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued). Property Address: 77 Spice Lane Ostervllle:.MA Owner: Mike Jonsberg .Date of Inspection: October 14, 2009 TIGHT or HOLDING TANK: None.(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 ; .. Alain present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Commments(condition of alarm and float switches,etc.): . ca DISTRIBUTION BOX: None (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 b(jx,etc.): PUMP CHAMBER:. None'.(locate on`site.plan) Pumps in,working order.(yes or no): Alanns in.w.orking.order(yes or no) Comments'(note condition of pump'chamber;'condition of pumps and appurtenances,etc.): ., 8 L Page 9 of 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 77 Spice Lane Osterville,MA Owner: Mike JonsberQ Date of Inspection: October 14, 2009 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan;excavation not required). If SAS not located explain why: Type leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: ✓ overflow cesspool,number: 1 Innovative/alternative system Type/name of technology: Comments (note condition of soil,signs of hydraulic failure,level ofponding,damp soil, condition of vegetation, etc.): The overflow cesspool was dry. The cover leas 10."below.grade. There did not appear io be any signs of failure A camera was used for the inspection. CESSPOOLS: None (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 or no): Comments (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (locate.on site plan) Materials of construction: Dimensions: . Depth of.solids: Cormments (note condition of soil,signs of hydraulic failure,level"of ponding,condition of vegetation', etc.): y' Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY.ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 77 Spice Lane Osterville. MA -Owner: Mike JonsberQ Date of Inspection: October 14, 2009 - 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. Li (3 ro' '. 1y3. .So s3 3a to c Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION.(continued) Property Address: 77 Spice Lane Osterville, MA Owner: Mike Jonsberg Date of Inspection: October 14, 2009 SITE EXAM Slope Surface water Check cellar Shallow wells . Estimated depth to ground water 35'+1- . `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: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: n water elevation: You must describe how you established the high ground . . Using Ba,,,nstable topographic and water contours inalis, the inaps were showing approxiniately 35'+A ground water at this site This report has been prepared only for the septic system and components described herein. This septic system has been inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the.future. There have been no warranties or guarantees, either expressed, written or implied, I-elating.to the septic system, the inspection, this report and/or any components of the septic system which have not been located and inspected. 11 . IL TOWN OF BARNSTABLE LOCATION 7� S l CL 1AAL SEWAGE# VILLAGE D ST{J ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. //+-�C,.S SEPTIC TANK CAPACITY ��CM I LEACHING FACILITY.(type) CL4J P (size) NO.OF BEDROOMS OWNER J0f S bM PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY rA_7Q&CFJ 0 77:�_ Fad f 0 /Y oa 1 y3 So a S3 3a 3[qc r 3 J, PROJECT 3 .2 9 LOCATION i`j� _ U ' SPICE LANE P a 9s LOT 10 J�e CPS�s- N s N/F " RKN, INC. I BENCHMARK: BOARD FENCE NAIL&CAP ROJECT oo.aloo.i •,N '•. ..loos PICOT- .F bE EL. 100.00 m POND LOCATION - ' 1 ! I, �. 114.29' CB/DH ' LOCUS A 5VNhVWOV FOUND / 100.0 m Z NOT TO SCALE °ISaNOR/9ES n oo (�n7 2 m NANIULWERzw� l s9.7 SHED 99.9------- PARCEL 108 PAVERPA90 _ ?x 9y,5 m 1oo. NSF GARAGE PAVED DRIVEWAY FRANK M. & GERALDINE M. COYLE ' F —I 991 RIG, - 9.6 I la MJN I i c_Yi l4/or slVai lO .- 102.0 y $ TyYM PUMP a-V9 OLi, F7LC /HJf/ d SAND AND AL"AW S' .. '99.' - BULL( 7'J.9 S f40• PUMP LY33P0IX,REMOYF m 'I- _I .I EAD 30.0' m v '"Do 3>7/L t - 7% QO., EXISTING LT9iY7AM EX/SM0 MAZER b�7PNCE m - /y•Ye .ws irs - I 1 0 10 M Lor s o O (. 13,660t S.F. 5-N/CH CAPAO7Y' I ..I 1 lSLB2O'M/N. 9_93 99.4 r,� IM-W 7RA7a4S JVM(4'Of m STQVE ALL AROUND 1,500 a4LLav MRnc rANK D R/E Cav)?Cla4"ALL EXC,4 wF 5'ALL AR6Y/NO AND OOBN 70 7NE 1'\• _J- I ` . SANG LAYER(E577AA7E0 AS 12'/B f ANO REY°V£ALL UN"M" ^' p STOCKADE MAMPM ANO REPLACE ww LYEAN a24R3F S4N0 UP 70 7NE m- l ❑.� '� _ a ❑ FENC N7'39'1 'E 98.7 1 R/£SYS7EM. 7NE REPLA675/9V7-MA7ER/AL MNU LYAYFa4JJ 70 7NE 101.2 11 49-. .9'ELYs7CARavS MET Fav771 7N J10 CW 1.5255(9),OILE 5) 1oi,al - 7 70 LOT 8 NJJF. ROBERT L. & ELAINE S. QUINAN 20 0 10 20 40 _ - SC ALE: :I INCH 20 FEET. sty N 444$y 2/25/13 REVISE PROPOSED SUNROOM, ADD PRIVACY FENCE. 2� MICHAEL J. BORSELLI m DATE REVISION L Ru.35CIVI054 = PLOT PLAN 9FO'S� � FOR #77 SPICE LANE - . I PREPARED FOR i BARNSTABLE HARBOR BUILDERS GENERAL NOTES: LEGEND IN -- =---- EXISTING 2' CONTOUR OS TERVILLE MA 1. HOUSE NUMBER: 77 I —�Dp_-T EXISTING 10' CONTOUR PLAN DATE: FEBRUARY 5, 2013 PLAN SCALE: 1`20' 2. A55ESSOR 5 NUMBER: MAP 165, PARCEL 004, LOT 9 e9.5 EXISTING SPOT ELEVATION CIVIL ENGINEERING WETLANDS PERMITTING 3. ZONING DISTRICT: RIC j P"L M O U 7' 4. FLOOD HAZARD ZONE: C (F.E.M.A. MAP 250001 0016D) n+Nl EXISTING TEST HOLE WASTEWATER DESIGN > COASTAL ENGINEERING 5. TOPOGRAPHIC INFORMATION COMPILED FROM AN ON THE GROUND SURVEY. PP'CL EXISTING UTILITY POLE TITLE D PLOT PLANS �C� PIERS AND DOCKS 6. ELEVATIONS SHOWN ARE BASED ON ASSIGNED DATUM. NGI NEERI� CB H o CONCRETE BOUND WITH DRILL HOLE LAND USE PLANNING � COMMERgAI/RESIDtl1TIAL 7. LOT COVERAGE BY EXISTING STRUCTURES: 1,797 S.F./13,660 S.F. = 13.2% I FOUND SerLrhg Cope Cad and Swtheartan Marsnchusefts 8. LOT COVERAGE BY EXISTING & PROPOSED STRUCTURES: 1,982 S.F./13,660 S.F. = 14.5% J - 141 LOCUST ST. UNIT A FALMOUTH. MA - 02540 - 508.495.1225 - 508.495.3229 fax PROJECT NUMBER: 13002 CAD FILE NAME: 13002SP DRAWN BY: L.M. SHEET 1 OF 2 C Q W m N Wow NEW DORMER 00 F11 4 a ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ,o ❑ ❑ ❑ ❑ CW235 ILIILIl11 p (A i Q o REPLACE DOOR _ >, -j F 'NEW 3 SEASON ROOM _ La Lu _..> O U J LLJ - 1 (L' REAR ELEVATION W, SCALE: 114" _ l'_O' r — r o Al - _ I JOB: 1301 DRAWN BY KW . DATE:' 2/26/13 H 7 � y w CY) ao m .N ti Wow NEW DORMER M r) 0 00 NEW SEASON ROOM I�1 . LL a p4 � 000 � ILIL L ❑W I. ❑❑a w AIE IIF ❑ 0 EXISTINGLLI Q O w J > LEFT ELEVATION v w SCALE: 1/4" I'_0" W w A2 - .. JOB: 1301 DRAWN BY: KN DATE: 2/26/13 S STEP-N N `•o) � +1-u-—� N 4ANTUCKET PAVE _ O PATIO 10, PS 61611 R SKIMGOAT PS 61611 R .72 3/4"x83" - CEILING 72 3/4"x83" 3 SEASON O AZEK FLOOR BEAD BOARD - F�1 �� - WALLS _ r� ,^q EXI ING PS 61611 L PS 61611 L B lC 72 3/4"x83" REPLACE 72 3/4"x83" H D REMOVE WINDOW WITH V1 - STEP HVAC WINDOW REMOVE NEW E-10 j AS SEAT G 35 DOOR AND - STEPO ILL ASTER BA N REPLAC ® O I----1-DW_ ° .REFFLUSH 2$ AZEK DOOR LVL STEPMOco 1/2 HDR `•,00 2� 3 EX BATH ' - V Y ao I I a [-� o REMOVE74' -4'- '" 3'-6" 3'-II HVAC ANT R KITG1-IEN HALF WALL.WINDOW t INFILL r 2Q 2Q -_C - I t BELOW FLUSH - COUNTER= � 2Q Q — z¢ I I IN ❑ GARAGE O . - -- FLU_5 DN. T Co W/- Z CO W/ - i HDR .LVL HDR UPRe " I J FOYER V-V I Lo Lo MASTER DINING (�V O W Z Z - j II II o W J Z Q IL• REMOVE/ - (L - REPLACE ' STEP - r W O 34'-0n 8'-0" 14'-0" 4'_On 70'_0 ' PROPOSED FIRST FLOOR FLAN SCALE: 114" 1'-0" 143 - _ JOB: 1301 DRAWN BY: KW DATE: 2/16/13 34'-0" M Q • r„j,^ 00 O 'y� m Cq cn ID AQUA GLASS F+1 12'-5 I/4" S'-7 1/2" S B 12'-& 1/4" �. BEDROOM #2 � BATI-I L. 2fe EDROOM #3OAK #2 OAKLINEN F�1 ry a HALL oN: U- 2Q 24 26 OAK , o ACCESS Lo LSl VENTVENT \9 UNHEATED - STORAGE N - w Q - Z .. Q LU W W Z - V _� Q _ CL 34'-0" _ 18'-0" 14'-0" .. W r PROPOSED SECOND FLOOR PLAN SCALE: 114" I'-O" • JOB: 1301 DRAWN 6T: KW DATE: 2/16/13 ^w m Co rD00 Q, m O cq U) d" ❑❑ ❑❑ ,wiz p00 pq c O 00 EXISTING FRONT ELEVATION O SCALE: 114" = 1'-0" ^ ►O � z o O z a Q U Q W LU J LU W -1 W � U J IL > z W EXISTING REAR ELEVATION AB1 SCALE: 114" 1,-& JOB: IB01 { DRAWN BY: KN DATE: 2/16/13 A Cfl 6� NO �i ap N -' LO c OO I-- CII00 W .�BEDROOM #i BATH m 0 0c) x FE KITCHEN a LIVING GARAGE O O DN. 0 i FOYER 6 m BEDROOM #2 DINING Lo LO I'9 N O 12'-2" .. _ Q � F- J -wi J W Z U � Q 34._O" - 18�_0�� 14'_0" In r w r � O EXISTING FLOOR PLAN SCALE: 114" = I'-0' AB2 JOB: 1301 DRAWN SY: KIN DATE: 2/16/13 r ` TYP DORMER ROOF 2x10's @ 16" O.C. - O 5/8" PLYWOOD SHEATHING/ EPDM ROOFING- DORMER - ' ASPHALT SHINGLES- ELSEWHERE - 2xlOs @ I6'O.C. - - � 0 12x8s @ 16"O.C. SIMPSON H2.5 FASTENERS AT ALL I \ \ RAFTER / TOP PLATE O \ Ix3 STRAPPING JUNCTIONS TYP. \\4<2" GYP. BOARD TYP. ROOF TYP. EXTERIOR WALL L• fit, 2x10's @ 16" O.C. 2x6 EXT. STUDS @ 16" O.C./ 0• oy 5/5" PLYWOOD SHEATHING/ VM.1 - `9 \Z \ 6" R21 F.G. INSUL./ �b ca ASPHALT SHINGLES O W M 12 W I/2" PLYWOOD SHEATHING/ @ 2xI0s @ 16 O.G. i6a0 F�71 ��./ W.\ #15 FELT / C. SHINGLES 12 +� 1 .0 SIMPSON H2.5 M 9� �_2" \ 9 "Y BEAD BOARD FASTENERS AT ALL Fib \ EXISTING 2x10s @ 16"O.C. GEIIJNG RUNCTIONS TTMPPLATE - �cq� 1 (3) CONTINUOUS 2x10 HDR E.y Lo - SIMPSON POST TOP CONNECTIONcn ! Qz cV - TYP. EXTERIOR WALL OI - N EXISTING 2x6 EXT. STUDS @ 16" O.C./ SEASO ROOM - I Aj FIRST-FLOOR 1/2" PLYWOOD SHEATHING/ UNH TED - '_7 •� #16 FELT /.W.G. SHINGLES wM w AZEK I[7ECKIN Q � I= 7 E I�-1 . — ---- - PT 2xtOs 1@ 16" 0. _ m O. - - n 00 IT1 EXISTING =ill 6 1 BASEMENT - �-2-PT 2x10 GIRDER + O I I L—J L-_J L_Y GALV. METAL POST ANCHOR r r 12" '50NO TUBE" PIER W/ -- 28" "BIG'FOOT" FOOTING TYP. - . a ADDITION SECTION • 26' O" SCALE: 1/4" 1'-0" DORMER SECTION SCALE: 1/4" 1'-O" Lo tSl �9 w ,f 2-PT 2xI0 RIM JOISTS Q z 4x4 P.T. POST - GALV. METAL POST ANCHOR Q - 12" 'SONO TUBE"' PIER W/ Ij LLI 28" "BIG FOOT" FOOTING TYP. O w J (L > Lu x O JOIST HANGERS EACH END FASTEN LEDGER TO RIM JOIST - (2) 5/6 LAG BOLTS @ 16" O.G. ADDITION FOUNDATION PLAN S1 SCALE: 1/4" _ 1'-0" JOH: 1301 DRAWN BY: KW - DATE: 2/26/13 DOUBLE ROW STAGGER NAILIN INTO BOTH PLATES " if Nt'l 2x6 DBL TOP PLATE [�] RAFTER O 16" O.C. 1"n1 i - Q _— up° H2.5 ® EA. RAFTER z E VERTICAL STRUCTURAL PANEL NAILED 8d COMMON ® 3" O.C. EDGE ° TOP PLATE AND 12" IN FIELD = 00 J _ _ O cncq , ^1 RAFTER TO PLATE CONNECTION ��_, LLo DOUBLE ROW j`` :3 O SCALE: N.T.S. STAGGER NAILIN INTO BOX AND SILL .r, _ 1�-•� I li II I \ 00 O SCALE: N.T.S. - FULL HEIGHT SHEATHING _-SINGLE FLOOR 1 NUM �.JOINT DESCRIPTION NUMBER OF NUMBER OF NAIL SPACING O COMMON NAILS BOX NAILS O ROOF FRAMING Q BLOCKING TO RAFTER (TOE NAILED) 2-8d 2-I0d EACH END RIM BOARD TO RAFTER (END NAILED - 2-16d 3-16d EACH END WALL FRAMING TOP PLATES AT INTERSECTIONS (FACE NAILED) 4-16d 5-16d AT JOINTS STUD TO STUD (FACE NAILED) 2-16d 2-16d 24"O.C. HEADER TO HEADER (FACE NAILED) 16d 16d - 24" O.C. ALONG EDGES - FLOOR FRAMING ' JOIST TO SILL, TOP PLATE OR GIRDER (TOE NAILED) 4-8d 4-I0d PER JOIST Lo , BLOCKING TO JOIST (TOE NAILED) 2-8d 2-I0d EACH END: BLOCKING TO SILL OR TOP PLATE(TOE NAILED) 3-16d 4-16d EACH BLOCK ILD \9 LEDGER STRIP TO BEAM OR GIRDER(FACE NAILED) 3-16d 4-16d EACH JOIST N JOIST ON LEDGER TO BEAM(TOE NAILED) 3-8d 3-10d PER JOIST '0 ' BAND JOIST TO JOIST (END NAILED) 3-16d - 4-16d PER JOIST Lu BAND JOIST TO SILL OR TOP PLATE (TOE NAILED) 2-160 3-16d PER FOOT Z �l ROOF SHEATHING Q (n `- WOOD STRUCTURAL PANELSLu 1 w. J Q RAFTERS OR TRUSSES SPACED UP TO 16" O.C. 8d IOd 6" EDGE/6" FIELD () U J �— DORMER WALL RAFTERS OR TRUSSES SPACED OVER IV' O.C. 8d - IOd 4"_EDGE/6" FIELD W WIND ZONE COMPLIANCE: IL (L > Q W= 38% OF EACH WALL RUN GABLE ENDWALL RAKE OR RAKE TRUSS w/o GABLE OVERHANG ad IOd 6" EDGE/6" FIELD VERTICAL SHEATHING WITH GABLE ENDWALL RAKE OR RAKE TRUSS w/ STRUCTURAL 8d IOd 6" EDGE/6" FIELD w 8d NAILS 3" EDGE/12" FIELD OUTLOOKERS r (4)16d NAILS PER FT BOTTOM PLATE GABLE ENDWALL RAKE OR,RAKE TRUSS w/ LOOKOUT BLOCKS ad IOd 4" EDGE/4" FIELD r L= II% OF EACH WALL RUN CEILING SHEATHING O VERTICAL SHEATHING WITH GYPSUM WALLBOARD 54 COOLERS - 7" EDGE/10" FIELD 8d NAILS 3" EDGE/12" FIELD (4)16d NAILS PER FT BOTTOM PLATE WALL SHEATHING WOOD STRUCTURAL PANELS - STUDS SPACED.UP TO 24" O.C. ad IOd 6" EDGE/12" FIELD Yz" AND 21% " FIBERBOARD PANELS ad - 3`EDGE/6" FIELD Yz" GYPSUM WALLBOARD 5d COOLERS - 7" EDGE/10" FIELD r FLOOR SHEATHING �� WOOD STRUCTURAL PANELS I" OR LESS 8d IOd 6" EDGE/I" FIELD GREATER THAN I" IOd 16d 6" EDGE/6" FIELD JOB: 1301 DRAWN BY: KW DATE: 2/26/13 PROJECT LOCATION SPICE LANE F sq ( LOT 10 N/F RKN, INC. 0 0� GF v �, CK PROJECT BENCHMARK: iNO > LOCATION BOARD ��' 100.E FENCE � � _100.3 PIC ET 100.7 NAIL & CAP 00 N70 39 30 FE CE EL. 100.00 N -� 114.29'_ NOT O O SCALE PRGIAOSEO 12x1 f' FOUND ,~ PP 100.o Q m MNR06W ON � � 4v SON07UBES BRIGW 70 BE V m Z REX/OI�EO 99.7 SHED 99.9 0 PARCEL 108 m _ PAAkfR PA AO Er 100.2 99 5 N/F (TYPC/ALJ GARAGE PAVED DRIVEWAY FRANK M. & GERALDINE M. COYLE x I- 99 --- °� °�� BRICK PATIO 9 6 I _ I j o 99.6 ��C+ 11 1 a 10' /n! I j A/crr STocp m 41020�; / , OI BE REMOPM PUMP CESSPOOL, FILL lJ'TH �ii Al o a TN Y SAND AND ,4BANDLW 46.3 cn �� BULK 99.9 O M �40' PUMP CESSPOa, REM04£ ( W 99. HEAD 30.0' $ m m v hnpF� CESSP0a AND '"-_-7� 00 EXISTING t,4 �Q CaVTAM/NATEO SM 1.1' HOUSE #7 EAISAN6 WATER,SER{�ICE m `" 4I V� r n I F.F. 101 T�'; ws 99.5 0 z I o 1a'MN. LOT 9 0 13,660f S.F. 1 2a' /�V 99.3 99.4 5 - H/GH CAPAGYTY ( m INF/L TRATGWS INTf/ 4( ar z STOYVE ALL AROZIMO I 1,500 CALLOYV - 11 /N. I � ,SE"PAC TANK ' ,� TM#3 p 11J Z 2 m THE CDN7RA076W MALL EXCAliATE 5'ALL ARAUND AND DOlfN TO THE `a�_ SAND LAYER 12Y)MATED AS 12=182 ANO REMOkF ALL UNSU/TABLE 10 p STOCKADE FENCE N7 3910E �8.7 MATER/AL ANO REPLACE NTH CLEAN COARSE SAND UP TO ME TLtu ar THE SYSTEM. THE REPLACEMENT MATERIAL MALL CONFORM TO THE 101.2 113.40 98. SRM97-CAT/OM.S'.SET FORTH/N .310 CMR 15.255(.T� (717ZE 5J vzz 101.4 � p SHED �,,� T�o� \ LOT 8 N/F C, ROBERT L. & ELAINE S. QUINAN 20 0 10 20 40 SCALE: 1 INCH = 20 FEET wo, A OF MgS`s q� MICHAEL J. �y BOlIVILLI � PLOT PLAN C) CIVIL ", p No.35054 Z FOR #77 SPICE LANE � F 7 PREPARED FOR GENERAL O ES N T : LEGEND BARNSTABLE HARBOR BUILDERS IN -------- EXISTING 2' CONTOUR OSTERVILLE MA 1. HOUSE NUMBER: 77 oo EXISTING 10' CONTOUR PLAN DATE: FEBRUARY 5, 2013 PLAN SCALE: 1"=20' � 2. ASSESSOR'S NUMBER: MAP 165, PARCEL 004, LOT 9 x 99.5 EXISTING SPOT ELEVATION gVIL ENGINEERING WETLANDS PERMITTING 3. ZONING DISTRICT: RC A,M O U 1' 4. FLOOD HAZARD ZONE: C (F.E.M.A. MAP 250001 0016D) TH#1 EXISTING TEST HOLE WASTEWATER DESIGN COASTAL ENGINEERING 5. TOPOGRAPHIC INFORMATION COMPILED FROM AN ON THE GROUND SURVEY. PP ca, EXISTING UTILITY POLE TITLE 5 PLOT PLANS T PIERS AND DOCKS 6. ELEVATIONS SHOWN ARE BASED ON ASSIGNED DATUM. CB/DH El CONCRETE BOUND WITH DRILL HOLE LAND USE PLANNING INEE COMMERCIAL/RESIDENTIAL 7. LOT COVERAGE BY EXISTING STRUCTURES: 1,797 S.F./13,660 S.F. = 13.2% FOUND Sarrahg Cope Cad and Southeastern Massachusetts 8. LOT COVERAGE BY EXISTING & PROPOSED STRUCTURES: 1,954 S.F./13,660 S.F. = 14.3% 141 LOCUST ST. UNIT A - FALMOUTH, MA - 02540 - 508.495.1225 - 508.495.3229 fax PROJECT NUMBER: 13002 CAD FILE NAME: 13002SP DRAWN BY. L.M. SHEET 1 OF 2 SOIL TEST RN/SH &?ADE,SHALL B£2X M!N/MUt! Ok0R ALL .SEPAL SYSTEM/ 0WR0VEV7S Date of soil test: 2/4/13 USE 4"D/A. SQVZWLE 40 PW 6W CAST/RGW PIPE Test taken by. MICHAEL BORSELLI,SE#210, APPROVED APRIL, 1995 20'MINIWUM SE79ACIl fR6W EDGE OF ST6WE TO CELLAR !NAIL Results witnessed by. DON DEMARAIS Percolation rate: < 5 MIN./IN.05' DEPTH 10'ANN/MUM.S 7B.40r Ground water NONE REMDVABLE COVERS SET TO WITHIN 3" OF FINISH REMOVABLE COVERS SET TO WITHIN GRADE (MIN. OF 3) /7� 9" OF FINISH GRADE (TOTAL OF 4) TEST HOLE #1 TEST HOLE #2 TEST HOLE #3 TEST HOLE #4 Iz. = 1Op 0 EZ. = 1005 7 0" ELEV. = 100.5 0" ELEV. = 100.5 0" ELEV. = 100.5 0" ELEV. = 100.5 6" A/0 6" A/0 6" A/0 6" A/0 S = .02 3' MAX. " LOAMY0 YR 7/6 " 10AMY LOAMY SAND LOAM YR 7/6 SAND B B s'Y S D IN{�£IPT a-V-\ 42 42 48" 10 YR 7/6 �" 10 YR 7/6 _ _ 1500 GALLON- d' s�TF7RST 975 h N SEPTIC TANK 2'LEVFL S = .O1 -L IVA-W�s ; ~ TD 1/2" C C C C 11 II I EZZ = 96.5 COARSE SAND OAR SAND I �o D/S7 BDX COARSE SAND COARSE SAND COARSE y. � Z5Y7/4 2.5Y7/4 2.5Y7/4 2.5Y7/4 N SET SEP77C TANK AA40 01SlR1911770N BDX II II INSTALL 4'OF.T,/4" TO 1 1/2" ON 6"LAYER OF CRUSHED STONE W '0a' E /NA.AYED, CRUSHED STAVE 120" 120" 120" 120" 1 z I Z W W ALL AAWNO/NAZ RA&WS AND 6f �. k OOfNV 70 771E B077W GF 771E ZPROFILE TRATl.FS RED? TO LA,VlYr Az INF/L OF SYSTEM Fes?MORE DETAILS NOT TO SCALE ELEY = 9O5 3 - REMOVABLE 24"D/A. LONERS REMOVABLE 24"01A. COY£R TH£CONTRACTIAR SHALL F=4 VA TE 5'ALL AR0W,0 AND DOH9V TO 7HE jewrl N/ OF TEST Ilaw SANO LAYER (ESAMATED AS 12=182 AND RENONE ALL UN57//TABLE ,a _ '- : ••_ .. :•. �:- ,.__': _, .'-�: 4` °:r;ZITMATERIAL AND REPLACE N17H CLEAN COARSE SAND UP 70171E TOP OF THE --_.,.,_TEE aOEN AT 7aP SET - SYSTEM. THE REPLAf,EMENT MATERIAL SHALL CGYVFORA/ TO THE S)°EC/f7CAAONS SET FOR711 IN.310 CWR 1•�255 r3J (A7Z£5) INLET KNOlWGiIJT 3"M/N. FR6W TANK C04£R x ! / OU71E7 I(N06,Ya1T INLET TEE SET OUTLET TEE SET 10"MIN. BELOW 14"SELow I/(,rYl/D LE12rL LIW119 L£1gZ p OAS BAFFLE - I s • h 4' : 1 •= 1+ 1'-3 1 '" WALLS (.3J -5"DIA. OU71E75' oa 2" 10' - O" 5' - 2" 1'-3 A" 10' - 6" 5' - 8" Ts 6" Q 1500 GALLON SEPTIC TANK (H-10 LOADINGS 4 ° 2" NOT TO SCALE PLAN VIEW CROSS--SECTION INSPECTION HOLE INSPECTION HOLE DB--3 DISTRIBUTION BOX H--10 LOADING NOT TO SCALE 16" 34" r. 6'-3" "�-" 6'-3" ---� TYPICAL HIGH CAPACITY INFILTRATOR CONSTRUCTION NOTES: (SHOWN AS A PAIR, SEPTIC SYSTEM DETAILS NOT TO SCALE FOR PREPARED SPICE LANE I lNSTALLAAGYV � THE PROPOSED SEPAL SYSTEW.SHALL BE IN ALO'Gy?DANC,E 11l771 AT LE 5 ANO THE BOARD OF HEALTHREGULAnw.� BARNSTABLE HARBOR BUILDERS 2. A COPY OF 711E PLANS-WALL BE AYA/LABLE OW SITE FOR REFERENCE AT ALL AWES IN DUR/NC THE/NSTALLAAaV G,' IWE SEPAL SYSTEM. OSIER VI LLE MA ,3. NO CHANGES TO THE DESYGN W&L BE PERFORMED Of771GY/T 7HE APPROVAL OF BOTH BASIS FOR DESIGN: FALMOU7H ENGYNEER/NQ INC AND 171EBOARO OFHEAL W PLAN DATE: FEBRUARY 5, 2013 PLAN SCALE: AS SHOWN 4 THE SWPAC SYS'TEN IS S7 S"r TO INSPECAGW BY FALMOIU7N ENGYNEE?1NQ /NC TOTAL 04AY FLOW IS BASED ON J BEDROYWS, NO GARBAGF D/,S P0SAL AND THE BOARD OF HEAL hV 707AL 0A&Y ROAV= 110 6PD/9EDRAAV X 3 A090 WS = -W aw � d CIVIL ENGINEERING *,� O T T WETLANDS PERMITTING 5. 771E CAN7RAO&W SHALL NOAFY FALA(al7H E/VGYNMWNG, INC AND THE BOARD OF HEAL 711 TOTAL LEACHING AREA PROPOS�O = 520 Sr �� P��H OF A446 WASTEWATER DESIGN lvl V �'r, COASTAL ENGINEERING 70 IN-9cFCT 771E&-RAC SYSTEM PRIOR 70 BACA-75EL. IN St71!!E INSTANCE.$ MORE 711AN ONE 9� �7 lNSPPECl 6W MAYBE NEEDED. THE 6W)W,1 C70R BALL OWL YBACKF!/_L 711E PORAAVS OF THE o MICHAEL J. APPLICAAON RATE- 0.74 a0,0 F. � � }. SY57EM THAT HAVE BEEN!N•SJ°ECIFO AND APPROVED BYFALMOUTH ENGYNEERN INC ANO C B CIVIL LII u� TITLE 5 PLOT PLANS �� ` PIERS AND DOCKS 771E BOARD oFHEAL711 0162%)V LEACHING C4RAGY7Y= ,.184 !RD > JU0 GPD " p c 5'054 1 INEERI �� LAND USE PLANNING COMMERCIAL/RESIDENTIAL 6. IF THE C�V7R40,r R EN 6VNTERS ANY YAR/AAOVS IN SYTE C�VD/AON.S; SVOI AS DIFFERING A�'o,c�Q�ST�� tiQ sOYL•S mPOGWAPHY, A -&ANDS OR OTHER CmD/AONS NA T MA Y REQ lmr R£-EVALUA AON OF `ASS/O,NAL EN\ Swmg Cane Cod and Southeastern Massachusetts 771E DE, ,, 711E C6NIh'A076W"AU lWME6V.4)ZL Y CWrACT F4LA01a1T71 DV67NEER/N12 INC n a 141 LOCUST ST. UNIT A — FALMOUTH, MA — 02540 — 508.495.1225 — 508.495.3229 fox 1 V _ PROJECT NUMBER: 13002 CAD FILE NAME: 13002DT DRAWN BY- L.M. SHEET 2 OF 2