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HomeMy WebLinkAbout0021 SUNSET LANE - Health u 21 Sunset Lane Osterville P ` A = 117 121 - . 7 e Y.. � Aeik . � N r. Commonwealth of Massachusetts - , Title 5 Official- Inspection Form Subsurface Sewage Disposal System Form .- Not for Voluntary Assessments I 21 Sunset Lane u Property Address — Penille_Monto Owner Owner's Name / information is Osterviile �/ MA 02655 10-26-_20 r} required for every — -- -- page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on,this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. `` N J\ o�;,,,���� M 1!//. , Important:When filling out forms A. Inspector Information on the computer, F ?� JAMES use only the tab James D.Sears key to move your Name of Inspector v "' cursor-do not Robert B.Our Co. INC use the returns'` � T It �� key. Company Name 1. �fryr F 5.1 NU SP�G���`��� 363 Whites Path _ — Na - r�. Company Address SouthYarmouth MA 02664 City/Town _- — State Zip Code scorn 508-477-8877 S 1623 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my i inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 10-26-20 spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and.the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts �v Title 5 Official, Inspection Form. �= h Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 21 Sunset Lane Property Address Penille Monto Owner Owner's Name information is Osterville MA . 02655 10-26-20 required for every — — page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 1 have not found any information which indicates that any of.the failure criteria described ;in 310 CMR 15.3,03 or in 310 CMR 15.304 exist. Any failure criteria not evaluated.are indicated below. r. Comments ± The system is a 1500.Gal Tank D Box and 28 ARC 36 HC Chambers. 2) System Conditionally.Passes:;.:` One or more system components_as described in theA"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"hot 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 (whetheir`metal or not)-is structurally unsound, exhibits substantial infiltration or exfiltration.or tank failure is imminent. System will pass inspection if the existing tank:is replaced with_a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of. Compliance.indicating that the tank is less than 20 years old is available.. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7I26I2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 , <1111\� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ( � 21 Sunset Lane - �� Property Address Pe_nille Monto _ _-- — --- — Owner Owner's Name . information is Osterville MA 02655 _10-26-20 required for every ----- -- - -—-—- page. City/Town State Zip Code Date of Inspection' C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): El Pump Health a Pump Chamber pumps/alarms,not operational..System will pass with Board appro val if pumps/alarms are repaired. ; ❑ Observation of•sewage backup or breakout 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 0 ND (Explain below): ❑ distribution box is leveled or replaced: ❑ Y ❑ N ❑ ND (Explain below): . I ❑ 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 pipes) are replaced ❑ Y ❑ N ❑ ND (Explain below):. ❑ obstruction is removed ❑. Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the'system is not functioning in a manner which will protectpublic.health, safety and the environment: t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 1 f �,, Commonwealth of Massachusetts �r : _, Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments « � 21 Sunset Lane _--.-------_-- -- -- ---------- `�� Property Address Penille Monto ----- Owner Owner's Name information is _ _MA_ 02655 10-26-20 required for every Osteryille _ --- - --- page. CltyTown u .- State Zip Code Date of Inspection C. Inspection Summary (cont.) " Cesspool or.privy is within 50 feet of a surface water ❑ 'Cesspool or.privyis within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and.the SAS is within 100 feet of a surface water supply or tributary-to a surface water supply.,, ❑ The system has a septic tank•and SAS and the SAS is-within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a"private water Supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". 1 Method used to determine distance: _— ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent:and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.` c. `Other: 4) System Failure Criteria,Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 III •� Commonwealth of Massachusetts w Title 5 Official, Inspection Form �I Subsurface Sewage Disposa[System Form - Not for Voluntary Assessments r 21 Sunset Lane Property Address Penille Monto _ -- -- --- - Owner Owner's Name - information is MA 02655 - 10-26-20 required for every Osterville —_—_ — -- ----- page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cost.) Yes No El ® Static liquid evel in the distribution box above outlet.invert due to an overloaded or clogged SAS or cesspool. ❑ ® Liquid depth in'seqapsail is less than 6" below invert or available volume is less than'/z day flow. o-EAelll14 'Required pumping more than 4 times in the last year NOT due to clogged or ® obstructed pipe(s). Number of times pumped: 0. . ® 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 watersupply well. ❑ 'Z 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.] El ® The system is a cesspool serving a facility with a design flow of 2000 gpd El gpd. The system fails. I have determined that one or more of the above failure ❑ ® , criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board.of Health to determine what will be necessary to correct the failure. 5) Large Systems:'To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. -For large systems, you must indicate either"yes" or"no"to each of the-following, in addition to the questions in Section CA. Yes No. ❑ ' ❑ the system is within'400 feet of a surface drinking water supply . ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El El Area system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well f5insp.doc•rev.7l26l2018 x Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 18 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form �I� Subsurface Sewage Disposal System Form -Not#or Voluntary Assessments <........... 21 Sunset Lane _--_—_ --- - u� Property Address Penille Monto Owner Owner's Name information is MA 02655 10-26-20 Osterville required for every - State Zip Code Date of Inspection page. Cityrrown C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® 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? ® El available 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 backup? ® ❑ 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. El ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 18 I Commonwealth of Massachusetts - - , Title 5 Official Inspection Form �. �I Subsurface Sewage Disposal System form - Not for Voluntary.Assessments 21 Sunset Lane _ _ — u Property Address Penille Monto _ Owner Owner's Name information is Ostervllle MA 02655 10-26-20 _ required for every — — - — — page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions:, Number of bedrooms (design): —4 - Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Description: 1500 Gal. Tank D Box and 28 chambers. 1 Number ofcurrent residents: Does residence:have a garbage grinder? ❑ Yes No Does residence have a water treatment unit? ❑ Yes ® No If yes,,discharges to: - -Is laundry on a separate sewage system?(Include laundry system inspection ❑'Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 2018-36,000GaIs2019-23,000Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: _Present Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form iIII Subsurface Sewage Disposal System Form-,Not for Voluntary Assessments 21 Sunset Lane -___ --.---- - -- u Property Address• Penille Monto — - Owner Owner's Name information is MA _02655 10=26-20 required for every Osteryille q page City/Town State Zip Code Date of Inspection .., D. System Information (cost.) 2. Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203). Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft:, etc.): --- -- Grease trap present? ❑ Yes ❑ No Water treatment unit present? 0 Yes ❑ No If yes, discharges to: -- — - — Industrial waste holding tankpresent? ❑ Yes ❑ No Non-sanitary waste discharged-to the Title 5 system?. ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy%use: Date Other(describe below): 3. Pumping-Records: 1-2020 -- - 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: - - ----- r Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 t5insp.doc•rev.712612018 Commonwealth of Massachusetts Title 5 Official Inspection Form y Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 21 Sunset Lane Property Address -- -- Penille Monto Owner Owner's Name information is Osterville MA 02655 10-26-20 required for every - .------ - - -- - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. . Type of System:. ® Septic tank, distribution box, soil absorption system ❑ Single cesspool Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach,previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained=from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval: El Other(describe): Approximate,age of all components,date installed (if known) and source of information D Box+ Leaching 2011 Permit # 2011 -029. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 26" feet Material of construction` ❑ cast iron ® 40 PVC ❑other(explain): - Distance from.private water supply well or suction line: feet Comments (on condition of joints, venting, evidence-of leakage, etc'): Pipeing is 4" PVC SCH -40. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -,Not for Voluntary Assessments ,• 21 Sunset Lane Property Address - p Y Penille Monto Owner Owner's Name information is Osterville MA 02655 10-26-20 required for every - — - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site.plan): 16" Depth below grade: feet Material of construction': ® concrete ❑ metal El 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: \1500 Gal. Precast H 10 Sludge depth: Distance from,top of sludge to bottom of outlet tee or baffle 2911 --- 011 Scum thickness. - -.-- ---- = 811 Distance.from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 18 How were dimensions determined? " Asbuilt- Plan --Tape Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, -liquid levels as related to outlet invert, evidence of leakage, etc.): , Tank at working level.Tank and covers at 16" below grade. Two inlet Tees, outlet tee. No sign of leakage-or over loading. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Foam Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 21 Sunset Lane Property Address Penille Monto Owner ----- --- " Owner's Name s information is Osterville MA 02655 _10-26-20 required for every ------ . ----- - — page. City/Town State Zip Code Date of Inspection D. System Information (cont) 7. Grease Trap(locate on site plan): Depth below grade: feet . Material of construction: ❑ concrete . ❑.metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness -- -- Distance from top of scum to top of outlet tee or baffle - Distance from bottom of scum to bottom of outlet tee or baffle - Date of last pumping: bate Comments (on pumping.recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (location site plan): Depth below grade: f Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: — y< Capacity: gallons Design.Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts _ Title 5 Official Inspection Form M1 Subsurface Sewage Disposal System Form Not for Voluntary Assessments 21 Sunset Lane Property Address Penille Monto _ — --- - — --- Owner Owner's Name information is MA 02655 10-26-20 required for every Osterville --- State Zip Code Date of Inspection page City/Town D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: — — Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened),(locate.on site plan): Depth of liquid level above outlet invert - 0 — Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any- evidence of leakage into or out of box, etc.): D Box is 16"x21"-16" Below grade w/4 Line's. No sign of over loading or solid carry over. Box is clean and solid. t5insp.doc-rev.712812018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts _ lP Title 5 Official Inspection Form h Subsurface Sewage Disposal System.Form - Not for Voluntary Assessments 21 Sunset Lane _ -- u Property Address Penille Monto — - Owner Owner's Name — information is Osterville MA _ 02655 10-26-20 required for every - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) , 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc:): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plah, excavation not required): If SAS not located, explain why: Type. ❑ leaching pits number: -- 28 ® leaching chambers number: - ----- ❑ leaching galleries number: ❑ leaching trenches. number, length: -- ------ ❑ leaching fields number, dimensions: ® overflow cesspool number: - ❑ innovative/alternative system Type/name of technology: --- t5insp.doc-rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form` Subsurface Sewage Disposal System Form - Not;for Voluntary Assessments 21 Sunset Lane Property Address Penille Monto Owner Owner's Name information is Osterville MA 02655 10-26-20 required for every --- — -- - page. CitylTown 'State Zip Code Date of Inspection D. System Information' (cont.) 11. Soil Absorption.System (SAS)(cont') Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is 28 ARC 36HC Chambers 4 row's of 7 per row stone less. Chamber's are clean and dry like new. - 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert - Depth of solids layer Depth of scum layer Dimensions of cesspool -- -- - - Materials of construction - Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): a. t5insp.doc•rev.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page.14 of 18 Commonwealth of Massachusetts t" Title 5wOfficial Inspection Form �I; Subsurface Sewage Disposal System Form Not for Voluntary Assessments 21 Sunset Lane -- Property Address , Penille Monto Owner Owner's Name information is MA. 02655 10-26-20 required for every Osterville _ — — ---: page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: J Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): r t5insp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 i r Commonwealth of Massachusetts � Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments I 21 Sunset Lane Property Address _ Penille Monto Owner Owner's Name . information is -• - MA 02655 _ 10=26-20 required for every OSterville - - - page. City/Town State Zip Code . Date of Inspection D. System Information (cent.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage•disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply`enteis the building. Check one of the bones below.,. ® hand sketch inthe area below drawing attached separately l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 RoR -Ba- 9 �� ci Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 21 Sunset Lane _ Property Address Penille M_onto — Owner Owner's Name information is Osterville page. CitylTown MA _02655 _ _10-26-20 required for every State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells NO 10, Estimated depth t high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record 2-2-11 If checked, date of design plan reviewed: pate ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: T.H. on Design plan 2011 10' No G.K. Bottom of chambers at T below grade. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 21 Sunset-Lane -- ---- --_ _ - Property Address Penille Monto - Owner Owner's Name v information is Osterville MA 02655 10-_26-20 required for every T _ State Zip Code Date of Inspection page. City/Town E. Report Completeness'Checklist Complete all applicable sections of this form inclusive of: ®. A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1;2, 3, or 4 checked ® C.-Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on.pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included 3 doom Na t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of_18 TOWN OF BARNSTABLE LOCATION of l SYt u .�4 / CG�n2 SEWAGE# 2-0 I) - 029 VILLAGE NWAL-t (U ASSESSOR'S MAP&PARCEL i 7— 121 INSTALLER'S NAME&PHONE NO. T` �vv(�, vt Se S So 477 �P SEPTIC TANK CAPACITY p \� LEACHING FACILITY.(type) �;LQ 3co,]D (size) II.3 X 3.I NO.OF BEDROOMS y OWNER Pe.�►'t< <Gt ov. PERMIT DATE: - COMPLIANCE DATE: a -/O. r 2zi Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility V6 it 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 l..A49W- eL G V qn-y e,5 LU A3 ,� AV 93 3c� $S 70, a No. dolt — b a� M _ Fee ( 6t THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS application for -Misposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(>Q Upgrade( ) Abandon( ) [:]Complete System ❑Individual Components Location Address or Lot No. '2,t Owner's Name,Address,and Tel.No.Per-,'Ole 10vti$y /4tpK ost tr :�t� 11 5v�n G Assessor's Map/Parcel ( 1 ! -Z ©5-r6lz„t r /" Installer's Name,Address,and Tel.No. �'q , ��,,}�j Designer's Name,Address,and Tel.No.1 npkkzly f woR Kr LA_Y'1 °- 5-x zC3 r2 w- 5-.'e)d /2-D L e,..��G.�,1LY ores fD R Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) t1yD gpd Design flow provided Vq7. 3 gpd Plan Date oZ Number of sheets �' Revision Date Title Size of Septic Tank 15—t)o Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when Qapplicable)) C4k 5 L b✓� �L �Y�yvL j^ r t7 � 7 v j. ML Date last inspected: -Zp l Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date oZ 4? Zo 0 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. O 0 Date Issued a� �O— 'Pot No. doll b r T`>Y a Fee ( �V r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer- PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 'Yes V. application for Disposal 6pstem Construction Permit k Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components' i Location Address or Lot No. vnc,,_eT l d},a.¢ Owner's Name,Address,and Tel.No.Per. i l2 Sys gy DSfT-r�:.t�.� Z1 SvrrSej L�>ce Assessor's Map/Parcel Z I D 5T/_-,z L'J Installer's Name,Address,and Tel.'No. �� �� � �.� Designer's Name Address,and Tel.No. hf,r �,1yf �o,t Kr . ;,. 7C3 �(7: ,5:.3.�,3R,._ �2 �,.- Cf=5sf' cif' ,2� Type of Building: Dwelling No.of Bedrooms Lot Size U Co- sq.ft. Garbage Grinder Other Type of Building d,.,(K �, No.of Persons Showers( ) Cafeteria,(;,• ) Other Fixtures Design Flow(min.required) Ll`{� gpd Design flow provided L/�i 7. 3 gpd Plan Date a—�S' I ,Number of sheets Revision Date Title Size of Septic Tank 1 Sv O Type of S.A.S. S)c.n.e.'<, S Description of Soil Nature of Repairs or Alterations(Answer when applicable),' ,}�_ ,� C Q t.✓ tj —�?o ') y G itn..e.��15� �.•��� �-� �j2 t 3 t- ram;��,,c lJ Date last inspected:: Agreement: — c The undersigned agrees to ensure the construction and maintenance of thMore described on-site sewage disposal system in accordance with the provisions of Title 5 ofthe Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. t, Signed a b Zoe Date _ Application Approved by Date ^2 O j � a Application Disapproved by Date for the following reasons Permit No. got I ` 0-1 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS ` Certificate of Comphinte THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(A Upgraded( ) Abandoned( )by at a i C�,� { 1��1 rt' b S ���4 has been constructed in accordance with the provisions of Title 5 and 1-cifthe for Disposal System Construction Permit No. a41 '�� dated Installer ('1 -fu1j; 1h O t 4 r,1.e( L, _k Designer CL,LA, ,.,4 ,A t y #bedrooms t., Approved design flow 4 7 , gpd The issuance f this permit shall not be construed as a guarantee that the system `il 1.hon as des* ed. Date p ' (I Inspector ,/. S I , No. � ' d Fee THE COMMONWEALTH OF MASSACHUSETTS ' PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair(x) Upgrade( ) Abandon( ) System located at a LA,S-4±�„� 4 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must a completed within three years of the date of this permit. Date „Z. Approved by /- 10/14/2020 ShowAsbuilt(1700x2800) TOWN OF BARNSTABLE LOCATION P 5—Itf Cen¢. SEWAGE 'ZOl — 02 VILLAGE_M u I la ASSESSOR'S MAP&PARCEL 112— 121 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type)faj)A•r_ 3( ,Ie_(Size) II.j x it NO.OF BEDROOMS y _ OWNER tun,((a. o�.. PERMIT DATE: a—g—t 1 COMPLIANCE DATE: —/O.—ZOI 1 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Watcr Supply Well and Leaching Facility(If any wells exist on site or within 200 fed of leaching facility) Feet Edge nt'Wetland and Leaching Facility(If any wetlands wrist within 300 feet of leaching r ility) I Feet FURNISHED Bv.CAP¢u1;r�2 Eatl�Q^,rh LI.0 . 40 i Ar 37 s ✓( Q A 31'0 P I +. A I 46,t A oV,y g1 t7.o 83 3V.r $6 7o,u y f. i https://itsqldb.town.barnstable.ma.us:8431/Home/ShowAsbuilt?mp=117121&sq=2 1/1 02/12/2011 11:30 5084775313 ENGINEERING WORKS PAGE 01 Town of Bamstable Regulatory Services Thomas F.Geiler,Director Public Health Division Thomas McKean,Director zoo Main street, Hyannis,MA 02601 Office: 50"62-4644 Fax: 508-790-6304 Date: 2 i 1 ti l Sewage Permit# b Assessor's Map/ftrml . Installer&D"ieser Certification Form Designer: f t- � . Mc —+ti � InstaDer: Address: !Ent WdA s or I n C. Address: 70 >z >r4 eat s s M4 (T 3 2, On 0 4s issued a permit to install a (date) (installer) septic system at -Zt S vvy ,0- I . Q S VCr%M kX_ based on it design drawn by (addrevo dated (designer) AC l certify that the septic system referenced above was installed substantially according to the design, which way 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 bt Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if re inspected and the soils were found satisfactory. (t10F PE'T� T•. McENTEE Ujgtaller's igri tore) CtV11, �No,38109� (Designer's Signature) ^(Affix tarnp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALJH DIVISION CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL TH TEUS EO AS- BUILT CUR ARE RECEIVEXI BY THE BARNSIanE PUBLIC HEALTH DIVISION. THANK Y gAoffice foms\c a ip*rcerrif➢caVon foim.doc Town of Barnstable P# ��3 1 ► e 'Department of Regulatory Services Public Health Division Date Z/-zMASS. s63p �� 200 Main Street,Hyannis MA 02601 Date Scheduled Z I I I Time 6 ` Fee Pd. C00,06 Soil Suitability Assessment for Sewage Disposal Performed By: � +e✓6�C `Lv.� �e Q L S c� 5 t cn�n�-c� J'Z s t s i _..( , Witnessed LOCATION & GENERAL INFORMATION Location Address 'Z i Svn-s v j,- l-�\" Owner's Name VkA p,n j-.( ,�t��;1�k- S erCf: Zl Sin Se +- Lh ss Addre - Assessor's Map/Parcel: 11-7 Engineer's Name NEW CONSTRUCTION REPAIR X Telephone# �'7—S 3�7.- e t i Land Use' � >`c��n f—f c.� Slopes(3'0) / ' 2 Surface Stones Ar kd� Distances from: Open Water Body 7/ ft Possible Wet Area 71S�ft Drinking Water Well j`�G ft Drainage Way 7 1 U ft Property Line y _Zo ft Other ft SKETCH:(Street name,dimensions-of lot,exactlocations'of test holes& erc test locate p s, oca a wetlands in proximity to holes) t t r Parent material(geologic) 11L)�01Jkk Depth to Bedrock f�j/AL Depth to Groundwater. Standing Water in Hole: IVIAr- Weeping from Pit FAce /"h Estimated Seasonal High Groundwater DETERAONATiION FOR SEASONAL IIIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in, Depth to soil mottlis: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level AdJ,factor, Adj.OrouttdwaterLevel PERCOLATION TEST bate Thne Observation Hole# c s°Q/� Time at9" Depth of Perc /4 q J, c Tune at 6" � dh Start Pre-soak Time @ �rTime(9"-6") End Pre-soak Q s -� t t C) i 4 0 r,zu,--� Rate Min./Inch. Site Suitability Assessment: Site Passed 14 _ Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back------_---- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one (1) week prior to beginning. Q:X.SEPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# I Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling '(Structure,Stones;Boulders. Consistency.%Gr lo.Y4112 5 L- y2-10- c, MS 213 ZO DEEP OBSERVATION HOLE LOG Hole# ',7 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) . 0 —c o A . to ` IE fl 1-- o- 36 y 5L to irZr16 6 - I Iti M °'7/3 11L-f ZU Gc, �� S L DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel)- DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, a Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes .:- Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervi us material? Certification I certify that on 1 (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 experience described in 310 CMR 15.017. . Signature Date Q:\.EPTIGIPERCFORM.DOC COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION [REEIVED 0 2003 FF- H pEPrABLE TITLE 5 _ OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A , CERTIFICATION Property Address: 21 Sunset Lane Osterville, MA 02655 Owner's Name: Dave Mansfield Owner's Address: I Date of Inspection: May 19, 2003 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Map: 117 Mailing Address: P.O. Box 49 Parcel: 121 Osterville,MA 02655-0049 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes NeeAs Further Evaluation by the Local Approving Authority Fai s Inspector's Signature: Date: May 26, 2003 The system inspector shall sub t 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. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title'5 Inspection Form 6/15/2000 page Page 2 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 21 Sunset Lane Osterville, AM Owner: Dave Mansfield Date of Inspection: May 19, 2003 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. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with 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 . . Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 21 Sunset Lane Osterville, MA Owner: Dave Mansfield Date of Inspection: May 19, 2003 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 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 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 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION' (continued) Property Address: 21 Sunset Lane Osterville, MA Owner: Dave Mansfield Date of Inspection: May 19, 2003 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 'h 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 ins addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 21 Sunset Lane Osterville, AM Owner: Dave Mansfield Date of Inspection: May 19, 2003 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: Yes No ✓ Existing information. For example,a plan at the Board of Health. J ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)]. 5` Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 21 Sunset Lane Osterville, MA Owner: Dave Mansfield Date of Inspection: May 19, 2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 3 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system (yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): 2002-89,000 gals.; 2001 - 70,000 gals. Sump Pump(yes or no): No Last date of occupancy: Currently occupied i COMMERCIAL✓INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,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 determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes,attach previous inspection records,'if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Jun 26195-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 21 Sunset Lane Osterville, MA Owner: Dave Mansfield Date of Inspection: May 19, 2003 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) Depth below grade' 12" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1500 gal. Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 31" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 10" Distance from bottom of scum to bottom of outlet tee or baffler 13" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert. There were no signs of leakage. 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 pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 21 Sunset Lane Osterville, MA Owner: Dave Mansfield Date of Inspection: May 19, 2003 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 Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even 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.): The D-box was level. No solids were present. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8' I Page 9 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 21 Sunset Lane Osterville, MA Owner: Dave Mansfield Date of Inspection: May 19, 2003 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) „ If SAS not located explain why: Type leaching pits,number: . ✓ leaching chambers,number: Infiltrators with stone-23'x 7'(per as built card) leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: Innovativelalternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): The infiltrators were located but not dug up. There were no signs of failure in the D-box. 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: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):. 9 Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 21 Sunset Lane Osterville, MA Owner: Dave Mansfield Date of Inspection: May 19, 2003 Map: 117 Parcel. 121 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. 3 A 1L B,ot,�c y i 3 y . 1 3S �� a ayaa 3 as 4.,0 10 Page 11 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 21 Sunset Lane Osterville, MA Owner: Dave Mansfield Date of Inspection: May 19, 2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 25 +/- 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: . You must describe how you established the high ground water elevation: Using the Barnstable topographic map and the Cape Cod Commission water contours map,the maps were showing approximately 25'+/-to ground water at this site. This report has been prepared and the system 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, relating to the system, the inspection and/or this report. 11 TOWN OF BA.RNSTABLE LOCATION L 2/ -S y�f� N SEWAGE # VII.LAGE_�Tlu ASSESSOR'S MAP &LO� INSTALLER'S NAME&PHONE NO.I 5!3 ' y— �' �`Q �✓2�SEPTIC TANK CAPACITY e LEACH]NG-FACILTTY: (type) (size) �� NO,OF BEDROOMS BUILDER OR OWNER g Y- 4!H AF PERMTTDATE � COMPLIANCE DATE:.e5"*�' ' Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist u'A,� on site or within 200 feet of leaching facility) T 2 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) �40 Feet Furnished by Z' I ' CI c.� I P P. E ,Vq' o• ` Al b i ' p TOWN OF BARNSTABLE \ LOCATION < SV•ts�-- �++�� SEWAGE # S' a"�\\ V LLAGE G ST e r v,ILL ASSESSOR'S MAP & LOT //7 /a'1 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY f S n 641 LEACHING FACILITY: (type) (size) a3 x - NO.OF BEDROOMS BUILDER OR OWNER l,/�Vc. ✓j'l�✓1.Sric•� PERMITDATE: 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 leachi' g facility)^ — Feet Furnished by`T n 1* o^ J • ral 8 13 iL y ze, t 1 t . y 1 13S Ilo a ayaa 3 as �o TOWN OF BARNSTABLE 1,-4k--ATION 2-1 S yIO.Pg✓ 6-*, F SEWAGE # �?aI7 N-T�?LAGE r0SQFiYZ4,21add L ASSESSOR'S MAP &LOT/ INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) tp FA (size) ��3�x 7 NO.OF BEDROOMS BUELDER OR OWNER PERMITDATE: �'� COMPLIANCE DATE: ' ' Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist TM'a 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) ` 74 00' c4- Feet Furnished by P` ti 0 1 i ,�`� o ASSESSORS MAP NO: Finc •� PARCEL NO: THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH, TOWN OF BARNSTABL.E Alip iration for Diinpwizil Wmrk,i C omitrnrtion ramit Application is hereby made for a Permit to Construct �X) or Repair ( ) an Individual Sewage Disposal . System at: Location-:\ d css or Lot No. Nsf _14 Owner J Ad ss np W akc . lvv Y,5 ----•--------•--•------------------•--•••- •-•�4' � ..os�"'i u � .. . A ,� �{f .h a Installer Address Uype of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms._____ _......__________________________Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures .-----_-------------_--- ----------------------------------------------------------- w Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity------------gallons Length________________ Width---------------- Diameter._-.._.----_.-- Depth................ x Disposal Trench—No_ ____________________ Width-------------------- Total Length_____-.--...___---__ Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet---................. Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY------- -----------------•-•------•---------------....---•----•-----•----- Date........................................ 04 Test Pit No. 1----------------mtnutes per inch Depth of Test Pit-.------------------ Depth to ground water-.__------_-_-_---_-__- (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a --------------------------------•-----•--•--....--------•------••-------•---•-•-•-••............•---......................................................... 0 Description of Soil.......................................................................................................................................................----------------- x ---------------------------------------------------------------------------------------------------------------------------------- ----- -------- ------------------------ -----•-----••. •. U Nature of Repairs- or Alterations—Answer when applicable._._.�jf_O---_�A ._....S: ,A.._k.___--. Chi!>fil �' ' 5.TR' c----------------------------•-•--•---....--- ---------------------------------------------------------------------•--------.......-•----•---- Agreement. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code -The undersigned further agrees not to place the. system in operation until a Certificate of Corn lia ce has been issue the board of heakh Signed . . . ............ ......... ..........--/�------------------...------ s---------- Application,A roved B - -. PP Y � ........................................... Daze Application Disapproved for the following reasons: ........................................ ------------------------------------------------------------------------------------ ................._..------------------------------------------------...---.............-------..........-_..--------...._-------------------- . ....... ................... �j � Permit No. ....L...-. �".��. ------- Issued ��` -..7 LD...---------- Dare !/�y / W ry_�J �• r N ............._....... L THE COMMONWEALTH OF MASSACHUSETTS; BOARD OF HEALTH , 1 � TOWN OF BARNSTABLE f � � Appliration for Dispaii it 19or1w Towitrurtivit ramit Application is hereby made for a Permit to Construct (x) or Repair ( ) an Individual Sewage; Disposal System at: ...............................................................................:............. Location-i\ d css or Lot No. Owner ! Ad fss r ao a ti vw� u ............ � �.... _y_.L.!.:_ AK Installer Address d Je of Building 2 Size Lot............................Sq. feet U Dwelling— No. of Bedrooms.......J---------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------------------------------------ ----- W ` Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. R, Septic Tank—Liquid capacity------------gallons Length______________: Width---------------- Diameter.......... ----- Depth________-___---. �-4 Disposal Trench— No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet_................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) � Y Percolation Test Results Performed by----------................................................................ Date........................................ a Test Pit No. 1________________minutes per inch Depth of Test Pit-------------------- Depth to ground water __............ Test Pit No. 2................minutes per inch Depth of Test Pit__.._.--_._________- Depth to ground water........................--------------------------------------------------------- -- R: ----*'.-••-----•--------------------------- -•.................................................... ODescription of Soil........................................................................................................................................................................ W yR V -----------------------------------}____---.-.____-.__----_._.__._.______.___-.--.._.-----_____._____________--_----_--__-.--__..___---.--.________ ____-_•_-..............._ U Nature of Repairs o�rA Alterations—Answer when applicable:___/��J-d___-�.A�..____5:��1h.�..._'..�<.!�f���?�? -------------------a-." - S N_�.... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia ce has been issued b the board of health. Signed .. 5- ..... .........._...V..5..-----_----------------- f S .. . .. ......: Application.Approved By s�? ` -�RD l Dace ........................................ Dare Application Disapproved for the following reasons- --------------------- ----------- ..........-- .. ...... ... . . .................._...... ----......._....._----------------------------------------------------------.....--------_..................--- --- . ----------------------------------- ------------ --------------------................. ice— Permit No. -------- h Issued ......- '°` . .�'. � Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (IT rtifi a e of Compliance THI IS ,TO ERTIF.;Y, That the Individual Sewage Disposal System constructed ( x ) or Repaired ` by .... AAC--- � . "..... c�.�-) a}Lt �' I ---------------- ..__....... ................--... ... - --- r-te - t�. -- e �a,.. at ....._... .. a 1..._....... �,.5. ---...�i+./`�1J.EC --------- ll� -G.tl cr. has been installed in accordance with the provisions of TITLE of The State Environmental Code as described in the application for Disposal Works Construction Permit No. r�_�� y 9 77 dated l z THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM W ILL FUNCTION SATISF CTORY. ' DATE.. '� :C7...." .... .�.. InspeCt0'r ___. .._ --- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.. '..:... FEE.12i� 7ailridividual Permission is hereby granted- 0 - --'�---..r....... --•- ..----....qA �._J... �1��'..... to Construct (X) or Repair ( ) Sewa g Disposal System ty at No. .l -f1z 6`' S.t ---L•!G-h'-�---- ----------- �_c�/f/J ------.--_--------------------------------------------------------.----..-.---.--- Street as shown on the application for Disposal Works Construction Permit N ._-�_ ___-W4�16ated.._. __. �7 ......... � Board of ealth DATE---- vv 1..-- -ill' ----------------•-------------------• FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS t6/ OltM- Olt,6 "I- ix Am4 6$w (In accordance N0?ZPZCA?,r0M OP AS88STOS jVopX All sections 01th the: PrOVIS-100s Of NIO&L, C. 1490 §646F an .4_3 of. this form. 4 453 cKR 6a2) Map2eted in order to 00-MAY with the nOtIfICO.,U08 requirements of 453 CMR 6.12, TVIV DAY PRIOR NOTIMAU06 IS MOMM OF ANY APAriMIT PR'WBC? GUAM MAY Ulna (3) LINEAR OR APUARV PUT Du rue hVXSER Contractor performing Projectffitwe 10 wo its JPM-vallin9 rates of wages- apply to this pr-oj&ot as requited under 249, 925* 27 or 27F? (circle. one.) YES NO Address, of Pro act Building name fit any Street Address 6-50 U'U NOW'type (circle one): DSHOUMN XBNOVATION RBPA, OTHER If *Other* selected; please, explain Asbestos Activity: (circle: one):: AMC ATED PROJECT ENCLOSURE OWN Indicate amount of: asbestos surface on, Pipes or ducts LINEAR FEET OR asbestos rirface on structures other to be removed, enclosed or encapsulated than pipes or ducts . SQUARE FTST Start date '7Z21 an Pm Weekends COMPletiOn Date 1 17 Project Supervisor ne.1 certificate- 9,� Asbestos Analytical Lab HAm_e 04ke 4,address. P NO,* 17 xs *$best*$ OOA,trof fifrJtE�f1 0 d xbal t i, Conte 410tor, Is>WQrkere t .0 rpdr�"00 .i sser +r t . Policy Nrzaber WC 31 -4 =;1 _ Facility owner Address City. State - - Zip Descrlptioq of work praictioe-8 to be followed: Cl•eetd" �d`� _ Arc-P�i✓ . �'�i.�gH'1t"s2/,l�+�C� S°c�/° �'/'L' G� LL _ 'T Ct iZtflKl (/O^et e./l S �• e Description of decontamination +systeats) to be used Mini 1-2 chamber,_ 6mil poly deconteiminatton facility (clean room and dirty/wash for two chambers). a Description of handling/disposal methods to Comply with 4S3 CHR 6.14{I) (g) "kF' Keep ACM wet, doublet 6 mil poly ertd labelled bags, ;k ,,. Name and address of transporterts) if other than the asbestos contractor: f BluegrM Transportation Co., Inc. P.Q. Sax 351,Catlettsburg, KV 41129 ••, The twdereigned herebyy states, tinder the.penaltiei of perjury, that die/she has .read end .understood the romonwealth of Hassaehusette Regulations-•for the Reatoval, Containment or 8ncapsulation of Asbestos, 4S3 CMR 6p00, and that -the Information Contained In this notification is-true and correct t0 the best of : his/her knovI edge and belief. Date ICZ224 Signed: title: Pro act.Coordinator.. . Conpany: AirSafe International .Ltd Please return this foray to: Asbestos Control Technical 'Services : Department of Labor and Industries . .. . Division-•ot•:Industriel-Safety I.00 Cambridge Street, Room 1101 "Boston, Mil 02202 ' .•00.494 :?`: ' ��` r I�. LEGEND N EXISTING CONTOUR X 100.98 EXISTING SPOT GRADE Mq/N yy EXISTING WATER SERVICE STREET G EXISTING GAS SERVICE H.-W.— UNDERGROUND WIRES ® TEST PIT ye� <° °°oo BENCHMARK ROoo P�qNa','r DEFT 6k �j26 �°c /2 �a LOCUS pG S6 �o qy APN 117-122 A moo, • 99.02 57.50' fence p� SHED I _ � d Pie cc } 98.25 i� 98.87 I APN 117-134 j K_0 1 3TP-1 —2 V —I T 2' ICI— I I S. jZ O � 98.5� 1—_.l� ,42 EXISTING GAS & WATER SERVICES c),2 e � I io LOCH TIONS ARE APPROXIMA TE ONL Y ( 11'--i ic�niN i I AND ARE ONLY SHOWN TO INDICATE _0 I IOt I I I THA T THERE IS A CONNECTION BETWEEN I i i r I THE BUILDINGS. I L I jib! I 1 0_I I II I j EXISTING S.A.S. TO BE ABANDONED. (SEE NOTE 11—SHEET 2) 9925 ' 9 .06 I EXIS77NG SEPTIC TANK N " ' BENCHMARK (TO REMAIN) j ORANGE PAINT AT OUTSIDE OF TOP OF TANK, EL.=98.12 PRECAST BULKHEAD CORNER INV.(OUT), EL.=96.79f j D IECK 7 EL.= 99.27 Assumed 99.06 98.20 99.51 98.53 v . Ln 00 N FF AC 99.02 APN 117-120 ,EXISTING HOUSE(#21) T.0.F.=100.6f 98.81 14RUB SHRUBS: 8' 9.90 Q- APN .117-121 0 10,062 S.F. (DEED) I 99.42 98, 7 - 57.32 99.31 PAVED SHOULDER 99.16 edge of road 99.67 SUNSET LANE jp �``P��� OF Mgss9�yG PETER T. PROPOSED SEPTIC SYSTEM UPGRADE PLAN McENTEE CIVIL 21 SUNSET LANE, OSTERVILLE, MA 35109 Prepared for: Capewide Enterprises, P.O. Box 763, Centerville, MA 02632 y0F PSI E`� OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO. MONTO, PERNILLE FONSBY Engineering Works, Inc. 1"=20' P.T.M. 112-11 I�� 1 21 SUNSET LANE 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. 2 2/8/11 OSTERVILLE, MA 02655 (508) 477-5313 P.T.M. 1 of 2 Y � tR NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL.95.8 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & WATERTIGHT INSTALL INSPECTION PORT OVER END UNIT T.O.F. OUTLET AND SET TO 6' OF FINISH GRADE COVER SET TO 6" OF GRADE EXISTING F.G. 98.8(MAX.) F.G. EL.=99.1 t � F.G. EL: 98.8t MAINTAIN 2% GRADE (MIN.) OVER S.A.S. L = 26' L = 7'(MAX) INSPECTION ® S=1%% (MIN.) p S=1% (MIN.) PORT 4"SCH40 PVC4"SCH40 PVC 1 MINIMUM) 6" �o"I 14" 10.75" TO EXISTING 48" LIQUID INVERT LEVEL cAs�BnFFLE J INV.=95.67J'INV.=95.50 PROPOSED 4 ROWS OF 7 UNITS AT 5.0'/UNIT = 35.0' • . S. „.. ' INV.=96.79f D-BOX INV.=95.4 EXISTING SOIL ABSORPTION SYSTEM (PROFILE) EXISTING SEPTIC TANK ESTABLISH VEGETATIVE COVER BACKFILL WITH CLEAN NATIVE OR PERC SAND TO TOP OF CHAMBERS NOTES: BREAKOUT=TOP TOP ELEV.=95.83 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INV. ELEV.=95.40 INVERTS, PRIOR TO INSTALLATION. 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE BOTTOM ELEV.=94.50-v ON A MECHANICALLY COMPACTED SIX INCH CRUCHED 1 2.83' STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 5' MIN. ABOVE BOTTOM OF 3) INSTALL INLET & OUTLET TEES AS REQUIRED. T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH=11.3' 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE EXISTING SUITABLE AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. NO G.W., EL=89.2(BOTTOM OF "Cl") = MATERIAL USE 4 ROWS OF 7-ADS Arc 36HC UNITS WITH NO SEPARATION BETWEEN EACH ROW & NO STONE SEPTIC SYSTEM PROFILE TYPICAL SECTION N.T.S. SOIL LOG DATE: FEBRUARY 2, 2011 (REF# 13,190) SOIL EVALUATOR: PETER McENTEE (SE#1542) WITNESS: DAVID STANTON-HEALTH AGENT GENERAL NOTES: Elev. TP- 1 Depth Elev. TP-2 Depth 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. 98.5 A 0" 98.4 A 0" 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS SANDY LOAM SANDY LOAM OF-THE STATE_ ENVIRONMENTAL CODE, TITLE --"AND ANY APPLICABLE - - T - 1'OYR-4/2 1OYR-4/2 0 LOCAL RULES AND REGULATIONS. 97:7 B 10 g7.6 B 1 " 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR SANDY LOAM SANDY LOAM TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 10YR 5/8 95 4 1OYR 5/8 36" DESIGN ENGINEER. 95.0 42" C1 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING C1 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN PERC ENGINEER BEFORE CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF MED. SAND MED. SAND THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 2.5Y 7/3 2.5Y 7/3 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED .BY TOWN WATER SERVICE. 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 89.2 112" 89.1 112" 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS C2 FINE C2 FINE AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE SANDY LOAM SANDY LOAM DIRECTED BY THE APPROVING AUTHORITIES. 88.5 2.SY 5/3 120" 88.4 2.5Y 5/3 120" 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING NO GROUNDWATER OBSERVED CONSTRUCTION. PERC RATE <2 MIN/IN. IN SAND "Cl" (RECORD) 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE. S.A.S. AND 63.25" REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL ts" 34. 5 TOP VIEW DESIGN CRITERIA 60" _ NUMBER OF BEDROOMS: 3 BR HOUSE + 1 BR ACCESSORY DWELLING END CAP END CAP (HOUSE) ( ) FRONT VIEW. SIDE VIEW 4 BEDROOMS (TOTAL) END CAP SOIL TEXTURAL CLASS: CLASS I REAR/TOP VIEW DESIGN PERCOLATION RATE: <2 MIN/IN NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT SIDE VIEW TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY DAILY FLOW: 440 G.P.D. DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. DESIGN FLOW: 440 G.P.D. 4640 TRUEMAN BLVD GARBAGE GRINDER: NO DS.HILLIARD, OHIO 43026 Arc 36HC DETAIL LEACHING AREA REQUIRED: (440) = 594.6 S.F. ADVANCED DRAINAGE SYSTEMS,INC. .74 PROPOSED SEPTIC SYSTEM UPGRADE PLAN EXISTING SEPTIC TANK: 1500 GALLON CAPACITY PROPOSED D-BOX:: 1 INLET, 4 OUTLET (MINIMUM) 21 SUNSET LANE, OSTERVILLE, MA USE 4 ROWS OF 7-ADS Arc 36 UNITS WITH NO Prepared for: Capewide Enterprises, P.O. Box 763, Centerville, MA 02632 SEPARATION BETWEEN EACH ROW & NO STONE Engineering by: SCALE DRAWN JOB. NO. BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.80 SF/LF OF UNIT) Engineering Works, Inc. 1"=20' P.T.M. 112-11 (Arc36HC Units) 28 UNITS x 5.0 LF x 4.80 SF/LF = 672.0 SF 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET N0. DESIGN FLOW PROVIDED: 0.74(672.0 S.F.) = 497.3 G.P.D. (508) 477-5313 2/8/11 P.T.M. 2 Of 2