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Home My WebLink About0033 WATERFIELD ROAD - Health a.a 33 Watef field Road° 118-125-002 Osterville y a 'i� o TOWN OF BARNSTABLE LOCATION SEWAGE# v2(J E7T VILLAGE( , -,� o�� ASSESSOR'S MAP&PARCEL I1 -EYS-- INSTALLER'S NAME&PHONE NOQ2S2cs A T*OW K-) T_n1 e SEPTIC TANK CAPACITY yTr l�o� LEACHING FACILITY: (type) aS It (size) 1 ZSX NO.OF BEDROOMS OWNER PERMIT DATE:I _'1j 7 COMPLIANCE DATE: // r _/-7 Separation Distance Between the: woAte 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 cLny` CGa.I/� Mot 3 � �- - 33,5 3ovi-` 3 4`5 �0 'D a-37 a Eov 1 No. G ' Fee V THE COMMONWEALTH OF MASSACHUSETTS Entered in corn Ater: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Bispasal 6pstem Construction jermit Application for a.Permit to Construct( ) Repair(/Upgrade( ) Abandon( ) ❑Complete System L�-Mdividual Components Location ftddress or Lot No. 3? Gpfky�/�Y� JZ Owner's Name,Address,and Tel.No. AsCse)sso s%0apP/Parcel 2 —p 02. 5k e0 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. t�Sl�s A i3lca�:�J�i�c 5 _y Coo i.�ex Di v fit. l��1 Type of Building: Dwelling No.of Bedrooms 3 Lot Size 1 <<� � sq.ft. Garbage Grinder( ) Other Type of Building (c�StC�cn9F►c.} No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) _3 30 gpd Design flow provided '3 z/$,7 gpd Plan Date 101`1CA 1:7 Number of sheets 2 Revision Date TT Title ` Size of Septic Tank I? 151-fg% Type of S.A.S. 2 Sim C.(C��\C94%j CIACA Kj� Description of Soil Nature of Repairs or Alterations(Answer when applicable) C1 N?°W 1—1 Q C)\p dK :L Q f[ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sian& Date -/ Application Approved by f Date Application Disapproved b Date for the following reasons Permit No. 96 Date Issued ti+..T.a._.l ,..h.,,, ^^,..tee � .,,^c . .. .. M+'R R°- "en �' -�. � .y,rC.��''kT-.,r'•%K -��rt w`'�H�i.r�' 'f ... i•�. .. S ' No. 6 ' V.� t Fee /6 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: s - PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplication for VsP616a stem Construction Permit F R%- Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System �3ndividual.Components Location A,,d`d�ress or Lot No. ? W(,kt((irl R Owner's Name,Address,and Tel.No. Assessor sapP/Parcel ( 1s 002. 5�►Pi Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Mbaslas A Type of Building: Dwelling No.of Bedrooms 3 Lot Size (Isa t! sq.ft. Garbage Grinder(. ) Other Type of Building ((-Si No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 3'!g,7 gpd Plan Date 101,2d 17 Number of sheets 2_ Revision Date Tr— Title ` Size of Septic Tank P)f tSF tN� Type of S.A.S. 2 5"G� "CAC L�GM,UP/5 v Description of Soil Nature of Repairs or Alterations(Answer when applicable) t 0i°L&J 1n !V COX c---J 0 2 V—10 ,-Soo !�JCAvN .rinrAAJOiPI% cs CakrAAj,,, nN tnit-n-) v � Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-ste 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. S/i e t y�2..•---— Date Application Approved by ` Date V V� —�� Application Disapproved b Date for the following reasons Permit No. G ( 7 Date Issued / - j -�7 �. THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(l/ . Upgraded( ) q Abandoned( )by -at a, ^� l tJet+-r' r r-) c� 1 C 1 St-►'/yAt r has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.)�y(7 -3-9 dated I i J'/ 7 Installer )n,\C,t A I ,C Designer #bedrooms Approved designflow gpd The issuance of this permit shall not be construed as a guarantee that the system will functio �degned. Date I 1 ''S l -7 Inspector ------ ---------------------- ---------=----•-------- ----------- ------------- - No. DID, 7- 3�� Fee l QU - THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposaf 6pstern onstrUction Permit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at G's c Nc� 1Z J (a�}c(y A�\T and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date /f'" -7 Approved by L�✓ /� .� fi Town :of Barnstable °E`"E'Owo Regulatory Services- Richard V. Sca1i Interim Director--: + BARNSTAISM • I MASS. Public Health Division. 039. Thomas McKean,Director 200 Main Street,Hyanpis,M. 026.0:1. Office: 5087862-4644 fax: 50.8-79076304 Installer & Desi�rier Certification Form l Date: 1113LI,2 Sewage Permit# ;®i 7 3M ,,Assessor's Map\Parcel .Designer: �iic��,rtee� n o� Lilo rats �n� Instaher:. ;,4 43,z Address: 1Z W t. C rb ss+-,e (j. t` d _. _ Address: e a: 1 1 k,.125— . . - :o re s f-66 to MA .6 2(-W -- L' Ikn jx,-y)I Le ,,4 3Z. Ori- j•- 3 -17 7 , A. , was issued:a erinit to iri tall a (date) (installer), C"kseptic system at, 3 3 ��✓ °fi �`- based on a.design drawn by ~ FK e r i, 1M C_ +k e 1; (address) I Ey►y ine� ^n9 tdrL Lit C , datecT- d ej �'�-� ►? �, 1).l3 P (designer) I certify that the septic sysiern-referenced above was:installed substantially according�to the design, which may include minor approved ch% anges!such as lateral relocation of the distribution box and/or septic`tank.. Strip out (if %equired) was inspected and the-soils' were found satisfactory:. d I certify that the septic system referenced .above was installed with,major :changes (i c; greater than 10' lateral relocation.of the SAS. or any vertical relocation of any component of the septic system) but-in accordance with State &..Local Regulations: Plan;revision or certified.as=built by designer to.follow. Strip out (r required) was inspected and the soils were found satisfactory; I certify that:the-system referenced above was constructe" nce with the;terms of the I\A.approval letters'('if applicable) HOF Pdji J T. a MctNTEE CIVIL #nAllei0's Signature) N6'-35t06. �FQ/STER (Designer's Signature) (Affix Designer. . famp 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. Q 14-13:doc 1Septic\D'esigncr-Ccrtification Form Rev 3- TIM Town of Barnstable P# is � I Department of Regulatory Services Public Health Division note 200 Main Sheet,]iyannis MA 02601 Date Scheduled Time Fee Pd. Soil Suitability Assessjanent for S 'e Disposal Performed By: 7 t k G�� ; S >-_( 2 Witnessed By: I-s- ]LOCATION & GENERAL INFORMATION [Assessor's cation Address "a� �l a v/3 • d'�t�4 e Owner's NameF}�IQcvS ;� U. Address 7,3--? �Z H• (V1 A •. Map/Parcel (•L'-� —,I Z - cf"Z Engineer's Name r INEiW CONSTRUCTION s REPAIR •"/— Telephone# �✓tq a, 4v_e e_rf eb Land Use _ Q.S rC L7 z x 1 Slopes(%) _ f' Z Surface Stones Distances from: Open Water Body ft Possible Wet Area f L:S7J--ft Drinking Water Well 7-__ft Drainage Way—1-7f�0_11i ft Property line ft Other __ft IKETCH: (Street name,dimensions of lot,exact locations of test holes&perc tests,to an Jn proximity to holes) I, G /2,a) Parent material(geologic)_QU4—Via.5 Vq � t M1 Depth to Bedrock:,_ ; _ T Depth to Groundwater: Standing Water in Hole: A d /�-C-__ Weeping from Pil:Pace 1VC1/LA_ Estimated Seasonal High Groundwa.:er — /3 DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Obs_-,ved sanding in obs.hove. in, Depth to so!!Depth to weeping from side of obs.hole: _ _ in, dre7tmdwntet AdJusttrjent o _ ,_ ft: Index Well# Reading Date: _. Index Well.level_. x, Adi,factor___ Adj,OroundwaterI-evel PERCOL;AT:[ON TE+.ST Date , _;,'Time Observation Hole# 4_'1 _ Time ut 4" Depth of Pere Time at 6" Start Pre-soak Time @ Time ff'-V) T End Pre-soak l Rate Min�/Lnch Site Suitability Assessment: Site Passed ✓ Site Failed:e 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 1100' of wetland,you must first notify the !f BarnsWble Conservation:Division at least one (1) week prior to beginning. Q:iSEP`I'IMERCI`ORM,DOC , DEEP OBSERVATION HOLE LOG IE[ole Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency.% ravel DEEP OBSERVATION HOLE LOG Flole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Oravel f7 DEEP OBSERVATION HOLE LOG Hole# _.._ Depth from 'Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling- (Structure,Stones,Boulders. Consistencj9'o Gravel) I-- _ __ --- --- -------i-- - = -- -- it — --- 7-- DEEP OBSERVATION HOLE LOG. T Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) "(Munsell) Mottling (Structure,Stones,Boulders, Consi�lencv,J Onvel)__._.._.- Flood Insurance Rate Mali,, Above 500 year flood boundary No— Yes_JeL 'Within 500 year boundary No Yes Within 100 year flood boundary NoA Yes. Depth of I'daturt►1)ly Occurrin�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 pervious material? (-'ertification I certify that on ll �V CL . (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was pe;formed by me consistent with the required tra' ' g,expertise and experience described in 310 CMR 15.01'1. Signature. __ _ Date Z0 7_61/_) (Q:\SBI'TIC\l'ERCFORM.DOC Y Town of Barnstable Barnstable Regulatory Services Department AN-`°'e`raCfty swxcvsrAHM � 'MASS . ,0� Public Health Division f°AAPYA 200 Main Street, Hyannis MA 02601 . 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL47015 1730 0001 4990 3943 September 29, 2017 DAGHER, MATTHEW & MAURA 237 LEAVITT STREET HINGHAM, MA 02043 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 33 Waterfield Road, Osterville, MA was inspected on 09/14/2017 by Mark Polselli, certified Title V Septic.Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching pit or cesspool with high liquid level,<12" below inlet(per Town Code 360-9.1). You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\33 Waterfield.Road Osterville.doc I Town of Barnstable MAM ,bg Regulatory Services Department Public Health Division 200 Main Street,Hyannis MA*02601 Office: 508-862-4644 Richard Scal,Director FAX 508-790-6304 Thomas A McKean,CHO Feb 63 2007 Rev. 5111116 DEADLINES TO REPAIR FAILED.SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) _ An`x"marked in tte ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑Discharge or ponding of effluent to the surface of the ground w . ❑Pumping more than 4 times during the last year not due to clogged or obstructed Pipe ❑Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE(1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). O (21 YEAR DEADLINE CRITE q in ❑Any"conditionally passed systems" (broken cover,relocation of a pipe,relocation of a driveway due to H-10 components, etc) eaching pit or cesspool with high liquid level,<12".below inlet (per Town Code y §360-9.1) ❑Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) ` OTHER I ❑ Repair deadline: Q\SEPTICIDEADLINES TO REPAIR FAILED SYSTEMS.doc h. oocp� x Commonwealth of Massachusetts w� Title idol Inspection Foil Subsurface Sewage Disposal System Form - Not for VVoiuntaty Assessments Property Address Owner Owner's Name information is l •/ required for every &S' page. City/Town State Zip Code Date of Ins action Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist aY the end of the form. Important:When filling out forms A. Genera0 Information on the computer, use only the tab 1. Inspector: key to move your p cursor-do not l use the return - .key Name of In VQ Company Name /50 Company Address City/Town State Zip Code Tefephon umber 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. am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes Plails ❑ Needs Further Evaluation by the Local Approving Authority Inspect '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 cf the DER The original should be sent to the system owner and copies sent to the buyer; if applicable, and the approving authority. This report on!v describes conditions at the time of inspection and under the conditions of use at that throe, This inspacdon does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc•rev.6116 Title 5 Official inspection Form:Subsurface Sewage Disposal system•Page 1 of 17 ValY S f It Commonwealth ®f Massachusetts "tie 5 Official Ins ct' n Fore Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Y 4M N Property Address Owner c, 44 Owner's Name information is �f.� / � required for every 3 page. City/Town — _ __ State Zip Code Date of Ins ction Bo ClaqVicat non (cunt.) Inspection Summary: Check A,B,C,D or E /always complete all of Section D A) System Lasses: ❑ 1 have not found any information which indicates that any of the failure criteria described in 310 C✓VIR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionaliy Lasses: ❑ 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, exhit,its.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 rn,e_tal 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. (mil ,r , ❑ V ❑ ND (Explain below): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonweakh of Massachusetts Title 5 O, dal Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assassments -k /C-j Property Address �g — Owner Owner's Name information is a eve for required 4 every _ S page. City/Town_ _— State Zip Code Date of I pecti Bo Cerr fficaijoon 'Cont.) ❑ Pump Chamber pumps/alarms not operational.System wiii pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally passes (cont.): ❑ Observai!or of seviage 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 p-ass 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 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. I. System vAll pass unless (Board of Health determines in accordance with 310 CMR 95.303(i)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ C:sspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc•rev.V6 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 I Commonwealth of Massachusetts Title 5 Official MspectionF--com Subsurface Sewage Disposal System Form - Not for V luntar Assessments Ile, . �7 Property Address r Owner Owner's Name information is required for every 01� page. City/Tovm State zi Cody ria'Ie of I spec' B. CertfficaUon (cont.) Z. Systerr, will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 1,00 feet of a surface wafer supply or tributary to a surface water supply. F-I The systam has a septic tank and SAS and the SAS *:s withn a.Zone I of a public water The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. F-I i he 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 systen-, 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 ppn%, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. 0 f 15 4 D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No" to each of the folioWing for all inspections: Yes "Xro LI 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 Fie bTalic liquid level in the distribution box above outlet invert due to an overloaded clogged SAS or cesspool r7r' Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts , Subsurface Sewage Disposal System Form -Not for Voluntar%/ assessments 23 (,/4 74,'r- Id Property Address ——- - �� --- ---- - Owner's Name information is Owner 0 s�q required for every page. City/Town State i� .;de r —__.__— —__---- f at InWtion Yes No � Required pumping more than 4 times in hr last year A10Tdue to clogged or obstructed pipe(s). Number of times pumped: ❑ I ,.Anv portion of the SAS, cesspool er pr i./`y is l,elow high ground water elevation. Any portion of cesspool or privy Is ,Mthin 100 feet of a surface water supply or tritiijtary to a surface water supply. Li L1 Any portion of a cesspool or pi mvy is vii, ;I a �cr; i 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 acceotable 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 arri'monia nitrogen and nitrate nitrugero is equal to or less than 5 ppm, prcw`sded that no other failure criteria are triggered. A copy of the analysis ansd chain of custody must be aatachled to this form.] I-h4 system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. - ❑ irhe system fails. I have determined that one or more of the above failure criteria exist as described in 310 C MR 15.303, therefore the system fails. The system owner should contact the.Board of Health to determine what will be necessarj to correct the failure. E) Large Systems: To be considered a large system the sifstem must serve a facility with a design flow of 10,00o gpd to 15,000 gpd. For large systems, yaj must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. ' Yes No .' ❑ ❑ _i-i.e systern is within 400 feet w 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 Arena IW?A) or a mapped Zone II of a public water supply well If you have answered -es"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 I system in accordance v/tl '10 rN4,R 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Title 5 OffidaHnspect'on, Fo ID-11 Subsurface Sew-age Disposal System Forums - Not for VGILMtary Assessments p y Property Address Owner - = --- =-- -- Owner's P�lame , � �� informationis —required wir for for every pp�� page. Zip Code City(Town State - - -- _ —_ — ede Cate of i specti Check if the following have been done. You must indicat:, "ves car no as to each of the following: Yes No " . CJ 4JmpMg information was`'pi'ovided by fife owner, occupant, or Board of Health yy re any of she system components pumped out in the previous two weeks? ❑ U Has the system received normal flows in the previous two week period? F Have large volumes of water been introduce;l 'to the system recently'or as part of this inspection? Were as built plans of the system obtained and.exarnined? (If they were not available note as N/A) r I Wss the facility or dwelling inspected for signs of sewage back up? lip Was the site inspected for_sigr.s of hreak olrr? FP 'J`,ere all system components,excluding the SAS; iocated on site? �❑ Were the septic tank manholes uncovered, opened. and the interior of the tank inspected for the condition of the baffles or fees, material of construction, Mimensions; depth of liquid, depth of siuc.ge a.id depth of scum? Was the facility owner(and'occupants if different from owner) provided with info rriation on the proper maintenance of subsurface sewage disposal systems? 4 he size and location of the Soil Absorption. Systems (SAS) on the site has been'determitied based on: Existing/'/0, intormation. For example, a plan at p p Board of Health. Determined in the field (if any of the failure criteria related to Part C is at issue approxiiria°ion of distance is unacceptable) 1'310 CIVIR 15.302(5)] Do System 'ruorlfut a''(;]olil Res7'denflal Flow Conelition— 4 Nurnber of bedrooms (dell In): Number of bedrooms (actual): ,DESIGN flow- based on 31O.CiVIR 15.203 (for example.1'10 cipd x#of bedrooms): I ' t5ins.cloc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 s Common eafth of Massachusetts H Title S fficial Mspection Form Subsurface Sey+age Disposal System Forma -Not for Voluntary Assessmenyts X", Property Address Owner Owner's Name information is t ~�� r ®� 1 required for every r la � .� ®� page. CitylTown State Zip Code Date of Inc ectio Description: lio® JOS 60�70_n Number of current residents: Does residence 'have, a garbage grinder? ❑ Yes No Is laundry on a separate sewage system? (include laundry system inspection information in this report.) ❑ Yes No Laundry systemn inspected? ❑ Yes No Seasonal use? Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sums;pump? ❑ Yes No Last date of occupancy: ;. ' Date Commerclalil odustriaal Flovi Conditions: Tyre of Establishment: -- Design.flow(based on 310 CMR 15.203): — 3allons 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, it available: --- t5ins.doc•rev.6/16 Title 5 Official Inspection Fcm:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth ®f Massachusetts "tie 5 Officla-M Inspection Form' Subsurface Sev-jage Disposal System Form m Not for Voluntary Assessments ej Property Address Owner Owner's Name information is � required for every tom' 9 page. City/Town State Zip Code Date of Ins ection Do Syste Irb hformation (cone) Last date of occupancy/use: Date Ouber(describe below): General information Pumping Records; Source of information: Vlas system purnpec. as pari of the inspection? ❑ Yes E No if yes; volurne purnpe'd: gallons ----- How,was quantity pumped determined? — Reason for pumping: Tyra of . e l�.5� Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool Ell Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Inno',,iative/Alternative technology. Attach a copy of the current operation and maair t i Banco contract (to be obtained from system owner) and a copy of latest inspection of the !/A system by system operator under contract [� Tight tank. Attach a copy of the OEP approval. !� Other(describe): l5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 fficW lInspection Forrn . Subsurface Sewage Disposail System Form - Not for Voluntary Assessments ` ®®-lete� M Property Address Owner Owner's Name he� p -- information is M ��yyt - Q required for every C _ � y page. City(Town _ _ __ _ State Zip Code Date of Insp tion Do System fiim'10,m&�an (corit.) Approximate age of all com pDonents,date installed (if known) and source of information: -6 Q Were sewage odors detected when arriving at the site? ❑ Yes No Builldling Sevier(locate on site plan,): E �/ Dep16h below grade: feet Material of construction: ❑ cast iron -0 PVC ❑ other(explain): _._.. Distance from private water supply well or suction line: feet Co niments (on condition of joints, venting, evidence of leakage, etc.): Sa rotl::Tank (Incate an site plan): Depth belov,v grad : feet Matari,� f GOn�tl'UC'ir)n: concrete metal ❑fiberglass ❑ polyethylene El other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No mansions: Sludge depth: t5ins.doc•rev.6/16 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts H TRIe 1,ffi ' Mspecflon Poem Subsurface Sewage Disposal System Form - Not for.Voluntarli Assessments Property Address Owner Owner's Name information is ��Gi �� lo-clss tly required for every �-�' page. City/Town _ _ — __— — State Zip Code Date of In pectin De System M0u Vna1VGn (cont.) -- Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness B _ L -e rs Distance from.top of:Scum to top of outlet tee or baffle Distance from l;ottorn of scum to bottom of outlet tee or baffle — How were dimensions determined? !. V/ Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): ---— - - — f» C Co.., it-/i®✓a , Gr a s a Tip-af (locp.te on site plan): ' Depth below grad : 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 purnpi Date l5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Title 5 Offi 'W �nspectlon Poem Subsurface Se wage Disposal System yster>n �orcti, - Not for Voluntary Assessme nts ents Property Address --— Owner Owner's t flame information is required for every page. City/?own _ State 21p Code Date of In pection �a System �RfOrrr-aUW1 (cone.) Comments (on pur,ipi,-,g recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related, to outlet invert, evidence of leakage, etc.): Tight or Holding i atn:k (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 (conilitison of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Fonn:Subsurface Sewage Disposal System•Page 11 of 17 <2�x commonweafth of Massachusetts I it o 10 �e 5 Offidal Inspection Forffl N A Subsurface Sewage DisPosai System Form - Not for Voluntary Assessments I4�/ PI—V Property Address Z_ Owner information is Owner's Name - required for every page. City/Town State Zip Code Date of In ection,' D. Systern kbfarmi2U0n (cont.) Distribution BrX (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comtrients (note if box is leve! and distribution to outlets equal, any evidence of solids carryover, any evidence o lac kage ;rAe or out of box, etc.): Pump Chamber(locate on:site plan): Pumps in working. or-der: ❑ Yes El No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of'purnps and appurtenances, etc.): If PU Mps or alarms are not in working order, system is a conditional pass. 81f5 tern (SAS) (locate on site plan, excavation not required): If SAS not located, exp!ain why: t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts fich.�, hspecbon Form TRIe 5- Of 11 1 i; Subsurilace Sewage Disposal System- Form Not for Voluntary Assessments 1-7 H �d � • S 9 'Sf l Property AddrE)I, Owner information is Owner's Name required for every page. City/Town.I State Zip Code (]ED5ateAofIns 4ction - --- 0. System Wormaflan (cont.) -----— Type: leaching pits number: ff;Lo n !eaching chambers number: le--ching galleries number: lea.ching trenches number, length: ❑ leaching fields number, dimensions: E71 overflow cesspool nurnber: innovative/alternative system Typeftarne of technology: Con-irrients (nof.-e condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): �7li" T ------ ,�-e !? , , o Cesspools (cesspool mjjs-L-be pumped as part of inspection) (locate on site plan): Number and corill"guration Depth—top of liquid to inlet invert Depth of solids 12yer Depth of scum layer Dimensions of cesspool Materials of coast:ucticin indication of grounclN.vater inflow [I Yes F] No t5ins.doc-rev.8116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commo9'tlwea th of Massachusetts Title 5 Offidahspecflon Form Subsurface Sewage Disposal System Forma - Not for Vol nt ry Assessments Property Address Owner Owner's Name information is required for every 'i �t�'�i 01 6� page. City/Town _ __ "'State Zip Code Gate of In ection 0. System �191i1 i�il Itlo , (cont.) R Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): r 0 Privy(locate on site plan): - s Materials of construction: Dimensions - Depti, of solids ; Comments (none.'=on "Htion of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc•rev_6/16 • Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 CotmmonweaNh of Massachusetts Title 5 OfficialInspec 'on Form Subsurface Sewage Disposal System Form -Not for V lu tary Assessments Property Address' - ke Owner Owner's Name — information is � required required for every page. City/Town _ State Zp Code Date of Ins ection Do SYStWn UJUMZHOTI (cone.) Sketch Of Sewage disposal System: Provide a view of the sewage disposal system, including ties to at least twopermane;t reference landmarks or benchmarks. Locate all wells within 100 feet. Locate whei _"mac water supply enters the building. Check one of the boxes below: -_- hand sketch in the area below drawing separately 14t"'31 A3 N t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 15 of 17 i comman eafth of Massachusetts H Title- 5 OffidalInspection Form Subsurface Sewage- Disposal System Form -Not for Voluntary Assessments iv M Propeny Address Owner Owner's Name ------- require tion is required for every page. Cltyr own _ — State Zip Code Date of I pection Do System hfarmalflo�j (cone.) Site Exam.- El Check Slope Surface ,r;i:ater f__j Check cellar El Shallow wells vie— Estimated depth to high ground water:- feet Please indicate all methods used to determine the high ground water,elevation: Obtained frorn system design plans on record F`checked, date of design plan reviewed: Date served site (abutting property/observation hole within 150 feet of SAS) � Checked wig bocci Board of Health -explain: Checked with local excavators,'installers - (attach documentation) ;accessed USGS database- explain: You ,""u t describa ho\,1,(yoLl established the high ground water elevation: C©C �3 V Berore rilino the lncz (t,..tion '.epo,rt, please see Report Completeness Checklist on next page. t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title ic'M Inspection Forin Subsurface Sewrage Msposal Systems Form _ Not for V lu tary Assessments Property Address Owner Owner's Name r information is required for every __^``° � c page. City/Town—`_ _ _ State Zip Code Date of In pection E. Re ar Corm p�e mess Checkfus ----- - 21 Inspection Surnrnary:A, B, C, D, or F_ checked In pectio/n'Surnmary D (System Failure Criteria Applicable to All Systems) completed ��// [.� S_y em ir.forrta�ion—Estimated depth to high groundwater W Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System°Page 17 of 17 r COMMONWEALTH. OF MASSACHUS ETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION - TITLE.5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: _ 33 Waterfleld Road Osterville.MA 02655 I Owner's Name: Bob Cullotta Owner's Address: Date of Inspection: December 22.'2012 Name of Inspector: (Please Print) .Tames M.Ford Company Name: James Al Ford Mailing Address: P.O.Box 49 " 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 ' eeds Further Evaluation by the Local Approving Authority ails Inspector's Signature: Date: December 31. 2012 The system inspector shall sub it a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of complet 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 p ag e 1 r Page 2 of 11 r OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 33 Waterfield Road Osterville MA Owner: Bob Cullotta Date of Inspection: December 22 2012 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 F 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 I , PART A CERTIFICATION (continued) Property Address: 33 Waterfceld Road Osterville MA Owner: Bob Cullotta: Date of Inspection: December 22'' 2012 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 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 33 Waterfield Road Osterville MA Owner: Bob Cullotta` Date of Inspection: December 22 2012 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 oar 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 tolarge systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim.Wellhead Protection Area-IWPA)or a mapped Zone lI 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 r OFFICIAL INSPECTION FORM'-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPPECTION FORM PART B CHECKLIST Property Address: 33 L7aterfield Road Osterville MA Owner: Bob Cullotta i Y Date of Inspection: December 22 2012 Check if the followin g have be en d one: Yo umust indicate cat e ye or«nY o 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? w ✓ Has the system received normal flows in the,previous two week period;?,' Have large volumes of waterYbeen 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,Aa.plan at the Board of Health. ✓ _ Determined in the field'(if an of the failure criteria"related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. r - ; i - 4 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: _33 Waterfield Road Osterville AM Owner: Bob Cullotta Date of Inspection: December 22 2012 FLOW CONDITIONS RESIDENTIAL 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 Number of current residents: 0 Does residence have a garbage grinder(yes or no): N/a Is laundry on a separate sewage system(yes or no): N/a [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 ast-dat"Loccupancy:_ Inknou n COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): _gpd, , Basis of design flow(seats/persons/sq/ft 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): 1 GENERAL INFORMATION Pumping Records Source of information: Uknown - Was system pumped as part of the inspection(yes or 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 ,Y Other(describe): Approximate age of all`components,date installed(if known)and source of information: Date of installation - Unknown 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: 33 Water field Road Osterville MA Owner: Bob Cullotta - Date of Inspection: December 22 2012 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: 28" 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):certificate) (attach a copy of Dimensions: 1000 gal. Sludge depth: 2„ Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 1" ' Distance from top of scum to top of outlet tee or baffle: 6" ` Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: _ MeasurinQ 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.). The Tees were present. The liquid level was even with the outlet invert. There did not appear to be anv sivans bf leaka'e. The outlet cover was 3"below. 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 tb bottom of outlet tee or baffler 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` } 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: 33 Waterfield Road Osterville MA Owner: Bob Cullotta Date of Inspection: December L. 2012 TIGHT or HOLDING TANK: None (t*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 normal. 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 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMErs TS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 33 Waterfield Road Osterville.MA Owner: Bob Cullotta m Date of Inspection: December 22 2012 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 6'x6'Pit]-000 QaI leaching chambers,number: leaching galleries,number: leachingtrenches, num ber, er,length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): The pit was dry. The scum line was app. 3'up from the bottom. There did not appear to be any si ns of failure.A camem was used for the inspection. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: w Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: 1 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 I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 33 Waterfield Road Osterville MA Owner: Bob Cullotta Date of Inspection: December 22' 2012 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. t .,CArAy— � p 1 31 3 3 SS aa • r 10 �r Page l l of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBS URFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) •i Property Address: _ 33 Waterfield Road Osterville.MA Owner: Bob Cullotta Date of Inspection: December 22 2012 SITE EXAM k Slope Surface water Check cellar Shallow wells Estimated depth to ground water 40+/- feet Please indicate (check) all methods used to determine the high groundwater 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: Topo-graphic and water contours mans Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours mans the mans were showing approximately 40+/ to-ground water at this site. • y 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, relating to the septic system, the inspection, this report and/or any components of the septic system which have not been located and inspected. 11 COMMONWEALTH OF MASSACHUSETTS v . EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION . VV ^SS✓✓ t-zl � U TITLE 5 OFFICIAL INSPECTION FORM—,NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 33 Waterfield Road Osterville MA 02655 Owner's Name: Jenna Stein Owner's Address: 22 Susan Carsley Way Sandwich MA 02563 Date of Inspection: September 11,2007 Job#07-199 Name of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. � I ,,Z S J 002 Mailing Address: '189 CAMMETT ROAD I MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779_ 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 DEPt_:� _ approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: '1 Passes C7; _X__ Conditionally Passes ,.Z I r A Needs Further Evaluation by the Local Approving Authority `„i a' Fails 3� Inspector's Signature: Date: 9/11/07 c� ~ The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health ore°' # DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow bf 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: Distribution box is deteriorated and leaking,needs to be replaced.Recommend pumping tank.Leaching pit is at half capacity with a high stain line indicating pit has never been more than 2/3 full. Pipe between tank and d-box is beginning to collapse and should be replaced with d-box. ****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. jPage 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 3:3 Waterfield Road,Osterville Owner: Jenna Stein Date of Inspection: September 11,2007 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: XX _XX 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. Distribution box needs to be replaced. 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 inspection if the unsound exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass ins p 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: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 33 Waterfield Road,Osterville Owner: Jenna Stein Date of Inspection: September 11,2007 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 bordering vegetated wetland or a salt marsh � III 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 aseptic tank and SAS and the SAS is within a Zone I 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 it DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence ofammonia 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: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ' CERTIFICATION(continued) Property Address: 33 Waterfield Road,Osterville Owner: Jenna Stein Date of Inspection: September 11,2007 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or ' clogged SAS or cesspool _ _X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow _X_ Required pumping more than 4'times.in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _X_ Any portion of cesspool or privy'is within 100 feet of a surface water supply or tributary to a surface water supply. _X_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that 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 Systems: To be considered a large system the system must serve a facility with a design flow,of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no",to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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 11 of a public water supply well �Y I 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. L Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 33 Waterfield Road,Osterville Owner: Jenna Stein Date of Inspection: September 11,2007 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No _X_ Pumping information was provided by the owner,occupant,or Board of Health _ _X_ Were any of the system components pumped out in the previous two weeks _X_ _ Has the system received normal flows in the previous two week period? _X_ Have large volumes of water been introduced to the system recently or as part of this inspection? _X_ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X _ Was the facility or dwelling inspected for signs of sewage back up? _X_ _ Was the site inspected for signs of break out? _X_ _ Were all system components,excluding the SAS, located on site? _X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _X_ Existing information,For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 33 Waterfield Road,Osterville Owner: Jenna Stein Date of Inspection: September 11,2007 FLOW CONDITIONS RESIDENTIAL 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 Number of current residents:2 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no):No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no):No Water meter readings,if available(last 2 years usage(gpd)): Two years total:75,000 gal.=102 gpd. Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIALANDUSTRIA L 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: None Source of information: 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: 1980 Were sewage odors detected when arriving at the site(yes or no): No Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 33 Waterfield Road,Osterville Owner: Jenna Stein Date of Inspection: September 11,2007 BUILDING SEWER.:,XX (locate on site plan) Depth below grade: 2' Materials of construction:_cast iron _X_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: XX (locate on site plan) Depth below grade: 2' Material of construction:_X_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:8.5'long x 5.2'wide—1000 gal. Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle:24" Scum thickness: 4" Distance from top of scum to top of outlet tee or baffle:6" Distance from bottom of scum to bottom of outlet tee or baffle:9" How were dimensions determined: STICK WITH HINGE FLAP. 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 are intact,_recommend aumyine tank.Liquid level was found at bottom of outlet invert. GREASE TRAP: No (locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scrum.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.): M Page 8 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART C SYSTEM INFORMATION(continued) Property Address: 33 Waterfield Road,Osterville Owner: Jenna Stein Date of Inspection: September'11,2007 TIGHT or HOLDING TANK: No' (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.): y DISTRIBUTION BOX: XX (if present mustbe.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.): No solids or huh stains Present.Box s deteriorated and leaking. PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,conditioni of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 33 Waterfield Road,Osterville Owner: Jenna Stein Date of Inspection: September 11,2007 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type ` _X_leaching pits,number: One 6x6 pit. leaching chambers,number: _leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Typeiname of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): Leaching ait is currently half full with a high stain line 2'below inlet invert. CESSPOOLS: No (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: No (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of.hydraulic failure, level of ponding,condition of vegetation,etc.): f Page 10 of 11 OFFICIAL,INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued). Property Address: 33 Waterfield Road,Osterville Owner: Jenna Stein Date of Inspection: Septembers 1,2007 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or f benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. Water Service ] . 3 31 . 37 28 35 55 - t Page 11 of 11 OFFICIAL. INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 33 Waterfield Road,Osterville Owner: Jenna Stein Date of Inspection: September 11,2007 SITE EXAM Slope None! Surface water None! Check cellar Dry Shallow wells None Estimated depth to ground water: More than 20 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: Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town groundwater contour map shows water below el. 10 and topo map shows property at or above el.40. T' WN OF BARNSTABLE Y LOCA ON 33 WAC/ IJi 1�Q C!• SEWAGE# 02007 yss ',ILLAGE dS1'e/V111?— ASSESSOR'S MA[PP&PARCEL rINSTALLERS NAME&PHONE NO. SEPTIC.TANK CAPACITY 100 LEACHING FACILITY.(type) P. (size) �C1� NO.OF BEDROOMS OWNER PERMIT DATE: /0 /0 0 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 1 � I 31 3y a a 3S 31 3 3ssa� . - TOWN OF B STABLE "LOCATION 7)� W CT-P-r.f€,�G �Cy SSE# £"•JILLAGE o5 Verb '1 LQ ASSESSOR'S MAP&PARCEL ir IN&Ikbi&RS NAME&PHONE NO. r�`C IC ��a%/�e 1 i !M-1715 SEPTIC TANK CAPACITY 1006 LEACHING FACILITY:(type) 1 (size) I6x)o NO,OF BEDROOMS 3 OWNER PERMIT DATE: C&MFEFARCIE DATE: ( 11 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 Water Service MXX ... .......... ................. ER 31 37 28 ! 35 55 J No. Q fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: .PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for �Digpogar *p5tem Con5tructfon Vertu Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. Assessor's Map/parcel oS(OC WAk, Pdi Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 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) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) �" �aC f CPh%r Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this�oardHealt ned Date 10 V i Q l Application Approved Date Application Disapproved by: Date for the following reasons Permit No. _SLs� . ,,s Date Issued l� — s5 a No.. ©�� Fee THE COMMONWEALTH OFMASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION . TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpprication for Migogal *pgtem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. e J/ /C; Owner's Name,Address,and Tel.No. Assessor's Map/parcel n WA i e(PJ� 0 ST(Vi C W Ae r Te 1 ' Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ape 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) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil M . n" 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 and not to place the system in operation until a Certificate of Compliance has._been issued by this Board Health S' ned Date 10119101 - Application Approved b Date Application Disapproved by: Date for the following reasons i Permit No. �� " S� Date Issued Q d c / "'� ———————— ———————————————— BARNSTABLE, MASSACHUSETTS ——————— THE COMMONWEALTH OF MASSACHUSETTS - �- n��d Certificate of Compliance 01 THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (✓) Upgraded ( ) Abandoned( )by Gorton Nnu w S _ at 33 k1i-op"(1; e, R-L, (�SI 2 rJ, has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. � `' Jr 'dated a/0/0 . Installer Designer #bedrooms Approved design flow gpd The issuance of this permit shll not bje construed as a guarantee that the system wijhfu ctio�; as/d/eJjgned. Date / f Inspector ('211!•�'/; �f r ————————————\---——————————————— --- No. Fee 00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS (CpAir Di!5po!5af 4p5tem Construction Permit 4 Permission is hereby granted to Construct ( �) Repair ( ✓) Upgrade (, ) Abandon ( ) System located at �3 W(a f,r t,✓� R e(tl�� C. and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction m�b com let within three years of the date of this p t. Date 111Q10 Approved :., F7 . L; r V-111, ' LO C � T4B b 1317 SEWAGE PERMIT MO. ,S VILLAGE l/C� -~ �_ OOa; INSTA LLER'S ADZE Q ADDRESS 0 U I L D E R OR OWN DATE PERMIT I S S U E D DATE COMPLIANCE ISSUED �_�_ } _ 3-6 rye y fir- No O Fns... .o.............. r THE COMMONWEALTH OF MASSACHUSETTS Tel BOARD OF HEALTH � ... .........OF.....,LJ . .._.. .0 ................................ Appliration for Uigpnsal Works Tonstrnrtiun Vamit Application is hereby made for a Permit to Construct (-) or Repair ( ) an Individual Sewage Disposal System�a,..: ......... ..... .. .---- .....................•-------- Locatron -Address r t o. ....... ��►'1_`�..1.: ._1. (� ...... .............G�1� . ......:�ht -......•--......_ wner, •ddress .............•--•- •--•••-- ••. ... . . Installer Address J� � � Q Type of Building Size Lot, ___i___________________Sq. feet U Dwelling—No. of Bedrooms.____._.___�.................. .....Expansion Attic ( ) Garbage Grinder (n'O) Other' —Type of Building No. of persons...........L............ Showers — Cafeteria Q' Other fixtures .................................................... _ W Design Flow..................5_�.................gallons per person per day. Total daily flow..........-3_3?.._____..__......._.__gallons. WSeptic Tank—Liquid ca acty/4U_gallons "Length;_______________ Width................'Diameter................ Depth................ xDisposal Trench—No. `__________________ Width.................... Total Length..........:......... Total leaching area....................sq. ft., Seepage Pit No _____- Diameter._._.._._ p ____ ___________ Total leaching area____2�....sq. ft. � pag __...__ __._._ Depth below inlet___ Z Other Distribution box ( ) Dosing tank ( ) - �o � Percolation Test Results Performed by..__{J&�!�.`� _ .. ��.:.................. Date........._._..____..____________........ a Test Pit No. 1.2 u1425Sminutes per inch Depth of Test Pit---_--- .Z.______ Depth to•'ground water_.___. UY/ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... Description of Soil.._..•- -.�•._-• --- - ............................= - -I Z / _ GL!!1?�_. F '1G ......... O G2 � -. C W .............---...................................................----------------•-•-•--•--•-•••---•--•----••-----•---------•••-••--------•-•----•••--•-•---•--•.........._..._.._..--.............. VNature of Repairs or Alterations—Answer when applicable........................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i I:'�.� 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued,by the board of health,- Signed---..... ,fr.L ........... 5-a .-ffD Date Application Approved By................ - ---•-----------•-•------• .... ............ Date Application Disapproved for the following reasons:_..----••-----------------------------------•-•-------...__...------------•-•----------------•••-----........... •-------------------•----.....--------------•--------------....--•-------•----------:_..._..--------.....••---•-•••-•-•-••-•-----•••------••----•--•----•-••----•---•-••---•--------•------•---••---•--- n_ Date PermitNo................:..............•------•---------........ Issued_.'fit'............................................... Date .� , ,y r« NgQQ •-- t - Fss _............... k�f THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH -----------------o F..........1 .l ?'�� Appliration for Disposal Works Tonstrnrtinn Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at •_-._r_.'P""" ................ ..'....y:...�. _.........._......... ........_..........._.._.._..._._........_............_.._..._. Location-A ress t No. - d Ow'e l' �� ress ..... .... . .In e .............. Address f.G.�..� J,........................... _ Type of Building Size Lot, 3f_ ?_.._._Sq. feet U Dwelling—No. of Bedrooms............_3...........................Expansion Attic ( ) Garbage Grinder t)o) p ....._....._ Showers ( ) — Cafeteria a Other—Type of Building ____________________________ No. of ersons__..__.__.�. ( ) dOther fixtures ----•--•-----------•-•........................•--•------...•............-..................................... W Design Flow................ j....................gallons per person per day. Total daily flow------ �L)......................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.....j.............. Diameter........%3........ Depth below inlet.....6?_`___._._. Total leaching area...2-cx,).....sq. ft. z Other Distribution box ( ) Dosing tank ( ) ''0 PercTPercolation Test Results Performed by...& _ r� .._._ �.:. ............... Date...... Q..._..... est Pit No. 1_�'_J k55minutes per inch Depth of Test Pit...... _�_.___ Depth to ground water....t 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.-...................... a' --------------------------------------------------- ......•.......... ......•--•--.................•--.._...._•-••----------•-•_. -- 0 `.._. O!'2 `:. .:1 i• = ' " - e•� 1 t' ! t�r _fiiyi _ rct. l i Description of Soil.__._. ._'. __ ..... V .---------------•--•----•--•--------•--•...-- lz��ir.,. -......................................................... W M. --•--------------------------------------------------------------------------------------------------------------------------------------------------------•..........._..........-•----......-•-••••-- UNature of Repairs or Alterations—Answer when applicable................................................................................................ ..••••--------•----------•...---•---•-•••-----••-•--••••---•••-••••••-•--------•-----•-----_.....••-•••••-•-••---------------•-----••-••••••-••-•-•••---•-•---•----•--••--•••••......-•_.__.--•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance}with r the provisions of:TTL; 5 of the State Sanitary Code— The undersigned further agrees not to place the system inri operation until a Certificate of Compliance has been issued by the board of health, �f Signed--- / rv✓�''t�il 1� �-----•t � f e ' ! rf Date J Application Approved B ............. -�� ._-r"�'� '. .- •------------------•------ ---s -------------- Date. Application Disapproved for the following reasons:.............................................................................................................. .......•--•---•--------------•-•-------------•------------...•------------•----•--------•-----------------••••-•...._......--•---•--•••-••••••--•------•-............---•--...... ..................... Date PermitNo......................................................... Issued..................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - f' p nc?a..................OF........_-..-. .11i..r.. ....:�� t ..................................... Trr#if irat a of Tompfianrr THIS IS TO CER FY, That the Individual Sewage Disposal System constructed (� or Repaired ( ) by............ ��t�e�.------•- � &*.-------------------------•-------._ ..........._...................................__....................... t Installer at.........:.�-r_r-....--= ----••----...---- 1 %�%r:..: ; r` k t �S has been installed in accordance with the previsions of TITLE, 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.-Qr)_-_.�_.4_.c�_........... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUP AS A GUARANTEE THAT THE SYSTEM IL U T,ISFACTORY. ... V DATE... ..... .................................. Inspector............... ...••. - ---- -- --•-----_--------•-•--•--•------------•--- THE COMMONWEALTH OF MASSACHUSETTS 1 BOARD OF HEALTH t ys� Noda! RIS FEE. ?. ...... e Dispo atl — ----- . ................................•-------........-•-•----.......-••-••••..................... to Construct ( or Repair ( an Individ-aJ evt�ag osal System at No. -C.n-� - 4---------------- _. Street as shown on the application for Disposal Works Constructio ermit No..................... Dated J---------------------------------------- --------------------------P Board of DATE.......a:7 0`�� ffJ FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS ��>��l�I�1 UsS♦T A � 1.10 GA28A�.� CaRI��Z 2aatt_�{ FL,ow _ Ilb � 3 t 3�b G•P•t7. SEPI'I G TAa.!1C = �30,r (S G % • d-5�ci 6.R D. � U USA- I ooc� 6A L.. t)ISPo5At. PIT - I�SE loon GAt t7 �� / =U*-V4tS,LL AeEA = LSD S.F. SF 2.S • �1S G.PD. �'� 7 sue. A ► .o - SO c�.R D. 1�e UP. So ; TOTAL �ESIGIJ = 42S G•pD• DWrc1.l. T-oTA L ID,dl L.-( FLDw = 330 6.PD. f MIZC-0 -QTIOU O&TE CIIJ SMI► . 02 �- �5,3 t000 CAL Z ICY* �G NO ri Girsey� xTtt• —] �• sr4*q =ram NYE weJ F , I a Tor F'.+o o ioo.o 4. r• � 4"ppP- � IW. GAL. G-7.'3 -box � 7 Sc-Qnc 10 -3 -- IWV �-A W. I000 � INv, GAL. - D p�fa �A i \IVITW .; WASHED G STowlt= f� 'S N CEQTI�IE.D pLbT" PL.Qttii D P2oT---i I_E: L 0CAT 10 tJ Q •�' 1J o Sc e♦t_�- 5 G1�1,C- 1 =�` b AT l= �� 1 CGIZTIt=�( TI4AT TI4r--? UP PL-b,Q RL-1= y—a~ .1GC-G :c:WlPLgG W I TN T► ;z: rj l D�.t_1►-1� ��--j-• Z Aua SETBACK �E4rJ1�EMc►-1TS of -r�� Fvi Tl�U1✓\/�sJ' CI�I�P�u �(�2CGlS'[CfZi=D V LA►J 1S LJOT aASGI D vas A•.I OS rE��/lL1_C o MAS`5.. 1l4.grC'J'-AE:k,4 i /ivt:�/t_♦( 4- T11L UFr~�i--1 , �i1IGwLD APPI-I CAI-JT_� 1•k>S' f'C U�.Gc' T'u t�r11 Cc:.Mt►Jl_ l�'Y' l_IN�� ------ - ---._.._,.._.. F �J ` N ter re en 2 ——98—— EXISTING CONTOUR w n x 100.98 EXISTING SPOT GRADE ® —W EXISTING WATER SVC. � —G 'EXISTING GAS SVC. OVERHEAD WIRES o `ro LOCUS TEST PIT 'N Q BENCHMARK a LEGEND EXISTING SEPTIC TANK s TOP OF TANK, EL.=38.00 pond INV.(OUT)=36.65±(VERIFY) LOCUS MAP NOT TO SCALE EXISTING S.A.S. TO BE PUMPED, FILLED W/SAND & ABANDONED " E x 37.66 BENCHMARK S .7 2 20'44 OUTSIDE CORNER 180,00' OF STONE LANDING EL.=39.90 3921 S 35.30 SPRU E � ] x 37.49 39.30 39,33 F., ;. .�,25 -; ' TP-2 - • 39.. + edge of laWn x53 `v 9.40 38.58 LOT 2 + 20,886 ±S.F. ° BM DECK N PARCEL ID: 118-125-002 ° 9.90 70 39,11' 39. + o Ln 38,93 • . . . . EXISTING 9: HOUSE 33 39.79::_. 36,20 39.32'`'.` �� T.O.F.=40.85± 2 GARAGE O, u'� 39.69 39,7.6'` + 40, 4 38.95 39,66 39.79 :39.34;.: ::.•.Zc�...: � . 39.90 OK G �0 a00. 40.00 39.43 + 46. . - • • gg.20A„ W 39.85 39.94• ' c,a N O ) GA N - O O N' O N O i Cn N 01 ZE OF ,ygss9cy �� • o PETER T. McENTEEO CIVIL "' PLAN REVISION 11/3/17 No. 35109 ..� 1) ADDED PARCEL ID IsAE�� 2) CORRECTED WITNESS ON SOIL LOG PROPOSED SEPTIC SYSTEM UPGRADE PLAN 33 WATERFIELD ROAD, OSTERVILLE, MA Prepared for: D.A. Brown, Inc, P.O. Box 145, Centerville, MA 02632 OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO. DAGHER, MATTHEW & MAURA Engineering Works, Inc. 1"=20' P.T.M. 269-17 237 LEAVITT STREET 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. HINGHAM, MA 02043 (508) 477-5313 10/26/17 P.T.M. 1 Of 2 1 NOTE: TO PREVENT BREAKOUT, FINAL GRADE SHALL NOT BE AT, OR BELOW, EL.=36.50 SEPTIC TANK FOR A DISTANCE OF 15' FROM THE EDGE PROPOSED D-BOX OF THE PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER PROPOSED S.A.S. OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE INSTALL RISER & COVER OVER ONE CHAMBER AND T.O.F.=40.85t SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT F.G. EL.=39.9t F.G. EL.=39.8t F.G. EL.=39:3t F.G. EL.=39.1 t MAINTAIN 2% SLOPE�t OVER S.A.S. J A n nJ L - 7' L - 5' ) ® S=1% (MIN.) p S=1% MIN. 4'SCH40 PVC 4"SCH40 PVC 2" LAYER OF 1/8" TO 1/2" s" DOUBLE WASHED STONE to"I a as $ as (OR APPROVED FILTER FABRIC) 14" 999 BBB aaaaaaa EXISTING 48" LIQUID -3/4" TO 1-1/2" DOUBLE LEVEL WASHED STONE ADD INV.=36.37 PROPOSED 4' 4.8' 4' GAS BAFFLE D BOX INV.=36.20 INV.=36.65 EFFECTIVE WIDTH = 12.8' 3 OUTLETS INV.=36.00 EXISTTNG SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS SURROUNDED WITH STONE AS SHOWN H-10 RATED TOP CONC. ELEV.=36.8t+ BREAKOUT ELEV.=36.50 INV. ELEV.=36.00 ease NOTES: Baaaa aaaaaaaaaaa aBaaaBaaaaa 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPES & BOTTOM ELEV.=34.00 INVERTS. EXITING HOUSE, PRIOR TO INSTALLATION. 4' SEE SKETCH 4' 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH VARIES-SEE SKETCH ON A MECHANICALLY COMPACTED SIX INCH CRUSHED - PERVIOUS MATERIAL STONE BASE, AS SPECIFIED 310 CMR 15.405(2). 5' (MIN.) ABOVE G.W. LEACHING SYSTEM SECTION 3) INSTALL INLET & OUTLET TEES AS REQUIRED. BOTTOM OF TEST PIT, EL.=28.2 =_ 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. SEPTIC SYSTEM PROFILE GENERAL NOTES: 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SOO, BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE .REQUIREMENTS �j� 47 OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULATIONS. Ilk 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. EXISTING 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF HOUSE(IIJJ) THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF GARAGE T.O.F.=40.85E 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. 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS AGREED 'UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. SEPTIC LAYOUT 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. 11. WHERE REQUIRED,-,CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS SOIL LOG IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. 'AND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). DATE: OCTOBER 26, 2017 (REF#15,528) 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE SOIL EVALUATOR: PETER McENTEE PE(SE#1542) INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL WITNESS: DAVID STANTON R.S. HEALTH AGENT 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND ELEv. TP-1 DEPTH ELEv. TP-2 DEPTH NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. 14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC 39.3 A 0 1 39.2 A 0" SYSTEM COMPONENTS NOT SHOWN ON THE PLAN LOAMY SAND LOAMY SAND 38.6 10YR 4/2 - 38 5 10YR 4/2 DESIGN CRITERIA LOAMY SAND 8 LOAMY SAND 8 -�I �, NUMBER 0 Tr------ 10YR 5/8 !F BEDROOMS: 3 BEDROOMS 36.3 36" 36.4 34" aD�BOTTOM AREAST 10YR 5/8 C C SOIL TEXTURAL CLASS: CLASS I (LOADING RATE=0.74' GPD/SF) N 320.0 S.F. I ca PERC DESIGN PERCOLATION RATE: <2 MIN/IN L- 1(6 30"/48" DAILY FLOW: 330 GPD 3.7' 1 L 11 F-M SAND F-M SAND .---� 2.5Y 6/6 2.5Y 6/6 DESIGN FLOW: 330 GPDj 2 8' GARBAGE GRINDER: NO-not allowed with design $•5' LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF PERIMETER=75.6' .74 GPD/SF SAS DIMENSIONS 28.3 132" 28.2 132" EXISTING SEPTIC TANK: 1000 GALLON CAPACITY PERC RATE <2 MIN/IN. "C" HORIZON SKETCH NO GROUNDWATER ENCOUNTERED PROPOSED D-BOX: 1 INLET, 3 OUTLET (MINIMUM), H-10 RATED USE 2-500 GALLON LEACHING CHAMBERS IN SERIES PROPOSED SEPTIC SYSTEM UPGRADE PLAN SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 33 WATERFIELD ROAD OSTERVILLE MA SIDEWALL AREA: 2(12.8' + 25.0') X 2 151.2 S.F. Prepared for:- D.A. Brown, Inc, P.O. Box 145, Centerville, MA 02632 BOTTOM AREA: 12.8' x 25.0' = 320.0 S.F. Engineering by: SCALE DRAWN JOB. NO. TOTAL AREA:.............................................................. 471.2 S.F. Engineering Works, Inc. N.T.S. P.T.M. 269-17 DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) = 348.7 GPD 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. (508) 477-5313 10/26/17 P.T.M. 2 of 2