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HomeMy WebLinkAbout0100 WIANNO AVENUE UNIT #A - Health 106A Wianno AveNtte- Osterville A = 141 — 112 � � 1 a f Commonwealth of Massachusetts W Title 5 Official -Inspection Fora o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M s••`'a 106 A Wianno Ave U' Property Address �^^` Charles Vesty Owner Owner's Name - information is ill terve required for every Os ✓ 'MA 02655 9-12-17 ; page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information P ,,O�N��t�tttlrNbp,, on the computer, \�`�� �,ZH OF MAS 1,,��i use only the tab `.`���� key to move your 1. Inspector: ;off.• yG cursor-do not JAMES •u'_ use the return James D.Sears key. Name of Inspector ?*:. ;0 Capewide Enterprises �._o "o: "� Company Name i� �RTIFrt G�.� 153 Commercial Street �4igF 5 I N sp� 0`` ,anuumt►a Company Address Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S 1623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported bellow is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Zw��_JTL s'� 9-12-17 spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of - 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M •'' 106 A Wianno Ave Property Address Charles Vesty Owner Owner's Name information is required for every Osterville MA 02655 9-12-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system is a 1500 Gal. Tank D Box and three chambers. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 106 A Wianno Ave Property Address Charles Vesty Owner Owner's Name information is required for every Osterville MA 02655 9-12-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection.if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts a v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 106 A Wianno Ave Property Address Charles Vesty Owner Owner's Name information is required for every Osterville MA 02655 9-12-17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50'feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: '* This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in I is less than 6" below invert or available volume is less than '/day flow L F,4cNiN6 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 106 A Wianno Ave Property Address Charles Vesty Owner Owner's Name information is required for every Osterville MA 02655 9-12-17 page. CitylTown State Zip Code Date of inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone,1 of a public well. El 0 Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303;therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large.Systems: To be considered a large system the'system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply El ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area-IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department._ t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 TOWN OF BARNSTABLE LOCATION (o<c A W 1AN00 AV SEWAGE# okO f 5 3 � VILLAGE ®STERVI CCU ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO.CAF&OMG 67r6R1 F" ( 7-1 8817 SEPTIC TANK CAPACITY 15 i Q C-,ALL-0 K� LEACHING FACILITY.(type) c Fo C-4L e-"W g5(size) I x.83' X 3 J►C< , NO.OF BEDROOMS 4 OWNER CDt{ARLW, i� Q scr` V ES'1�l PERMIT DATE: 10-1 ,3LO l i— COMPLIANCE DATE: 10 s l` -.a61 S Separation Distance Between the: No G.W e Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility C-tJCou tJ TtPURD Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) N A Feet Edge of Wetland and Leaching Facility(If any wetlands exist within q 300 feet of leaching facility) rt Feet j FURNISHED BY 6P"�awu7c-- C-L re y fLSc—S �JL�- i of o N A �° �► s A = 33,16 ' [3-4 z5a,7 (3 I Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 106 A Wianno Ave Property Address Charles Vesty Owner Owner's Name information is required for every Osterville MA 02655 9-12-17 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health I ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 .t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 106 A Wianno Ave Property Address Charles Vesty Owner Owner's Name information is required for every Osterville MA 02655 9-12-17 page. Citylrown State Zip Code Date of Inspection D. System Information Description: 1500 Gal. Tank D Box and three chambers. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2015-99,000Gals g ( y g (gp ))' 2016-123,000Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding-tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts 4 - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 106 A Wianno Ave Property Address Charles Vesty Owner Owner's Name information is required for every Osterville MA 02655 9-12-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 106 A Wianno Ave Property Address Charles Vesty Owner Owner's Name information is required for every Osterville MA 02655 9-12-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 2015 Permit #2015-347. Were sewage odors detected when arriving,at the site? ❑ Yes ® No Building Sewer(locate on site plan): 'Depth below grade: 34" feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH -.40. Septic Tank(locate on site plan): Depth below grade: 22" feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ® Yes ❑ No Dimensions: 1500 Gal. Precast H-10 1 Sludge depth: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 106 A Wianno Ave Property Address Charles Vesty Owner Owner's Name information is required for every Osterville MA 02655 9-12-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 0" 811 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 18" Asbuilt- Plan -Tape How were dimensions determined? Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank at 22" below grade w/both covers at 8". In and outlet tee's. No sign of leakage or over loading. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 106 A Wianno Ave Property Address Charles Vesty Owner Owner's Name information is required for every Osterville MA 02655 9-12-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): II Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene, ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 106 A Wianno Ave Property Address Charles Vesty Owner Owner's Name information is required for every Osterville MA 02655 9-12-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any. evidence of leakage into or out of box, etc.): D Box is 16"x1T-33" below grade w/cover at 1'. Box is clean and solid w/two lines out. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not.located, explain why: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 i r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 p Y rY M 106 A Wianno Ave Property Address Charles Vesty Owner Owner's Name information is required for every Osterville MA 02655 9-12-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is three 500 Gal. dry well chambers w/4' stone. Chambers at 3' below grade w/cover at 8". Bottom of chambers wet. Wall's are clean like new. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool t Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 L — I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1y 106 A Wianno Ave Property Address Charles Vesty Owner Owner's Name information is required for every Osterville MA 02655 9-12-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 106 A Wianno Ave Property Address Charles Vesty Owner Owner's Name information is required for every Osterville MA 02655 9-12-17 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately A-a= .3 -/-'�`' 3 " /a-3 : 3f-3 f /3-3= 3�-- ? i N S- .58-/ o Jr Fit m,•'r A t C,4RA � F t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 I I Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4M , 106 A Wianno Ave Property Address Charles Vesty Owner Owner's Name information is required for every Osterville MA 02655 9-12-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells N° Estimated depth to high ground water: 10'-6" feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 9-18-2015 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked)with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: T.H. on Design plan 9-18-15 10'-6" no G.W.. Bottom of chambers at 5' below grade. Bottom of chambers at 5'-6"above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 106 A Wianno Ave Property Address Charles Vesty Owner Owner's Name information is required for every Osterville MA 02655 9-12-17 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of.Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 No. / 1 Fee ( c� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftpfication for Bisposar bpstem Construction Permit Application for a Permit to Construct( ) Repair(X) Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. j NP A W 4 At)& Owner's Name,Address,and Tel.No. 0S1r C 5 5, IxeNotm: t/Fa Assessor's Map/Parcel 1 C N 0 _ y 1 Installer's Name,Address,and Tel.No. 5Og-qj-j-jg`7-7 Designer's Name,Address,and Tel.No. 509-X-13 -0-3 7 7 T a28554 atA - 6. Type of Building: Dwelling No.of Bedrooms Lot Size 13 3 8j sq.ft. Garbage Grinder( ) Other Type of Building P ES Cis of j"Ci AL_ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �L� gpd Design flow provided ��►� gpd Plan Date oc—, l e a,(D1 2 Number of sheets r Revision Date Title I o(n A wi AN&D AV 6 6 Size of Septic Tank 1,45700 GAL- Type of S.A.S. (3) SC© �m-4L (, (��--C—a&A Description of Soil Mxa w_6_AgZ_ �R Nature of Repairs or Alterations(Answer when applicable) d ID Tb (3) 50-0 06i 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 gn Date 10 -a Application Approved by Date /e_ - Zo/ti Application Disapprove y Date for the following reasons Permit No. Date Issued APOZ_411 Fee ( THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Vspo8al,*pstem Construction Permit Application for a Permit to Construct( ) Repair X) Upgrade( ) Abandon( ) ]Complete System ❑Individual`Cmponents Location Address or Lot No. I Q P A W IAA)W AVG Owner's Name,Address,and Tel.No. OST cis � ix&vefa VES ice{ Assessor's Map/Parcel L � (O A WiAN06 AV 6 d s Ry w-q- Installer's Name,Address,and jelf.No. $8g-'P1 -igl-7 1 Desi ner's Name,Address,and Tel.No. 509-XI 3 -0317 GMD ��E E i4�5�5 u.c.e 6 �55� 6 13& -X-k 1 Go -5T .s Type of Building: Dwelling No.of Bedrooms �' Lot Size sq.ft. Garbage Grinder( ) Other Type of Building R�It)Q;N ! 44, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ! gpd Design flow,provided' ;:-7 451#9 gpd Plan Date VdT , �(�! _Number of sheets i ! 'Revision Date Title f 0(n A 14h AM J O AV C 0 S ZEIts[l[.[.6-L Size of Septic Tank .'SOU G"014-- t.` Type of S.A.S. 3J 50 j-<AL U44041VC, Description of Soil MVD1t XM :500Zms(¢ 3(. Nature of Repairs or Alterations(Answer when applicable) --tWS'r'*4-4.- 6.1l�[J /�`'QS (,.. 5ET'14i 'Vt11/ .1 D W eV J 0-6oKe 7 (3) Soo G#k_Q&1 Lb14CN c[�G�. C s�Cu 6y IT 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 east . gn Date Application Approved by/ Date Application Disapproved.by Date for the following reasons Permit No. Zolr1- Date Issued ------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance ` THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(Y) Upgraded( ) Abandoned( )by (!AeF-i.c)1 0f= EiI��1565 u.C' at I 0 ta A 1.4/&ANND AVAC OST. has been constructed,in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.��,y' -5T; dated /0/?/A/Y-- Installer C,4Nswlp6 U C. Designer J C ENQrtiJ€6iJb(i , 7X7NG #bedrooms -- Approved design flow gpd_ The issuance of this permit shall not be construed as a guarantee that the system will f inctio designed a, Date r��— 1 � Inspector N L ---- ----------- ---------------- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS MispoBar 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( �6 Upgrade( ) Abandon( ) System located at 10G A MANNA AVE and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty ompl_y with Title 5 and the following local provisions or special conditions. / Provided: onstruction must be completed within three years of the date of this permit. Date �� ���r'h Approved by ■ 44,szv r. vv i/vv i Town of Barnstable Regulatory Services Thomas F. Geiler, Director Public Health Division i6 ►� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office; 508-862-4644 Fax: 508-790-6304 Date: Sewage Permit#2c31S—34°7 Assessor's Map/Parcel Installer&Designer Certification Form Designer: S� EnS;t�ee�inc� , roc Installer: Cnee.W; le. eoyuf,rese-s Address: L e 51 C rcwAbzrry wShWoy Address: ► 5 3 Comm erci'a l . Strec;{ Fo .1 Wa(elnom. 1 A 62536 rIR 026`! -;05-2-M-0377 On CApe iaL CwEe4 e,(5ea was issued a permit to install a (date) (installer) septic system at I i)b A W i ann o Ave—yiu e_ based on a design drawn by (address) C En5ineercn5 , Tor , dated 0CA66er i I 26 15 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced;above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow.. Stripout(if required) ected and the soils were found satisfactory. 114 OF JCHN L. I CHURCHILL (Ins ler's Sig re) JR. IVIL 4160 P fesigner s Signature (Affix De gn Here) ASE RETURN TO ARNSTABLE PUBLIC REAL DIVISION. CERTIFICATE OF COMPLIANCE WELL NOT )�E ISSUFD UNTTL BOTH THIS FORM AND AS- BUILT (.AKll ItECEIVFD BY THE BARNSTABLE PUBLIC HEALTH DIVISION THANK YOU. gAof(ice lormsWesignercer ineation form,doc - Town of Barnstable P#. / ��`�' ► ' ' Departiment of Regulatory Services Public Health Division y �A _ . Date �A ie3P 200 Main Street,Hyannis MA 02601 N14 rEp MAI A , Ifi n -`, c f Data Scheduled Time . �"� Fee Pd. Soil Suitability Assessment for ,sewage Dispos all Performed By:. 1 `tc,la,,t (l'M�y�'� C ZT C S"� t ' Witnessed By: v h. i LOCATION& GENERAL INFORMATION Location Address .10 6 .,^�w W`A N U O AU&,— . , Owner's Name ei4qR�S v 40STQZV1LL/ Address (oc,A WtAN� Au 7 Assessor's Map/Parcel: 1'7 t�j p�. • < SAP&"taE Engineer's Name NEW CONSTRUCTION REPAIR Telephone# 506._CL -� 8g7.7 5OS-273-0377 Land Use" RC:5iOEAlf//IL xyou Slopes('Yo) Surface Stones.., Distances from: Open Water Body >I SD ft Possible Wet Area >16 ft Drinking Water Well .>IS•0 ft Drainage Way i 0 ft Property Line >I a ft Other ft SHETCII:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes) Parent material(geologic) OVTW45H PLIJW " • . Depth to Bedrock Depth to Groundwater. Standing Water in Hole: 1 lip" 8(4S 1Z(r,�' Weeping 1'i•om Pit Face 6Co5� Estimated Seasonal High Oroundwater > t zu` 1365 OETERNHNATION FOR SEASONAL"IIIGT WATER TABLE Method Used: 1Dr Zee.f 0I3S6t2V#nod Depth Observed standing in obs.hole: 140 Id, Depth lt)6011 ttiUttles: �121", Depth to weeping from side of ohs;hole: 7 i up" ►n. Index Well# Reading Date: Index Well level ". In. j,fact Groundwater AdJtidttdenk fr. _ _ --•_-M._,.,,_ AcU.fkctbr A�.dt�nundwuterl.eval,,,,_, . Observation PERCOLATION VEST bate i� IS �Ctmm tQ'os9M � Hole# .-- w Time at 91, Depth of Pero 3(e• -• Time at 6" start Pre-soak Time @ I O:v15 T � Time(9"-6") End Pre-soak, Rate Min./Iuch Site Suitability Assessment: Site Passed ,site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back------:-= ***If percolation test is to be conducted within 100' of wetland you must first notify the Barnstable Conservation Division at least one(1) week prior to beginning, Q:ISEPTIC\PERCPORM.DOC I�s . b V DEEP-OBSERVATION]MOLE LOG Hole# Depth from Soil Horizon Soil Texture Sdil Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. onsi tency.%arayel) p �- l'Z 36 13 tG H Sq,4® 1 b-0 s�b 172A,_IZ(o C '500. Z,SY )DEEROBSERVATION HOLE-LOG -`Hole C Depth from Sall Horizon Soil Texture Soil Color Soil Other Surface(in.)" - r' (USDA) 3` ' (Munsell) Mottling (Structure,Stones,Boulders, Consistencv.%Gravel) ]DEEP OBSERVATION BOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Q DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency, Flood Insurance Rate Map: Above 500 year flood boundary No— Yes . Within 500 year boundary No V . Yes ' Within too year flood boundary No., Yts - Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious mliterial exist in all areas observed throughout the area proposed for the soil absorption system? ES If not,what is the depth of naturally occurring pervious material? - Certification I certify that on. 16.-27-p 9 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise an 7ex, fence described in 10 CMR 15.017. Signature ' Date /o-Z 1 S Q;\SEPTICIPERCFORM.DOC ' FINISH GRADE OVER D-BOX- 32.5�t TOP OF FOUNDATION = 33.3 FINISH GRADE OVER CHAMBERS= 32,$' - 32.5' G F N F R A I N OT F S �- PROVIDE EXTENSION RISER REMOVABLE WATER-TIGHT COVER OVER SLOPE t�2% MIN. OVER SYSTEM 3/4"TO 1-1/2" DOUBLE WASHED WITH COVER OVER INLET& STONE TO CROWN OF PIPE FINISH GRADE OVER TANK EL.= RISER TO WITHIN 6"OF FINISHED GRADE 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION � FINISHED GRADE OUTLET TO WITHIN 6" OF F.G. 32 6,f 4" SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL_ @ FOUNDATION = 32.9'f 5" DIA. OUTLET(S) MIN SLOPE 1% BOX TO F.G. (SEE NOTE 19) OF DOUBLE WASHED CODE AND ANY APPLICABLE LOCAL RULES. --- _ STONN E OR GEOTEXTITILE FILTER FABRIC 20"MIN.ACCESS }N. 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE COVER(3 TYP.) 36"MAX. I i , PLACE RISERS ON ALL i DESIGN ENGINEER. PROP. SCH. 40 9" MIN. 9"MIN TOP OF SAS=29.$3 CHAMBERS WITH 3. 4" SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL PVC SEWER PROP. SCH. 40 36' MAX. 29 00- 36"MAX. INLET PIPES TO 6"OF SYSTEM UNLESS OTHERWISE NOTED. PVC SEWER BREAKOUT EL= 29.50 FINISHED GRADE 6" 3" 2" DROP MIN. 3" 9" _ , 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN MIN.SLOPE @ 1% 3 DROP MAX. L-11 � MIN.SLOPE@ 1% PROVIDE WATERTIGHT ELEVATION = 29.83' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 13" 4" PVC IN FROM JOINTS (TYP.) o 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF *30.1 14 29,60' SEPTIC TANK O 4" PVC OUT TO 0 0 0 0 O o THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. O LEACHING FACILITY o o � 00 � � � � � 0 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. 29.85 12 6 0 0 0 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. 48" OUTLET TEE 29.40� MIN. 29.231 2- 00 C o� 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK GAS BAFFLE 6" CRUSHED STONE °0 0° o00 oo FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS OVER MECHANICALLY p, _ NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH 10.8' OFFSET TO FND COMPACTED BASE AND DESIGN ENGINEER. 5 � 8.5' TYP I ' 6" CRUSHED STONE OUTLET DISTRIBUTION BOX 4.0 ( ) 4.0 4 0 4 83' 4.0 8. ELEVATIONS ARE BASED ON APPROXIMATE M.S.L. DATUM. ELEVATION OF 33.00, OVER MECHANICALLY TO BE INSTALLED ON A LEVEL STABLE VARIES (SEE PLAN) (TYP.) ESTABLISHED ON THE TOP OF A NAIL SET IN A PINE TREE, AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET , GROUND WATER ELEV.= < 22.00' COMPACTED BASE C 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION PIPES TO BE LAID LEVEL. 27.00 VARIES (SEE PLAN) PROPOSED 1 ,500 GALLON H-10 CONCRETE SEPTIC TANK THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT LENGTH 10'-6' WIDTH 5'-8" DEPTH 5'-8" (Dimensions per Wiggin 3-500 GALLON CHAMBERS 5 MIN. CHAMBER END VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES `GUI;i KAU I UK i U VERIFY Lxi6 i IN6 Precast Corp.,Pocasset,MA) CROSS SECTION VIEW TYPICAL CHAMBER PROFILE TO THE DESIGN ENGINEER. ANK ` �CFILI ""TEES TO BE CENTERED DISTRIBUTION BOX DETAIL CHAIV��` � ' '-TAILS ELEVATION PRIOR TO ANY WORK& ,,;Jo��` I �� � 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE STRUCTURES SHALL BE MADE NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE DIRECTLY UNDER RISERS NOT TO SCALE NOT TO SCALE WATERTIGHT. _ NOTES: _ - --- TEST PIT DATA 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF "' ■��!;,.-' 4"r r`" 0♦ PERC NO. 14820 REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM EACH SEPTIC SYSTEM COMPONENT. `' ark ` L` " y ' • �' , 4 "' /, Ij '! APPROPRIATE AUTHORITY. • ..11 INSPECTOR: David W. Stanton, IRS ' 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE • ,•��� �; } j 1(�E :. �✓;; -�' EVALUATOR: Michael Pimentel, EIT, CSE PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT : ' `' � r*"`�� ..;"' %,`�, • LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE . ,'ti^„ i'� +: , •_2 •' C.S.E. APPROVAL DATE: Oct. 1999 DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF ! ',Y `� ` ;�' '`�.' •� R /' . �' - - -i * THEY SHALL WITHSTAND H-20 LOADING. ' ''� �' `4 ' • '` ' DATE: September 18, 2015 HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. ' 4 ••°ti *` i'+s• •,•' �' •! of •'� • r ■ 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. 5; • s .-....swill• ,Jy* Y,5 asks •`;�,. ;'`• ,! dd ! i ,� i lr 1 ._• - t (a i t'" a TEST PIT#: 3.) ENTIRE PROPERTY IS NOT LOCATED WITHIN A DEP APPROVED ZONE 2 OR =� _ •' '- ;• �. j . �.? ^• `�,•'r +' • , ._'•* ,�4 _ ,+. _ . _ , • ',` 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE ESTUARINE WATERSHEDS. `` ZONE 2 ` ' •"* ""• .I' }';. + ELEV TOP= 32.50 • i ,�: . r «i.: MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. • • *;*,,� M !'' 1/ I* • •„ It • ;`':' • � '.. ' ELEV WATER= <22.00' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, ' a .k" w �• j �, :. > � : ti• ' w - FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). h� �� r ` . •'a�4 PERC RATE <2 min./inch 0' ° ��"- .. i � 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN � �°ph �0 T -, ,_F �r■• ' -s- ,ti• �i DEPTH OF PERC = 36"-54' _x =: '� SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. 'ram +' '"�'' ' Sr a • ('�JI16. PROPOSED PROJECT IS LOCATED WITHIN.- TEXTURAL C7 �' • , , -- - _. M +r °7 ! CLASS: 1 0) -°1 MAP 141 «•' t"►'4`' ' �'• i •• •4ti'' a kS f '� ° • ' l ASSESSOR'S MAP 141 PARCEL 112 O O m X QS ': •' �r Ja'•`° OWNER OF RECORD: CHARLES H. & RENEE VESTY TRUSTEES ,�0'p., PARCEL 12 a• • ._ .. h,... -, 0,. =f 32.50' d' F f , . Fill 106A WIANNO AVENUE NOMINEE TRUST 0 :. . ,. . LOCUS v�� •f.. �:.:. • .• ., ,'� *ri r �• + � 12 31.50 ADDRESS: 106A WIANNO AVENUE '` "�. "11`'rIL •'` °` •' • I� * OSTERVILLE, MA 02655 O • s' ��`' ''. . ' . ' _ °� B Loamy Sand MAP 141 , t . ,. ., ,�al F�� �. Z •I ." +' F :},' „+.`4 1 OYr 5/6 FEMA FLOOD ZONE X PARCEL 13-CND {`tk, r }. ;`,y.' ; ,'°:• �; i� . + ":;-q�' fJ 36 _ 29.50 COMMUNITY PANEL# 250010544J +r •,' \ ��ti' + • �,.■ !• • a --• t. r'y a 1-, r.7i 1'_ PerC MAP 141 { >,, , +�, �,.•'0. ; ';. : " 17. DEED REFERENCE: BOOK 10276, PAGE 54 PARCEL 112 (' +R'+4`� •',''` ���. .1 . ". ■�, � ti 54" 28.00 • 1, „ ,. •.ltr .�,`•�, �. .� • -tir t,�;,�. .,•; • ► 18. PLAN REFERENCES: 1. PLAN BOOK 189, PG. 75 13,389 S.F.± , l °'. , �, +5.. .(� *;, II 4,,,,. *� :. yy •, , ! • 1,, • .` 2. PLAN BOOK 197, PG. 133 _ . �- :g• �, ,.,,• , ' , �`•�; Medium Sand 19. A 4" PERFORATED SCH. 40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A 2.5Y 6/6 DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3" OF FINISH GRADE. A �� �� ( r „� " • e * a: i` ■Fti ; "t", <+ ' *!;' REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. #106A :fs',l ' I • ;, r,`■" + r.. 20. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. EXISTING 11 �''�+'er•k LY, • _,^,�•{ y LIGHT POLF �_ 4-BEDROOM -� - -- 21. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY DWELLING MAP 141 l - FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. TOF = 33.3'± �" PARCEL 6-003 LOCUS PLAN F _-- 103 FULL BASEMENT 122. IN ACCORDANCE WITH 310 CMR 15.401 -15.405,THE FOLLOWING LOCAL UPGRADE 'N FLOOR ELEV. - 26.3'± HC-2 APPROVALS ARE REQUESTED FROM 310 CMR 15.211: Q. rn SCALE: 1" = 1000' 1. A 9.8'WAIVER (20.0'- 10.2' FOR THE SETBACK FROM THE PROPOSED LEACHING SYSTEM CRAWL SPACE 126" 22.00' ) ) �O FLOOR ELEV. = 28.6'± �'m TO THE HOUSE FOUNDATION. J U Z No Mottling, Standing or Weeping Observed FQP/ m -+ -} g p g _ 2.) A 5.0'WAIVER (10.0' -5.0') FOR THE SETBACK FROM THE PROPOSED LEACHING SYSTEM GAO - ---- - - - _-- --- I-- TEST PIT DATA- TO THE GARAGE SLAB. HC-1 ,� a� DESIGN DATA PERC NO. 14820 - ��g \� ��'`R�pO INSPECTOR: David W. Stanton, RS LEGEND �._ x32.7 'o �' / �' NUMBER OF BEDROOMS (DESIGN) 4 EVALUATOR: Michael Pimentel, EIT, CSE n'- (7) .- C.S.E. APPROVAL DATE: Oct. 1999 (6) 3.1, < w , DESIGN FLOW 110 GAUDAY/BEDROOM EXISTING CONTOUR --PAVED DRIVE- (2) (1) �`L Q��1 DATE: September 18, 2015 15" MAPLE / / �•`��0 TOTAL DESIGN FLOW o 440 GAUDAY TEST PIT#: 2 50 PROPOSED CONTOUR PROPOSED ELECTRIC LINE p O �; � / !` DESIGN FLOW x 200 /o = 880 GAL/DAY EXISTING UNDERGROUND UTILITIES TO BE RELOCATED -�\ / x32.6 / ��O ELEV TOP= 32.70' (5) � �p USE EXISTING 1,500 GALLON SEPTIC TANK ELEV WATER= <22.20' MAP 141 Benchmark x32.g EXISTING UNDERGROUND ELECTRIC LINE PARCEL 4 �' Nail in Asphalt � 0 __- JP PERC RATE_ EXISTING WATER LINE Elev. = 33.00' x32.8 r ��' 32.5 / �Q0 Approx. M.S.L. 1 ' - DEPTH OF PERC= TP INSTALL 3 500 GALLON CHAMBERS w/ STONE TEST PIT LOCATION x32.8 LP 32x5 TEXTURAL CLASS: 1 SIDEWALL CAPACITY o Q PROPOSED 1,500 GALLON SEPTIC TANK 1~ (PERIMETER) (2' HIGH) (0.74 GPD/S.F.) GAUDAY (91.5') (2' ) (0.74 GPD/S.F.) = 135.4 GAL/DAY 0" 32.70' PROPOSED 4" SOLID SCHEDULE 40 PVC PIPE 2 O, �` -PROPOSED 1,500 Fill 2x7� \ GALLON SEPTIC TANK 12" 31.70' ® PROPOSED DISTRIBUTION BOX �_ BOTTOM CAPACITY �.p �, p, EXIS I iNU I.CJJt UUL i U Cat PUMPED AND REMOVED (BOTTOM AREA) (0.74 GPD/S.F.) = GAUDAY B Loamy Sand (427.7 S.F.) (0.74 GPD/S.F.) = 316.5 GAUDAY 10Yr 5/6 c� PROPOSED 500 GALLON LEACHING CHAMBER 36" 29.70' GARAGE \ DISTRIBUTION BOX 33- - (4) TOTALS: MAP 141 SLAB = 33.2'± _ REV. DATE BY APP'D. DESCRIPTION PARCEL 5 \ - , - PROPOSED 3-500 GALLON LEACHING TOTAL NUMBER OF CHAMBERS 3 - CHAMBERS WITH AGGREGATE TOTAL LEACHING AREA 610.7 SQ.FT. PROPOSED SEPTIC SYSTEM UPGRADE TOTAL LEACHING CAPACITY 451.9 GAL./DAY C Medium Sand PREPARED FOR: / \ - `�, PROPOSED INSPECTION 2.5Y 6/6 EXISTING LEACHING PIT TO BE - PUMPED, FILLED WITH CLEAN, \ - ��� PORT WITH ACCESS BOX CAPEWIDE ENTERPRISES COARSE SAND, AND ABANDONED SWING-TIES LOCATED AT DESCRIPTION HC-1 He-2 106A WIANNO AVENUE \ / TANK INLET COVER (1) 35.4' 37.0' OSTERVILLE, MA 02655 TANK OUTLET COVER(2) 27.6' 432' 126„ 22 20 SCALE: 1 INCH = 10 FT. DATE: OCTOBER 1, 2015 0 5 10 20 40 FEET CHAMBER CORNER(3) 47.2' 51.1' No Mottling, Standing or Weeping Observed k�- s � PREPARED BY: - \ % CHAMBER CORNER(4) 47.7 63.6 RESERVED FOR BOARD OF HEALTH USE + JON JC ENGINEERING, INC. `�j� CHAMBER CORNER(5) 15.8' 66.0' l cHu C I ��R. 2854 CRANBERRY HIGHWAY � CHAMBER CORNER(6) 13.4' 56.4' �4, N . 18 \ �, ER EAST WAREHAM, MA 02538 SITE PLAN CHAMBER CORNER(7) 15.8' 53.4' � 508.273.0377 \0' �• SCALE: 1"- 10' Drawn By: BSM Designed By:MCP Checked By: JLC JOB No,3244