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0011 WINFIELD LANE - Health
11 Winfield Lane Osterville F A = 116 099 � r 0 6 r t f1 a N TOWN OF BARNSTAtLE LOCATION l( v'� � INC� SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. lil SEPTIC TANK CAPACITY 150b=,1-66 1,01 LEACHING FACILITY: (type) (size) 3 C �- 140 NO.OF BEDROOMS r BUILDER OR OWNER T PERMITDATE: 7 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted:Groundwater Table S�`theBottom 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 f f lea n aci 'ty) Feet Furnished by � of J � v> .,� � -•C y C� i -C °�1 1 No. ' )0% — `� Fee , v— THE COMMONWEALTH OF MASSACHUSETT.S Entered in computer: ✓"` Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for Mioozar *paem Conaructiou Permit Application for a Permit to Construct( )Repair( ✓)Upgrade( )Abandon( ) ❑Complete System O Individual Components Location Address or Lot No. a f 4-A�eleL LC[ &L Ow er's Name,Address and Tel.No. G,54crr,'iie j�af�ie�acc,7owl� Assessor'sMap/Parcel m 1/4 Pree/Ol9 �� XihT/G!d. L4& , 6sA-f^Y/°//e ► rnA oaj Installer's Name,Address,and Tel.No. Desi er's Name,Address and Tel.No. Type of Building. Dwelling No.of Bedrooms _ Lot Size 5� - 5 Garbage Grinder yes y 2P-g�3 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow I CJ 4(Z/© gallons per day. Calculated daily flow 41 q o,-f 5a%'D 4r 6'C' gallons. Plan Date Q-0041 Number of sheets Revision Date N R Title Se- '!' e // r) 'a ct 121Z.e © Yj Size of Septic Tank /J�04 a- C. pe of S.A.S. /2- 3 7A Cj n /5D o Description of Soil,_ y O LCxc—- ' 4 L &r'n 04arl-'e. S�cpd `- _/ A brn Cueru_ saner >Ucfr S/& 3 a1 - /aa (!.Poste 6 a_,Qd , 60 b6lrs l /o (;4r to Nature of Repairs or Alterations(Answer when applicable) Date last inspected: /n&PM 15, ¢ Agreement: The undersigned agrees to ensure the construc ' aintenan of the afore described on-site sewage disposal system in accordance with the provisio itle 5 of the nv' o o and not to place the system in operation until a Certifi- cate of Compliance has b i s- ar f e Sig Date Application Approved by `-~ Date V- Application Disapproved for a following reasons Permit No. as 0 N d a Date Issued d'�' 2 m.. r�" ) No. 01 L� Fee J v THE�' --- Entered in computer: - COMMONWEALTH OF MASSACHU �ETT'S PaUBL1C HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIPPYication 'for'Zigaal *psstem Construction Permit Application for a Permit to Construct( )Repair( !®)Upgrade( )Abandan� ) D Complete System 0 Individual Components " Location Address or Lot No. �' (,)/o` j0r�� 4a Ow er's Name,Address and Tel.No. t'_'S��' Assessor's Map/Parcel f i n�C�� 4 y 0S7 ` 007,6 �"r�Ile , �'?�! Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. -^ ^U, o S / Type of Buildings � t Mc , Dwelling No.of Bedrooms �` Lot Size §4 ft. Garbage Grinder(: e l y ;,f-- Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow , I It,/ gallons per day. Calculated daily flow o_f o� 4r c_c' gallons. Plan Date v ©t3 Number of sheets Revision Date N!R ' Title - Se_. 11'1' S'*1.S#1- / !'(" e , // 0_r4r ` Y)'J1e Size of Septic Tank d 0.1 Q.1161 l��t�nri-1Type of S.A.S. /-� Y S 3 /i clOL ! _ . Description of Soil'o- !' 0 f>4�Sv" o l fQ & "'I q+l am o") 6, Ido L r,6 Va 114 .1c. 4-h t 60 64/t-4 , /d crr (e ' r Nature of Repairs or Alterations(Answer when applicable) Date last inspected:ffikfCh 66", Q00 Agreement: The undersiihed agrees to ensure theT.construe'o aintenan of the afore described on-site sewage disposal system in accordance with the provisions-ofTitle 5 of the Env• o n 1- o and not to place the system in operation until a Certifi- Cate of Compliance has been s 9.d_by-tlr1s~Boai`d f e ` Signed. ( _1 Date /Q` /e .d 7 Application Approved by i tv v�< l r Date '�U_ Application Disapproved for:the following reasons Permit No. 9.U O q a s Date Issued I/ U V THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance - THIS IS TO CERTIFY,that the On-site SewageDisposal System Constructed( )Repaired( ►/�)Upgraded( ) Abandoned( )by R, 4 (un �-6i, at J11 I.u4)7T5�_ nir, , 4e_r ►r)g//e has been constructed iip accordance with the provision"s-of Titl 5 and the for Disposal System Construction Permit No. D b dated Installer Designer The issuance of this permit` s�1p©t e construed as a guarantee that the system wi"11.fun f tiPnn'as designed. Date l l Inspector -------------------------------------- No. d d oZ Fee J THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION . BARNSTABLE., MASSACHUSETTS ]0i!6Po!5a1 *p5tem (Con0truction Permit Permission is hereby granted to Construct( )Repair( Upgrade( )Abandon( ) System located at _11 /A)ih Ae"1 eL La/(,Pi 0,s *.rYi`1I�- 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 must be completed within three years of the date of th e f s p . Date: s.� Approved byres , I / TOWN OF BARNSTABLE LOCATION l /� �� ��f SEWAGE # Y VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC.TANK CAPACITY LEACHING FACILrj Y: (hype). (size) 3 C NO.OF BEDROOMS JeX!W AW BUILDER OR OWNER PERMITDATE: b COMPLIANCE DATE: Separation Distance Between the: / Maximum Adjusted Groundwater Table Iootthe 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 f ' flea n aci 'ty) Feet Furnished by -J Poe,- 7ARw � 3 -FEY q3 6— iov y)f, —2 .�..._ -35, �' 6--Y, ` 5/25/01 Notice: This Formis To De Used For the Repair Of Failed Septic Systems Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, PE TE rz S U L U VA P , ,hereby certify that the engineered plan signed by me dated M.A`I 3-, 01 ,concerning the property located at I I W#A/r1 ELD LIN ®STE21/1LLC- /MAV meets all .of he following criteria: • This failed system is connected to a residential dwelling.only. There are no commercial or business uses associated with the dwelling. • The soil is classified as.CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct preliminary tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W.Elevation Ll. 6, +adjustment for high G.W. l s DIFFERENCE BETWEEN A and B SIGNED : DATE: NOTICE Based upon the above information,a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. i q:health folder:perceicmp 6 Pipe Capacity Sewer Capacities Job# 2004*132 = Client: Paul Kozloff Date: 10/7/2004 Project: _11 Winfield Ln:;Osterville, MA IDesigned By:1 MWE I Checked By: MWE Enter values in shaded areas Sewer Capacities Average Daily Design Flow 440 gpd = 0.31 gpm = 0.001 cfs Peak Hour Factor 4 Peak Hour Design Flow 1,760 gpd = 1.22 gpm = 0.003 cfs Mannings Equation Channel Flow(Q) =]1.486/n*A[R"2/3][S^1/2] Q is quantity of flow(cfs) R is the hydraulic radius (ft) Gravity Pipe Capacity- House to Septic Tank/Dbox to Chambers S is the slope (ft/ft) Diameter, D Op inches A is the cross sectional area (sq. ft.) S10 ft/ft n is a pipe roughness coefficient n11 (PVC) Pipe Capacity(Q) 0.22 cfs > 0.003 cfs which is the Peak Hr. Design Flow Full Flow Velocity(V) 2.56 fps (see attached Flowmaster Calculations) Selected Pump Design Operating Level 42 gpm > 1.22 gpm which is the Peak Hr. Design Flow 2004-132 Pipe Velocity_Volume_Capacity.xls 10/8/2004 Circular Channel Analysis & Design Solved with Manning' s Equation Open Channel - Uniform flow Worksheet Name: 11 Winfield Ln. Comment : Line Capacity - House to septic tank Solve For Full Flow Capacity Given Input Data: Diameter. . . . . . . . . 0 .33 ft Slope. . . . . . . . . . . . . 0 .0100 ft/ft Manning' s n. . . . . . . 0 .011 Discharge. . . . . . . . . 0 .22 cfs Computed Results: Full Flow Capacity. . . . . 0 .22 cfs Full Flow Depth. . . . . . . . 0 .33 ft Velocity. . . . . . . . . . 2 .56 fps Flow Area. . . . . . . . . 0 .09 sf Critical Depth. . . . 0 .26 ft Critical Slope. . . . 0 .0105 ft/ft Percent Full . . . . . . 100 . 00 % Full Capacity. . . . . 0 .22 cfs QMAX @.94D. . . . . . . . 0 .24 cfs Froude Number. . . . . FULL Open Channel Flow Module, Version 3 .21 (c) 1990 Haestad Methods, Inc. *� 37 Brookside Rd * Waterbury, Ct 06708 Pipe Velocity Sewer Velocities JoWb �2004-132' " e, Client PauI!Kozloff I Date: 10/7/2004 Pr6001:1111 Winfield Ln: Osterville,MA Designed By:'By:'I MWE I Checked B I MWE Enter values in shaded areas Sewer Pipe Velocity Forcemain Delivery Pipe Pipe Cross Sectional Area,A Diameter, D (inches) 2a00i inches Pipe Area, A=3.14 x (D)^2/4 Diameter, D (feet) 0.17 ft Area 0.022 square feet Flow, Q Pump Discharge 2 9Pm 0.09 cfs Q=AV or V=Q/A Velocity,V 4.29 fps VA2/2g 0.29 ft Forcemain Velocity within acceptable range 3 fps to 8 fps /OK 2004-132 Pipe Velocity_Volume_Capacity.xls 10/8/2004 Pipe Volume-Dose Volume ._Pipe and Dosing Volumes Job;# 2004-'f32 Client: Paul Kozloff Date 10/7/2004 Projects 11 Winfield Ln.,9sterville,MA IDesigned''By7. MWE I Checked By:I MWE Enter values in shaded areas Pipe Volume Delivery Pipe Pipe Cross Sectional Area,A Diameter Laterals, D (in ) r �inches Diameter, D (ft) 0.17 ft Area 0.022 sf Pipe Area,A=3.14 x(D)^2/4 Volume Length of pipe 7Q 0]ft Total Delivery Pipe Volume 1.53 cf 11.42 gal Distribution Pipe(all segments) Pipe Cross Sectional Area,A Diameter Laterals, D(in ) #,OQ' inches Diameter, D (ft) 0.33 ft Area 0.087 sf Volume Length of pipe(combined length of the 3 distrib pipes) Er"- 7�a O ft #of laterals 1 00 Total Distribution Pipe Volume(Min. Dose Volume) 6.54 cf 48.96 gal Required Dose Volume #of Doses for Sands, Loamy Sands 4 Dose Volume is Volume Per Dose 110 gal Daily Design Flow Volume Plus Drainback Volume 11 gal divided by Dose Volume 121 gal #of doses required Volume Per Dose is greater than min. Dose Volume required/ OK 2004-132 Pipe Velocity_Volume_Capacity.xls 10/8/2004 Pump Chamber Pump Chamber Sizing Job# 2004 1 ,.'. Client: Paul Kozloff Date: 10/7/2004 Project: 11 Witn ieI;d Ln. Osterville, MA IDesigned By: MWE I Checked By. MWE Enter values in shaded areas Pump Chamber Sizing Pump Chamber Dimensions Size Specification I ; 1.,500 gal Interior Length 10.00 ft Interior Width 5.00 ft Interior Useable Height 4.33 ft Tank Invert Elevation ' 2.77 Area 50.000 sf Pump Chamber Incremental Elevations Height Incremental Volume Pump Chamber Invert 2.77 0.00 cf= 0.0 gal 0,50 ft 25.00 cf= 187.0 gal Low Water Alarm 3.27 Too ft 50.00 cf= 374.0 gal Pump Off 4.27 ft 25.00 cf= 187.0 gal Lead Pump On 4.77 0.50 ft 25.00 cf= 187.0 gal High Water Alarm 5.27 EMERGENCY 1.83 ft 91.50 cf= 684.4 gal Invert Into Pump Chamber STORAGE 7.10 TOTAL 4.33 ft 216.50 cf 1,619.4 gal 2004-132 Pipe Velocity_Volume_Capacity.xls 10/8/2004 C , �.�,g... Pump SizingW,, Job# 2004-132 Client: Paul Kozioff I Dater 10/7/2004 Project. 1.1 Winfield Ln.,;O_sterville MA ned F3 :.4� MWE ,. �Checkedr8.: .aw"M11VE Enter values in shaded areas Calculate Static Head(Hs) Highest Point in System (DBox Inv In) Elevation 15.07 Lowest Point in System (Pump off) Elevation 277 Hs= 10.80 ft Calculate Friction Loss NO Formula:L(3.55Q/C'DA2.63)^1.85 Pump Chamber to D-Box L,ft ]20 C Hf= 0.60 ft D,inches Q,gpm L,ft 70 C 1501 Hf= 1.27 ft D,inchesr = 2 Q,gpm L,ft 70j C 11!1,5© Hf= 2.17 ft D,inches 2 Q,gpm 40. L ft 70 C 150� Hf= 3.28 ft D,inches - Q,gpm 50t Calculate Minor Losses(Hm) Formula:K'(VA 2/2g) Use 5%of Hf and add 5'for loss through pump to D-box Total Dynamic Head(TDH) TDH= Hs+Hf+Hm GPM Hm TDH 20 5.63 TDH= 17.03 ft 30 6.34 TDH= 18.41 ft 40 7.28 TDH= 20.25 ft 50 8.44 TDH= 22.52 ft Pump Selection Select the Hydromatic SP40 Sewage Ejector Pump-Simplex 0.4 hp at 1750 rpm Operating point approximately 42 gpm at 20 ft.TDH A s` I r 1 Bronze Version Available Typical Application' High capacity sump/effluent,TSewage Typical Application' Sewage,Dewatering Capacities to 120 GPM(7.5 Vs) Capacities to 140 GPM(8.8 Vs) Heads to 28 ft.(8.5 m) Heads to 28 ft.(8.5 m) Electrical I I5V,le,9.5 FIA,60 Hz,230V,le,4.7 FLA,60 Hz Electrical 115V,Io,12 FIA,60 Hz,200V,le,6.8 FLA,60 Hz; Motor 4/10 HP split phase w/thermal overload protection, 230V,1 e,6.0 FIA,60 Hz,200V,3e,4.1 FLA,60 Hz, 1750 RPM 230V,3e,3.5 FLA,60 Hz;460V,3e,1.8 FIA,60 Hz, Minimum Recommended Simplex=18"(457 mm); 575V,3e,1.4 FLA,60 Hz Sump Diameter Duplex=30"(762 mm) Motor (single phase)-1/2 HP Split phase w/thermal overload Automatic Operation Diaphragm pressure switch(manual available) protection,1750 RPM;(three phase)-1/2AP Materials of Construction Class 30 cast iron polyphase,1750 RPM Impeller Thermoplastic non-dog Minimum Recommended Simplex=24"(609.6 mm); Discharge Sae 2"(50.8 mm) Sump Diameter Duplex=30"(762 mm) Solids Handling 1-1/4" (31.8 mm) Automatic Operation Diaphragm pressure switch(single phase only) Power ford 10',S1TW,(20'optional) (manual available) Superior Features • (arbon/Ceramic type 21 mechanical seal Materials of Construction Class 30 cast iron • Oil-filled motor w/automatic reset thermal Impeller Thermoplastic non-clog overload for maximum protection Discharge Size 2"(50.8 mm);3"(76.2 mm)optional • Upper and lower single row ball bearing construction Solids Handling 1-1/2" (38.1 mm) • Piggyback plug available for easy maintenance Power ford le-10',SWARD'optional);3o-20',STW-A and switch replacement Superior Features • CarborAeramic type 21 mechanical seal • Oil-filled motor w/automatic reset thermal overload for maximum protection • Upper and lower single row ball bearing construction • Piggyback plug available for easy maintenance and switch replacement 9 30tA �a? Haack Switeb ti . W 950&SP50AB Q`d'9rr �G9 6 Z 20 � a Q' W Q = 3 0 10 SP40 0 0 (opacity-U.S.G.P.M.0 20 40 60 ." 80 100 120 140 Liters/Second 0 2 4 6 8 f Commonwealth of Massachusetts • " m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 11 WINFIELD LANE Property Address KOZLOFF Owner Owner's Name information is Owners required for MA 2/10/09 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not use the return Name of Inspector key. DOUGLAS A. BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE MA 02632 City/Town State Zip Code 508-420-4534 S14297 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 16.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ fails ❑ Needs Further Evaluation by the Local Approving Authority 0/09 Inspector's i ature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ***`This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. I A It Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments '< 11 WINFIELD LANE Property Address KOZLOFF Owner Owner's Name information is OSTERVILLE required for MA 2/1 Q/09 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) 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: METAL COVER ON PUMP CHAMBER NEEDS TO BE RE-CEMENTED TO PREVENT WATER INFILTRATION B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass' section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old" or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. "A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments r 11 WINFIELD LANE Property Address KOZLOFF Owner Owner's Name information is OSTERVILLE required for MA 2/10/09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ distribution box is leveled or replaced ND Explain: I I ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: 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. Tide V Inspection Fonn.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 11 WINFIELD LANE Property Address KOZLOFF Owner Owner's Name information is OSTERVILLE MA required for 2/10/09 every page. City/Town State Zip Code. Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 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.gg A copy of the analysis must be attached to this form. 3. Other. D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than'/day flow , ❑ ® 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. Title V Inspection Form.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 11WINFIELD LANE Property Address KOZLOFF Owner Owner's Name information is OSTERVILLE re wired for MA 2/10/09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ❑ Any portion of a-cesspool or privy is within a Zone 1 of a public well. ❑ ❑ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] The system is a cesspool serving a facility w - Y with a design flow of 2000 d p g q ❑ ® y g �p 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone it 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. Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Officia!I Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 11 WINFIELD LANE Properly Address KOZLOFF Owner Owner's Name information is OSTERVILLE required for MA 2/10/09 every page. Clty/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? Z ❑ 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 El 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. n ❑ 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)] Title V Inspection Form.tioc•0&06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 11 WINFIELD LANE Property Address KOZLOFF Owner Owner's Name information is OSTERVILLE required for MA 2/10/09 every page. Cdy/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes Z No Is laundry on a separate sewage system? [if yes separate inspection required) ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes Z No Water meter readings, if available(last 2 years usage(gpd)): 07/816-08/660 Sump pump? ❑ Yes ❑ No Last date of occupancy: CURRENT Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR. 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): Title V Inspection Form.doc•08/06 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 11WINFIELD LANE Property Address KOZLOFF Owner Owner's Name information is OSTERVILLE required for MA 2/10/09 every page. City/Town State Zip Code Date of inspection I i D. System Information (cont.) General Information Pumping Records: Source of information: PUMPED RECENTLY ACCORDING TO CARE TAKER 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): PUMP CHAMBER ALSO Approximate age of all components, date installed (if known)and source of information: SYSTEM INSTALLED IN 2004 ACCORDING TO AS BUILT CARD Were sewage odors detected when arriving at the site? ❑ Yes No Tie V Inspection€o,`m.doc-JIH108 Titre S.Ogcial Inspection Form:Subsurface Sewage Disposel System•Page;of 116 bA Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 11 WINFIELD LANE Property Address KOZLOFF Owner Owner's Name information is OSTERVILLE required for MA r 2110/09 every page. City/Town State Zip Code Date of Inspection I D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 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 Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Title V Inspection Form.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments y� 11 WINFIELD LANE Property Address KOZLOFF Owner Owner's Name information is OSTERVILLE required for MA 2/10/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): TANK LOOKS FINE PUMP CHAMBER METAL COVER NEEDS TO BE RE CEMENTED TO PREVENT WATER INFILTRATION 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene other(explain): Title V Inspection Form.doc 06106 Title 5 official Inspection Form:Subsurface Sewage Disposal System+Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 11 WINFIELD LANE Property Address KOZLOFF Owner Owner's Name informationfire for is OSTERVILLE required for MA 2/10/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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 Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): SLIGHT SOLID CARRY OVER INTO D-BOX APPEARS TO BE LAUNDRY DETERGENT Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No Alarms in working order: ® Yes ❑ No Titfe V fnapeavcn(e,rTi.dOu•08,106 Me 5 Official fnapaction Form:oufsaurface oalloge Disposal oyotem-Page 11 of t5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 11 WINFIELD LANE Property Address KOZLOFF Owner Owner's Name information is OSTERVILLE required for MA 2/10/09 every page. Clty/Town State Zip Code. Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: NO OBSERVATION PORTS OR COVERS NEAR GRADE Type: ❑ leaching pits number: ® leaching chambers number: 7--? ❑ 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.): NO PLAN WAS AVAILABLE AT THE B.O.H. AS BUILT SHOWS 7 CHAMBERS,COULD NOT TELL LEVEL OF PONDING NOTE HIGH WATER READINGS PROPERTY DOES HAVE IRRIGATION Title V Inspeclion Foms.uoe•08/06 Title Official Inspection Form:Subsurface Sewage Disposal Syotem.Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 11 WINFIELD LANE jProperty Address Owner KOZLOFF Owner's Name information is OSTERVILLE required for MA 2/10/09 every page. City/Town State Zip Code Date of Inspection D. System Information (Cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration, Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note conditioni 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.): Tide inspection,i=cm.dac-08,= Tits 55 Malai inspection ft m:Subsurface Ssua a Jis g pasai Sys tam•page t3 ct 1 E Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments yt 11 WINFIELD LANE Property Address KOZLOFF Owner Owner's Name information is OSTERVILLE required for MA 2/10/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. LI [31 '1 A 110 9 $ 7 G S to 17S I - I& 9� 61, 6 1 r 14,S 10- 70, )- " 3 Me V Inspection€orm.doo=08M �• iCe 5 Official Inspedo•,Form:Subsurface So age Disposal Systsrn•Page 14 of 15 Commonwealth of Massachusetts Oft Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments a` < 11 WINFIELD LANE Property Address KOZLOFF Owner Owner's Name information is OSTERVILLE required for MA 2/10/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to ground water: AT LEAST 5 FT feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site ;abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how ycu established the high ground water elevation: Title V Inspection potm.doc•06106 Title 5 Official Inspection Form:Subsurface sewage Disposal System•Rage 15 of 15 uai t: _ 5/29/96. PROPERTY ADDRESS: ,"11 Winfield ' 9 Osterville ,Mass fl 02655 On the above date, I Inspected the septic system at the above address. This system consists of the following: _ 1 . 1 -1000 gallon tank. fie' ' 2. 1 -1000 gallon leach pit. ✓� �C fIL Based on my ing.,*ction, I certify the following condltlonse 9 1g 1 . this is. a title five septic system. ( 78 Code)`=. '- � 2,. The septic system is in proper working r, ` order at the present time. 3 . No repairs are needed at the present time . SIGNATURE: ` Name:_J_P .Macomber Jr_._-__-_- i J• P,Macomber & Son- ,-Inc . Company; Address:_ _x_.66-----_ ---,-- Centqrvi1l,e LMass__02.632 Phone:---50.8_7_7-5A3338------- 1 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY a JOSEPH P. MACOMBER & SON, INC. Tana<rCeupoolrLeschileld: Pumped 6 Initslled Town Sewer Connection: P.O. Box 66 Centerville, MA 02632-0066 775-3338 775-6412 U Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of ► Environmental Protection William F.Weld Trudy Cox# do.«no( 8—wy A� Paul Celluccl avid B ruhs s SUBSURFACE SEWAOE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION PropertyAd&,"&- 11 Winfield Wke Osterville ,Mass . Address of Owner. Date of Inspootloa:5/2 9/96 (If different) Name oflnspootor. Joseph P. MaC OT ber Jr. Company Name,Address and Telephone Number. I' J.P.Macomber & Son Inc. Box 66 Canterville,Mass . 02632 508-775-3338 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 inspoction. The inspection was performed based on my training and experience in the proper function and maintenance of on•sita sewage disposal systems. The system: Passes . _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority — Fad InapootoeZ Signature: �'/ ' 1 Date: The System Inspoctor s submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspoction. If the system is a sharod 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 Department of Environmental Protoction. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A) SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluatod'are indicated below. B) SYSTEM CONDITIONALLY PASSES: One or more system oompoaents hood to be replaced or repaired. The system, upon completion of the replacement or repair,passes inspection. Indicate yes-,Aio, or not determined(Y, N, or ND). Describe basis of determination in all instances. If"not determined",asplaiu why not) The septic tank is metal, crurked, structurally unsound, shows substantial infiltration or exAltration,.or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Street 0 Boston, Massachusetts 02108 0 FAX(617) 556-IN9 9 Telephone (617) 292•5S00 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (oontinued) PropertyAddreea: 11 Windfield CUB Osterville ,Mass . 02655 Owner. Bradford Towle` Date of Inspeotlom 5/2 9/9 6 B1 SYSTEM CONDITIONALLY PASSES (continued) A/C! Sewage backup or breakout or huh static water level observed in the distribution boat is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four 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 C1 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: LP Cesspool or privy is within 50 feet of a surface water dW 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT. U Z> The system has a(septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water sup*. The system has s_s4ptic tank and soil absorption system and is within a Zone I of a public water supply well. 41.0 The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis 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. 3) OTHER Au04 (revised 11/03/95) 2 , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) PropertyAddrea&: 11 Winfield Way Osterville ,Mass . Owner. Bradford Towle Date of Inspeotion:5/2 9/9 6 DI SYSTEM FAILS: t A)d I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an 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. A&e— Static liquid level in tho distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in•eeaspoel is less:than 6"below invert or available volume is less than IN day flow. d(j3 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy'is within 100 feet of a surface water supply or tributary to a surface water supply. II, Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Q� 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for ooliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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(MA)or a mapped Zone II of a public water supply well) The owner or operator of any such system&hall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for Auther information.. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST PropertyAddrem 11 Windfield Way Osterville ,Mass . Owner. Bradfor Towle Date of Inspeotion.5/2 9/9 6 e Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. ,None of the system components have.been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. 1'As built plans have been obtained and examined. Note if they are not available with N/A j 7U facility or dwelling was inspected for signs of sewage back-up. ,/The system does not receive non-sanitary or industrial waste flow ZTh,site was inspected for signs of breakout. L , All system components,;iicl uding the Soil Absorption System,have been located on the site. , The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of bames or tees,material of construction, dimensions,depth of liquid,depth of sludge,depth of scum. , The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. ZThe facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub. Surface Disposal System. i (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 11 Windfield Way Osterville,Mass . Owner. Bradford Towle Date of Inspection: 5/2 9/9 6 FLOW CONDITIONS RESIDENTIAL Design flow: J' looms ,s+ � y • Number of bedrooms: b Number of current residents: Garbage grinder(yes or no): J Laundry connected to system(yes or no):,a::-,R Seasonal use(yea or no):]�L9 Water meter readings,if available: .y. b ,iy -60 Last date of occupancy:52; 6 COMMERCIAL NDUSTRIAU Type of establishment: Design flow: 14,Ail gallons/day Grease trap present: (yes or no)" Industrial Waste Holding Tank present: (yes or no)A�g .. Non-sanitary waste discharged to the Title 5 system: (yes or no)&/ Water meter readings, if available: r1%� Last date of occupancy: 10+ OTHER(Describe) Last date of occupancy: F GENERAL INFORMATION PUMPIN RECORDS of information: System pumped as part of inspection: (yes or no) If yes,volume pumped: Qle> Reason for PumPm& TYPE O SYSTEM Septic tanh/ en-bam/soll absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components, date installed(if known)and source of information: lc e q y`. Sewage odors detected when arriving at the site: (yes or no) AI (revised 11/03/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C• • - SYSTEM INFORMATION (continued) Property Address: 11 Windfield Lane Osterville,Mass . Owner: BE7W§9 Towle Date of Inspection: SEPTIC TANK: I:l41161' V (locate on site plan) Depth below grade:_d Material of construcion: concrete _metal _FRP —other(explain) Dimensions: Sludge depth:_ Distance from top of.,lu dge to bottom of outlet tee or baffle:. Scum thickness: Distance from top of scum to top of outlet tee or baffle:_= a Distance from bottom of scum to bottom of outlet tee or baffle. U Comments: (recommendation for pumping, condition of inlet and outlet tees or baffle depth of liquid IPvel in relation to outlet invert, structural integrity, evidence of leakage, etc.) p. Wit• aftd outlet tees are in ace•Se•tic aii. `i. ' strucfura sound•N"o time, GREASE TRAP. (locate on site pian) Depth below grade:,'1(/4 Material of constn.irtion; :oncrete4Lnetal _FRP —other(explain) Dimensions- Scum thickness:.-iE/4 Distance from top yr scum to top of outlet tee or bahle:_xd Distance from bottom of From to bottom of outlet tee or baftle:_ Comments: (recommendation for pumping, condi—rl of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc_i /I�4 Cd'�N N',cQiiC�rs r;r, (revised 8/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontinued) ProPertyAddress: 11 Windfield Way Osterville,Mass . Owner. Bradford Towle Date of Inspeotion:5/29/96 TIGHT OR HOLDING TANK kd)e, (locate on site plan) 0 Depth below grade:& Material of construction:A&Iooncrete_metal_FRP—other(explain) UA Dimensions: Capacity: IVR muons Design flow: ona/day Alarm level: Comments: (condition of inlet tee, condition of alarm and floc:switches, etc.) DISTRIBUTION BOX- (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER:,&Q. e (locate on.site plan) Pumps in working order:(yes or no) IVA Comments: (note co tion of pump chamber, condition of pumps and appurtenances, etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) PropertyAddresx 11 Winfield Way Osterville Mass. owner. Bradford Towle Date of lwpootion: 5/29/96 >f o SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if posaibls;excavation not required, but may be approximated by non-intrusive methods) • If not determined to be present,explain: Type: leaching pits,number: leaching chambers, number: C/ leaching galleries,number:, leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note co o f soil,p' of ulic f 'ure, level of nding, condition of vegetation,etc.) Sand & grave ; o sig'�"nsiyrati c failure or pondin ;All vegetation s normal . No repairs needed at the present time CESSPOOLS:"we, (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: AN inflow(cesspool must be pumped as part of inspection) Comments•�(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc. �1/lv Cer�.�t�yr5 PRIVY:_4�VkAe (locate on site plan) Materials of oo n: /1�/� Dimensions:_ Depth of solids Comments:(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.) (revised 11/03/915) g SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) PropdrtyAddreax 11 Windfield Way Osterville,Mass . Owner. Bradford Towle Date of I=peotiou: 5/2 9/9 6 SKETCH OF SEWAGE DISPOSAL SYSTEM: • include ties to at least two permanent references landmarks or benchmark, locate all wells within 100, Centerville Osterville Marstons Mills Water Company 428-6691 M A DEPTH TO GROUNDWATER Depth to smundwater. 1 6 + feet method of determination o ppr.imation: Installed new title five septic system at 40 Lane 197 Permit - o water encountered (revised 11/03/95) 9 W i THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Depa-rtment' s qualifications s recttitred and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15 .340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. June 8, 1995 Acting Director of the ion of Water Pollution Control l k:....--•:•-_:-. Barnstable 'TOWN OF BOARD OF HEALTH SUBSURFACE SF,NAGE DISPOSAL SYSTEM INSPECTION FORM - PART D .- CERTIFICATION —•r,,:—:—c.-crr..ra�-^...—:.-- ... -:--r.rn.—.--rn--r.^.—rrr=•srr....�--.—n•a-rrra-.--r.•r:rr�-rtrr+-arr..-.•.—rr—•r.-. ._ —TYPE OR PRINT CLEARLY— PROPERTY INSPECTED STREET ADDRESS 11 Windfield Way Osterville .Mass . ASSESSORS MAP , BLOCK AND PARCEL # OWNER' s NAME Bradford Tbwle PART D - CERTIFICATION r T NAME OF INSPECTOR Joseph P. Macomber Jr. . COMPANY NAME J.P.Macomber & Son Inc. COMPANY ADDRESS Box 66 Centerville ,Mass . 02632 Street Towtt or City State LIP COMPANY TELEPHONE ( ) - FAX ( ) - 508 _ 33�8 5O8 7q0 1578 _z CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposu7 system at this address and that the information reported is true , accurate , and complete as of the tune of .inspection . The inspection was performed and any recommendations regarding LlDgrade ,- maintenance , and repair are • consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems , Check one : XXXXXXXXXX System PASSED The inspection which I have conducted has not found any Information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . Sys tern FAILED* The inspection which I have conducted has found that the system fails to protect the public health and the environment in accordance with Title 5 , 3.10 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature / - Date 6/11 /96 One copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF HEAL1'll. 11 If the lnapection FAILS the owner oroparator shall upgrade ' the ayatem within one yearof the date of the inspection, unless allowed or required otherwise as provided in )10 CMR 15 . 305 , COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION FALED INSPECTION MAP PARCEL, LOT r TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION 1 is �l� � --� Property Address: 11 Winfield I � i,A u� Osterville. AM 02655 ' Owner's Name: Patricia Towle r C:, Owner's Address: Nl o Date of Inspection: March 15, 2004 Z ---t> s Name of Inspector: (Please Print) James M. Ford rco Company Name: James M..Ford rn Mailing Address: P.O Box 49 Osterville.MA 02655-0049 Telephone Number: (508)8624400 CERTIFICATION STATEMENT I certify that I have personally inspectedthe 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—W of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes NeeA Further Evaluation by the Local Approving Authority ✓ Fai s Inspector's Signature: Date: March 19, 2004 The system inspector shall subm a cope of this op inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 f - Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 11 Winfield Lane Osterville, M4 Owner: Patricia Towle Date of Inspection: March 15, 2004 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 imthe distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 r Page 3 of 11 OFFICIAL,INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE'SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 11 Winfl?ld Lane Ostervilie, AM Owner: Patricia'Towle Date of Inspection: March 15, 2004 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 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 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: 11 Winfield Lane Osterville, MA Owner: Patricia Towle Date of Inspection: March 15,,2004 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped— ✓ Any portion of the'SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ' ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis..[This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] Yes (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 1Tth 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 I1 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 I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 11 Winfield Lane Osterville.,MA Owner: Patricia T)wle Date of Inspection: March 15, 2004 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N!A) ✓ _ Was the facility or dwelling inspected.for signs of sewage back up? ✓ _ Was the site inspected for signs of break out? ✓ Were all system components,excluding the SAS,located on site? ✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and'location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 11 Winfield Lane Osterville, MA Owner: Patricia Towle Date of Inspection: March 15, 2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n/a Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 Number of current residents: 0 Does residence have a garbage grinder(yes or no): Yes Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Approx. 3 weeks ago COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:Pumped in 1993-per owner 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 Tink Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 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: 11 Winfield Lane Osterville, AM Owner: Patricia Towle Date of Inspection: March 15, 2004 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well :)r suction liner Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 12" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 gal. Sludge depth: 2" Distance from top of sludge to bottom of.outlet tee or baffle: 30" Scum thickness: 6" 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: Measuring stick ' Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Cement tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage. GREASE TRAP: None (locate on size plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom.of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION-FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: I Winfield Lane Osterville, _CIA Owner: Patricia Towle Date of Inspection: March 15, 2004 TIGHT or HOLDING TANK: None.(tank must be pumped at time of inspection)(locate on site plan) - Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons,.-day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: None (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distr>>ution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): 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 I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 11 WinfieEd Lane Osterville. MA Owner: Patricia Towle Date of Inspection: March 15,2004 SOIL ABSORPTION SYSTEM(SAS-1: ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: 2-6'::6'(1000 Qal.) leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: , Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): One leach pit 03)was 6'x 6'x 8'bottom to grade. The outlet pipe was a the 4'7evel. There was Y ofwater in the pit. No outlet tee was present. The scum line was up to the bottom ofthe pipe. The cover was 16"below grade. Tate other pit(#4)was 6'x 6' x 7'bottom to grade. The inlet pipe was at the 4'level. The scorn line was up to the inlet pipe. The cover was 10"below grade. There were signs of past failure. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS_ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 11 Winfield Lane Osterville, MA Owner: Patricia Towle Date of Inspection: March 15, 2004 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. L� Q 1 GArA6e_ A t 3 a3 a� 1 y S 3$ 10 Page 11 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 11 Winfield'Lane Osterville, MA Owner: Patricia Towle Date of Inspection: March 15, 2004 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 11 +/- 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 propertyfobservation hole within 150 feet of SAS) ✓ Checked with local Board of Hez.lth-explain: Topographic and water contours maps Checked with local excavators, i-istallers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using the Barnstable topographic map and water contours map, the maps were showing approximately II'+/-to ground water at this site. This report has been prepared and:°he system inspected and failed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees,either expressed,written or implied,relating to the system, the inspection and/or this report. 11 EX ST. 5TopE � \ftrni WINFIEL D PARKIN o- LANE 1 Fc.17.5 S `) FG. 10.0 "14.7 �� . L / Top E 1.15.5 � - - - --Bot. 112.5 •�•• .3' \ o v�t�l t 14.90 a = 8.0 1500 Gal. 5, s �0' �•I• „• . o :_ -} -- .--, 7.8 Pump LOCUS •• \ Gas Chamber I El. 7.5 _ )♦� � `• i z Groundwater piabllq �i •e: ' 0 -E µ_I Baffles Bedding as N0 rj tendin' 3° sue\ \a. Per Title 5 �'9A)'r \ o-Box ` / (-2 Comportment 150OGal.Septic ' + W. Iv c \ \ \\ Tank.See Note No.B. $W 1`� .Par r Neck � DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM P y p o�y Not to Scale sec o 24"0Openinq Above For M.H. LOCUS PLAN r I/2{a Galy.i,Ipe For Frame 6 Cover.Float Support Scale: I 2000 h - r Assessers Map 116 k 1 PumpPower 8 Float Control T1 i a• d Cables Installed in Accordance Is @ - With Local Bldg.8 Elec.Codes. 1 A O -- CF Aj �/ u1vIP GXIST. r1K - -7. q e u•, T.4•a• 1 �t_ear• \ S C (,V AND l- 1TSa. FILL .• 6 �' v wITt1 LEA ATF.RIA a 4"0 Sch.40 PVC Precast Pump 0 LOAM 02C�AN IC /o From Septic Tank Chamber r v } 10-0 9107 0PLV4. GCARSE LAND CO A, ! y�.L15N i3RlV ARSt B S l 'SA \ Y IZ G h O or D oo� l a PLAN 37 V •sg�R ( � Cil•�N'►SN YEL. COARSE FII is 'Campoded III .. . C SANO�GOD131-�5 IOYR l.,/� N,` 4"0 Sch,40 PVC Finished 9"pain. 1 2G *rA0 C+C2o1aNOwAT1=tL 9 v 2 1 a From Septic Tank Grode Cover l/e=v2` I;3y: 5u1_L.IVAN.'ENGINL`Ef2tNC► INC Pea Slone gnaws�. Conduit Thru Chamber . '0 3/4"-11/2°Double . - •� a Washed Power fl Float Galv. Chain Emergency Storage a Cables. a; Vol.440Gal. Inv.7.4 0 PLAN VIEW Alarm on 6.3 2"O Sch.40 PVC u Pum on 5.8 Mercury Float ' Threaded Pipe Scale: l = 4O Switchs-3Req'd 1/8"0 Weep Hole - CROS SECTION OF CHAMBER --NOT TO CASE Pumpoff Check Valve . � Secure Pipeot Top 8 Bottom of Chamber- Bottom 3.4 6 Wo`hed NOTES • Stone Min. �N �'' ®FP.f '.-t. ..;.... I.Water Su SECTION T— P y� Supply Lot is Municipal Water (1500 GALLON) �ULL�V� yf 2 Location of Utilities s Shown on This Plan Are For Th PUMP CHAMBER DETAIL p "1D.2�?� At Least 72 Hours Prior to Any Excavation For This Not to Scale i� Pro ad The Contractor Shall Make The Required i CII�. rA Nof lfication to Dig Safe(1-888-344-7233) 3 The Contractor is Required to Secure A rl to 4 =ppproropp Single Family Bedroom Permits From Town Agencies For Construction .1 With a Garbage Grinder Defined byThis Plan. Doily Flow=110 x 4=440 GPD 4 Install Risers as Required to Within 127of Septic Tank:4406PD x 200%=880GPD Finished Grade. Use a 1500 Got:Septic Tank. See Note No.8. ; 5.All Structures Bu}ied Four Feet orMoreorSubject• LEACHING AREA to Vehicular Traffic lobe H-20 Loaiaing. 440 GPD/0.74=595 SF.50%=893-S.F.Required. fa Septic System to be Installed in Accordance With Sidewal I=2(12*x53')2=260 S.F. 310 CMR 15.00 Latest Revision And The Town of Bottom Area=12'x53 = 636 S.F. SEPTIC SYSTEM REPAIR Barnstable Board of Health Regulations 896 S.F.Total Provided r AT T. All Piping lobe Sch.40 PVC. LEACHING CHAMBER DESIGN S.Septic.Tank Shall be o 1500 Gal.,2 Compartments. All Pipes to be Schedule 40.Use 1 ( I W I N F I E L D LANE The First Comportment Shall Have a Volume of Not 6-500 Gal.Leaching Chambers in a O STE RV I LL E,MASS. , Less Than 880 Gal.And The Second of Not Less 12�x53�Washed Stone Field as Shown. SCALE AS SHOWN. r DATE MAY 3, 2004 Than 440 Gal. SULLIVAN ENGINEERING INC. OSTERVILLE ,MASS. EAR aT. aTogE Vent B e'•' `� WINF/EL D PARK,.r� m LANE FG.17.5 4 FG. 10.0 "14.7 � . Top E1.15.5 Bot. I.12.58.0 14.97.8 Pump I El. 7.5 LOCUS =`�'j• „ '`.• I i Gas Chamber • „ 7 -�_-Fubhr�, Qil •e: c T H-► Baffles Bedding as No Groundwater : jA. •. randin it Per Title 5 A�A�r 1. 2 Compartment 1500 Gal.Septic ' :- ti�o'\ �\ Tank..See Note No.8. $ � �" ar r Neck ��� %s.r DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Pon ' . 5� o yq�A o�y@ Not to Scale + -0' ' " a D8�o @c o 46 a \ R QOa 'tiG; OP 24'0Opening Above For M.H. LOCUS PLAN V"Galv.Pipe Far Frame 8 Cover. Scale I =2000' O .y� Float Support v !� ..,:,., Assessers Map 116 '• Parcel 099 a T tii aN I Pump Power B Float Control O - A,°bs ` Cables Installed in Accordance 1 _ /rs� d SCA �_ - With Local Bldg.8 Elec.Codes. 1 l �F ri [�/ PUMP GX%5-r. SEPTIG TANK •9C C GV ANO t_EOCHPITS. fr1LL its ti e a 4"0 Sch.40 PVC O Lo A wt. O At`l►� w{TN GLEAN MATERIAL., Precast Pump /o From Septic Tank Chamber ,0 v \ C 10'-0" 4 910 C3R1a. GIJARSE sAMD {4 x PLAN g -6AtrD~{DYCi SCOARst o eGraadn r l I 37 � Ci.S89R � .. CiCjN'�SNIC'pAtZSe- yc, / z Filter Ir 'SANO�C.ADQL�°S tOYR l�C G C 4"0 Sch.40 PVC Finished ea I Fabric Ca iVacted Fill I _ t 9"Min. 20 _ O Caf2oNMD�NAT�tL . 9 v 2 N From Septic Tank Grade . Cover [3y r 5u{.L{VANE NGt tdt.aRim 6-.WNC o �TN• ve=v2" _ Poo Stone • Crlr rp • vr0/)NR Leaching' Conduit Thru Chamber • '0 \ • .Chamber 3/4"-11/2"Owble GCIv. •� For Power 8 Float a washed Emergen�y Storage o Cables. ChainF ae PLAN VIEW _ Va1.44pGnl. - t Inv.7.4 2'0 Sch.40 PVC I_ 12'-0" I Alarm on 6.3 Mercury Float �' Threaded Pipe - „ , Pum on 5.8 SCOIE� I = 4O Switchs-3Req'd 1/8"OWeepHole CROSS SECTION OF CHAMBER •'1roT To SCALE Pumpoff Check Valve Secure Pipeat Top a Bottom of Chamber I moo; _ Bottom 3.4 ;� � Wig"Washed HOfp/ . NOTES - ,�,: .. .' b: Stone Min. �w �A I.Water Supply ForThis lot is Municipal Water SECTION T - ` P�r� ry�� (1500 GALLON) ". .SULLIV� 2 Location of Utilities Shown on This Plan Are F6rTh PUMP CHAMBER DETAIL. � SULLI��� � At Least T2 Hours Prior to Any Excavation ForThis Not to Scale Project The ContractorShall Make The Required CIAL NotficationtoDigSafe(I-BOB-344-7233) DESIGN DATA 3 The Contractor is Required to Secure Appropriate eq DProP Single Garbage Bedroom Permits From Town Agencies For Construction � With a•Garbage Grinder � 10�, � • Defined by This Plan. Daily Flow=11 O x 4=440 GPD .� d...� A Install Risers as Requiredfo Within 12 of Septic Tank:440GPD x 200%=880GPD Finished Grade. °1 Use a 1500 Gal:Septic Tank. See Note No.8. 5.All Structures 8uried Four Feet or More orSubject' LEACHING AREA to Vehicular Traffic to be H-20 Loaning: 440 GPD/0.74=595 SF+50%a=893 S.F.Required. & Septic System to be Installed in Accordance With Sidewal I=2(12x53)2=260 S.F. 310 CMR 15.00 Latest Revision And The Town of Bottom Area=12'x 53 = 636 S.F 4 SEPTIC SYSTEM R E PA I R Barnstable Board of Health Regulations 696 S.F.Total Provided t AT T. All Piping to be Sch.40 PVC. LEACHING CHAMBER DESIGN 8.Septic Tank Shall be o 1500 Gal.,2 Compartments. At Pipes to be Schedule 40.Use I I W I N F I E L D LANE The First rtment Scat I Have a Volume of Not 6 -500 Gal.Leaching Chambers in a + , , Como OSTERVILLE MASS. Less Than 880 Gal.And The Second of Not Less 12'x53'Washed Stone Field as Shown. SCALE: AS SHOWN + DATE : MAY 3, 2004 Than 440 Gal. SULLIVAN ENGINEERING INC. OSTERVILLE ,MASS. z�„ � r 1 ..:.y .t....::� t� ,, .w f .�,... u.s§s�,�;Y=�i'+'7,kKx'#ir�til� s.�,n.•n..:. ..:.,;. ,t...�,.;: , .. .. .. , GENERAL NOTES LEACHING AREA REQUIREMENTS �.��.' 1. THE INTENT OF THIS PLAN IS TO DETAIL SEPTrC 5'fS Eri Uh'v�L4iJE A. LuCt1S NIIROGt':N LOADING LIMAIADON: NA ' RLSIDEN I IAL: 4 BEDROOMS r r ( 2. LOCUS AREA IS COMPRISED OF : ASSESSOR'S MAP 116 PARCEL 99 _ xtl:'U,'B�D11�0M l - �'�{�?:� v , �°` OWNER/APPUGWt: PAUL KOZLOFF d TO IAL DESIGN FLOW = 440 GPD w•• a �' `3 c/o BRUCE BESSE 1 GARBAGE GRINDER = YES (INCREASE LEACHING ARUi BY 50%) L.I L� :rely y�� ,mod`•: ■ � 205 HOLMSTEAD DRIVE PERC FcATL = MINI. INCH CLASS 1 j• i �',\"; ��P1 c,', `X y •` �� dry'�" < MaRSTO( MILLS, MA 02648 ��_-- ( ) PHONE: 508 982-4743 Li/-Ail = 0.74 GPD/S.F. ` -- . . -�� k ^o` '�• , •�:' �' . �• 3. A TITLE SEARCH HAS NOT BEEN PERFORMED FOR THIS SITE. IF DEl-ERMrNED MIN_ �A HING_AR _QF SAS. FZECZUIR Q I I F+(; I}�;�.. �)� _" ,'; TO BE NECESSARY A TITLE SEARCH SHALLi3E PERFORMED 8Y O HERS. (•140 G!'D% 0.74 GPUj"S.F.) x 1509� - 892 S.F. MIN. � 4. THE PROPERTY LINE INFORMATION SIOWN IS BASED ON CURRENT AVAILA8LE kECGRD v- s_� 7". THIS PLAN IS NOT A FIELD SURVEY PLOT PLAN. THE EXISTING CONDITIONS ARE BASED i WORMADON CONSISTING OF PLANS AND DEEDS. Y 12' WIDE x 53' LONG x 2' DEEP LEACHING CHAMBER SYSTEM �° ` '` o(f -` 1Q�' / Lal1lYgr' !� ON THE TOWN OF BARN`TABLE GIS FROM 2004 AND PLITLID, 'SEPPC SYSTEM JLE DLTAILJ IiLRLON f0R SPECIEIGAI ONS AN EIVT �`.. ' r i o ,';ti4' �j. _4 REPAIR AT 11 INWFiELD LANE• DATED: MAY 3, 2004. SIDE'rV`ALL A!;'CA: (53' + 12')2 x 2 UL!'IH = 260 SF - v -v v -v v v v -v v - i '�� may. . •�• • C3 �, G� , �, 5. COMMUNITY PANEL NUMBER: 250001 0016 D k3Q i:1 OM AR LA: 636 _SF T r i� THE FLOOD INSURANCE RATE MAP DEFINES THIS AREA AS ZONE B, �' ;� .�• ,, ,�, '��.�- AREA BETWEEN 100 YR AND 500 YR FLOODS AND ZONE Al (ELEV 11), TOTAL EFFEC IIVE LEACHING AREA = 896 SF 2 (., " EEL RIVER ROAD 1 ��. ��r, ; �`n°. �y AREA OF 100 YR FLOOD AND ZONE C, AREA OF MINIMAL FLOODING. SYSTEM OL'SIGN CAPACITY = 896 SF x 0.74 GPD/SF = 663 GPD r+d►'1' 6. LOCATION OF UNDERGROUND UTILITIES ARE APPROXIMATE AND SHALL BE VERIFIED IN THE SEPTIC TANK SIZING: 440 GPD 200% = 880 AL 1 F.•. ■ ,A ■ , y�� FIELD BY THE CONTRACTOR AND APPROPRIATE UTILITY COMPANY PRIOR TO ANY CONSTRUCTION. UE__1 x50_GALLON TANK_MIN ; ,,\ n $01L LOGS DATE : 05/04/04 BARNSTABLE \ 1. ' SOIL EVALUATOR: BOARD OF HEALTH AGENT: \ \ SCREENED VENT 1 I • ' LOT AREA 1 SULUVAN ENGINEERING, INC NAME TEST F'I l 1 H-1 \ \\� � ,_>�.,•�-1" I � I �, +.\��� �,` 0.58 t AC. 1'. I T10N NOTE \ 1 25,264 S.F. CONSTRUC S' p" C.S.E. = 17.5 \ ;I , \\ Ei^8'x4' CONCRETE I I i `y •' y �J I 1. ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE WITH TITLE V OF LEACHING CHAMBERS i r' -' i-' l I THE STATE SANITARY CODE DATED MARCH 31, 1995, AS AMENDED THROUGH THE DATE 0' 0 LOAM ORGANIC \ \ \ ��� l J TIE INTO EXISTING SEPTIC INVERT j ; '� I OF THIS PLAN, & ANY LOCAL RULES & REGULATIONS APPLICABLE. OUT AT BLDG FACE. INVERT IS 9" (ELLG' 16.75) ASSUMED CONTRACTOR TO 2. ANY CHANGE TO THIS PLAN MUST BE APPROVED IN WRITING BY THE ENGINEER. \ \ ` VERIFY IN FIELD EXACT INVERT j a I i ELEVATION INFORMATION MUST NOT BE CHANGED WITHOUT WRI'FiEN PRIOR APPROVAL BY E 10 YR 5/3 BROWN COARSE SAND \ \ _ 4' BEFORE ANY WORK IS COMMENCED. ! THE ENGINEER. IF IT DIFFERS FROM THE PLAN, ;I " E1.fV 1.5.92 \\ \ TES IT , CONTACT THE ENGINEER �✓ „7 3. WHEN CONSTRUCTION IS COMPLETED, PRIOR TO BACKFILUNG, NOTIFY THE BOARD OF 19 - �----- - IMMEDIATELY FOR POSSIBLE HEALTH AGENT AND ENGINEER FOR INSPECTION. B ; 10YR 5/6 ; YELLOWISH BROWN COARSE \\ \ \ i �.` I . REDESIGN. Y Ys. 4. ALL SANITARY DISPOSAL SYSTEM PIPING TO BE 4" SCHED 40 PVC. UNLESS OTHERWISE 37" FLFV 14.42) \ r I -20' MIN.--� MU PUMP AND A NDON/REMOVE EXISTING I NOTED HEREIN. SEPTIC TANK ID LEACH PITS. ^ 5. EXCAVATE UNSUITABLE MATERIAL IF ENCOUNTERED, TO THE "C HORIZON" , FOR A C ; 10YR 6/6 ; BROWNISH YELLOW ELEC SERVICE «2 / \ HORIZ. DISTANCE OF 5' SURROUNDING THE LEACHING FIELD, AND REPLACE WITH CLEAN COARSE SAND, CULIL3LES /� 3 TO ALARM PANEL \ SAND PER 370 CMR 15.255. 120" ELEV 7.5 / j ANI D POWER _�_. ( ) L_ i \ \ ` f 6. INSULATE ALL PIPES AGAINST FREEZING AS REQUIRED WHEN LESS THAN 3' OF COVER. NO WA AT 120" (ELEV 7.5) / O \ ��- _ 0 1 PLRC 0 - (ELEV 7. THE SEPTIC SYSTEM DESIGN OLL INCLUDE A GARBAGE GRINDER DISPOSAL. RATE= <5 MIN/IN ^\ // \ \ ✓. ' «� ( ' • CLASS I SOIL �/ \\ ' ' ` [3dn:r, b ( 8. CAUTION THE CONTRACTOR SHALL CONTACT DIG SAFE AT 1-888-DIG-SAFE AND Vp ,r UTILITY COMPANIES TO LOCATE ALL EXISTING UTILITIES, AT LEAST 72 HOURS PRIOR TO THE START OF CONSTRUCTION. THE LOCATION OF EXISTING UNDERGROUND FM O 00 O ✓" ; INFRASTRUCTURE, UTILITIES, CONDUITS AND ONES ARE SHOWN IN AN APPROXIMATE WAY 2.5' - 48' - 2.5' / \ \\ ONLY, MAY NOT BE LIMITED TO THOSE SHOWN HEREIN AND HAVE ONLY BEEN 70LF -2"SCH80 1 RESEARCHED BASED ON THE AVAILABLE UTILITY RECORDS NOTED HEREON. THE 3/4" - 1 Y�• 4' / \ l \ FORCEMAIN i CONTRACTOR AGREES TO BE FULLY RESPONSIBLE FOR Ati,'Y AND ALL DAMAGES WHICH WASHED S1ONE / L \ \ 1500 GAL SEPTIC TANK i \ _- - MIGHT BE OCCASIONED BY THE CONTRACTOR'S FAILURE TO LOCATE SAID \ \\� 1500 GAL PUMP CHAMBER INFRASTRUCTURE AND UTILITIES EXACTLY. IF FIELD CONDITIONS DIFFERS FROM PLAN INFORMATION, THE CONTRACTOR SHALL NOTIFY THE ENGINEER IMMEDIATELY FOR POSSIBLE REDESIGN. AT UTILITY CROSSINGS, VERIFY IN FIELD THE LOCATION / INVERTS O 4' 12' \ / I \ \\ \ , \ ` j i I OF ELECTRIC, (x,i, TtL cPriUNE DA7f/✓✓✓ ` ' COMM AND RELOCATE IF CONFL;CT1�Va iWI;'; PROPOSED INVERTS PER THE ENGINEERS DIRECTION. THE CONTRACTOR SHALL \\� �� \ PRESERVE ALL UNDERGROUND UTILITIES AS REQUIRED. i 6�4 x8'x24' LOW PROFILE H2O CONCRETE'LEACHING CHAMBER 4, \\ \\ y - ` `' , • EXISTING SEPTIC SYSTEM INFORMATION OBTAINED FROM TOWN OF H'rANtJ1S HEALTH DEPARTMENT ON OCTOBER 7, 2004 i, \� -, J I / i �� \ - \ i • WATER LINE AND APPURTENANT INFORMATION IS BASED ON A PLAN FROM PLAN OF COMM WATER DEPARTMENT RECEIVED ON OCTOBER 7, 2004. PRECAST LEAC NG CHMIMER SYSTEM 1 \ \� \ , NO SCALE . , i \., �� 1 • GAS LINE INFORMATION PER PLAN PREPARED BY BAXTER do NYE IN 1994. WATERTIGHT MANHOLE FRAME AND / COVER TO GRADE A (FOR INSPECTION PORT) 3A - 1)�i• \ WASHED STONE / \ c / '��� i PUMP SPEIGMATIONS i / ; / i PUMP SYSTEM COMPLETE WITH ALL EQUIPMENT AND +c / c ® IN ACCORDANCE WITH ALL • } CIS INFORMATIONP�D SPECIFICATIONS HEREIN. 2" PEA;TONE r. i F "IV y THE PUMPS SHALL BE RATED TO DELIVER FLOW LINE 7 .�-:r'..t`.} ' ' ' �� ` '.; "<{ / c t2 r (1�s1'� :: 1 42 GPM O A TOTAL DYNAWC HEAD OF 20 FEET - l t i I ® I : s- r3 \ o �I v 24• 19• r ® s r �z iT Y z. / 7 , CAPABLE OF PASSING 1-1/4• DIA SOLIDS. SITE PLAN for EFFECTIVE l DEPTH 5" s f I r {�-; r t :� ` / Fy >e , 1 f_ t-: ) * ,,'�' t,.A. f< { • , \1` 1� i THE PUMP SYSTEM SHALL BE THE HYDROMATIC NON-CLOG 11 Winfield Lane OsterViile (Nl�l ' ■ �_. „ •_ _ L...,. �,;:, ^`,+,'c.1'. :'*. •.=+J 't � ' �. SEWAGE EJECTOR PUMPS MOLL SP40-1750 RPM /1 4 4 4' } F / PHASE/230 VOLT OR EQUAL THE PUMPING SYSTEM TO BE PREPARED FOR l PROVIDED AS A COMPLETE SIMPLFXING PACKAGE, TO 12' ,/ ! ` �, ) / INCLUDE THE HYDROMATK: HYDR-O-GUIDE RAIL SYSTEM, Paul Kozloff c% Bruce Besse ' FOR A CONCRETE PUMP CHAMBER OR EQUAL PER MANUFACTURERS SPECIFICATIONS HACLUDING, Bur NOT 205 Old Holmstoad (Drive Marstons A 02648 CONCRETE L.EACH�IG CHAMBER SYSTEM DETAIL ) LIMITED To: WATERTIGHT ACCESS HATCH, GUIDRAIL.S, > Mills,> •.�.`+..••••. )i ° -- DISCHARGE ELBOW ASSEMBLY. VALVES, LIFTING CHAINS, (H 20 LOADING) (508) 982 4743 '� � ''� _-�'`� MOUNTING BRACKETS, FLOATS do PIPING). A FiYDROAIATIC • �� Q-PANEL OR EQUAL SHALL BE PROVIDED FOR INTERIOR NO SCALE "!_��••„�•r' ` l,) �. / �! :x BUILDING MOUNTING MEETING THE SPECIFICATIONS PROVIDED TITLE WITHIN THESE PLANS. Proposed Upgrade to On-Site CONTRACTOR TO SUBMIT PUMP CURVES AND MANUFACTURER Sewage dISpO�a� Phan DATA/SPECIFICATKNIS FOR SELECTED PUMP AND SIMPLEXING TYPICAL SYSTEM PROFILE SYSTEM EQUIPMENT TO THE ENGINEER FOR APPROVAL NOT TO SCALE J.K. HOLMGREN ENGINEERING, INC. RAISE 2 COVERS NOTES: OPERATION MD MAINTI�� TO FIN. GRADE AS SHOWN WITH 1. ALL MATERIALS SHALL MEET H-20 LOADING REQUIREMENTS. PUMP SHALL BE INSPECTED IN ACCORDANCE WITH TITLE V BAXTER, NYE & HOLMGREN WATER TIGHT RISERS ENVIRONMENTAL CODE FOR PROPER OPERATION AND IN T-T do COVERS ACCORDANCE WITH THE MANUFACTURER RECOMMENDATIONS AND Registered Professional -T EXISTING GRADE - 10.0 SPECIFICATKNNS. INSPECTION REPORTS SHALL BE SUBMITTED TO THE LOCAL BOARD of HEAI.TH. __-._.. En ineLFS and Land SuIVe ors 24" NA OPENING 1 IN , RAISE COVER TO FINISHED -COVER TO FINISHED g y GRADE WITH WATER TIGHT SET MANHOLE FP,4AE GRADE WITH WATER TIGHT -`1 � � 12 Main Street, Osterville, Massachusetts 026.55 RISERS COVER RISERS a� COVER R ERS o GRADE /l4' one - (508) 428-9131 Fax - (508) 428-3750 RISERS do COVERS SHALL BE WATERTIGHT FINISHED GRADE OVER TANK = 11.4 L=70' 2 OF DOUBLE .;• .CREErI Q, � ti \s\\ i ( _ POSITfVE SLOP BACK O PUSMP CaFiAA1BER FOR DRAINBACCKK) ` WASHED PEA STONE ,� � W. INSTALL NEW -ENV IN-7.10 FINISHED GRADE D. BOX - 17.0 �` 20 0 20 40 4" SCH 40 PVC FINISHED GRADE OVER l E7ICHING CHAMBERS - 18' TO 17't L= 55' S=1.00X :.�. *...,s MNr7.10 4" SCH 40 PVC TOP OF D-BOX EL-16.40 + f J q / s' MIN 2• rt-T VALVE SCALE IN FEET NG) „ �` / INV IN 7.45 10" MIN. 684 GALS. - 24HR STORAGE HIGIiWATER ALARM EL=5.27 9" (min) Cover SCALE:1 =20 PVC Z ilr'. a 187 GALS. FIRST 2' (TO BE LEVEL) TOP OF PEA 36• (mox) Cover CONNECTION PER TOP OF CONC. n LEAD PUMP ON EL-4.77 4' SCH. 40 PVC O 1.00X STONE, EL=15.25 2.5' COM3RETE MANUFACTURER CHAMBER EL 15.08 ASSUMED EXIST.-� w 1 1/8" WELD I"f 187 GALS. PUMPS OFF El 4.27 1 INV OUT - 8.0 4, g• HOiES a t CHECK 'kL.VE - 2' SCH 80 INV IN-15.07 •. 2•-�--� �I LEACHING CHAMBERS RECOMMENDATION CONTRACTOR TO 374 GALS. LOW WATER ALARM EL-3.27 6' SUMP . OUT-14.90 VERIFY IN FIELD REINFORCED CONCRETEBAFFLE 187 GALS. INLET TEE TO 1• � ..T.•� GAS BAFFLE 4" DIA. PVC - - ;, X: F'fR10R TO STARTING ANY WORK. EL-2.77 - _ r +� ABOVE OUTLET ELEVATION_ r" , INVERT STEERS, CONTACT BASE. PRECAST y DATE: 10/08/04 IF I� 0 1� S 1HE ENGINEER IMMEDAIT3Y `�s' CRUSHED 24 -: --' _ a . FOR POSSIBLE REDESIGN. 1.500 GALLON TWO-COAIPARTAIENT 1.500 GALLON PUlil� CHAMBER STONE BASE 6" cIn1SHED GREATER THAN 1 DAY STOIC- BASE �' + , •~ ' •_ L� r SEPTIC TANK (H20 LOAMM SEPTIC TANG OW LOADW STORAGE PROVIDED ABOVE 4al$Ti�UT1Dfil 80); (M20 LOADN� - ROTONDO ST5X10-5 - OR EQUAL ROTONDO ST5X10-5 - OR EQUAL HIGH WATER ALARM 684 GAL > 440 GAL (DESIGN FLOW) LED 12.5 C01 TO BE INSTALLED ON A LEVEL STABLE BASE TO BE INSTALLED ON A LEVEL STABLE BASE TO BE ROALLED DB-9 OR EQUAL INV. IN - 14.50- 1Yi• SEPTIC TANK TO BE INSPECTED & CLEANED ANNUALLY SEPTIC TANK TO BE INSPECTED dt CLEANED ANNUALLY INSTALLED ON A LLB' STABLE t 5' MIN ASHED STONE 9 ��; ��� N0. BY DATE REMARKS (1ST COMPARTMENT GREATER THAN OR EQUAL TO 880 GAL) PROVIID OFOR 4 F 2" D IN No Groundwater Obswved O Elev. 7.5 DRAWN BY: SV DESIGNED BY: SV CHECKED BY: MWE DRAWING NUMBER AND(2ND COMPARTMENT GREATER THAN OR EQUAL TO 440 GAL) PUMP NOTES - SEE PUMP SPECIFICATIONS HEREON CONCRETE LEACHWG CHAFER SYSTEM H-20 LOADNK3 1. 1 PUMP REQUIRED (SIMPLE() UNITED CONCRETE 24' LOW PROFILE LEACHING GALLEY (H-20) OR EQUAL 0: 2004 04-132 CIVIL PLOT 2004-132SP.dw 2. ALARM TO BE ON SEPARATE CIRCUIT FROM PUMP. 3. 1 AUDIO AND 1 VISUAL ALARM REQUIRED. TO BL: INSTALLED ON A LEVEL STABLE BASE 2004-132 4. MOUNT ALARMS ON BUILDING INTERIOR.