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0017 YORK TERRACE - Health
17 York Terrace Osterville P A = 140 150002 ,i a it 1 ra TOWN OF BARNSTABLE V/ v � LOCAT?a I TN _ O r4a SEWAGE # VILLAGis" ASSESSOR'S MAP& LOT�q LSD INSTALLER'S NAME&PHONE NO. L' a SEPTIC TANK CAPACITY LEACHING FACILITY: (type) P� �oX�o I°�TS (size) �lfUb G��• NO.OF BEDROOMS BUILDER OR OWNER MAC/ PERMUDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leac4,ng facility) �+ Feet Furnished by 1�►S/0C.6 �00. T� P P. A.`4 ifs Ar f ✓,�1 TOWN OF BAR?VST1►L LOC/t ION 40r6�0 � � EWAGE #__ VII LAC,ff , 0 ASSESSOR'S MAP & I.OT/yD lso INS''ALLER'S NAME 6: PHONE NO. _ SkYTIC TANK CAPACITY_�Y LEACIi[NG FACILITY:(type)r � (size) l I40. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: _ VARIANCE GRANTED: Yes NJ r 2, ° 15'0 Z) . tt, ". > ' 1. I .jam I !.• ,., , i ..i 5 J i, . -1. } , 1 / .1 ' ` I. f' c !/. r I/ erg .'.ka .. t y }•`'rY T 5 t . "., lr E �.;.* 'S iSI r;0 tl Y � r' .1 I k-..:�-tt...1.."b.....,..:I.S_..;:-.7�'':-.l�:..;...-.,�,;,":I 4,b.:1.....-�.7_.1,*-".--�...:..I,.F.;_.�),,-.7I......-...-.7-�.l��-'.I_..".,.�,..��Ib."..::..,I1'�..-. z. r 't J J. ..' 'a 1 t �f 7 tr.'` . . 1. yf..t,f v. 1- `. t may. r er 4 E 3E 4 i r i s �� ! t. �01 4. t t ;( , (r) t . \. .•trtlr of 1 {R ; f 2. Y ,a.,, L , •i J S , t.ety. , 1t r �. t< �J. r , ♦ 1 +.5.+ S. ' , - G L+ i,v of 1+* CC 5 �4.i t f i f <!' ) ;; ' - u 5 r ) }YLr�' r 4S` xn Q •. y 3 1 `1R ^'iI J}SL .Y 5 Y �. 1 f .`. t.. .i..L� °`�sl.: �Rii�', 4, • S .lt 1'. ,�. •, • -; t r, 3 tLtE`r' Lpw` _+ t t{ , c r ;,� 1 r r 3'4 i�li til!.,�.�,� ni f 4 U .• + ; , r r r t .. t tS'1.'+' t'+M^•r I1r71^K\� r`•"�Y21. J� _q -. .qt,. 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VILLAGE F, i� I N S T A LLER'S NAME A ADDRESS N ,1 6 s SST N, Imo' �M q B U I L D E R OR OWNER 12A If Lp /3 R d . • DATE PERMIT ISSUED ' � DATE COMPLIANCE ISSUED e �t v � c �l �7' •tH OF.. THE COMMONWEALTH OF MASSACHUSETTS ` -r � R A ER N !l BOARD OF HEALTH .. v M'No. 'oaao Z � CIVIL - Town.....................OF...B.arnst.able.......-------------•--- o ��, Appliration for Bhyviial Works Tomitrnrtion amit ' Application is hereby ade for Permit to Construct (X ) or Repair ( ) an Individual Sewage. Disposal iv/�3� System at: 7 � �- ......wiannQ ?�-v-a.,.'.-_4.Ster_viUP....----•---.....-•---•---- ._--_ -•-•--z•'ct...lfi....::I�._C...C_--.1.�9h7>:.......................•-----.. _'_„ --I:ocat p _ ddress of Lot No. 4 n 7 6 �ln.c 1- A, 'y�R .....:.....c �;. rz_��..--�`z s�. --.-: i2 li:�----- -------------- ----:: Y =^' ---- . . 's. . .�.......-- Owner A ------------------------- .... = ess =L ............ d � Installer Address 2 2 5 30 U Type of Building Size Lot..........................Sq. feet a Dwelling—No. of Bedrooms-•_--.4....................... .....Expansion Attic ( ) Garbage Grinder (\To) pa Other—Type of Building ............................ No. of persons.....__...._......_.:______. Showers ( ) — Cafeteria ( ) Q' Other fixtures -----------•---------•-••-•------------ • --•-•• -- W Design Flow............5.5.............I-YOt9--_gallons per person per_day. Total daily flow------4.4-Q..............................gallons. WSeptic Tank—Liquid capacit gallons Length 1,0 '-II"Width.5; Diameter________________ Depth.' 8".. x Disposal Trench--,No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..... '�..___.__.. Diameter...I-Q.-........... Depth below inlet..5_'............. Total leaching area._.::52.4......sq. ft. Z Other Distribution box (X ) Dosing tank ( ) aPercolation Test R€sults Performed by.Cape__._God...Survey..ConsuLt..antDate......ImI7. =.83.............. a Test Pit No. L.2...........minutes per inch Depth of Test Pit-__12........... Depth to ground water..nane........... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... P4 ........................................................ ....................................................................... 0 Description of Soil........Q•.0..'__-1._Q_'._..IQ.=--- .'___me-d-___-c-0ar F s� x sa��,�1..wit h_._s_ome...�akzbles-.----fi--D--'-_-12-•-D'•--�e�d-----�hite..sa�ad_..... � (� 'KMNrTH R. �N W �orterat y / .......... ; EE6R©Y U Natu f Re a ons—Answer livable..................••------ f ------ .CIY.IL.. • .o ,p No.2..... � Agreemen : Z� �o�fi�ISTEQ`��y��`' The undersigned agrees to install the aforedescribed Individual Sewage isposal System in acco S Eq ifs the provisions of iTL� 5 of the State Sanitary Code—The undersigned further agrees not to place the sy t n operation until a Certificate of Compliance has been issued by the board of health. Signed ..........-- -------• -` Application Approved BY --------"- Date Application Disapproved for the following reasons:-----•------------------------------------------------•--------------------------•----•••--•-----•••-...._...._ .................•--••-----•-•---•-...........--•--•••--•---------•-•----•-----•--•....•••-•--------••-----------•------•--•------•-------•-•---••----------------•-•------•----•------------•-••---•-•- Date PermitNo.......................................................... Issued....................................................... ` Date - NO.-----== `= •-=--• , Fizz.......... OF THE COMMONWEALTH OF MASSACHUSETTS V q ROGER yG BOARD OF HEALTH � PAUL �' MICHNIEVYICZ. t No.30420 ... OF.... arnstable...................................................... �p CIVIL Tov7n.. .1 B p lirtil�tt fug dial Works Cnttrrt'utt 11vormit �SQ Application is hereby;rmade for a Permit to Construct (X) or Repair ( ) an Individual Sewag sposa System at ��1......V�7iaxtllo 4..... . •A.a... ;stert1,3.l1e..... ................ ......K���--�- �,a� e.. �:��'�.:�L�r_P:{.........-- � tionio I t1 dress r�i .' "4 or No. ! /� 5.....!.�..... O .�......L..................... .... �.� .....C�. _:... wners t. ir 1?.d. .-.-.-........._. Address `_ Installer '� t� Address UType of Building ; r Size Lot----2.2_, 52D.._..._Sq. feet Dwelling—No. of Bedrooms______?.._._._.___.`______________________Expansion Attic ( ) Garbage Grinder (I40) aOther—Type of Building ...........................`_,•N,o. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures -----------•••. •••-••••--••••••--.-=----. •-- - ----- W Design Flow............. 5_____.._____ . gallons per person per c�ay. Total daily flow....... 4 ..................gallons. Ix Septic Tank—Liquid capacity�l25(Wallons Length p '��Width{ �0"• Diameter________________ Depth_5 8' W Disposal Trench T ° _.._.____ Total Length _._� ______.._ Total leaching area....................sq. ft. x �o- -------------------- Width-- Seepage Wit No .. _._._.. Diameter Q_. Depth below inlet 6.............. Total leaching area 524_.__sq ft. r s Z Other Distribution box (X) Dosing tank ( ) '-' Percolat'on Test Results Performed`by.-C.a G._-.ad.._S.UI vay. ...cons 21tant)date.______1-_-1.7_=E0_____________ Tesdt Pit No. l._s�~_._,______mmutes per inch Depth of Test Pit._12........... Depth to ground water_.none______,__. 44 Test Pit No. 2........:_.....minutes per inch Depth of Test Pit____________________ Depth to ground water........................ O Description of Soil......... ° 3.0-1----loam and su.hi.0 .1,i ��q3' -Ff- sand w pia-... om per . :. . .a4` 12.:Q.'..__me wlv.te_._aaz .. off' U •••KEP1E�Fi R. W ----••--•--•............:....•-------------•----- ---;:o----.._..._..•••--••-----•----._...--•••-••----•-•-••••= - TEEBA Y �CIVIL U Nature of Repairs or erati ns—Answer when,applicable._....___ _____________ _ _____________ __... e`7. S._........ Agreeme The undersigned -agrees to install the aforedescribed Individual Sewage Disposal System in accor the oi'�TITi.^. further SSl E�� _ p 5 of the State Sanitary Code—The undersigned furtl er agrees not�fo place the syst Op until a Certificate of Compliance has been ued by the poa ,p -Pih�A Signed.............. ..••-•--•------•--•-=........................--•--••--•••. '4; Date ApplicationApproved By--••--•---•----............................................... "................................. ........................................ Date Application Disapproved-for the following reasons-........................'..................................................-...................................... .................•--•---•-....---....._._....._....-•-------•-----•--••-•.....__......_..----•••••----•---•=-••••--••-••--•-••-•--•-----•---•--••••------------•-----•-•--------•---••••--•-----•------- r, : Date PermitNo........................................................ Issued->......a.............................................. Sy Date t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.. ............................. ....................... THIS IS TO CE.2TIFYItividual Sewage Disposal System constructed`( ) or Repaired ( ) by �'' s �j•��s� !� �i'nst�aller -------------------------------- at.. •--. --- '' '•••5 has been installed in accordance with the provisions of TI i '' dj�� e State Sanitary Code;jas described in the application for Disposal Works Construction Permit No......................................... dated_........'_._._...___ ---------------........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTIONSATISFACTORY. DATE..:.......: `: Inspetor �- a•••• •------•---•--•-------THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No................=........ FEE.....::................. 'ax •� �t��r�r�ttl ��� ����tt�#i�n �ra�ti� `, F�. Permissionis hereby granted..-•----------------------------•--------••------------------...---------......_....-----•-------•---......-•-•--.... F..................... r ' �i �a sSystem. ,to Construct or a> ! eoan I� ` ` at No ----•---=..-••-••-•••........ Street as shown,on the application for Disposal Works Construction Permit No. _________________ Dated........................ i........... --------•-----------•--------- _ / Board of Health , DATE__d -""_c _` ----------••••• { FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS Commonwealth of Massachusetts //M Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 17 York Terrace Property Address George Alliegro Owner Owner's Name information is Osterville MA 02655 3-11-16 required for every page. City/Town State Zip Code Date of Insion Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms /l ``���gwtmHq��1� on the computer, OF IygSS�'•,,, use only the tab 1. Inspector: key to move your cursor-do not JAMES use the return James D.Sears Name of Inspector to key. Capewide Enterprises, LLC o.- Company Name �TTY.... ` 153 Commercial Street i,F�St INSPE`��p��` Company Address few Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S 1623 Telephone Number License Number B. Certification certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: f ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 3-11-16 nspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use. at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 o �s f Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 17 York Terrace Property Address George Alliegro Owner Owner's Name information is required for every Osterville -MA 02655 3-11-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system is a 1500 Gal.Tank D Box and two pits. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. , The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): M I t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts w W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 17 York Terrace Property Address George Alliegro Owner Owner's Name information is required for every Osterville MA 02655 3-11-16 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑. ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ' ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 17 York Terrace Property Address George Alliegro Owner Owner's Name information is Osterville MA 02655 3-11-16 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in usspsO is less than 6" below invert or available volume is less than '/2 day flow /°/75 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 i Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 17 York Terrace Property Address George Alliegro Owner Owner's Name information is required for every Osterville MA 02655 3-11-16 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead;Protection Area—iWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 I Commonwealth of Massachusetts d Title 5 Official_ Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 17 York Terrace G„M Property Address George Alliegro Owner Owner's Name information is required for every Osterville MA 02655 3-11-16 page. Cityrrown State Zip Code Date of Inspection. C. Checklist Check if the following have.been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® 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? El Have large volumes of water been introduced to the system recently or as part of ® this inspection? ® El 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? ❑ Z. Was the facility owner(and occupants if different from owner) provided with . information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): NA Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts w W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ,M 17 York Terrace Property Address George Alliegro Owner Owner's Name information is required for every Osterville MA 02655 3-11-16 page. City/Town State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal.Tank D Box and two pits. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2014-145,000Gal g ( y g (gp )) 2015-179,000 Gal's Detail: II Sump pump.? ❑ Yes ® No Last date of occupancy: Present Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 I� I Commonwealth of Massachusetts - Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 17 York Terrace Property Address George Alliegro Owner Owner's Name information is required for every Osterville MA 02655 3-11-16 page. City/Town State Zip Code Date of Inspection D. System Information.(cont.) Last date of occupancy/use: Date Other(describe below): General information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 17 York Terrace Property Address George Alliegro I Owner Owner's Name information is required for every Osterville MA 02655 3-11-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: NA Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 30" 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.): Pipeing is 4" PVC SCH -40. Septic Tank(locate on site plan): { Depth below grade: 20"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal. Precast H-10 Sludge depth: NA t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 17 York Terrace Property Address George Alliegro Owner Owner's Name information is required for every Osterville MA 02655 3-11-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Na cover under brick patio. 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 Asbuilt-Tape How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Inlet cover under raised room. Note: Cover can be dug up and opened. Outlet cover under brick patio. No sign of leakage or over loading. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 17 York Terrace Property Address George Alliegro Owner Owner's Name information is required for every Osterville MA 02655 3-11-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 17 York Terrace Property Address George Alliegro Owner Owner's Name information is required for every Osterville MA 02655 3-11-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): Camera back to D Box. Box under brick patio. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 f Commonwealth of Massachusetts H W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 17 York Terrace Property Address George Alliegro Owner Owner's Name information is required for every Osterville MA 02655 3-11-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ leaching chambers number: EJ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is two precast pits. Pit# 1 wet bottom. Pit and cover at 21" below grade. Clean wall's H-10. Pit#2 wet bottom. Pit and cover at 15" below grade. Clean walls. Pit is H-20 w/sq H-20 cover. No sign of over loading or solid carry over in pits. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth_top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 17 York Terrace Property Address George Alliegro Owner Owner's Name information is required for every Osterville MA 02655 3-11-16 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 17 York Terrace Property Address George Alliegro Owner Owner's Name information is required for every Osterville MA 02655 3-11-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately Q ,fit 13-9= /8 ��= aQ o � t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 I . Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 17 York Terrace Property Address George Alliegro Owner Owner's Name information is required for every Osterville MA 02655 3-11-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12 feet Please indicate all methods used to determine the high ground water,elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Hand Auger T.H. at 12' no G.W.. Bottom of pit at 8' below grade. Bottom of Pit at 4' above T.H.. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 17 York Terrace Property Address George Alliegro Owner Owner's Name information is required for every Osterville MA 02655 3-11-16 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 4 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION R. TITLE 5 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION v v� Property Address: 17 York Terrace Osterville. MA 02655 Owner's Name: Claude Thomas y Owner's Address: `� �` z _?Date of Inspection: . Mav 31, 2006 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford 1 .? xP- Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the:sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15:340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Nee s urther Evaluation by the Local Approving Authority Fai s Inspector's Signature: Date: June 4, 2006 The system inspector shall su t a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of comple ng 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 Cotntnents ****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. Tjtle 5 Inspection Form. 6/15/2000 page 1 Page 2 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION.(continued) Property Address: 17 York Terrace Osterville, MA Owner: Claude Thomas Date of Inspection: May 31, 2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipes)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health); broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system-will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 I Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 17 York Terrace Osterville, MA Owner: Claude Thomas Date of Inspection: May 31, 2006 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 aseptic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 17 York Terrace Osterville. MA Owner: Claude Thomas Date of Inspection: Me 31, 2006 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 q p o ed or obstructed p g y i e s . Number ggP p ( ) of times pumped_. _ ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 17 York Terrace Osterville. MA Owner: Claude Thomas Date of Inspection: May 31. 2006 . 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)]. e 5 I Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 17 York Terrace Osterville, MA Owner: Claude Thomas Date of Inspection: May 31, 2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n/a Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 Number of current residents: 0 Does residence have a garbage grinder(yes or no): n/a Is laundry on a separate sewage system(yes or no): 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: Unknown COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based.on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION , Pumping Records Source of information: Unavailable Was system pumped as part of the inspection(yes or no): No ' If yes, volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank, distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank'' Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Date of installation unknown Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 17 York Terrace Osterville, MA Owner: Claude Thomas Date of Inspection: May 31, 2006 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC. other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): r SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 16" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1500 Qal. Sludge depth: 2rr Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.). Tees were present. The liquid level was even with the outlet invert There did not appear to be any si.ns of leaka e GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene•_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or.baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 f Page 8 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 17 York Terrace Osterville, MA Owner: Claude Thomas Date of Inspection: May 31, 2006 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 alarn and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover;any evidence of leakage into or out of box, etc.): The D-box was level. No solids were present. PUMP CHAMBER: .None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 f Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 17 York Terrace Osterville. MA Owner: Claude Thomas Date of Inspection: May 31, 2006 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 2-6'x 6'(1000 gal.) 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.): Both nits were dry. There did not appear to be any signs offailure A video camera was used for the inspection CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan). Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): . PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Conunents(note condition of soil,signs of lydraulic failure, level of ponding,condition of vegetation,etc.): 9 Y Page 10 of I 1 y OFFICIAL.INSPECTION FORM-.NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 17 York Terrace Osterville, MA Owner: Claude Thomas Date of Inspection: Mav 31, 2006 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. t a3 1 rr 3 3 3� a9 y I ' Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOS AL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 17 York Terrace ; Osterville. MA Owner: Claude Thomas Date of Inspection: Mav31, 2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 25 +/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of.Health-explain: Topographic and water contours maps Checked with local excavators,in (attach documentation) Accessed USGS database-explain: t You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps the snaps were showing_approximately 25'+/ to ground water at this site. tr. This report has been prepared only for the septic system and components described herein. This septic system has been inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. 'There Have been no warranties or guarantees, either expressed, written or implied, relating to the septic system, the inspection, this report and/or any components of the septic system which have not been located and inspected. 11 f ulCOMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PRO ECTI'ON IVED 4 ni'T 0 1 2003 t,04STABLE L'TH DEPT. TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A - CERTIFICATION MAP t. �...�.., PARCEL Property Address: 17 York Terrace Osterville, MA 02655 Lc r 2 Owner's Name: Mary Tyrrell Owner's Address: Date of Inspection: September 15, 2003 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O. Box 49 Map: 140 Osterville,MA 02655-0049 - Parcel. 150 Telephone Number: (508) 862-9400 Lot.21 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. .I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓— Passes Conditionally Passes N Further Evaluation by the Local Approving Authority Fai Inspector's Signature: Date: September 20, 2003 The system inspector shall sub racoppy of this inspection report to the Approving Authority(Board of Health or _ DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 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: 17 York Terrace Osterville, AM Owner: Mary Tyrrell Date of Inspection: September 15, 2003 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage'backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The'system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: . 17 York Terrace Osterville, MA Owner: Mary Tyrrell Date of Inspection: September 15, 2003 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment., 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: l 3 f Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS_ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 17 York Terrace Osterville, AM Owner: Mary Tyrrell Date of Inspection: September 15, 2003 D. System Failure Criteria applicable to all systems: , You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool - ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged.or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board_of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gPd• You must indicate either`des"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 II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 3 f 0 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 f Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 17 York Terrace Osterville, AM Owner: Mary Tyrrell Date of Inspection: September 15, 2003 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ _ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection ? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) . ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ _ Was the site inspected for signs of break out? ✓ _ Were all system components,excluding the SAS, located on site? ✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? ✓ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? l 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)J. i 5 Page 6 of I 1 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 17 York Terrace Osterville, MA Owner: Mary Tyrrell Date of Inspection: September 15, A03 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n/a Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 Number of current residents: 0 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system (yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Unknown i COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Unavailable Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: Qallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Unknown Were sewage odors detected when arriving at the site(yes or no): No 6 f Page 7 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENT_ S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 17 York Terrace Osterville, MA Owner: Mary Tyrrell Date of Inspection: September 15, 2003 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 16" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1500 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: I" 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: 12" How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet'and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): _Tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) r Property Address: 17 York Terrace Osterville, MA Owner: Mary Tyrrell Date of Inspection: September 15, 2003 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete metal fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box,etc.): The D-box was level. No solids were present. The cover was 2'below grade. 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 r 01 Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 17 York Terrace Osterville. MA Owner: Mary Tyrrell Date of Inspection: September 15, 2003 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 2-6'x 6'(1000 gall 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 pit 03)was dry. There did not appear to be arty signs offailure. The cover was 15"below Qrade. The other pit(#4)was dry. There did not appear to be any signs offal ure. The cover was 2'below grade. The bottom to grade was approximately 10'. 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: 17 York Terrace Osterville, M4 Owner: Mary Tyrrell - Date of Inspection: September 15, 2003 Map: 140 Parcel: 150 SKETCH OF SEWAGE DISPOSAL SYSTEM Lot:21 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. 1 ' aa pA A g 11 _ !y6 3 3 3/ 1ZL9 y 10 I Page 11 of 11 e OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 17 York Terrace Osterville, MA Owner: Mary Tyrrell Date of Inspection: September 15, 2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 25 +/- feet Please indicate (check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked, date of design plan reviewed: Observed site(abutting property./observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using the Barnstable topographic map and the Cape Cod Commission water contours map,the maps were showing approximately 25'+/-to ground water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 REVISIONS: DATA DATE GF TEsrma ` /-� _�_$_ _ PERC. TEST DATA SEPTIC TALK DEl`A/L s�zE- _-.1Z 5�---_CAS_-___. -__ D/ST. BOX DETAIL : LEACHING C/L /T Y DETAIL: h0 DATE _rEST PIT D ,, �oCT 23;a4 RWVISC HoutsIL LOC•ATIOM TEST BY ___ r 1.��. %77 TO- CONFORM TO TITLE 5 REOUIREMENrS DATE OF TESTING., /- /?- �8� rANk� ry CONFORM ro TITLE 5 REOU/RFMENTS'. � FQAI ELEYAT1O11 , S>EPTtC 1AY1/EStTS no WITNESSED BY, �a�_.,�,�r�►c��-- G', NO. OF _---�___—.- R, ._._ _-- .TEST BYE ^ ,r.�`A�'�G �w.rri�� - $, _ _ _-_ --T-,�1 4" ', £MOW-48LE COVER SED BY ,, "+�.�► - -Li!_ ___ >T- ' ,` - ," -._ _ MA>vh."OL . BROUGHT ToR_ _-�_ P"PEASTOME QdM9FILL10"MAX.M •s y ..• v.„ s..- . o e.:. FINi$h' GRADE. , ----e---- --- , �r- — -- • o _+� CL EAR 3 CLCL AR 4 i rT. _ _ -.-- - - ---- -- -- t_-_-_,. �T- , OUTLET PIPES DEPTH OF TEST r 6"MINT J� 2`'M,I N 6„MIN °� _- ' I1 AS REQUIRED �+ if RA rE .ems _ - i r2.__ Ici',ti+/N. r I ox ' -- /ti"LET rEE -- - —ourLET TEE - If 8o i I tx I . '± 0UTL ET TEE DEPTH: 71i /000 GAL. I I . i i /ZSO GAL. Z`��►i ----' INLET AND OUTLET 4' O MINIMUM � SEPTIC TANK .. I �_._-------_!� , I . � PREcp�)i OR BLOCK 'ti!/�f' PEES TO 8E CASST L IOU/D DEPTH I� l4"AT LIOUID.DEPTH OF 4' ' 0 2' 6' f I 1 �- CONCHETF { SEEPAGE P T i -- _ __-- _ _ _.___. _ _.._.._.. r v S RUc TI /O- -- - - t --..- - --- ---- ___ - - DEPTH OF TEST' IRON, SCHEn 40 I,' 6 N vn' /9 I / I I P VC. OR CAST 'N I i J' -- �" o'' M/0 74 � C T . SDI I a I ' � PLACE CONCRETE { 29 � - .?.._ I � , �• � ' ' _-__ RATE :• C?NCN�7'E ,_ 34 8' 80TTOM ON LEVEL ST,484E84SE -�� (WANt +N ON TTE - SLOPE F AT .. ._.Ij. .f• ti', E T PROVIDED WHERE PE I . .,..• .. �__. OF INLET PIPE EXCEEDS 0.08 / OR UUNO /ON t ., }=- ----_ I�fd. i 1 j I ; ••.•_'.o.,, .�__.__----- ;Pr A PUMPED SYSTF-M. 20�MIN. I i i I 80TTOM OF TANK ON LEVEL ST A8L E 84SE HA/0 LOAD NABUNLE�UNDt TAv -- -- -- ----------.-- /j2"WASHED aTONE - — D PA OR DRIVE. H �0 ( ' { --- L OA:^,;'.NG UNDER PAVEMf N'•OR DR/VET hr _____f�- -___----------�•t � �` RECOMMENDED/.MANUFACTURER _-._,41A ���4S-_.__ ---__- NCi,`DMMEh'DFD MANUFACTUnEk' — L //l_��) �.E `s T _-- �� M►�"��vlE�r++ t 'q (O.R APPROVED EOUAL; ( OR 4PPROVEG EO(/AL I Y �..�-. NOTES PLAN i//Ew '' INVERT ELEVATIONS• .Ag'/ 'FOR rHE DESIGN ANO CONSTRUCT/ON OF THE 'SEWAGE !. THIS PL S G' DISPOSAL FAC/L/T Y ONL Y, INV AT SCALE - ! "= zo ' .� •>��� of M�, - eY � /NV. AT SEPTICLDi T4NK(/lV1 ALL CICtVSI RUCT/ON METHpf.'J AND MA TER/ALS SHALL CONFORM TO — _ �_ _ .LAMES MASS. O.E.O.E. TITLE 5 ANO THE z4x y 7)4,d4,r___- BOARD OF [�[� T- /� /yam 4 IN AT.X.P!IC+ TAIVK(CU Z« ' - --_- _ --a-'�- d�.- CIVIL � a 7 I ` .p'/..'7 .p N;. Z 9807 tfEAl_, /�' RF GJL.4 T64NS. Y. w <?' � 1 ----INV. AT D/ST 8C).�l/,V), - Z_ `t' _ st��'i $ -—INV AT GIST 190X(OUT) �. s-r •+ AT ,LEACHING FACILITY: 2G�4B BOSTON, MASS. WORCESTER, A ;S. t Bo7Tor( f_,��4CN/hN'- !? Z©• 6$ HALIFAX, MASS NORWELL, MA',.c r BEDFORD, MASS. HYANN S MASS. MANSFIELd LULL ,�5 1 L cJ N'f P. I �TON, MIA CRANSTON, R.1. DERRY, gg �• �,�,y ii 0 SCALE PROFILE: - ----- - ___ , I 1 - w = � ) I � � � m '��� .G�'�C`f,✓! �2 Sa�SR�- � I�Rc�+0 5�O i � cV `� R >n�o o DESIGN DA TA DESIGN FLOW k. µypt-,�,� REQUIRED SEPTIC 134NK� - ✓� GAL . SEPTIC TANK PROVIDED = 1 �� ' GAL. SURVEY � �• . �. CONSULTANTS REQU/RED SIZE LEACHING FACILITY; 3 H YEA MASS. 02601 617-_—-�- -- — -- — -- -- 775 716 n 01VI$ION OF } BOSTON SURVEY CONSULTANTS INC. 140 I ; I SIZE OF LEACHING FAC/LlrYi°RO�'/DED: ENGINEFFWNG SURVEYING -PLANMING W ',° TYPE OF SYSTEM TITLE: _ ,5ECTIO : SCALE . I�_ � --- 4 V1 Si.a�:avz•ti . 1r7�t14�,p - ___—. ---- - -- - -- — -- -- __ S �-�-.o� -- - - - x-- SEWAGE DISPOSAL SYSTEM { , T DESIGN k Z - � �--- -- ______-- -----,------__--___---- .�,� 77 B.L. ,�� -- - -- - ---- -� __ - --- LOCUS PL N: �. J I ! I M � Cis T� �E' V/L L �' _ . .S o G FOR: a � SCALE: AS SH(3wr� .. l� METERS I { � L ^ FEET 0 � _....-------. ---•---J DATE: .TWh6 COMP. DE.. IGN. CHECK: T' DRAWN: .TPL1 1 i S'�Av-v ,Pe�')W',�#`a+Z -0 Ysy.�" /�9T.��Y� FIELD: R,-4 'y" c'x I II 3 .; --- - FILE NO: _ 44av 3� 3 - DWG. NO: 5c73 JOB NO: SHEET: I OF: I yo K ? `e ��