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0017 CHINE WAY
17 Chine Way Marstons Mills P —- A 008 013 Town of Barnstable P# '?O�L Departinentof Regulatory Services M Public Health Division Hate J w s639r- �� 200 Main Street,Hyannis MA 02601 EDM1d,� Date Scheduled *too, G6 Time Fee Pd. Soil Suitability Assessment for Se Performed B : f 0- c&�� s(5`'t(5 _T y _Witnessed By; �. 77 LOCATION& GENERAL INFORMATION Location Address 17 Ctq"_, ne WAY Owner's Name d 5-K�,ku I Address Assessor's Map/Parcel: 1 ^] — �j Engineer's Name F.-1.t..er t` cjc -ee NECONSTRUCnON PEPAIR � NEW Telephone# Land Use �se�w�-w f Slopes(%) ?�Z-' Surface Stones Distances from: Open Water Body 73d� ft Possible Wet Area;;;, ft Drinking Water Well `�D ft Drainage Way ft Property Line 'l--' ft .Other` ft SKETCH:(Street n e,dimensions of lot,exact locations of test holes&pert tests,locate wetlands fn proximity to holes) i 9 Rw f 7 el. Est Qua1 /�l 7* Parent material(geologic) M�,O Depth to Bedrock �"'� . Depth to Groundwater. Standing Water in Hole: 6W Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR.SEASONAL HIGH WATER TABLE - -� Method Used: to Depth Observed standing in obs.hole: _ _._In, Depth to soil mottles: Depth to weeping from side of obs,hole: -_ In, groundwater Adjustment ° ri Index.Well# Reading Date: Index Well level, Adj,factor— Adj,Groundwater Level,- PERCOLATION TEST bate_� Tone Observation Hole# 1 Tinto at ry J" Depth of Pere Q �1 L Z 5 �(��S Time at 6" v Start Pre-soak Time® i Time(V-6") �S End Pre-soak Rate Min./Ineh. L 2 Site Suitability Assessment: Site Passed�_ Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one (1) week prior to beginning. Q:IS EPTICIPERCFORM.DOC DEEP.OBSERVATIONBOLE LOG Bole#•-(.— Depth from Soil Horizon Soil Texture S011 Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Stricture,Stones;Boulders.. o l t -Gravel) Z LS Ld a S Z- ZS 2�5 DEEP OBSERVATION HOLE LOG Hole# Z Depth from. Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consiste vel) (A3 2,SY�f DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Con ie DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,.Stones,Boulders. Flood Insurance Rate Maw Above:500year flood boundary No— Yes Within`500'year boundary 'No;Q Yes Within 100 year flood boundary No Yes Depth of"Naturally Occurring Pervious Material Does at least four feat of naturally occurring pervious material exist in all areas.observed throughout.the area proposed for the soil absorption system? -- If not, what is the depth of.naturally occurring pervious material? _.. ..�. Certification I certify that on �Q. (date)I have passed the soil evaluator examination approved by the Department of Bnvironmental Protection and that the above analysis was performed by me consistent with .T the required training,expertise and experience described in 10 CMR 15.017. Signature Date Q;\SEPTIC\PBRCFORM.DOC TOWN OF BARNSTABLE LOCATION c,-ki. SEWAGE#-',-)-0 VILLAGE o SSOR'S MAP&PARCEL�7 c7f INSTALLER'S NAME&PHONE NO A -( SEPTIC TANK CAPACITY LEACHING FACILITY:(type)/�adJ( �(size) �;Z NO.OF BEDROOMS OWNERA! PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: N!1 N Y e'ta►�� /3['P(°� Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Gc t- '?Pf C Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching-facility) Feet FURNISHED BY7 'Flit- -3 -36 3 o�' — ® 2 coo D -18 No.(;�0/ / —` L C Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ftpftation for ;Disposal fpstem Con truttior Vermit Application for a Permit to Construct( ) Repair(✓�Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 17 !CNI,iN,f Owner's Name,Address,and Tel.No. Assessor's Map/Parc�� & W y N�� j C4 C7 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 5 —q77- 5_3i ' Type of Building: Dwelling No.of Bedrooms 3 Lot Size 32,365- sq.ft. Garbage Grinder( ) Other Type of Building 6a.77Y No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 311131`1 gpd Plan Date 2 i ` 1 Li Number of sheets Revision Date Title Size of Septic Tank E I S� Type of S.A.S. 'Z soc, r4ced[vii (-`q&L"bels" Description of Soil ' Nature of Repairs or Alterations(Answer when applicable) :L N5 i- )l 2 5-00 C4 41,0"y C"iJ lord Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si /�L� Date 2 — S--/ Application Approved by Date �- Application Disapproved by Date for the following reasons Permit No. b Date Issued No:�/(-/ v I Fee /� Z�ioe,� THE COMMONWEALTH'OF MASSACHUSETTS Entered in computer: ' Yes PUBLIC HEALTH DIVISION -TOWN OFBARNSTABLE, MASSACHUSETTS 9pplitatlon for MispoSAY-6pstru ConstrUctlon 3permit+- Application for a Permit to Construct( ) Repair(✓�Upgrade. ) `Abi/ddon( ) 0 Complete System ❑Individual Components Location Address or Lot No. 17 C 4;IV Owner's Name,Address,and Tel.No. f � rn .Assessor's Map/Parcel ������ "O/S Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. '"5�45 A �jtpv�^T�rc Scp-N�-71 S5 E,vS�,,,rrii•�s Lto1k5 -477- S 31 Type of Building: Dwelling No.of Bedrooms 3 Lot Size 32 30- sq.ft. Garbage Grinder( ) Other Type of Building 10"5-r- No.of Persons Showers( .) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 3'10,`T gpd Plan Date 2 1 L) 1 Ll Number of sheets 2 Revision Date Title Size of Septic Tank Type of S.A.S. C4ej) 1 L,n e(f Description of Soil , Nature of Repairs or Alterations(Answer when applicable) A 2 5-00 G CjG✓U r Ii[.Mb P(5 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of • , Compliance has lieen issued by this Board of Health. Si ed /Z-- Date 2 Application Approved by . `'" Date Application Disapproved by Date for the following reasons 4 x, Permit No. ( b ' Date Issued t vAJu THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance �. THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( 11� Upgraded Abandoned( )by� n `6(OwN at � � iw WC&y ate(0 t t) �p has been constructed in accordance ?' with the provisions of Title 5 and the for Disposal System Construction Permit Ng Z-/ G5 dated c�/ Installer",, (y -\&Ow rJ Z-nSC Designer #bedrooms 3 Approved desinditionas gpd The issuance of this permit shall not be con ed a uar tee that the system will designed41 . d Date Inspector ��I/�I /i - _/ yI �iyv" vrt No. <9DI l e15 1 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *p8trm Construction Permit Permission is hereby granted to Construct( ) Repair( 1� Upgrade( ) Abandon( ) System located at C P !A)a., (}4fe and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. --� Date ` t�// 7 Approved 6 . Pp Y -__�•.- - 02/26/2014 15:16 5084775313 ENGINEERING WORKS PAGE 01 Town of Barnstable Regulatory Services Richard Y, Scan,Interim Director MAK ' Public Health Division Thomas McKean, Director 200 Maim Street,Hyam2is,MA 0260I pftica: 508-862-4544 Fax 508-790-6304 Installer & DjesigAer �Certfiication Form Date: r Sewage Perm 7ii#o, — LL Assessor's Mapl?arcel tf q_7 '10 )3 Designer:, � �.�� Installer: � �A e Address: 12 . Address: On ro'�'✓` ��� was�ssued a permit to install a (date) (installer) 0 1 septic system at 1'7 �►`r+-i °� based on a design drawn by (address) e-mr.11 n-ter 1 m 5 f L dated (designer) _ 1 certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out ;if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major chazges'.(i,e, greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constr. with the terms of the RA approval letters (if applicable) PETER T. McENTEE CIVIL No.8�1� (Installer's Signature) Q �.BTis /ANAL (Designer's Signattue) (Af5x Designer's Stamp .Here) PLEASE RETURN TO BARNSTABLL+ PUBLIC l ALTH DIVISION. CERTrPICA.TE Off' COMPLIANCE WU L NOT BE ISSUED UNTM BOTH THIS FORM AND AS-. BUILT CARD ARE RECE17EA BY THE BARNSTABLE PUBLIC HEALTH DIVISION, THANK YOU. QASeptic0esigner Ceitincation Form Rev&14-11doo jj- TOWN OF BARNSTABLE A,ION CIll/� SEWAGE # AGE - 19 ASSESSOR'S MAP & LOT 097. O 3 IN AT LER'S NAME&PHONE NO. C.O 1 J SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 1".T LI (size) NO.OF BEDROOMS 3 BUILDER OR OWNER Al)lw P SMAT TrV Cr. 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 leacng facility)—�— Feet Furnished by'X-/1 Sa& 10^ (� ..A � .T'�On� ... ` J �'] / S d O a a s ay � � 3 y s a� a8' y y� a� 3 Fee No. J �^ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: s PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0ppYicatiou for lh6pomt *pgtem couttructiou permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. Owner's Vame,Addre d Tel.No. Assessor's Map/Parcel /j•� O S7rj411tf-- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. G Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) OX Al Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued byAs Boarfi of Health. l3/�� gne Date �y / Application Approve Date /�V 3/a� Application Disapproved for the following reaso - Permit No. 3 > Date Issued �� } 1 No. Fee • �►. - THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes " PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS ZIpplication for Zizpo$al bpgtem Con�truction 'Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. (y Owner's Name,Add d To1 No. Assessor's Map/Parcel Installer's.Name,Address,and Tel.No.✓lT Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title i Size of Septic Tank Type of S.A.S. Description of Soil tj 6. Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued s Boar. of Health. 'gne \ -^' Sd J Date } Application Approved Date Application Disapproved for the following reasons ~ i Permit No. Date Issued ------------------------ -------------- THE COMMONWEALTH OF MASSACHUSETTS ' BARNSTABLE, MASSACHUSETTS t~' '�' ��x, Certificate of Compliance � THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by ��r"i rr> It ,-*t'q, p j5 `/ C, . r�`,, E Q(f`T,—f e-A l Lc i at ��� �been c�nst�icte� in4cc)o�d�c�e� J ♦d`l 4'',.. with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer C o-c_j Designer The issuance of this re t shall hot be construed as a guarantee that the s.111 I I difu cti n as designed Date / O / Inspector t —�3�3—--------- ------------- No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS),) ;x �A l f xizpozat *pztem � " gtructton Permit Permission is hereby granted to Construct( )Repair( )Upgrade(_ Abandon( ) System located at lCd�/ `� t! '� .�li�•Iic 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 conditio S. Provided:Constructions ust b completed within three years of the date f this per Date:_ � X ,/ Approved by 4 / : ' = v TO STABLE LOCATION /7 444k, SEWAGE # VII: ✓��S ASS SSOR'S MAP &LOT INS f ALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ® LEACHING FACILITY: (type) Ik7l (size) sly NO.OF BEDROOMS / BUILDER OR OWNER 29gif �f PERMTTDATE: � — COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet c 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 well ds exist within 300 fee of leac ' g , ci ' Feet Furnished by > ` J'lm _ _ �, r .. �` ��) � � � � � �� � ��� x � �� �r©. � � , � � �. �; • �000 UExecutive Office of 11vifonmentai Htrairs Department of En Protection William F.Wald Trudy Cox* Governor Argoo Paul Celluccl Da thh I d�;'A LL Gonmor ®tccrnn,h.lon.r r s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 0 A' PART A - A Y 4"' CERTIFICATION1996PropertyAddress: 17 Chine Way l e,Mass . Address of Owner. Date of Inspection: 4/2 6/9 6 (If different) Name of Inspector. Joseph P. Macomber Jr, . Company Name,Address and Telephone Number. J.P.Macomber & Son Inc. Box 66 Centerville ,Mass . 02632 508-775-33738-- CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported belgw is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: ZPases _ Conditionally Passes -- _ Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signal / / Date: �7 The system Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(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 Department of Environmental Protection. 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: =ve PASSES: 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 evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: A- One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,-no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If"not determined",explain why not) The septic tank is metal, cracked,structurally unsound, shows substantial infiltration or exfiltration,.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 a Boston, Massachusetts 02108 a FAX(617) 556-1049 • Telephone (617)292-SSW Printed on R"kd Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) PropertyAddresa: 17 Chine Way Osterville ,Mass . 02655 Owner. Fred Stocker Date of Inspection: 4/26/96 B)SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(&) 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 A,, 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 C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: /-)6 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: j Cesspool or privy is within 50 feet of a surface water .&j 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: 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 supply. L The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. AZ The system has a septic tank and&oil absorption system and is within 50 feet of a private water supply well. _ The system has a septic tank and&oil 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 AZ (revised 11/03/95) 2 r • � s SUBSURFACE SEWAOE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (oontlnuod) Pr•oportyAddross: 17 Chine Way Osterville,Masd. 02655 Ownor. Fred Stocker Data of Lrupootion: 4/26/96 D) SYSTEM FAILSs • • Af61 I BAY*determined that the system violates ona or more of the following fallur•criteria a.s dafinad in 910 CUR 16.909. 'I'ha basis for this determination is idsatiLed below• The Board of Health should be contacted to datermins what will be naoesss•ry to correct th• failure. : Backup of aavxs.g• into facility or system component due to an ovsrloaded or clogged SAS or oosspooL Discharge or ponding of eP.luent to the surface of the tround or surface waters due to an overloaded or clogged SAS or cosspool. .AN Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in oow?"it less than 6"below invert or available volume is lass than 1/2 day flow. Roquirod pumping more t.l=4 times in the last year NOT duo to clogged or obstructed plpo(s). Number of times pumped _ AY Any portion of the Soli Absorption System, cesspool or privy is below the high groundwater elevation. i1J Arty portion of a cos.spool or privy is within 100 foot of a surface water supply or tributary to a surface water supply. Ary portion of a co, pool or privy is within a Zone I of a public well. t�l Any portion of a cesspool or privy is within 60 feet of a private water supply well. 4) Any portion of a cesspool or privy is lass than 100 feet but greater than 60 foot from a private water supply well with no acceptabls water quality analyze. 11 the well ha, boon analyzed to be acceptable, attach copy of well water anaLysis for coliform bacteria,volatile Organic compounds, ammonia altrogon and nitrate nitrogon. E) LAROE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The rystam servos a facility with a design Dow of 10,000 gpd or graator (Large System) and the system is a signla=t threat to public health and safety and the environment bo:ausa one or more of the following conditions ezists the rystem is within 400 foot of a surfacs drinking water supply the system is within 200 1A,,of a tributary to a surfaces drinking water supply J�J/t the rystom is located in a ni:rogea sensitive area (Interim Wellhead Protection Aron (ITRA)or a mapped Zone 11 of a public water supply well) The owner or operator of any such system sha.1 bring the system and facility into hill compllana with the Ys•oulidwater trattment Prop= requirements of 314 CMR 6,00 and 6.00. Plop_9 consult the local regional office of the Department for NAher information.. 1 < SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Ad 17 Chine Way Osterville ,Mass . 02655 owner. Fred Stocker Date of 4/26/96 • Check if the fr:",•..:ng have been done: z•!i•ping information was requested of the owner, occupant, and Board of Health. X/rc-e of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. °':t plans have been obtained and examined. Note if they are not available with N/A : +cUity or dwelling was inspected for signs of sewage back-up. " tem does not receive non-sanitary or industrial waste flow e was inspected for signs of breakout. components,Akluding the Soil Absorption System, have been located on the site. ptic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or terial of construction, dimensions,depth of liquid,depth of sludge, depth of scum. 7, and location of the Soil Absorption System on the site has been determined based on existing information or `mated by non-intrusive methods. :lity owner(and occupants, if different from owner) were provided with information on the proper maintenance of Sub- 7ieposal System. (revised 11;" 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM SUBS , PART C SYSTEM INFORMATION Property Address: 17 Chine Way Osterville ,Mass . 02655 Omer. Fred Stocker Date of Inspection:4/26/96 FLOW CONDITIONS RESIDENTIAL: Design flow: ns Pei d • Number of bedrooms: Number of current eats: Garbage grinder(yes or no):#h Laundry connected to system(yes or no): S Seasonal use(yes or no):� t @ Water meter readings,if available: - ) I 1 1y_ Last date of occupancy:,�,=� ni Y COMMERCIAL/I ND U S TRIAL: Type of establishment: ,t_l R Design flow:_&16 __gallons/day Grease trap present: (yes or no)" Industrial Waste Holding Tank present: (yes or no)_&)_'q Non-sanitary waste discharged to the Title 5 system: (yes or no) `jt Water meter readings, if available: A)4 Last date of occupancy: OTHER: (Describe) 1l)14 Last date of occupancy: Niq GENERAL INFORMATION PUMPING RECORDS and so of information: A'iw e /9"V & , System pumped as part of inspection: (yes or no) J If yes,volume pumped: DD one l Reason for pumping TYPE 097 SYSTEM Septic tank/distribution box/soil absorption system 416 Single cesspool M Overflow cesspool 1A2Privy 4 Shared system(yes or no) (it yea, attach previous inspection records, if any) _ Other(explain) APPRO TE AGE of all components, date installed(if known) and source of information: f✓�I P.'�I' Si^ Uu'�Q!' Sewage odors detected when arriving at the site: (yes or no) /I d (revised 11/03/95) 6 •-_...- I 3 -3E�R�itit p� 0 9�•3 f 4,q5 PT I coo r be W AL.L S G-f'� t° 021& X 2• C ll3�c I�o s I13 4JOA -TEA L. -t:,N I Ll R-ow i 4`r rc 1IIu �R (�S L�... ?1•0 :� r a�z A`C 1 o A ��.'T$ 2 w� r•� RICHARD o "LA�' A. `a�� i w 1�'• 4 t.L •V 9 f, ,gyp �• BAXTER v JON[ ; , ; I(,)`, •'1 'I?No.210480 1O��TgR4,VQ- �� G SU �� �Iy�Q. IZO V-9 i FG To P FNu• Icb• I,� I 97 PA- 6.an�dErL.^• - �' � l5om wv• 97•d LG111M G 4I.. INS. e,EPTtG 4 i 9uX 97TI.NK { z ,o0o INSr, i LEACu INV• INV. PIT 4 2- 47.1-1WITW 3A.1%L wlJA 6TvN� q10 ti-o'T PLA►J CE2TlFIGC7 P I P R U P I L G L o C 4-T 10 tJ /u b�iTt)l�j /�I c•� .I V ATE til 0 5 CA L E c Go VZ- p L P.N R E F S2EN c.Tc 1 CF- RTvFY ?NAT TH uh�'bA't'10l.1 511oµ!N EIzsoN CoMPL,(6 YJITN-THV-� N'rD of 'T N� LOT I.1D S�-T�GK R.6Rv12EM1` oWN Op -E 1AW44t7TAP� AND IS � ` G• G, Z 1 LOGp.TED WITNI T .E Gl.00D PLAIN A-TEYl�22 BAXTEIZe NYE INC. e �tJs,N C�3TE2VIl.L1r • Jos• }i S E W A G E PERMIT N0• ::;. L 0 G `:X N � i ADDRESS NAME R Urhl1< it OR OWNER A p DATf PERMIT ISSUED y 3 DAT .E, .; COMPLIANCE ISSUED �D P q z� 4t b SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontinued) ape,tyldd,.,,, 17 Chine Way Osterville ,Mass . 02655 Owner. Fred Stocker Date of Inspection: 4/2 6/9 6 SEPTIC,TANK- (locate on site plan) Depth below grade: � Material of construction:Yconcrete_metal_FRP—other(explain) Dimensions ` ' ! 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:_ Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, T �e evidence of leakage,etc.) ! IS , deb GREASE TRAP•.1V.'e (locate on site plan) Depth below grade: Material of construction:A.�-oncrete_metal_FRP _other(ezplain) AA Dimensions: Scum thickness: AM Distance from top of scum to top of outlet tee or baffle:: Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) Ain ��;yiiYlE�.rt.JT�> _ (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Property Address: 17 Chine Way Osterville ,Mass . 02655 Owner. Fred Stocker Date of Inspection: 4/26/96 TIGHT OR HOLDING TANK&-C (locate on site plan) e Depth below grade: -Llr1 Material of construction ncrete_metal_FItP_other(explain) a A' Dimensions: AM Capacity: n!A gallons Design l: gallons/day Alarm level: ' Comments: (oo tion of inlet tee,condition of alarm and float switches, etc.) Ale Len d?F%1L�G DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: Comments: ( o if leveLGad distributio is evidence of sgli carryover, viden of into or out of box,etc.) ll-box has equa� o'w o evidence o so`�l1 s arry over; No evidence o 1p.akagp ;n or out of the box. No repairs needed at this time. PUMP CHAMBER:Al"C_; (locate on site plan) Pumps in working order:(yes or no) 22 Comments: (note ndition of pump chamber,condition of pumps and appurtenances, etc.) (revised 11/03/95) 7 9UFiSJ�Ri~'Ai:E SEWAGE 1)1SY09AL SYSTEM INSPECTION FOR M PART C SYSTEM INFORMATION (oontinued) PropertyAdd.reas: 17 Chine Way Osterville ,Mass . 02655 Owner. Fred Stockdr Date of Inspection: 4/26/96 nn SOIL ABSORPTION SYSTEM (SAS):�—jc�c�Oq 4x �cA (locate on site plan, if possible;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:_ leaching galleries, number: leaching trenches, number,leagth:ons: �_ leaching fields, number, dimensi (J overflow cesspool, number:D— mmen4: (note co t n o soil, s of h dr{n . failure level of ponding, condition of vegetatio etc.)Soil s see page 5A �o signs o�' lycrau is fai�ure ;igo signs of pondin • 11 ve e a ionis normai. No repairs nee e a is time. CESSPOOLS: (locate on site plan) Number and configuration: LtA Depth-top of liquid to inlet invert: A)A Depth of solids layer: Depth of scum layer: 10F� Dimensions of cesspool: Materials of construction: Indication of groundwater: too inflow(cesspool must be pumped as pert of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) 1R'P1 �/.� �Y1r✓162ry i PRIVY: /4%1 , (locate on site plan) Materials of construction: Dimensions: All l Depth of solids: AIR Co n : (note condittiion of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) /�y" Hof l��t✓!i%�'�f (revised 11/03/95) 8 I .. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) PropertyAddresa: 17 Chine Way Osterville ,Mass . 02655 Owner. Fred Stocker Date of Inspection:4/2 6/9 6 SKETCH OF SEWAGE DISPOSAL SYSTEM: ' include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' Centerville Osterville Marstons Mills Water Company 428-6691 000� -05 I i DEPTH TO GROUNDWATER Depth to voundwater. 1 +feet method of determination or approximation: See plan page 5 A No water encountered when +Act hn1A and installation was donr. (revised 11/03/95) 9 THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION DE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required 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 rrnrr+-n•ta�.-rr�a-sr.-.-•r.trsr-rr..rr..: r.:-.•x-rrr:-pre-n-rr-ter.-rcrrt.._ .. _.. .. -. - r. r,-y�r--.rt*•rre•-.r.-.r. ..',�✓ r-•� k' TOWN OF Barnstable BOARD OF HEALTH SUiISURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION .� F•••�;•ter.•_::rr..fr.-.e�.r.-n•rc:m-r.-rirr..-r�rr.-r-ir....-s.r. -r-er.nrarrsr-rers:e+r•rsa sam rt•mrrnrsrtrr+rr�•.-r•rr•r.•n -TYPE OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS 17 Chine Way Gstervi le.Mass . 02655 ASSESSORS MAP , BLOCK AND PARCEL # OWNER' s NAME Frod Stook Pr PART D - CERTIFICATION r NAME OF INSPECTOR Joseph P.Macomber Jr. . COMPANY NAME J.P.Macomber & Son Inc. COMPANY ADDRESS Box 66 Centerville,Mass . 02632 Street Town or City State LIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 l 790 - 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposaj system at this address and that the information reported is true , accurate, and complete as of the time of :inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one: XXXXXXXXXSysteln 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 . System 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 is Date J One copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF HEALTH. * If the inspection FAILED, the owner or"" 'P' erator shall upgrade ' the system within one year of. the date of the inspection, unless allowed or required otherwise as provided in 310 CHR !15 . 305 . � r A COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION RECE-1 ED JAN 1 2004 TM N OF ''ARNSTABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 17 Chine Way MAP \-vN k&v,g 9s#eA41k, MA 02655 PARCEL ; O 15 Owner's Name: M1 L-U Annah Potter Smart Trust �OT Owner's Address: y- Date of Inspection: December 12, 2003 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O. Box 49 Osterville,MA 02655-0049 Telephone Number: _ (508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP k approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs F her Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: January 3. 2004 The system inspector shall submi copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 17 Chine Way _ Osterville. MA Owner: Annah Potter Smart Trust Date of Inspection: December 12, 2003 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes, no or not determined(Y,N,ND) in the for the following statements. If"not determined", please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 17 Chine Way Osterville, MA Owner: Annah Potter Smart Trust Date of Inspection: December 12, 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 wel I. 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 Chine Way Osterville, MA Owner: Annah Potter Smart Trust Date of Inspection: December 12, 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 Y2 day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems 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 i Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 17 Chine Way Osterville, AM Owner: Annah Potter Smart Trust Date of Inspection: December 12, 2003 Check if the following have been done: You must indicate`yes"or"no"as to each of the following: Yes No ✓ _ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ _ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection ? ✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ _ Was the site inspected for signs of break out? ✓ Were all system components, excluding the SAS, located on site? ✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction, dimensions,depth of liquid,depth of sludge and depth of scum ? ✓ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ _ Existing information. For example,a plan at the Board of Health. ✓ _ 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 r Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 17 Chine Way Osterville, AM Owner: Annah Potter Smart Trust Date of Inspection: December 12, 2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 1 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: Currently occupied COMMERCLUJINDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Qnd 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: Unknown Were sewage odors detected when arriving at the site(yes or no): No 6 I 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 Chine Way Osterville, MA Owner: Aanah Potter Smart Trust Date of Inspection: December 12, 2003 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC other(explain): Distance from private water suoply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 10" 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: 6" Distance from top of scum to top of outlet tee or baffle: 8" 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.): Tees were present. The liquid level was even with the outlet invert There did not appear to be anv signs of leakage GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 17 Chine Way Osterville, AM Owner: Armah Potter Smart Trust Date of Inspection: December 12, 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 broken down structurally and dirt was caving in. A new D-box was installed(see Permit No. 2003-633). 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.): i 8 f I Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 17 Chine Way Osterville, AM Owner: Annah Potter Smart Trust Date of Inspection: December 12, 2003 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 1 -6'x 6'w/3'stone(per information available) leaching chambers,number: leaching galleries,number: leaching trenches,nurr_ber, length: leaching fields,numbe-,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The pit had Y of water on the bottom. The bottom to grade was 7'6". There did not appear to be any signs of 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 I Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1"Chine Way Osterville, MA Owner: Annah Potter Smart Trust Date of Inspection: December 12, 2003 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. Q � a a s ay 3 y 3 a8 ag y yv a� 10 i Page 11 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 17 Chine Way Osterville, MA Owner: Annah Potter Smart Trust Date of Inspection: December 12, 2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 30 +/- 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 30'+i=to ground water at this cite. 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 andlor this report. 11 DATE : 5/26/98 PROPERTY ADDRESS:-17 Chine Wa ,Mass. �. ' ----- -------------- -- 02655------------ -" ro"4 8 1998 On the above date, I inspected the septic system at the ve addres CL This system consists of the following: P 6 1 . 1 -1000 gallon septic tank. 2 . 1 -Distribution box. 3 . 1 -1000 gallon precast leaching pit packed in stone. Based on my inspection, I certify the following conditions: 4 . This is a title five septic system. ( 78 Code ) 5 . The septic system is in proper working order at the present time. 6 . Tank cover is 6" below grade. 7 . Distribution box cover is 14" below grade. 8 . Leaching pit cover is 18" below grade. L Name : J . P . Macomber Jr . SIGNATURPI ---------------------- Company:,josggh ,per_ M_!�comtter 3 Son, Inc . Address :__BQx _C.FZ____________ -_Gin-t-erY.ill-e-,_Ba--n632-0066 Phone : 508-775- 3338 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY (JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-Leachfields Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775-3338 775.6412 . f COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS ' DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTON, MA 02108 617-292.5500 WILLIASI F WELD TRLDI COX-E Gos cmor Sc,rc Lv\ ARGEO PALL CELLLICCI DAB ID B STRUHS Lt.Goscrnor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissionc! PART A CERTIFICATION Property Address: 17 Chine Way Osterville,Mass. Address of Owner: Date of Inspection: 5/27/98 (If different) Name of InspectPr: ber Jr. I am a DEP approved system inspector pursuant to Section 15.340 of Title S (310 CMR 15.000) Company Name: J.P.Macomber & Son Inc Mailing Address: Box 66 n rvi l l p P M;j_g 02632 Telephone Number: SnR_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 inspection. The inspection was performed based on my training and experience in the proper iunRion and maintenance of on-site sewage disposal systems. The system: z Passes Conditionally Passes Needs Funher Evaluation By the Local Approving Authority _ Fails / Inspector's Signature: i 2� / Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (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 repon to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the sys7em owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, 8, C, Or D: A) SYSTEM PASSES: 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 evaluated are indicated below. COMMENTS: el SYSTEM CONDITIONALLY PASSES: —,d2 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, indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined', explain why not The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (10) years prior to the date of the inspection, or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, 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 04/25/97) Page 1 of 10 DEP on the World Wide Web: httpJtwww.magnet.state ma usJOep Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 17 Chine Way Osterville,Mass . Owner: George F.Stacker Date of Inspection: 5/2 7/9 8 B] SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box 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). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced dD 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 C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: AID 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: &$ Cesspool or privy is within 50 feet of a surface water _40 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 PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS 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. Method used to determine distance �_(approximation not valid). 3) OTHER (revised 04/25/97) Yaffe 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 17 Chine Way Ostervi lle,Mass. Owner: George F. Stacker Date of Inspection:5/2 7/9 8 D] SYSTEM FAILS: You,must indicate ei;-.er "Yes" or"No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CN1R 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. Yes No 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. Static liquid level in the distrihwi tion box above outlet invert due to an overloaded or clogged SAS or cesspool. rV9 vtr Liquid depth inkes5ti9el•is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped a- 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. 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. 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 coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: 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: Yes No NO the system is within 400 feet of a surface drinking water supply , 4W 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) The owner or operator of any such system shall 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 further information. (reviaod 04/25/97) Page 3 of 10 L SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 17 Chine Way Osterville,Mass. Owner: George F.Stacker Date of Inspections/2 7/9 8 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes N� Pumping information was provided by the owner, occupant, or 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. As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components, 4cluding 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 baffles 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: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. Existing information. Ex. Plan at B.O.H. Y _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)) (revised 04/25/97) ?&9. 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Propers) Address: 17 Chine Way Osterville,Mass . O»ner: George F. Stacker Date of inspection:5/27/98 FLOW CONDITIONS RESIDENTIAL: Design floN.�,g.p. ./bedroom for S.A.S. ''umber of bedrooms: Number oi'current residents: Carbage gander (yes or no)./16 Laundry connected to system (yes or no).AL--? Seasonal use (yes or no).A& r ��ater meter readings, if available (last two (2) year usage (gpc): Sump Pump (yes or no):lob 77 :=ODD 5 a �a�s ��c Last date of occupancl•S'0 COMM FRCIAUINDUSTRIAL: Type of establishment. De.s,gn flo» _d2A allons/day Crease trap present. (yes or no)42,1- indusuial Waste Holding Tank present: (yes or no)"Non•san,tar) waste discharged to the Tale S system: (yes or no)A4 \1 ater meter readings, if available. AV a Las: date of occupancy: OTHER: ,Describer Last date or occupancy GENERAL INFORMATION PU..MPIN'G RECORDS and source of information. q4, /aL)rn� �Tanl� System pumped as pan of rnspeciion: (yes or no)&O If yes. volume pumped: gallons Reason for pumping TYPE Of SYSTEM —fay/Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, anach previous inspection records, if any) I/A Technology etc. Copy of up to date contractf Chher APPROXIMATE AGE of all components, date installed (if known) and source of information: ����L✓� '} S,e.age odors detected when arriving at the site: (yes or no)/e tr.v:..a osils/s�i p.y. 5 of 10 SUBSURFACE SEWAGE DISP•. i. SYSTEM INSPECTION FORM I C SYSTEM INFOI: :ION (continued) Property Address: 17 Chine Way Osterville,Mass. Owner: George F. Stacker Date of Inspection:5/27/98 I Depth to Groundwater /s Feet Please indicate all the methods used to determine High Groundwater Ov.a:ion: Obtained from Design Plans on record bservation o(Site (Abuning property, bservation hole, basemtrY simp etc.) —L/Determine it from local conditions Check with local Board of health Check FEMA Maps heck pumping records heck local excavators, installers Use USGS Data Describe in your own words how you established the High Ground1w,aierElevation. (Must be completed) Used water contours map. Gahrety & Miller Model 12/16/94 .� (r.vi..e 04/25/97) P.c• lc)af 10 • a•rmn'+r.—nrsr•�r�,earram•nr.n�.n+�rsaRan rer+srnr�.s+nnn r.vr+t�+*.r�raan..r• •rn�'��"van—...tr.r'•1 TOWN OF Barnstable BOARD OF HEALTH l SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION I �� �:-•rn^r••.-::r—n.►^r..rrarr.+n-rt.•+s.rwnrms+rr+rnrr.�-.vt+�vrrtr�armsr�++r�.snr mnn :.+..-rr•r.-nr—..A -TYPL OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 17 Chine Way Osterville,Mass. ' ASSESSORS MAP, BLOCK AND PARCEL # _ © 7 013 OWNER' s NAME George F. •Stacker PART D - CERTIFICATION r NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber & .Son ific. COMPANY ADDRESS Box 66 Centerville,Mass . 02632 Street Town, or Crty State LIP COMPANY TELEPHONE (508 775 - 3338 FAX ( 508 ) 790 -1578 A CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and complete as of the time of .inspection , The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one: 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. System FAILED* The inspection which I have con tcted has found that the system fails to Protect the jitiblic health and the environment in accordance with Title 5 , 310 CMR 15 - 303, and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signatur ' Date GJ` , One copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF 11RAL711I, If the inspection FAILED, the owner or operator shall upgrade ' the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 3.10 CMR 16 - 306 . partd .doc f SUBSURFACE Sf�%AGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Propert, Address: 17 Chine Way Osterville,Mass. O"nef: George F.Stacker Date of Inspection:5/27/98 BUILDING SEWER: .:ocate on site plan) 1) Depth below grade.-d Material of construction: _ cast iron Z40 PVC _ other (explain) Distance from private water supply well or suction line l0 O�ameter i Comments: (condition of joints, venting, evidence of leakage, etc.) ,joints_ appear tight_ Nn Sgc' n of Ieakac.®:System is vented e ous vent. SEPTIC TANK: /oWys11k4s' ;locate on site plan) Depth below grade. material of construction: concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal. Qlist lage Is age cfonffiir/med by Cenificate of CC)ompliance _(Yes/No) D menS on5 / / „ ;t Y I „K/�I /7�/ G�7 Sludge depth • D,stance from top sludge to bonom of outlet tee or baffle. az- Scum thickness Distance from top of scum to top of outlet tee or baffle:_Z— — D,stance from bonom of scum to bonom of outlet tee r baffler now dimens-ons were determined: Comments trecommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, stfucturai integrity, evidence of leakage, etc.) Pump septic tank every 2-3 years _ Tnl ey and nut 1 pt tp_ps Arp i n Plane _ TA Quid at the outlet inyQrt is 51 11 The septic tank is G r _ 7ra11y Snund and Ghnwc nn sigms of leakage GREASE TRAP: (iocate on site plan) Depth below grade nnater.al of con struaionW,#concretelmetaW1 berglassy0Polyethyleneoi other(explain) 4119 Dimensions: Scum thickness. Distance from top of scum to top of outlet tee or baffle:�� Distance from bonom of sc m to bonom of outlet tee or baffle:14N Date of last pumping: 4M Comments: trecommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet inven, struclurai -ntegr,ry, evidence of leakage, etc.) Grease Trap is not present. (r.vi..d 0//1s/97) P.g. 6 of 10 Ob SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 17 Chine Way Osterville,Mass. Owner: George F. Stacker Date of Inspection: 5/2 7/9 8 TIGHT OR HOLDING TANK (Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: .V,* Material of construction:4 concrete.Ametal C&Fiberglass,E,4Polyethylene iL.4other(explain) Nil Dimensions: AA Capacity: A)A gallons Design flow: AA gallons/day Alarm level: VA Alarm in working orderN/l Yes;A14 No Date of previous pumping: A)A Comments: (condition of inlet tee, condition of alarm and float switches, etc.) Holding tanks or tight tanks are not nrPs_pnt DISTRIBUTION BOX:J-�� (locate on site plan) Depth of liquid level above outlet invert:A Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) Distrihutinn hnx has—nne lateral. NO evidence of solids carry nvPr No evidence of leakage in or nut nf the hny PUMP CHAMBER:41, 1f/2ei (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.) Pump Chamber is not present (revisal 04/25/97) Png• 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 17 Chine WayOsterville ,Mass. � Owner: George F. Stacker Date of Inspection: 5/2 7/9 8 SOIL ABSORPTION SYSTEM (SAS):L���^'� (locate on site plan, if possible; 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: leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: T Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Loamy sand to boney fine sand; No signs of hydrat,l ; c failure or pon ing; All vegetation is normal CESSPOOLS: d/ff t(� (locate on site plan) Number and configuration: 0 Depth-top of liquid to inlet invert: /)A Depth of solids layer: Depth of scum layer: Dimensions of cesspool:_ & Materials of construction: of Indication of groundwater:_ A2 inflow (cesspool must be pumped as part of inspection) Cesspools are not nrpspnt Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Cesspools are not prpspnt PRIVY:A)OiU-e- (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.) Privy is not present, (revlosd 04/25/97) Pag• 8 of 10 • J �T� 73r>Rc�itit h ;, I ' � • 30 �7 t � I 3 t 4 G a-�— Soo94-', FT - I a ±7t>Jc� r•q c I 10 I .�.p Pep ,42�rA. r II `J ,.�. 4WA l 13�c l'o � � I -� �••�, ` � -T�lL 1. 111,14 2►vA rR �x S Cif Lt,f.:j '` �� -I�::•'• ��� � t ' i ALAN �.. .� BAXTER NO.21048O Jr; sum To P FNU laa• j a��I: wfr•By �L- 9� Q- ice• �8 9� P/w • 6.arr lr=rz. Y^ �. � (Soo Il1�. 97•a d'r D16T. (N� tL, 6uK Z I Coo 9�•L I N�• I �CACu INN. INv. PIT I ' 47.2- 4j '� 6T�N6 al0 ` _.,f I R.T I F I G D c'T I P R.o F l L G L o 4 4-T 10 t-I I.1O• SCALE SCALE rtGp pP"Trc (Z.IZ��� --^ cZ614 LE � IER6O11 GOMPL`(5 YJITN 'THE S 1�EI..1b-► � ...01' � � I .up o 56-T�GK tZ.6Qv►2�M6NY> oI. o W F�.'fN� I G � Z � ►�1 f A BA w�iT P� A ND I S t�r C. _OGp.TED MTNI T GLOOD PL," 1 4 �.-r t✓ g-TV-e6 c�u SuQv�Y�eS R- EGIS _ -''., ALI o3TE2YIl l E • 1 'SS' ' 'LJ - f W A L E P E N M I T MO- SE L 0 C; ?>`I N -414 :,.LLER'S NAME ADDRESS � NS:T.A.. a. d R OR OWNER l A 2 O D.� E R M I T ISSUED Y / D A T;E: 0 M P L I A N C E ISSUED �D �a 41 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontinuod) PropertyAddreaa: 17 Chine Way Osterville ,Mass . 02655 Owner. Fred. Stocker Date of Inspootioa:_:.5 2J .98 SKETCH OF SEWAGE DISPOSAL SYSTEM: ' include tiee to at hart two permanent reforencos landmarks or benchmarks locate all .Fells within 100' Centerville Osterville Marstons Mills Water Company 428-6691 000� �1 .05 �� \ I i DEPTH TO GROUNDWATER Depth to Qraindwater. 13 1 +feet method of dvtarmiaation or appm:imation: See plan page 5A No water encountered when +P4t hn] p_ and installation was donr. (revised 11/03/95) 9 LOCATION SEWAGE PERMIT NO. VILLAGE �iN STA L L F R'S NAME i ADDRESS -Td� rl/l a..}'�2I 5�l',Q lAf OY, YVIa-.Ar n lanS'-1'l{ B U I L D E R OR OWNER QDATE PERMIT ISSUED DATE COMPLIANCE ISSUED P r GUI t Q �\ Y � _ i fq� . a4 �� '� `' �,$ C .�� �3_.... :� Flms.... �...................... THE COMMONWEALTH OF MASSACHUSETTS BOARDAHEAL ......................................OF...... - .------------......... Appli,ratiun for Uiiipuutt1 Works Toustrurtiun ramit Application is hereby made for a Permit to Construct (1) or Repair ( ) an Individual Sewage Disposal System at• G.YTI�2 /� L ;ion_ U. .. •Ad ess or 1 �_ ..---------- `---- ---.....---- •--- •------- . ............ Owner / Address Installer Address Q Type of Building Size Lot._. ._._...Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder 0 aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ...................................................... W Design Flow..................................:.. ..-__ allons per person per day. Total daily flow............................................gallons. W Septic Tank—Liquid capacity_�L�---gallons Length................ Width.........--.---- Diameter---------------- Deptli............. --- x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching are.1--------------------sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date--------------------------------------- ,� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-__________________-_._. f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_-_______-__________--. ----------------------------------------•------------------------------------------------------•----......................................................... 0 Description of Soil................................................................................................................................................ ----------------------- x U w UNature of Repairs or Alterations—Answer when applicable-------------------------------------------------------------------------______________________. ------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersign further agrees not to place the system in _ opera until a ertificat of Compliance has been issued b tboar�oeal h. need --------- ---- -----------•------. --------------------- -•-•--... . ..7 ..... .. a Applic io Approved B ..._ . ......... ... Date Application Disapproved r e following reasons-------------------------------------------------------•------------------------------------------------------- ---------------------------------------------------------------------------------------------------------•------------------------------------------------------------------•----------•-•-----.....-- Date PermitNo......................................................... Issued........................................................ Date FEE............................ . + THE COMMONWEALTH OF MASSACHUSETTS r' 0 BOAR® OF HEAL OF...........�i�/:-..-......51------ `_.:.-----------•----...... Appliration for Uiapoual Works Towdrurtiun rrrntit Application is hereby made for a Permit to Construct ( �orepair ( ) an Individual Sewage Disposal System ate/, p� Jf /n� fff�f//� I v f ' 4,? l / � 'O /f �d � �K/1' 6:..- ✓ fYY r ,/�r'""z ��.... ......... -. ---------- .--..---- .-....-------.::..I... .......-. .� ..-I...._ I --- ---�,�.... .. _ ______ s� Lo'ation Address or t No ---%rA �. ..f .._a ...................................... ...... �!I� <�" „� ---- - ,;:f....---------- Owner r , Addrer.. V"J� /r. at'=..r.'bi.c :!�*1' .. ........... ............ tYYYYYY4���° ? tl -' "j''i f� r�I staller Address Q Type of Building fi Size Lot._____ , ....Sq. feet U Dwelling—No. of Bedrooms._.....................................Expansion Attic ( ) Garbdge Grinder (4,< `4 Other—T e of Building No. of persons............................ Showers — Cafeteria a Other fixtures -------- ------ •----•-•----... •• - WDesign Flow.................................. ,:_,, Lllons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity_��,...... allons Length................ Width---------------- Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area__-____________-_-_sq. ft. 3 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area------------------sq. ft. z Other Distribution box ( ) Dosing tank (. ) Percolation Test Results Performed bY.........................................................••-••.......... Date--------------------------------------- a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water_._-___-_-_..___-.__._.- tz Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description of Soil..........................................................................................................................................------------------------------ x c, -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- w UNature of Repairs or Alterations—Answer when applicable------------------------_______________________________________________________________________. ------------------------------------•---•------------•---------••••---•••---•••••••--------------•---••••-••-•--••--•---•--------••--••-••-•--••...•-•-••••••---••••••--•...-••-•-•••....--------•----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigne further agrees not to place the system in opera n until a ertificat o Compliance has been issued by t boa of heal h. igued.-�-....jr".•..td le '�''`-=" `f �'--' $_._ r Appli do Approved Bv+`` ...---•----------•----- •------------------------------ .3x .......... ______________ ate Application Disapprov r the following reasons:................................................................................................................ -•-------•-•---•••-•---•---•-----•••--------------•-•---------•----••-•••-----------.....---•-•••••......---•---•-•---•--•-•------••----•---•-••-••---•-•------------------------••••••----•-----•---•.. Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... AT /"� mi.ertifira#le of Toutphatirr 4 IDS CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) by . -:-- ................ ,. ..-- ........................ ---•--.._ ............................................ Installer at.......... ... has been installed in accordance with"i'e provisions of Article XI of The State Sanitary Code as described in the 0.11 application for Disposal Works C traction Permit X ....................... dated................................................ 9 TIE ISS ANCE OF THIS CERTIFICATE SHALL NOT BE CONST ® AS A GUARANTEE THAT THE SYSTEM W LJFNCTION SATISFACTORY. DATE_. . ----------------•--------------------------------------- Inspector--. ----••-------••----••-•-------••--------•-••-•---•------=•--•...:.....---•--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 3-/I75 ..........................................OF.................................................................................... No......................... ---------------------- Bign kiiC�on� rnriun prnti# Permiss' rr'is hereby gran _d_�:f:'��:----.. to Constr X R qwAIP I ividual Sewage Disposal System at N ... s /�id street as shown on the application for Dispo^ Works Construction Permi ___________________ DA 6...................... �-. �._ _ Board of Health DATE......Z---•-�-- . , E FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS u5a f Sdo G I Goo b( �Q{,r �T - ��4L `3 557DJC-3 / ri I'DA W AluL P2 XA 12210 �o�-roW, �4r�A. � 113 sr � 9�.� � • l 13�c 1,0 s 113 s-P> �.l .^j• sr••1- � � .* -p7r-k 1. 'Tor-& L 1cola I Ll F-ow - 4q S 'r� 41.y 116�,1 '2,� �R �S ' � 2 7•af�v r ' � s. C4zr�la`T 1 O 1J ��4'T$ ,K c%F P. die ;�,¢ r� RICHARD ALA.fV `� � � �� �G+� A. o w. 1 4q.t_ •� 94•I 44.1 j v BAXTER Jor4�sNo.21048 I <4'd0 SUR��•/ i. ;�� y V �Iti/EstZ. Ic.D Y7•g I . TOP FWD F too I' f4- q7 PAuL dAr-m> lErz. D►6T. INV. GAS /O + Z BvK fafiPTIC. i 'I (GOO �,JY, 97•G TANK I LP Tu V. INV. wlTu ' �• I 3/� I/L �I � v/ASNGD 6TvNE j GE2TIFI cm.C) P>-oT P1..AW i� PRUFIL� LOCA-T10t-J it L10 SGAI.E SCALE ` �cliD �ATrc EN C E- '� ` CEMTIPY THAT 'tH� FO()k'L`&rIOtj 5KowN I' HrpSoW GOMPL`(S 1 MA-THE SIoEu1N� + ®1.. i A►�P 51^TeAG'K (z,6,Qu19-EMEMTV 0F 't1-1a- .� -Tv W N o r- BAw%ViTAFW-a A ND 1 S LOCP.TED MMAI T .E G%.oOD PLAIN I' DATE BAxTEcz.e WYI` INC. K-EG IS'TE.Q6D%Auo 5uMYEY�es T%AI•'j PLatI IS Nam' 4n5c v o►d A OSTE2.VILLE - MASS• 1u,57-9-uMENT 'SV9-VE`( 1� 'TNE 01=5SE"r5 SuOUZ No-T 1�1^ u5EDTo 0ETEFCI�1►-1� L•or -INE�j APPLICP, ��r�A LD 1 97--EXISTING CONTOUR I N x 100.98 EXISTING SPOT GRADE Y. -77 97 PROPOSED CONTOUR LCP 25575 D W EXISTING WATER SERVICE na9 � �.. G o EXISTING GAS SERVICE f U UNDERGROUND WIRES TEST PIT `roGf eilcity , +aeso �n 47.10 BENCHMARK coy ` IF LEGEND '� Tronquility Ln 51 W c e°�aS LOCUS 227,58, A 9A � LOCUS MAP + 46.32 MBL 097 LOT 5- as.oi 013 ) 4 I NOT TO SCALE W 32,365 ±SF gpAro /� 43.24 \ wOQ lk 43.32\� 44.03 \N� � 46.30 ' 46.54 OD o °'- GENERAL NOTES: 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL \ 43.37 �� BOARD OF HEALTH AND THE DESIGN ENGINEER. EXISTING ::;< .':`` ;.;':: :.•:,.;. :: :": :.. 44.3 �t� GARAGE �'''` =' '-'"''` " '` "' 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS ��3.62 HOUSE(#17) ;>r::":'.,- '`:;% ;`;:_ OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE 45,6s +46.30 T.O.F.=47.8f ENTRY da;17:;r:' • .;'- ;;` LOCAL RULES AND REGULATIONS. 7 .52 43 �� ' .' ;`.. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR ' TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE a 30 �� DESIGN ENGINEER. 46,45 46,54 WALK o rox. x x 44.40 44,19 "'r"`' `'a \ 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING CHdh BM I 46.42 46.85 + 47.70 4f"� x 45.66 \ Y:' FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 45,79 x as,ie \ ;:;,.�':„` 43,19 ENGINEER BEFORE CONSTRUCTION CONTINUES. 46,04 46.e �( a(A6\ii �� \�I OGj 43'15 5. ALL ELEVATIONS BASED ON ASSUMED DATUM (BARNSTABLE G.I.S.t). a t9 46,67 Q L- 96 `� 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF ea a u�, 0 ��� CBdh 19161 ' 3x9I �se ,� `�: .;' �" - ZO�$O�emert a3.se HEALTHTHE FORCTOR OR PROPER IOWNER TO NSPECTIONS DURING IFY CONSTRUCTION.CONOCAL STRUCT OND OF try F' �. 47.60 48.40 \ P p92 P-1 as.oa N o{ P� 7. WATER SUPPLIED BY TOWN WATER SERVICE. ..; 54 ae,45 ti... OP S"' `- edge 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 78 / t pR -; e N 17- i STONE.:';: es-j.'__ 25`48 _ 6 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS ' CA- Catchbasin 21 of , w .,J.. , 48.13 x AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE a7.ai E L=123.73 \ EXISTING LEACH PIT DIRECTED BY THE APPROVING AUTHORITIES. CONTRACTOR SHALL PUMP, 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY 48.47 "'^ FILL WITH SAND & ABANDON THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 49,14 CONSTRUCTION. _ 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS EXISTING SEPTIC TANK L' WAY BENCHMARK THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND 48.46• TOP OF TANK, EL.=45.54 REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). PK SET OUTSIDE COR./BOTT. STEP INV.(OUT)=44.29.E 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE EL.=47.70 INSPECTED BY A LICENSED SOIL EVALUATOR PRIOR TO BACKFILL. 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND R4Sp �G IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. o PETER T. t� PROPOSED SEPTIC SYSTEM UPGRADE PLAN M EE CIVIL N 17 CHINE WAY, OSTERVI LLE, MA No. 351009 Prepared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 o R£GIST OWNR OF RECORD SS/ONAL V INDELICATO, GERALD T Engineering by: SCALE DRAWN JOB. No. I & PAULA L Engineering Works, Inc. 1"=30' P.T.M. 108-1 4 P.O. BOX 941 12 West Crossfield Road, Forestdole, MA 02644 DATE OSTERVILLE, MA 02655 CHECKED SHEET N0. I (508) 477-5313 2/16/14 P.T.M. 1 Of 2 i E - 97--EXISTING CONTOUR 5 o N !, 4 x 100.98 EXISTING SPOT GRADE yn Rd T. z i 97 PROPOSED CONTOUR LCP 25575 D I W EXISTING WATER SERVICE G EXISTING GAS SERVICE °so 4n w 0� U UNDERGROUND WIRES 47.10 TEST PIT `ro`f ellnity In 1 +48.50 BENCHMARK LEGEND �- Tranquility Ln 1 ? S 10'31' ll .� e G `--4-e'� 227.581" W `mn9 LOCUS LOT 5 ` 4501 - 9AA�of +46,32 MBL 097-013 �� _ _ 1 LOCUS MAP J �w NOT TO SCALE00 G qpp 32,365 ±SF ��'� -^ - `� 43.32 46,54 i \\ '•.�: ;i `•• -+ 00 \ ' .''' - O °'• GENERAL NOTES: DRIVEWAY:; : 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL EXISTING 43.217 BOARD OF HEALTH AND THE DESIGN ENGINEER. 44.3 -4 GARAGE ;.v;';':::;.::'• -• J 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS +�3.62 I HOUSE(#17) > :: ='' ' '•:;;':;": OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE ENTRY aai7:.�,•:. .•.. •43:64 J+46.30 T.O.F.=478t LOCAL RULES AND REGULATIONS. 45,65 x x 43,9� = 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR s2 43.9 \ TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 46,45 x46.54 4i,30 rox \\r � ,: DESIGN ENGINEER. WALK o x 44.19 CBdh BM x 44.40 \ 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING I 46,42 46.65 + 47.70 40 x 45,66 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 45,79 x 45.18 ENGINEER BEFORE CONSTRUCTION CONTINUES. a6,oa / 46,8 �� a6\l1 �Ocj� a3'15 5. ALL ELEVATIONS BASED ON ASSUMED DATUM (BARNSTABLE G.I.S.t). a 46.67 Q L-- 96 $ " 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF '� ^� 3x9' use �_- $O� t a3.se ~ THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF CBdh x..•. y� ZO o�em HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 47,60 //48.40 1't PO2 P-1 \ 45.04 N { P 7. WATER SUPPLY TO BE PROVIDED BY PRIVATE WELL. 46,29 CA 7 96 8 p � ed9 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. N 17. / STONE:'';: es_ 25�4��,.> x 6 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS Cntchbnsln 21 ' � ••�^T , 48,13 x AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 5 PARKING::; 46.77 a7.a1 0� E .;., .. ..,.,, w L=123.73 \ 46.97 > EXISTING LEACH PIT DIRECTED BY THE APPROVING AUTHORITIES. C "4 as,90 R=186.58 i CONTRACTOR SHALL PUMP, 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY 48.47 FILL WITH SAND & ABANDON THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 48.96 49,29 49.14 j CONSTRUCTION. EXISTING SEPTIC TANK 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS A TT BENCHMARK IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND • ae.a6 1 TOP OF TANK, EL.=45.54 REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). PK SET OUTSIDE COR./BOTT. STEP INV.(OUT)=44.21t 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE EL.=47.70 INSPECTED BY A LICENSED SOIL EVALUATOR PRIOR TO BACKFILL. 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND OF Mgss IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. o PETER T. ' PROPOSED SEPTIC SYSTEM UPGRADE PLAN Mc Ln 17 CHINE WAY, , MA�O/8 /�� o CIVIL CIVIL "' No. 35109 I R£G/ST `� �`� Prepared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 OWNR OF RECORD S ENG� INDELICATO, GERALD T Engineering by: SCALE DRAWN JOB. NO. & PAT L Engineering Works, Inc. 1"=30- P.T.M. 108-14 P.O. BOX 941 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET N0. t� r OSTERVILLE, MA 02655 b (508) 477-5313 2/16/14 P.T.M. 1 Of 2 a t ' t NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL:44.32 SEPTIC TANK FOR A DISTANCE OF 15' AROUND THE INSTALL RISERS & COVERS OVER INLET PERIMETER OF THE S.A.S. AND SET TO 6" OF FINISH GRADE. PROPOSED D-BOX PROPOSED S.A.S. PROVIDE ACCESS TO GRADE OVER'OUTLET COVER INSTALL WATERTIGHT RISER & PROVIDE TWO ACCESS MANHOLES TO WITHIN 3" ' T.O.F.=47.8t COVER SET TO 6" T GRADE OF FINISH GRADE FOR INSPECTION PURPOSES F.G. EL.=46.5t F.G. EL.--47.5(MAX.) EX/STING F.G. EL.=46.1 t F.G. EL.=47.Ot HOUSE(#17) GARAGE MAINTAIN 2% GRADE (MIN.) OVER S.A.S. T.O.F.=47.8f ENTRY L 17' L = 5' ® S=1% (MIN.) ® S=1% (MIN.) 4"SCH40 PVC 4"SCH40 PVC T6- EXISTING 48" LIQUID aNa aaa S2,mom LEVEL ADDGAS BAFFLE 4' 4.8' 4' INV.=44.04 PROPOSED INV.=43.87 INV.=44.21 D-BOX EFFECTIVE WIDTH - 12.8' �,�� 5 S• INV.=43.82 EXISTING SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS !,p OP •- /, SURROUNDED WITH STONE AS SHOWN H-10 RATED =7 TOP BREAK BREAKOUT z SEPTIC LAYOUT NOTES: INV. ELEV.=43.82 �aaa NNaaB aaoEmm aa 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE NOUN ONa60 INVERTS, PRIOR TO INSTALLATION. BOTTOM ELEV.=41.82 4' 2 X 8.5'=17.0' 4' 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE 4' MIN. OF NATURALLY OCCURING EFFECTIVE LENGTH = 25.0' ON A MECHANICALLY COMPACTED SIX INCH CRUSHED PERVIOUS MATERIAL STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 5' MIN. ABOVE GROUNDWATER LEACHING SYSTEM SECTION eE3 ®® 0 3) INSTALL INLET & OUTLET TEES AS REQUIRED. BOTT. OF TP-2, EL.=36.0 — f- ®®®® ® ® ®®® 33'# 4) CONTRACTOR SHALL INSPECT EFFLUENT FILTER ON 3/4" To 1-1/2" DOUBLE d WOUTLET TEE AND REPLACE IF NECESSARY. WASHED STONE N Z ®®® ® ® ®® 3" LAYER OF 1/8" TO 1/2" SEPTIC SYSTEM PROFILE DOUBLE WASHED STONE (OR APPROVED FlLTER FABRIC) 102„ DESIGN CRITERIA SOIL LOG 4" KNOCKOUT DATE: FEBRUARY 12, 2014 (REF#14,282) 20" DIA. COVER NUMBER OF BEDROOMS: 3 SOIL EVALUATOR: PETER McENTEE PE(SE#1542) SOIL TEXTURAL CLASS: CLASS I WITNESS: DONNA MIORANDI R.S. HEALTH AGENT 4" KNOCKOUT / 4" KNOCKOUT 58" DESIGN PERCOLATION RATE: <2 MIN/IN ELEV. TP-1 DEPTH ELEV. TP-2 DEPTH 0 (0.74 GPD/SF LOADING RATE) 47.0 A 0„ 47:21 A 0„ DAILY FLOW: 330 GPD LOAMY SAND LOAMY SAND 4" KNOCKOUT DESIGN FLOW: 330 GPD 46.0 10YR 4/2 8" 46.3 10YR 4/2 10" GARBAGE GRINDER: NO B B 330 GPD = 445.9 SF LOAMY SAND LOAMY SAND 500 GALLON CAPACITY, H-10 LOADING LEACHING AREA REQUIRED: ( ) 10YR 5/8 10YR 5/8 .74 GPD/SF 44.3 C1 32 44.3 C1 34" CHAMBERS EXISTING SEPTIC TANK: 1500 GALLON CAPACITY PERC N.T.S. PROPOSED DISTRIBUTION BOX: 1 INLET, 3 OUTLETS 40/52" USE 2-500 GALLON LEACHING CHAMBERS IN SERIES PROPOSED SEPTIC SYSTEM UPGRADE PLAN SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES MED. SAND 10YR 6/6 1n0YR 6/6 17 CHINE WAY, OSTERVILLE, MA SIDEWALL AREA: 2(12.8' + 25.0') X 2 = 151.2 S.F. Prepared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 BOTTOM AREA: 12.8' x 25.0' = 320.0 S.F. Engineering by: SCALE DRAWN JOB. N0. TOTAL AREA:..............................................................471 .2 S.F. 36.0 132" 36.1 132" Engineering Works, Inc. NTS P.T.M. 108-14 DESIGN FLOW PROVIDED: 0.74 GPD/SF(471 .2 SF) = 348.7 GPD NO GROUNDWATER, PERC, RATE: <2 MIN./IN. 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. (508) 477-5313 2/16/14 P.T.M. 2 Of 2