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HomeMy WebLinkAbout1855 SOUTH COUNTY ROAD - Health 1855 SOUTH COUNTY ( ' MAR STONS MILLS A = 023 002 i ' TOWN OF E.UtNSTABLE LOCACION Its �1 i SEWAGE # `Y VII.LAGE '�t ASSESSOR'S MAP & LQT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) UC) a., I (size) ^ 3 NO.OF BEDROOMS _ BUILDER OR OWNER PERMITDATE: I q CO]l'PLIANCE DATE: Separation Distance Between the: 1 Maximum Adjusted Groundwater Table and 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 H- tlands exist within 300 feet of leaching facility) Feet Furnished by _ r � ._w ��- �'�r���� �- �� D .� -. .. ��. . , . , . T-� � # TONVN OF BARP,STABLE JJ LOCA'rTON ,� e�I" `t cc)v,/ 7 SEWAGE # q33 VILLAGE (P�;5-re ' efl /lam ASSESSOR'S MAP'&LOT®9l' �` z Boa INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHINGFACELrrY: (type) NO.OF BEDROOMS c:t`> L. - BUILDER OR OWNERT /L�� / �✓ __ PERMTTDATE: COMPLIANCE DATE: Separation Distance Betw�n the: Maximutn Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on si[z'or within 200 feet of leaching facility) _ Feet Edge of,Wedand and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet. Furnished by. r -� /""^+ �� '�� � ��� ,3�` �,� :�- - c Commonwealth of Massachusetts oqg - oa3 - aoZ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �,j 1855 South County Rd.. (Main House) a Property Address CLARK,ALEXANDRA M Owner Owner's Name �4 information is required for every Clsterville r✓rn m MA 02655 3/25/20 page. CitylTown State Zip Code Date of Inspection 1t Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information / ° /idly on the computer, use only the tab Robert Paolini key to move your Name of Inspector cursor-do not Robert Paolini use the return key. Company Name 67 Tanbark Rd. IC=V Company Address Marstons Mills MA 02648 Cityrrown State Zip Code Miffin (508)280-9499 S14454 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails ® � 3/25/20 Inspec or's Ign Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 1855 South County Rd.. (Main House) Property Address CLARK,ALEXANDRA M Owner Owner's Name information is required for every Osterville MA 02655 3/25/20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 1 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: 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 1855 South County Rd.. (Main House) Property Address CLARK,ALEXANDRA M Owner Owner's Name information is required for every Osterville MA 02655 3/25/20 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ ' Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) 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. a. 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: t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1855 South County Rd.. (Main House) Property Address CLARK,ALEXANDRA M Owner Owner's Name information is required for every Osterville MA 02655 3/25/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cunt.) ❑ 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 b. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well*". Method used to determine distance: '* This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: 0 You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7128/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form F Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1855 South County Rd.. (Main House) Property Address CLARK,ALEXANDRA M Owner Owner's Name information is required for every Osterville MA 02655 3/25/20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 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: . ❑ ® 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 water supply well. ❑ ® Any portion of a cesspool or privy is,within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® 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. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. II 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 t5ipsp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page S of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 1855 South County Rd.. (Main House) Property Address CLARK,ALEXANDRA M Owner Owner's Name information is required for every Osterville MA 02655 3/25/20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: 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: ❑ ® Existing information. For example, a plan at the Board of Health. ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 1855 South County Rd.. (Main House) Property Address CLARK,ALEXANDRA M Owner Owner's Name information is required for every Osterville MA 02655 3/25/20 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NA Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form F' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1855 South County Rd.. (Main House) Property Address CLARK,ALEXANDRA M Owner Owner's Name information is required for every Osterville MA 02655 3/25/20 page. Cityrrown State Zip.Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped,as part of the inspection? ❑ Yes ® No If yes, volume pumped: i gallons . How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 4 Commonwealth of Massachusetts �m Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,u 1855 South County Rd.. (Main House) Property Address CLARK,ALEXANDRA M Owner Owner's Name information is required for every Osterville MA 02655 3/25/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 2001 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 9' . feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from.private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of-leakage, etc.): • Joints appear tight. No evidence of leakage.System vented through house vents. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 l A Commonwealth of Massachusetts Title 5 Official Inspection Form FI} Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 1855 South County Rd.. (Main House) Property Address CLARK,ALEXANDRA M Owner Owner's Name information is required for every Osterville MA 02655 3/25/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate.on site plan): Depth below grade: 8 ` feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 GI. Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle 46" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 101, How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition; structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump every two years.Inlet and outlet tees in place.No signs of leakage. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form �! Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1855 South County Rd.. (Main House) Property Address CLARK,ALEXANDRA M Owner Owner's Name information is required for every Osterville MA 02655 3/25/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from to of p scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: '❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1855 South County Rd.. (Main House) Property Address CLARK,ALEXANDRA M Owner Owner's Name information is required for every Osterville MA 02655 3/25120 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert No 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.): Box is level.Box has two outlet laterals with equal distribution.No signs of leakage. t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 AN, Commonwealth of Massachusetts Title 5 Official Inspection Form i, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1855 South County Rd.. (Main House) Property Address CLARK,ALEXANDRA M Owner Owner's Name information is required for every Osterville MA 02655 3/25/20 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): 1 " If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 2/6'x6' 2' stone ❑ leaching chambers number: ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: '❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 1855 South County Rd.. (Main House) - Property Address CLARK,ALEXANDRA M Owner Owners Name information is required for every Osterville MA 02655 3/25/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System(SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of , vegetation, etc.): Sandy soil.No signs of hydraulic failure. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 c Commonwealth of Massachusetts �o Title 5 Official Inspection Form JA Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ` 1855 South County Rd.. (Main House) u Property Address CLARK,ALEXANDRA M Owner Owner's Name information is required for every Osterville MA 02655 3/25/20 page. City(rown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I� Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1855 South County Rd.. (Main House) Property Address CLARK,ALEXANDRA M Owner owner's Name information is required for every Osterville MA 02655 3125/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately s �s 1 of 1 2/23/2020, 1:12 ISlnep.doc•rev.MOMS Tdb 50Uicia1 Inspection Form:Subsurface Sawaye Disposal SyMm•Page 16 of 18 Commonwealth of Massachusetts • Title 5 Official Inspection Form 'PI. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1855 South County Rd.. (Main House) Property Address CLARK,ALEXANDRA M Owner Owner's Name information is required for every Osterville MA 02655 3/25/20 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 6 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: As- Built ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Used USGS observation well data.Used technical bulletin 92-0001 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts • Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1855 South County Rd.. (Main House) Property Address CLARK,ALEXANDRA M Owner Owners Name information is required for every Osterville MA 02655 3/25/20 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed& Dated and 1, 2, 3, or checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 Ll g - 0,:�3 - 00�-- c Commonwealth of Massachusetts n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a 1855 South County Rd.. (Pool House) Property Address CLARK,ALEXANDRA M Owner Owner's Name information is Osterville NI M ✓ MA 02655 3/25/20 ; required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information LS/-* I gLt9 S filling out forms on the computer, use only the tab Robert Paolini key to move your Name of Inspector cursor-do not Robert Paolini use the return key. Company Name 67 Tanbark Rd. - �V Company Address Marstons Mills MA 02648 City/Town State Zip Code (508)280-9499 S14454 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address . listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection 1 have determined that the system: 1. P1 Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local.Approving Authority 4. ❑ Fails 3/25/20 Inspector's ig atu Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the,buyer, if applicable, and the approving authority. Please note: 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. t8insp.doc-rev.7/28/2018 Tile 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 1855 South County Rd.. (Pool House) Property Address CLARK,ALEXANDRA M Owner Owner's Name information is required for every Osterville MA 02655 3/25/20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 1 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: 2), System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. r *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y_ ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form F Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1855 South County Rd.. (Pool House) Property Address CLARK,ALEXANDRA M Owner Owner's Name information is required for every Osterville MA 02655 3/25/20 page. CityfTown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of,Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) 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. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 C Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1855 South County Rd.. (Pool House) Property Address CLARK,ALEXANDRA M Owner Owner's Name information is required for every Osterville MA 02655 3/25/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS,and the SAS is within a Zone 1 of a public water , supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1855 South County Rd.. (Pool House) Property Address CLARK,ALEXANDRA M Owner Owner's Name information is required for every Osterville MA 02655 3/25/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.,[This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ w 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. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. 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 0 ❑ 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 t5insp.doc•rev.7126/2018 Tdle 5 Official Inspection Form:Subsurface Sewage Disposal Systam•Page S of 18 Commonwealth of Massachusetts Title 5 Official . Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 1855 South County Rd.. (Pool House) Property Address CLARK,ALEXANDRA M Owner Owner's Name information is required for every Osterville MA 02655 3/25/20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for.each of the following for all inspections: 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? r Was the facility owner(and occupants if different from owner)'provided with ® ❑ information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 69-) 1855 South County Rd.. (Pool House) V Property Address CLARK,ALEXANDRA M Owner Owner's Name information is required for every Osterville MA 02655 3/25/20 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 0 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description- Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes 6 No information in this report.) Laundry system inspected? ® Yes ❑- No Seasonal use? ® Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): L Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NA Date t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 1855.South County Rd.. (Pool House) Property Address CLARK,ALEXANDRA M Owner Owner's Name information is required for every Osterville MA 02655 3/25/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes' ❑l No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1855 South County Rd.. (Pool House) Property Address CLARK,ALEXANDRA M Owner Owner's Name information is required for every Osterville MA 02655 3/25/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed i p (f known)and source of information: 2001 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 9' feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Joints appear tight. No evidence of leakage.System vented through house vents. t5insp.doc-rev.7/26l2018 TAIe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form I, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments J 1855 South County Rd.. (Pool House). Property Address CLARK,ALEXANDRA M Owner Owner's Name information is required for every Osterville MA 02655 3/25/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 2'feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 GI. Sludge depth: 2 Distance from top of sludge to bottom of outlet tee or baffle 48 Scum thickness 011 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 12» How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump every two years.lnlet and outlet tees in place.No signs of leakage. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1855 South County Rd.. (Pool House) Property Address CLARK,ALEXANDRA M Owner Owner's Name information is required for every Osterville MA 02655 3/25/20 page. CitylTown State Zip Code Date of Inspection D. System Information (cunt.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete 0 metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): i Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1855 South County Rd.. (Pool House) V Property Address CLARK,ALEXANDRA M Owner Owner's Name information is required for every Osterville MA 02655 3/25/20 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑. No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert No 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.): Box is Ievel.Box has two outlet laterals with equal distribution.No signs of,leakage. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 0 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1855 South County Rd.. (Pool House) Property Address CLARK,ALEXANDRA M Owner Owner's Name information is required for every Osterville MA 02655 3/25/20 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working'order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): 1 * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 2/500 Ic 4' stone ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ' r ❑ innovative/alternative system Type/name of technology: 1 t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts • q F Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1855 South County Rd.. (Pool House) Property Address CLARK,ALEXANDRA M Owner Owner's Name information is required for every Osterville MA 02655 3/25/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System(SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy soil.No signs of hydraulic failure. 12. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction I Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.),* E q � , i t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 l c Commonwealth of Massachusetts Title 5 Official Inspection Form Yh} Subsurface Sewage Disposal System Form-Not forrVoluntary Assessments .�/ 1855 South County Rd.. (Pool House) Property Address CLARK,ALEXANDRA M Owner Owner's Name information is required for every Osterville - MA 02655 3/25/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15.of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form it Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1855 South County Rd.. (Pool House) Property Address CLARK,ALEXANDRA M Owner owner's Name information is required for every Osteryille MA 02655 3/25/20 page. City/Town State Zip Code Date of inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a.view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: 10 hand-sketch in the area below drawing attached separately D 1 N10 MA1A t.1. 1 of l c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 1855 South County Rd.. (Pool House) Property Address CLARK,ALEXANDRA M Owner Owner's Name information is required for every Osterville MA 02655 3/25/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water c ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 12 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date , ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: As- Built ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Used USGS observation well data.Used technical bulletin 92-0001 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1855 South County Rd.. (Pool House) Property Address CLARK,ALEXANDRA M Owner Owner's Name information is Osterville MA 02655 3/25/20 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed& Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t i t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0(ppfication for Mi-go5ar *p5tern Conotructfon Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. JSS7a i (n��V Owner's Name,Address and Tel.No. iMI�r24sjtjdUS tLL$ P-'41Lkl,V-0 C—L�� - Assessor's Map/Parcel q�J 23^ t�S 0ui?� 0O NT-( Co In let's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 3-3 A� 1�—e-k �..o. �- i�co�-E.Suc.c.�vrskov Q6 Z cc� V-0 Type of Building: A�� Dwelling No.of Bedrooms KLOP_l G- Lot Size 5,4 5- sq,-*' Garbage Grinder JqA Other Type of Building :�L No.of Persons Showers(y ) Cafeteria( ) Other Fixtures a Aj 1L Tvu 4 54_ lead Design Flow 330 gallons per day. Calculated daily flow '3 gallons. Plan Date AJO\J tl a l Number of sheets I Revision Date Title IS t TE-el-Alu E2©O S E PSG !G:;S LnEsm t_18 �S Cc o u,4 D Size of Septic Tank t SM CAA r 1 n ft Type of S.A.S. J^ t P_=L_ Description of Soil 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 operati until a Certifi- cate of Compliance has been is b his Board r , Signed Application Approved by Date Application Disapproved for the following reasons Permit No. � Date Issued r _ -`�, �. � � ' •�,,�,�... ,.may. „�t„� •�"'f.4+"" ;No._.IFee kTHE COMMONWEALTH OF'MASSACHUSETTS Entered in computer. Yes _PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Application for Mizpaaf *pgtem Cow5tructiou Permit -� Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address.or Lot No. 1&S S `ov 1' -A,6 V vV Owner's Name,Address and Tel.No. 1MrklLSrb,tt,,,5 Y�lt ��Sr�J�. Assessor's Map/Parcel qp/ k 8's 5' �SoUT'l-1 r O u ruT�{ co VVt% L-L 5 [p�tallec's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Z%Z6- 1� ••. 0,61, L.c t Type of Building: _ Dwelling No.of Bedrooms KOAt G— Lot Size S '4S" sqe�e' Garbage Grinder( . Other Type of Building CAL b No. of Persons Showers(y ) Cafeteria( ) .Other Fixtures- s ,u IL s (7yy ✓l Design Flow 336 gallons per day. Calculated daily flow gallons. Plan Date N 00 l k 1996 Number of sheets 1 Revision Date cv Title S t TE >J ?LCJfb 8 ' C 277G ` i l S t" yVl !° 1 f!>3 5 L�,vZ ! ( D `4 Size of Septic Tank 1 SOD &A c_C-0 k) Type of S.A.S. 1" t e _iD t r- Description of Soil _ 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 m accordance with the provisions of Tide 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is btbis Board Signed lY d Application Approved by w`-- r D Date Application Disapproved,for.the following reasons \ r _64 Permit No. ..� 11 Date Issued I co r r *hgl THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CER IFY,.that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded ( )b ( ) Abandoned Y at 5; 5 ou—\t oca r�7` a constructed in accordance with the provisions of Title 5 and the-for Disposal Sys em Construction Permit No. dated Installer / 1, Designer n The issuance of this e t r/o 1 nt be onstrued as a guarantee that the sy t will,.fun�tion 's des�gn�' 7 / Date � �� Inspector � �. 4 -- — -------------------- No. ------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH-DIVISION - BARNSTABLE., MASSACHUSETTS Mfgpogar &psstem Long r ction 30ern�it Permission is hereby gr. teed Co struc�ts� )R )U a e( A a�jdon System located at <�J o —V and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction Inust beI cork etterd.within three years of the date of t s prmit.9 / ,1Q .y Date: �l l (i Approved by (/l/��� ✓'� 04-03-1998 12:51PM CENT DST FIREDEPT 5087902385 P.02 .•........ar N,,..ua,v,. ,v �va.Al r V 11 C C}Jd �71!u11 L Fire Department retains original application and issues duplicate as Permit. APPLICATION and PERMIT Fee: $10.00 for storage tank remcvaJ and transportation to approved tank disposal yard in accordance with the provisions of M.G.L. Chapter 148,Section 38A, 527 CMR 9,00, application is hereby made by: 4: 09,F, (923 , od Tank Owner Name(pfeaw print) Rich Clark X �"Ibrs(if 401yevrorp-mir Address 1855 South County Rd. 09terville MA 02655 Street Coy Scan ZIP Company Name Enviro-Safe Corp Co. or Individual Enviro-Safe Corp. Print Pnnr Address P. 0. Box 304, Saaamore Beach MA Address Pnnt r177( Signat applyin cr- ) Signature(if applying`ar=ermit) fI7 XIFCI Cartiner Other IFCI Certified = L S= n Other 7Tank ocation 11855 South County Rd.- Tank M a4 I� SroaradOrasp �, � `��e' allon H' apacity(gallor�: $ Substance Last Storer #2 fuel . l Tank Dimensions(diarratZ,r x length) -o Remarks: LO t ; Firm transporting was,= Enviro-Safe Corp. State Lic.# 329 Hazardous waste mard.-- E.P.A.# Approved tank disposal vwd Turner Salvage -Tank yard : 002 Type of inert gas Tank yard address Lynn, MA City or Town Centerville FDID# 01920 Permit# Date of issue April 1, 1998 Date of expiration _April 14, 1998 Dig safe approval numbrzr- _ 081407910 Dig Safe Toll-: Tel. Number-800-322-4844 Signature/Titfe of O ranting permit l I After removals)'send Fort.7P-290R signed by Local Fire Dept.to UST Regulatory Complies Unit, One Ashburton Place, Room 1310, Boston,MA 02:35-1618. FP-292(revised 9/98) TOTAL P.02 -► C l No.-_-------� THE COMMONWEALTH OF MASSACHUSETTS X ��o� BOAR® OF HEALTH .. O `0 ............... ��rN---------.oF........-. ,4.. - ....................................... Appliration for Disposal Works Tonstrnrttun Prrmit Application is hereby made for a Permit to Construct (r/) or Repair ( ) an Individual Sewage Disposal System at: ................ihc�T1�/ �u.vT/ /Zoe //A92STD/VS M/ZZ-s Z1,7 z _........... ... .y.. ...................................... ........................................... ............._._..................._...--- Location-Address or Lot No. (J. �12�...................................................... .72 o r s.------------•---•-........................... • = -- •• r Owner ................................Address Installer Address Type of Building Size Lot... 3 S..Sq. feet ±7 Dwelling—No. of Bedrooms.................. 1......................Expansion Attic ( } Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P4 Other fixtures ---------------------•----•----------•-------- W Design Flow..............3....___..____...._..____gallons per person per day. Total daily flow____.__...._.___....._.._...................gallons. Septic Tank—Liquid*capacity.ZSo.gallons Length_8-K _-_. Width__4.�... /._ Diameter________________ Depth 6.�$"-... W Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area......_-------------sq. ft. Seepage Pit No.......... Diameter.....lo.._..... Depth below inlet.._..G_........... Total leaching area...- -3 ...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed by... wAD _.. « ................... Date. _-.z�_...1�8¢-_... aTest Pit No. 1.L.Z:_.....minutes per inch Depth of Test Pit..../4.__....... Depth to ground water..................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ pd ..••------•----•-----•------•--••-•-•••-----------••---------•-------•---•----------•----------•--•...............•----•----------------•----•---•----•.---- 0 Description of Soil.......V•,-al-" WoobGo .... .S�6-Soil `36"_�p p G'o, 2 Gs SA-,ve . .............. V .............�0....... !.?GSDEuH.....s!9 !e -----•-•---•-----•--•.................................•. W ..................................•....................-----......................_....................•----•------------------------..................------...•-------•-••....••......-------------•- U Nature 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 TITLL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in op eration until a C tificat o o ance has b en (�' d by e board of health. igned.. / -------• -- --.._...-•---------•----------------•• -------- < Dt A ication Approved ......... .--- ------. •••......-•---�`. ............................. .........LL11 7 ---------- Date Application Disapproved for the following reasons:----------•-----------------•--------------------------•------------------------............................... ---------••---------------------------------•------...------------------------------.........-------•---------------------•-------•••--•-----------------••-----••--•-••---•••-------•-•---•------------ Date Permit No....�� .. P O C Z(------------------- IssuecL.-----•--..._..-----------------------•--•---........_. -------- --- C)- Date No.... ` l(�CC�( Fss....�T_7.0 c�..a.:. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -----------TOIn//V------.....OF....... iY. n/.ST.q GC:.. ApplirFatiou for Disposal Works Tunstrttrtiun throb# Application is hereby made for a Permit to Construct k/) or Repair ( ) an Individual Sewage Disposal System at: �HizsTDMs................................................. LoT Z Location-Address or Lot No. . ........... {T /4-1,4 5 s -_ W Owner Address -RCA........................................................................ ..--.•-•.-•-•••.....•••-••----.......•••-•••.•••---••.......__......................_..........--. Installer Address d Type of Building Size ....Sq. feet±' Dwelling—No. of Bedrooms................ .......................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------------------------------------•••--•••••-•-•-••--••••-••---...._..•••--•••-•••-••-•-••-••••••-••---•--•-••--•-•••--•---•--•-- W Design Flow........... S.........................gallons per person per day. Total daily flow.............�0......._............gallons. WSeptic 'Tank—Liquid capacity!c? ..gallons Length. .'�.N...... Width."4_'-/" _ Diameter---------------- Depths '6........ x Disposal Trench—No..................... Width.................... Total Length.........._......... Total leaching area....................sq. ft. Seepage Pit No....... ------------ Diameter----Zq--------- P 4---------.... g 53.... q. _ � Depth below inlet__..__. � Total leaching area......_. _. s ft. Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed by._C-,>W q"Zp.___ _._l CZ�-N Test Pit No. 1 .Z......minutes per inch Depth of Test Pit___/6...__....... Depth to ground water.._._................ LL, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ...••-•••--•................••-••••••••••••---••--••----•-•--••-•••--•-----•-•-••-•--••..................................................................... O Description of Soil......G"-34" Woo�jGvA V Sum-SoiL 36"-La Cv�?ZSG"•••SA-/Io -------------------•---- -----------•....-----•••. x .......D--G!Z'1'r..z.--•----------. 6 '` '`.. 2u.... SRn!D (� W U Nature 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 TITLE 5 of the State Sanitary Code— Th undersigned further agrees not to place the system in operation until a C rtificate q Co fiance has e s )d�b the board of health. > jIed -• ....................................... ................................ D 7*licatio�n'7p'p"r"o--vfe77..'.;Pp.. f �t Date Application Disapproved for the following reasons:---•----••----------•--•-----------------••------•-----•------•---•------------------•-•....................... --.....--•---•-------•----•-----•-------------------•------•---.........------......-----.•-•------•-•--••--•-••••---•-•---•--••••--------•---•-••---•---•-----•••-••••-•----•-•---•••......--...------ �� y �q Date PermitNo._...................................................... IssuedL....................................................... Date M� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............TrN., ..........OF.......... nisr. f�c '..................................... Clurrtifira e of TompliFaure THIS IS TO CERTIFY,"That the Individual Sewage Disposal System constructed (✓) or Repaired ( ) by.....A�1r,.��li. - ....��,C�►�!.+�t:�..�^i"1:�a�.....=.......-- �1�:Jv���. --•---'-`�---•----------------•------------.....---------------------.... Installer has been installed in accordance with the provisions of TLE 5 of T]i 1 e State Sanitary Codes �K" described in the application for Disposal Works Construction Permit No.__ . ___-_v_-{-�--. ..... dated .f__r'-t-l._� .................. THE ISi"UAKCE 0,F-�°TITS'fCE,RtiFlC:ATE:;SHALL`NOT BE C®N. TRU.ED AS A GUARANTEE THAT THE SYSTEM WILL FU1JCTI0N SATISFACTORY. DATE....................6.-.....; TInspector........... , .THE COMMONWEALTH OF MASSAC SETTS BOARD OF HEALTH ............�h/ni OF.........Q��c/S711r��`" �a No.�..�.` i?.. FEE..^- ........... MsposFal Works Tonu#r uan eruti# Permission is hereby granted----- ------( --------•-------------------------------------....................................... to Construct (✓) or Reair ( ) an Individual Sewage Da al System at Na.. 'a � 5? Z �� ..[ ?�,1�.1°T ------------•------------•--•--- ----------------------•--•---••-- j Street as shown on the application for Disposal Works Construction Per at No"A�( 100y___ Dated....L .�. �... l Board of Health DATE............. w t '"'sue •. . ...--- ---- FORM 1255 A. M. SULKIN I C., BOSTON ' .. sf z--7- Z o.� 2 SyE�c TS At,-So TOP OF FOUNDATION CONCRETE COVER e CONCRETE COVERS e o 4"CAST IRON . mm7�lT II2 MAX. 12"MAX. P- SCHEDULE 40 4"SCHEDULE 40 PV.C.(ONLY) P.V.C. PIPE PIPE - MIN. LEACH PITCH 1/4"PER.FT PITCH I/4 PER,FT. PIT e.e PRECAST b' INVERT a LEACHING EL• ,3-S3•• INVERT INVERT e W q,,' PIT OR SEPTIC TANK o DiST. .SZ BZ �' EQUIV. INVERT , BOX ,.' � - e; ELS3..3z.. �` .. .. GAL. (NVERTa INVERT % ' � v°• 0: i: 3/4"TO IIli' w W �. EL. U. ° WASHED p o ' W STONE 41 36 --►�---W DIA. 121- o. • • . �---- �p� DIA. PROFILE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE P- 33z SOIL LOG WITNESSED BY : DATE !� -?�/!` TIME.!/r-3`>. . . . . `T S coB/ , , . . . BOARD OF HEALTH TEST HOLE I TEST HOLE 2 L'Dln!rrYlZ� �. lac--LG� ' ENGINEER ELEV. . ELEV. .. .. . . . . . . 7*77, 777777- 3�„ see-so,c. DESIGN DATA : Ez•S3,/0 4 NUMBER OF BEDROOMS sA•n.o �' 6 gqv�-Z TOTAL ESTIMATED FLOW GALLONS/DAY BOTTOM LEACHING AREA 78'��". . SO.FT. /PIT/G.P.D. SIDE LEACHING AREA SQ.FT./ P1T/47/Gp?D, GARBAGE DISPOSAL .yam . . .(50% AREA INCREASE) TOTAL LEACHING AREA .`S-3¢. . . SQ.FT /68Y PERCOLATION RATE MIN/INC H MP-WATER ENCOUNTERED LEACHING AREA PER PERCOLATION RATE ����.. SQ.FT/�;p.,D. • NUMBER OF LEACHING PITS . . Two . /T5 Lv07W APPROVED . . . . . . . . BOARD OF HEALTH To �l15>VA16•ate DATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AGENT OR INSPECTOR STETSON LOT HAL ELLEY 1 Sou77�/ Cou�17�/ /zoAa 9�No.26100�0 h •M,9iZsTo•vs /`'JiGG 5 (qN0 UB�E��e S�NRIIA\A� PETITIONER 2 Cam. CL�?LfG - TOIIYN OF BAR)NSTABLE . V„ y LOCATION :�� S,l` a� •f r�' C c-' ���! SEWAGE # � ASSESSOR'S MAP& LOT���1,�� INSTALLER'S NA &PHONE NO. / Y�; . /�, � — 5' ('D ME �.r, : SEPTIC TANK CAPACITY .-) LEACHING FACILrrY: (type) I�'/9 (size) NO.OF BEDROOMS j BUILDER OR OWNER/ i i PERMTTDATE: COMPLIANCE DATE: i Separation Distance Between the: Maximum Adjusted Groundwater Table.and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) _Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by s a TOWN OF BARNSTABLE LOCATION �o C, i 1 Cd u. r SEWAGE # VILLAGE ASSESSOR'S MAP & L V- - ��--T— Q INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) OC)' 'C ./4 . r (size) ,--_ ;,�i_/� NO.OF.BEDROOMS . BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Gr u w o nd ater Table and Bon: ,J �m of Leaching.•a tun Facility: Feet.. cili t g' y : 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 w-[lands exist within 300-feet of leaching facility) Feet Furnished by q. t _ L ?'_ ;_: ,... y`• ,.l::..r .: u;ix?h:j ,' .-,,'P is ,;{:'. g,r..- ., ... :t `'h�.*:.... .'fir. ,1Pr '" v L0CAT10N � SEWAGE PERMIT NO. VILLAGE I N S T A LLER'S NAME i ADDRESS 0 U I L D E R OR OWNER O DATE PERMIT ISSUED ' DATE COMPLIANCE ISSUED Z �G Ct'rS" GA�AG� -- f ..._ .._ NOTES�•' i • WARRENS is Lot' Municipal Water.I.Water Supply ForTh CO VE I o f Utilities Shown on This Plan Ara Approx. , 2 Location o 1 At Least 72 Hours Prior to Any Excavation ForThtits . / Pro'ed The ContraetorSholl Make The Require ,' .. .: ,.--" ' �,:_ ,;'' / / / ,-.� _. ,•. Notificotionto Dig Safe(1-800-322-4844) - x: r,,..,. .' -.: i •• ,: / ,,- •.. ,: ,,.. ,.- ,i �..�., r 3 The Contractor is Required to Secure Appropriate ,,•;; LOCUS o J , r , Permits From Town Agencies For Construction .. /,, •, , .;ram r,r y / �, ''�, .i''. /'. // ,{ / .i..' / Defined b This Plana .-.._ 3 i 2 ,.-- Install Risers as Required to Within 12 r � , Finished Grade.. in _ / ,', / ,, /' ;� I •� � __ 5.All Structures Buried Four Feet or More or Subject. - f ff t b H to Vehicular Traffic to be -20 Loading. � r i / j ! /' j � r �,•`/ ,:', I riI' � c ;\ w__,_•, .:._ ; ' ' % �' ' •-. / / , .. _= ,,,;,: �...._....._,�'"/ � fs Septic System to be in Accordance With f' / i. / / ' .._ 310 C M R 15.00 Latest,Revision And The Town of pl' Barnstable Board of Health Regulations. �, _.T_ ... -' - % / i / � -- � - _. ..• � _-______ PLAN 7. All Pi pi to be Sch 40 PVC LOC US f .n_..� ......._ _.._ .__— _' / f ^,, .._.' j � •' ;-.__ '' �,� ,-��-=�.., ...• _ Assessors Map 98 Parcel t , , 4 , 3 DESIGN DATA _..._ i ---.._ 2 Pool House Minimum Flow i _ _..---- /'. r � ., ,\ With no Garbage Grinder Y J,,,.<---•-.._-/ ,' ,._. — .. - � : / \` � CNG N LR TO INSP6GTAN C•ERTIF SO �`%/ / � Daily Flow 330 GPD AT TIME OI- INISTALt_ATIQN AS --- - - = D R EC ED d I-I A D D A TN, . -- 0% 660 GPD a O P x 0 T Y T E�3p R F I-I E L - / t Usall 00 Gallon Septic Tank _-_ ..: LEACHING AREA, i - 330 GPD/0.74=446'SF Required � ` `• Sidewall =2(121x 25)2=148 S.F Bottom Area= 12'x25'= 300 S.F. 448,S.F.TotalProvided J� J :'`' %•\ 1 - LEACHING- 0 '4N ic RDESIGNA All Pipes to be Schodule 40. Use ff 2_...._....._._.. -' ;! - Gat Leaching Chambers ins ( " OQ / "' ,r / - 12, 5 x 2 5 Washed Stone Field as Shown , , , i R P / { r ;• � �:. \\ / it RQ .-.�� MM ' � i ;\�• ? ilpy'4p��SFo `SF 9X�8^ W : Rod �� S D Tti 4, Q N k�oM 91 FG.68.0 F G.56 / !� rif n C F {••.`\ 560 o 53.6 15C0 Gallon55.8 fop El.54.655.6p R� Septic Tank 54.0 Bat.E1.51.6 53.8 Bedding as N • � .a ..,. Per Title 5 46.6 , �XliGround Water at El.5.0asPer 1 ` r, ` OH T.O.B. Ground Water Mop N DEVELOPED PROF � ST 8 \ • ' �4g`'`�� `, ILE OF PROPOSED SEPTIC SYSTEM co Not I to Scale `.\ ❑ ti, Finish Grads Filter Fabric L—'Compacted Fill PLAN VIEW - N u a Scale , 1 = 40' IPoo Stone M Leaching �� ��.. a Chamber 3/4 -1 1/2 Double Washed ' Stone -_ 4!-Id r - CROSS SECTION OF CHAMBER NOT TO SCALE. ca` PETER ` BULL~ SITE PLAN CIVILPROPOSED SEPTIC SYSTEM s, .. ' AT 1855 SOUTH COUNTY ROAD MARSTONS MILLS . MA FOR RICHARD CLARK SCALE: AS SHOWN DATE: NOV. I 1 , 1998 SULLIVAN ENGINEERING INC tzEVi tOhl 3�to/GQ (�E�oCArEo s.Al� OSTERVILLE ,MA { -7 HA- 7- N lo, VA �. E � �.�A Lo7� 2 �5���j • ,'� j 35 n�✓ / � S � } 4F"'" La•"�✓. Ply; Ak Nt `s , AK .` r i r f,3 CAt a pj �,.� � ..f � .� �,%rc -- ��V���•,�„�' �,�,,;�,w�.� ram ��;��/ .5�� Gc�vca'�..