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HomeMy WebLinkAbout0010 NYE ROAD - Health 10 Nye Road 146-010-004 Centerville ' i 0 r N 1 Health Department Drop-Off Hours: 8:00 AM —4:30 P.M Town of Barnstable Received by Healtti­ oFIm Regulatory Services Department on P. ` Richard V.Scali,Director BADNSTA]MAS&` r Public Health Division " Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 ACCESSORY AFFORDABLE APARTMENT SEPTIC QUESTIONNAIRE �&Property Address: `� - - Assessor's Map/Parcel Number: Applicant(s) Name: Size of Lot: i - l 2, 2a. How many bedrooms exist at your property now? 2b. How many bedroom are you planning to add as part of the Accessory Affordable Apartment Program application? -'er- 2c. How many bedroom total are proposed at this property (including the Accessory unit)? 2e. Is the proposed Accessory Apartment contained within: the main house; OR a detached structure 2f. Submit floor plans for all buildings on the entire property. Show all existing rooms in the dwelling and the proposed accessory apartment. Label each room clearly. Label measured width of all open doorways. Use straight edge for hand drawn plans and be sure all labeling is legible. Signed: �� Date: `� 1I tg 1 ACCESSORY AFFORDABLE APARTMENT SEPTIC QUESTIONNAIRE FOR STAFF USE ONLY 1. Is the dwelling connected to Town sewer? ❑ Yes X�No 2. Dwelling located ❑ INSIDE ❑ OUTSIDE the Saltwater Estuary Protection Zone 3. Dwelling located ❑ INSIDE ❑ OUTSIDE public supply well Zone of Contribution 4. Dwelling is connected to ❑ ON-SITE WELL APUBLIC WATER 5. Disposal works construction permit on file? ❑Yes ❑ No 6. If yes, how many bedrooms were allowed by this permit: bedrooms 7. Were building permits obtained for additional bedrooms? ❑Yes ❑ No 8. Engineered septic system plan: a. On file at the Health Division? ❑Yes ❑ No b. If proposed accessory unit is detached from principal dwelling, is that plan on file? ❑Yes ❑ No 9. Existing septic system capacity is 4 'bedrooms For the accessory unit to receive approval from the Health Department the following action must occur: ❑ Existing system accommodates proposed additional bedroom(s) ❑ Upgrade existing system to accommodate additional bedroom(s) ❑ Must remove a bedroom from the main house ❑Must connect detached structure to the existing septic system ❑Must install septic system for the detached structure ❑ Other Sign Date ILt 2 Commonwealth of Massachusetts �?L/ 41, -0/0- 001 7nw--%- Title 5 Official Inspection Form l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Nye Rd ' Property Address Annette Crowleys Owner Owner's Name :;' information is Centerville required for every Cente MA 02632 3-17-18 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. A. General Information SJ. Ja9a3 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Eva a ' the Local Approving Authority 3-17-18 spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 loerd o Commonwealth of Massachusetts ` r� Title 5 Official Inspection Form lal Subsurface Sewage Disposal.System Form -Not for Voluntary Assessments Fy„> 10 Nye Rd Property Address Annette Crowley Owner Owner's Name information is required for every Centerville MA 02632 3=17-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System.Passes:,.,, . ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. B) System Conditionally Passes: ❑ One or more system components as described in the "Co nditionalPass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20,years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑N ❑ ND (Explain below): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments :..J 10 Nye Rd Property Address Annette Crowley Owner Owner's Name information is required for every Centerville MA 02632 3-17-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y El ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑Y ❑N ❑ ND (Explain below): ❑ obstruction is removed ❑Y ❑N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1: System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts I., Title 5 Official Inspection Form /o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �,,�.>' 10 Nye Rd j Property Address Annette Crowley Owner Owner's Name information is required for every Centerville MA 02632 3-17-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ _ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts r� Title 5 Official Inspection Form hi Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c `> 10 Nye Rd Property Address Annette Crowley Owner Owner's Name information is required for every Centerville MA 02632 3-17-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No , ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 1 0,000g pd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E► Large Systems:To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form �1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments :'>r .z. ., 10 Nye Rd Property Address Annette Crowley Owner Owner's Name information is required for every Centerville MA 02632 3-17-18 Z State City/Town i page. Cit Y p Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided b the owner, occupant, or Board of Health Y P ❑ ® 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 El ® 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? ® ❑ Wasthe 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 ® El approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System,Information Residential Flow Conditions: Number of bedrooms.(design): 4 Number of bedrooms (actual): 4 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts fi� 3 Title 5 Official Inspection Form -i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Nye Rd Property Address Annette Crowley Owner Owner's Name information is required for every Centerville MA 02632 3-17-18 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 3-2018 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts 7 Title 5 Official Inspection Form w., ? ill Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Nye Rd Property Address Annette Crowley Owner Owner's Name information is required forevery Centerville MA 02632 3-17-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner--pumped 2016 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the-current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form 1.1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Nye Rd Property Address Annette Crowley Owner Owner's Name information is required for every Centerville MA 02632 3-17-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1998 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 24"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.): Good condition. Septic Tank (locate on site plan): Depth below grade: 18"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gal Sludge depth: 12" t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form w: "Ni Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Nye Rd Property Address Annette Crowley Owner r'Owne s Name ml Is reqquireduired for every Centerville MA 02632 3-17-18 o page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form -61 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Nye Rd �l Property Address Annette Crowley Owner Owner's Name information is required for every Centerville MA 02632 3-17-18 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts ,. Title 5 Official Inspection Form �i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Nye Rd Property Address Annette Crowley Owner Owner's Name information is required for every Centerville MA 02632 3-17-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level and no sign of back-up from pits. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts 3, Title 5 Official Inspection Form ,.I w., Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Nye Rd Property Address Annette Crowley Owner Owner's Name information is required for every Centerville MA 02632 3-17-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2-1000 gal ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pits in good working order with water level in pit"4" at inlet invert. Pit"5"was empty at inspection with no visible stain lines. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts - , Title 5 Official Inspection Form C�i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Nye Rd Property Address Annette Crowley Owner Owner's Name information is required for every Centerville MA 02632 3-17-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 17 Commonwealth of Massachusetts i� Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r�. frf 10 Nye Rd Property Address Annette Crowley Owner Owner's Name information is required for every Centerville MA 02632 3-17-18 page. City(rown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 3 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form 0.1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments J_ > 10 Nye Rd Property Address Annette Crowley Owner Owner's Name information is required for every Centerville MA 02632 3-17-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database- explain: You must describe how you established the high ground water elevation: USGS and town maps show groundwater at greater than 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form , 1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments /oT 10 Nye Rd Property Address Annette Crowley Owner Owner's Name information is required for every Centerville MA 02632 3-17-18 • page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file \ t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 f5i AA CERTIFICATE OF ANALYSIS Poge: 1 Barnstable County Health Laboratory 'spn �Ly Report Prepared For: Report Dated: 9/24/2007 Richard Hughes Order No.: G0743511 10 Nyes Pt. Way Centerville, MA 02632 Laboratory ID#: 0743511-01 Description: Water-Drinking Water Sample#: Sampling Location byes Pt:•Way,_Centervill"e,MA-1 Collected: 9/19/2007 Collected by: R.Hughes Before Filter Received: 9/19/2007 Test Parameters ITEM RESULT UNITS RL MCL Method# Tested Iron 14 mg/L 0.1 SM 311113 9/20/2007 Based on the results of the parameters tested,,the.water is suitable for drinking,but may present aesthetic problenis(taste;odor; s`tkiiwlg)a to Iron. w _ r� —, rr, ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 '~° CERTIFICATE OF ANALYSIS ,o ��`� Page: 2 Barnstable County Health Laboratory hJr 9�rnHtsw� " Report Prepared For: Report Dated: 9/24/2007 Richard Hughes Order No.: G0743511 10 Nyes Pt.Way Centerville, MA 02632 Laboratory ID#: 0743511-02 Description: Water-Drinking Water Sample#: Sampling Location 10.Nyes Pt.Way;Centerville,'MA� Collected: 9/19/2007 N - L .a'---- Collected -- Collected by: R.Hughes After Filter Received: 9/19/2007 Test Parameters ITEM RESULT UNITS RL MCL Method# Tested Iron 8.2 mg/L 0.1 SM 3111 B 9/20/2007 Based Fit the results of the parameters tested,tlie`water is suitable for drinking,but inay present aesth iiic problems'(taste;odor, Lstaining)due to Iron. - - --__' Approved BY' (Lab or) ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 -- I Town of Barnstable Health Inspector of THE Tp� Office Hours yP� do Regulatory Services 8:30—9:30 r Thomas F. Geiler,Director 1:00—2:00 • &%UWSraac E, - 9g7p 6 9 ,�� Public Health Division Tfo �a Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-63( AMNESTY PROGRAM APPLICANT— SEPTIC QUESTIONNAIRE 1. General Information: Size of Property:. / Z Address: 1/7�'�°���L(,� Map 7iv Parcel Name 2a. How many bedrooms exist at your property now?4, 2b. Are you.planning to add any bedrooms? /r If yes, how many? (� 2c. How many bedrooms total are proposed at this property (including the amnesty unit)? 2d. Please include a copy of the floor plans for the entire property - showing the existing rooms in the home plus the proposed amnesty apartment and/or addition. Please label each room clearly on the plans. 3. Is the dwelling connected to public sewer? YES or NO If tare dwelling is connectedAto public sewer slop questions4 through#9'.below 4. Location of dwelling is INSIDE or OUTSIDE . a Zone of Contribution to public supply wells? 5. Is the dwelling connected to an ONSITE WELL or to PUBLIC WATER? 6. Is a disposal works construction permit on file? YES or NO 6a. If yes,how many bedrooms were approved according to this permit? Bedrooms. 7. Were any building permits obtained for construction of additional bedrooms? I ES or NO 8. Is there an engineered septic system plan on file at the Health Division? IYES ' 1Vb•' Ca �9. Has the septic system been inspected by a DEP certified inspector within the last two years YES. Q ]k -------------------------------------------------------------=---------- — FOR OFFICE USE ONLY , �!ti The Public Health Division has no objection to _bedrooms at this pro erty. Special Conditions: o Signed: Date: O;/health/wpfiles/amnesryapp :.12/13/2005 10: 35 15087906230 BUILDING PAGE 02 �w Crowley Existing HOMe First Floor 10 Nye Road Centerville MA April 4, 2004 a,•Z, g•.e• .. ....7,7' ... 8'•10' 9'.7' _ 2.10' . • n :2'•0' �'n 9•8 S.B T-2- Dining Room S irs Living Room N L q 7•.Y :.. r 5•.B'. .. Existing ,,.6:,,.6,,,•:e.;2..,. Garage • r 4Aicf Room Kitchen Den 0 o n " PADGETT BUILDERS, INC. Custom Homes and Additions 184 School St. ; P. O. Box 133 la Cotult, MA 02635 (508) 428-0001 Fax: 420-0117 12/13/2005 10: 35 15087906230 BUILDING PAGE 03 r . Crowley Existing Home 10 Nye Road Centerville MA April4, 2004 Secon Floor g e36••0-'7' ,.. ,•.,o° TO' 1'.10' § closet r a Bedroom #1 Master b tairs a Bedroom #3 ]'-z' rz, ....,,.s. Sitting Room �. a Hallway Storage 12'- , 6., , �a� w• .r ,.•7,. Bedroom #2 Closet Bath Bath c 1 12/13/2005 10: 35 15087906230 BUILDING PAGE 04 Crowley Existing Home Basement April4, 2004 36, 0„ Utility Area Unfinished Basement w N N (p N W � (V p 4'-5" Storage Storage 30'-0 6'-0 fF i oIS IX �soe / ►�! 11l 4y f j iil IMT 3r 15 3r Lk1c1-p -rr _3 is � - /\ - / �. �3`/ '` '�a C--'-- l G•-C_ I /� .�� n _ \ l�lv THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH \ TOWN OF BARNSTABLE 1 ,� pltrtt tun for DttVaiial Wnrkii uit.itrur#tun rams# Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: >�A .� ------------------------•- --------......------..•-•••---------.......••---.... ------•-------------------------------------- -�=-•.----...----...---.........----•-----------• .--•-•--•-- -Locatio, -Add"s or Lot No. ......................_. G .............-----------._.... .................................................................................................. Owner Address W Installer Address dType of Building Size Lot____ _..¢ U Dwelling—No. of Bedrooms................... --------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) p' Other fixtur s W Design Flow....................... .`�.___.._� _. gallons per person per day. Total daily flow........................ .._. ..__ ...._.....gallons. WSeptic Tank—Liquid capa6tvf __gallons Length................ Width______.-..______ Diameter...-_._._____.__ Depth..... .......... x Disposal Trench—No. ........... ....... Width.................... Total Length--------- _......_. Total leaching area._____ ..._._.sq. ft. Seepage Pit No--------Z'-____.. am eter.........I�-------- Depth below inlet...... Total leaching area........ D...sq. ft. Z Other Distribution box ( ✓� Dosing tank ( ) / �y ~" Percolation Test Results Performed by..__..__�,4.�g_`_�.f14-----__--(_�-L..... Date------- �/-�......._.. as Test Pit No. 1----�:minutes per inch Depth of Test Pit-------r' Depth to ground water_.:-`—�.... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R: ..........•----------- !� 0 Description of Soil--------------------- --.-...�`Z ��� - - - - ...................`Z7- -� -44-,JAA6---------------------------------------------------------------------------------------------- x .................... ------ •- --------------------------------------------------------------------------------------- -------------------•--••-----•--•-•----...•--•-•----••-•••••............•••. 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 Environmental ode—The undersigned fur er agrees not to place the system in operation until a Certificate of Compliance h . een issued t boa ellth. Signed ..- A . ------- ...... . Application Approved By .. . .m.... .. ......�r.. ..�-U---- Application Disapproved for the following r as s- --------------------------------------------------------------------------------------------- . ............ ................................. ------------------------------------------------------- ---- -- - ... -----------.. Permit No. ---- --------------------- Issued ------------ � Dace ` __.__—_---__—.—.—_.J No....-•"•"�---.----- C Fx$a.�.a........ , r THE COMMONWEALTH OF MASSACHUSETTS r^ BOARD OF HEALTH TOWN OF BARNSTABLE p iratiun for Uhry utt1 ifflortai Tontitrnrtiun hermit Application is hereby made for a Permit to Construct or Repair (� )�n :Individuals Sewage Disposal System at • .. S Local n.—Addyess or Lot No. ...................•-- =<-• . Owner W Address ...._..._. Installer M Address iY UType of Building / / / , ►,e Size Lot./_'......'-�.f..... eet Dwelling— No. of Bedrooms...................��__.-----_.___...___.__Expansion Attic ( ) � - �Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons----------------------<: = Showers`( Cafeteria ( ) Other fixtures,✓-................ '`==' ,r- + � -= ` '`:.:..._I f�_ - W Design Flow........................ ........ ......gallons periperson;per day. _Total daily flow....__......._.___...�.........._........__gallons. .. y WSeptic Tank—Liquid capacitv�_ __gallon' ,Length"7--__" _ Width________________ Diameter_.._/_________ Depth................ x Disposal Trench—No. ................... Width............._...... Total Length.....................Total leaching area ..__...._.%_......sq. ft. Seepage Pit No--------2-_..earneter........ ....... Depth below inlet___--:. ..._.,Total leaching area.-_- . ...sq. ft. z Other Distribution box ( Dosing tank ( ) / ' "-/ q aPercolation Test Results Performed by........75.Ay_rjP,...'�./✓ Z_./A!::n..... Date.......-,___-� —/_T.......... � Test Pit No. 1---_7- _minutes per inch Depth of Test Pit.................... Depth to ground water....---_..^....... 44 Test Pit No. 2................minutes per inch Depth of Test Pit-___--___--•___..__- Depth to ground water............I........... a ••--------------------- . - A..-----•--•••-••-----••••--•-------•---•--•-------•--•-••--••-•---•-•------•---•-----•----.....--•-- DDescription of Soil.....................�- .... Z_------. J ---------------------------------------------------------------------------.-----•------ -•---------------------------------- /l . .. .. ........... ,V �............................................................................................... ........................................................................................................................................................................................................ 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 Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance h been issued b th/- board`ofiealth. Signed 41. ........ },.. .........�.�...... / ` ------------ ------- Application Approved By ' ---- - //� �/ ✓ - /7 i�.. Imo .-..�...r.:_.. Application Disapproved for the following realf c nr: ./. � . -------- - - ....................`.. .�i`..'._.�. f/.��./,...._�.....D.l..a....e_. -.-.-.-..--. --------.... ---------------------------------------------------------- ( -------------------------------- PermiN .. 5n;//"LJ.................... Issued ------------� - ?)Dacel THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE GPrtifirate of Complianve THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( I ) or Repaired ( ) by ----------------------------------------------------------------------------------------- -------------- ----------------...------------------- ....------......_..--------- ......... . - - ....------ -- ---.-------- hs�:aie at ------------------------1 C J� --- -----------------.......!07 to- . ---- --------------- -------------------------------------------....---..........------............----------------------------- has been installed in accordance with the provisions of TITLE,5,o e Stage En .ironmental Code as described in the application for Disposal Works Construction Permit No. .. :J.."" � z.. dated ........_------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUEA AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............ ................ Inspector -- r C" - ------------------------------- ----------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH i . TOWN OF BARNSTABLE /"� No.....i.�.......... FEE.... o---..... V ... 3�i��ruu�tl urk� �un�tr�rtiun �rrntit Permissionis hby granted----------------------------------•----••---------------------------------------------------------------------------------------•----.----- to Construct ( /or Repair ( ) anj Individ,al Sewage Disposal System at No......- e!_5 `f' r . Vcjl C -f(la .................-- :� !.0 ---.... Street as shown on the application for Disposal Works Construction Perrnj� No.__rr._..,_-.--_-__:._ Dated-_- ............................... Board of Health DATE...................................................... .................... / FORM 36508 HOBBS&WARREN.INC..PUBLISHERS r _ 51"16L F.L( IL-(. 4 $E��MS �. - ary+$ Co A/o 6AZ5A6r= GRIIJ�Ert -.PAIL-( P-oW 4 olo SE FI C TANV- .4,4U,(/ VS E /Soo GAS I 4 a r --P l SFNA P i T 'z-MAP 444, S l D C W4LL AWC-A Son sf ao I'1 �► g00 St:X 5 =. 7So GP'D, 7vT,AL Me-& $0 APC S� I� Qo� 11�i1'0 TTOM � I ov /o /OlJpg 6f-P, rot tf ]�,vELL, a `TrAL oAl LY ter/ =-449 ewji� T�EP�V LAT oN FA )/jl MIS ad'.�S ?1 T� " = / 3a2�r-40 i' I 14OF \ ., v� 87 39 , 1 0; \ P.r T,..R c. - 82.5 / ?o� a' "off. F Ti*r s ri3lgs I0L:- 176=4 ; TF=A4 FAG=42 _•_„�T •.,_,�•rl�-.... __.�ecr�, -'77�cr1r�a- � ; Lv44 P V.c. 5 vas0iL (000 14) Box ay.�l xv4- GAL 4. T"ANY C�ca -1 L . P - o' kw l/Z kE, 'AI-L.-5MV-ruQEs s� -TO NE MDW BE H Y.oEE-P Zo�1F RC 20 /10 1 to R/IAn 14G (�4.5 to d Ip-� 45 vqF- 8 ?v-oFl Ls— CGZTrFI® FLOE PLAN Mow II EL= 3v MAC 3 IggS 0.-wA , I R° � PLAN P�1--E RQJC.E 1 CEL'TIFy 744,kr T* SQN owN NEZEoN �MP�YS wltN -DTwNTu4iL4- 51�E V E Lors 4 ¢ 5 As O s- 'S 7-F--0. CT: T4(E- 7DWN OF Bmz►4srQaLr- pL '�� d.:l�5 h�7- -0 4AT�-� W I(,Tg I d VE '1ODD M&I I.1, PG b g pAT� 3'3-95 A X'rLIZ NYE INC `77F 1'5 FI Ati iS No - �3A� p loTJ4r_ Auk Su!'VeJozS L. E+JGI N EE>LS u 6UfZVC`j a1Jv rN��N�FF5ET" �4oU1-,D u or BE o 5`(ErZV I LLE MA;� .,c7D To GS*aL �eoT`/ NL 5 1; APPLICANT' A1� vac , TOWN OF BARNSTABLE ` LOCATION: J � -is, /V Y,6 /lam SEWAGE # VILLAG LL C ASSESSOR'S MAP& LOT LLZ oLD- Gby `. INSTALLER'S NAME&PHONE NO. I SEPTIC.TANK.CAPACTTY LEACHING:FACII.ITY: (type) (size) NO.OF:BEDROOMS BUILDEk:O` OWNER �O X 77061 •g e.P PERMTTDATE: s,L�y s COMPLIANCE DATE: Separation:Distance Between the: ' Maximurii Adjusted Groundwater Table to the Bottom of Leaching Facility Feet i Private:.Water..Supply Well and Leaching Facility (If any wells exist on thin 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist witlri'0.0 feet of leaching facility) Feet ;. .. .,._ Furnished K. -^ L I G 1 i Crowley Existing Home First Floor 10 Nye Road Centerville MA April 4, 2004 4.2" 6-4".. 7,7". 6'40"- r 8 7" 2 10" O O --... --- - - -22%0" .-.. _.._. .._..._..a Dining Room S irs Living Room N N � I 5,6„ a Existing 2,_,", Garage 4'-8" 3'-8" �p ;Mufl ROOM Kitchen w Den �};•0a - 10.-81, 17_0" 14._6., _.:....__ 9.4 4,_5„ 3,_0„ 2c4" 58,_4" C PADGETT BUILDERS, INC. Custom Homes and Additions 184 School St. P. O. Box 133 Cotuit, MA 02635 (508) 428-0001 Fax: 420-011 41 e. J Crowley Existing Home 90 Nye Road Centerville MA April4, 2004 Secon Floor o 36,_0•,w.. ... 2'-1°,1•_f0". :2'-1"-1'-10, o®loseF o w o 3•_10"_ Bedroom#9 Master tairs Bedroom V Ull/ #33 Qv a +� 2v 3'-2" 2•-2„:. 0 13'S" i N � Sitting Room i3,_o,• HallwayN & Storage 5'-1" 6'-1" 3,-7„ -N vza.cr ra=s.e: 1'-2- 3'-f 1" ._; 2'-5" Bedroom#2 N Closet Bath Bath 1'-10 2'-0" A O. R 35'-10" - ��.�� r 0" 11'-2"i g 10•4011 .. p 2" .._ tPh Crowley Existing Home Basemenfo�. April 4 2004 36'-0" Utility Area Unfinished Basement w ` y � N ' i N �p N N v 4'-5" Storage Storage 30'-0" - - -- - 6'-0" TOWN OF BARN S-T"LF, . SEWAGE#`____�___ p,SSES50RI MAP&.LOT INSTP►LI.E ..NAME& HONE NO L1ACILtNG ll1. �C�..I'M"Y (ty $) 60 SDRO �idIX.R7EId f�R C91� "'.�" FIEIt T'AI�Tt+ colyal�.IiAI�tC,E pA S�p�taon��tsu�I�stv�ee�i�e feet Maxi�t►um ArIjus 1 G oUndwatet'l'sWia tltG o►tnm at X,each n t�nei sky .� - PclvuBsJAic:r aPpky Weld dace I,caa`4io �?acility t .any�reZ�s exist' ori`sste uc within�d0 feot of l�aciu����tc;�lit}�) ` k�ca9 alLt, y iNet9ar►d aa�ci lLeacd�t �actl y( Ally wEliancl ezusY Thee r�lFfaua'�QQ �.- urnl17 Co 0 2 , 13 _ _ � A"6L-,3� - % 31 ' # TOWN OF BARNSTABLE � LOCATION © ✓ 6EMS A'Y,6 /1.9 SEWAGE # VILLAGE m eft Lr®LL C ASSESSOR'S MAP & LOT tq4 1,0- Uay IP�-sTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACIL=: (type) /✓f (size) �r311 �a �� NO.OF BEDROOMS /9� a C./c�S A4So `T/IL oOOG-MS BUILDER OR OWNER ,�i1.E� T�,,,-/ P64, v e.P PERMTFDATE: _��, �� �� COMPLIANCE DATE: 3 w 9 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 leaching facility) Feet Furnished by r ��# . Pogue - r __ �� .•�r�cam_�__ :_�� _------ _ — � ,_ _ /L ce cf - - .�� •� - ,� 1. -/ � • -� \\ � \' `•.- \ - \ '• /r /}! r?,f �J ]J��i � �is�i�t•�rt�e-�YG-t /� r 17 •� '•{l p APPwOVm BT: • - � /\/� r s� ` I � SATE: -/ r / _ . _ /\ �.Yl�I���✓stir,�.JfirFF�J� . �' \ % v LEGEND VENT d NOTES Se !ce SYSTEM PROFILE ALL MARKED WITH COMPONENTS SHALL BE • MARKED WITH MAGNETIC TAPE OR 1. DATUM IS ---- 99 -- EXISTING CONTOUR SYSTEM DESIGN. (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. N AVD 88 ACCESS COVERS TO WITHIN 6' OF FIN. GRADE CAST IRON COVER TO GRADE TOP FOUND. EL. 48.0' 2 PEASTONE OR GEOTEXTILE 2. MUNICIPAL WATER IS NOT AVAILABLE X 99•1 EXIST. SPOT ELEV. GARBAGE DISPOSER IS NOT ALLOWED \ FILTER FABRIC OVER STONE 99 MINIMUM .75' OF COVER OVER PRECAST 2x SLOPE REQUIRED OVER SYSTEM 41.0' 3. MINIMUM PIPE PITCH TO BE 1/8- PER FOOT. -[ }-- PROPOSED CONTOUR EXISTING 4 BEDROOM DWELLING 43.0' (98.q BLOCKS OR 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS PRECAST H-so WATERTEST' D BOX FOR LEVELNESS ] PROPOSED SPOT EL. DESIGN FLOW: 5 BEDROOMS ® 110 GPD 550 GPD r:!SERS CM.) PRECAST RISERS TO BE AASHO H-22 2'� 4-OSCH40 PVC MORTAR ALL rH1 USE A 550 GPD DESIGN FLOW INVERT IN 38.0 y• •, PIPES LEVEL 1ST 2' COMPONENTS �2.5 3• 5. PIPE JOINTS TO BE MADE WATERTIGHT. , TEST HOLE ":7 ENOS mp') S►DES 39.0' z Locus SEPTIC TANK: 550 GPD (2) = 1100 43.0' 10- 1500 GAL H-20 14- ' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH Wequaquet n 2� SLOPE OF GROUND 38.67' TEE SEPTIC TANK TEE 4 ® - ® t.� USE A 1500 GAL. SEPTIC TANK ,' 310 CMR 15A00 (TITLE 5.) Lake OpOpOpOppo �Q� UTILITY POLE CAS BAFFLE', pOOo�o9,p,p° ®� o ®® 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO o t LEACHING: + ` 4' LIQ. LEVEL (ACME OR EQUAL) - 38.36' 36.0' BE USED FOR LOT LINE STAKING OR ANY OTHER ego° FIRE HYDRANT :. .:. _ 1 L PURPOSE. Lok 0( ••,ppppppppppppppppppppppppp pp O•pp Op YpppYpppCp4. � •.` SIDES: 2 (47.5 + 10.8) 2 (.74) = 172.5 GPD �p po°�°^°�°�°�°:°:°:°:°:°�"� "+'�':°:•° H-20 500 GAL. LEACHING CHAMBERS BY ACME PRECAST.PR EQUAL » NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING , ' - _ 3/4--1-1/2- DOUBLE WASHED STONE 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4 PVC. 2.5 AT ENDS AND 3.0' AT SIDES (5) UNITS REQUIRED BOTTOM 47.5 x 10.8 (.74) = 379.6 GPD 6- CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 47.5' X 10.83' 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED COMPACTION. (15.221 [2]) "�, WITHOUT INSPECTION BY BOARD OF HEALTH AND TOTAL: 746 S.F. 552.1 GPD ( x SLOPE) (_x PERMISSION OBTAINED FROM BOARD OF HEALTH. MIN. 1 SLOPE, (� ) LOCUS MAP USE (5) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) H-20 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING FOUNDATION- 1 fi' SEPTIC TANK 12' D' BOX 21' LEACHING 31 0' B'OTTO TH-1 DIGSAFE (1-888-344-7233) AND VERIFYING THE NOT TO SCALE WITH 2.5' STONE AT ENDS AND 3' AT SIDES FACILITY NO GROUNDWATER FOUND LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF WORK. ASSESSORS MAP 233 PARCEL 023 „ ' .. ! , 2 , .. , . 0 f .•• i ii i! l r, A' t .. I' 1 • . 1 i .. • . I 1. " ' ' ' ` ' ' • � - i MATERIAL ENCOUNTERED SHALL BE • � SITE IS LOCATED WIT,HIN•,GP GROUNDWATER • ' ' 11 � ANY UNSUITABLE REMOVED 5' BENEATH AND AROUND THE PROPOSED PROTECTION OVERLAY DISTRICT, - LEACHING FACILITY. STATE ZONE II, 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND SALTWATER ESTUARINE OVERLAY DISTRICT, REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. AND ONSITE WELL & SEPTIC AREA 13. WETLANDS FLAGGED BY LYNNE HAMLYN OF HAMLYN CONSULTING 9-24-15. OWNER OF RECORD 14. ALL ROOF RUNOFF TO BE DIRECTED INTO DRYWELLS. MARK I FLETCHER TR 15. WELL SHALL BE TESTED AND PASSED PRIOR TO AND 29 OAK RIDGE ROAD MELODY POND CONSTRUCTION. OSTERVILLE, MA 02655 PART OF WEQUAQUET LAKE LOT LINE PER �- (A GREAT POND) PB 1 PG 53 MITIGATION TABLE REFERENCES EXISTING HARDSCAPE 1,167 SF EXISTING BEACH AREA 280 SF DEED BOOK 8242 PAGE 105 337 f PROPOSED HARDSCAPE 5,657 SF PLAN BOOK 1 PAGE 53 PROPOSED MITIGATION 2,324 SF LOTS 28 & ZONING SUMMARY 65.142t Sq Ft TEST HOLE LOGS EXISTING INTERIM 1.49t Ac. PIER APPROVAL UPLAND - 41.191 sq Ft ZONING DISTRICT: RD-1 RESIDENTIAL DISTRICT 5132 WETLAND _ 23>951 Sq Ft DANIEL E. GONSALVES, SE #13587 REQUIRED PROPOSED # ENGINEER: MIN. LOT SIZE 43,560 S.F. 65,142 S.F. DB 10014 PG 287 DAVID STANTON. RS WITNESS: MIN. LOT FRONTAGE 20' 373' ART 0095 - - --- - - - --' -- �� • +- � DATE: 9/25/15 MIN. LOT WIDTH 125' 373' - - - - - -- APPROX_WATER EDGE_-_-- - __ _ _ EXISTING PERC. RATE _ < 2 MIN/INCH MIN. FRONT SETBACK 30' 30.3' 'f S MIN. SIDE SETBACK 10' 10, 1 , /--- -KACH `'� 35-�- � - CLASS I SOILS p# 14827 MIN. REAR SETBACK 10' 10' • ARE 7 MAX. BUILDING HEIGHT 30' < 30' VEGETATED WETLAND J 36 4 BORDERING -- ,A �A 3j6^ �. ELEV. ELEV. '� �j�1 ELEV. ELEV. - _ ;._ 'PROPOSED �/ - 42.0 0 43.0 p 43.5 0 43.0 D \ 34 ' MITIGATION A A _ LS LS LS 43 LS LAW TO �'�PLANTED44 ` 1OYR 3/2 » 10YR 3/2 » 10YR 3/2 .. 10YR 3/2 F�OPOSED WITH NATURALIZING 5 6 4 3 - 4' PATH F ��� _r- SPE IES `AND MAINTAINED j"= g B B B A UN I TURBED BUFFER 45f� G H -� � LS LS LS `) EXISTI G LS \J\ EXISTING _� TREE, NE ,` �_._�•----_ - 10YR 4/6 10YR 4/6 10YR 4/6 10YR 4/6 , CESSPOOL _ . � \� ,-- � � ,, �-_ _- ._ (TYP.) _-'� _ \ 13 40 9 16 41 7 12 42 5 10 42 2 4 - EX` E REM V p \•\ �� -� BENCHMARK \ �.. MS MS MS MS =o ROPOSEp ' EON PIPE L. 40 0' » W/ GRAVEL >, W/ GRAVEL W/ GRAVEL >. W/ GRAVEL �Q s PpRCN PO CN Q� 36 1 CYR 6/4 39.0 36 10YR 6/4 40.0 50 1 OYR 6/4 39.3 46 10YR 6/4 39.2 PERC C2 C2 PERC C2 C2 G �� ` S WEU- `_ _-o 150, A UTTING SAS - M/CS M/CS M/CS M/CS �� I �ROP,QSED ppSEp �B(/FFe k 2.5Y 7/4 2. 4 7/4 2.5Y 7/4 5Y 7/ 2 5Y DWELLING _ is `, GA EG1- 43•O TOP OF FND I• -2 / EL. 48.0SSA _ 120 33.5 120 � Ile _ -• / �9� / 132 31 .0 132 32.0 33.0 Cb�J j 44 <v / A� �S , f / r: NO GROUNDWATER ENCOUNTERED NO GROUNDWATER ENCOUNTERED PRO D J / TITLE 5 %L RESERVE STONE S� RIVE � �.�--•41--ram / �. .'- / p�� �' , OF l �. �90 /WpR IT LINE ,� �` z. 1:1 S LT F`NCE - �N� ,i / 2 ,��0 INGLE FAIL �P 10 NYES NECK ROAD EAST / ENCE OR_ % 1- i \IF-�'�c• ALTERNATIVE) / CENTERVILLE, MA Ip �% 03 r -n w PREPARED FOR � J- o• /� SAD � 4 -- i f ROP. VEND / / �j R - __� � RPOAL ,� Ec , 5 TRY HERMAN �f �FIL/TEf�,AND Y BUS-SCREEN 1 • 6 . DECE ER 1 ��8�9 DATE: MB 3 2015 r " / �► r- ? i \ f, '� �p N le: 1 = 20' 10 20 30' 4�0 F C; - w ,j•;;of�� t.. s / / G 4 - LOT LINE PER C� '%r A�� d�' - 3 2U1 40 / off 508-362-4541 DANI A �► o� DrD � PB 1 PG 53 / CIVIL ��, �' 0 � � i, ('1 �Q� fax 508-362-9880 - E I - Gnr ��S':� EN down cape civil engineers 1 r - h land su9 e ors I y � 939 Main Street ( Rte 6A) DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 DICE # 15--260 15-260 HERMAN.DWG I _