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HomeMy WebLinkAbout0040 BARNARD ROAD - Health ,4Q�F3arriarcl'1Zoad� .°a'`ts t Oserville i ' :;�, ° "' 139" a e 0 u f , ° o ° ° m ° 1 , R Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 40 Barnard Rd. M Property Address Irene Bagley-Heath Owner Owner's Name information is required for Osterville Ma. 02655 4/21/2011 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: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not use the return Name of Inspector i f key. Ca ewide Enterprises,LLC. p p Company Name r� P.O.Box 763 Company Address Centerville Ma. 02632 �D City/Town State Zip Code (508)477-8877 S14454 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 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority eow 4/21/2011 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 40 Barnard Rd. Property Address Irene Bagley-Heath Owner Owner's Name information is required for Osterville Ma. 02655 4/21/2011 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/a/ways'complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is .structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 s � Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 40 Barnard Rd. Property Address Irene Bagley-Heath Owner Owner's Name information is required for Osterville Ma. 02655 4/21/2011 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ;M 40 Barnard Rd. Property Address Irene Bagley-Heath Owner Owner's Name information is required for Osterville Ma. 02655 4/21/2011 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2: System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 40 Barnard Rd. Property Address Irene Bagley-Heath Owner Owner's Name information is required for Osterville Ma. 02655 4/21/2011 every 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- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M 40 Barnard Rd. Property Address Irene Bagley-Heath Owner Owner's Name information is required for Osterville Ma. 02655 4/21/2011 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced.to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ® El information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Barnard Rd. Property Address Irene Bagley-Heath Owner Owner's Name information is required for Osterville Ma. 02655 4/21/2011 every page. CitylTown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2009:96,000 g ( Y g (gp ))' 2010:135,000 Detail: Sump Pum ? ❑ Yes ® No P Last date of occupancy: 4/21/2011 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Fora _ Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M 40 Barnard Rd. Property Address Irene Bagley-Heath Owner Owner's Name information is required for Osterville Ma. 02655 4/21/2011 every 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: Capewide Enterprises,LLC. Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Measured 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ^M 40 Barnard Rd. Property Address Irene Bagley-Heath Owner Owner's Name information is required for Osterville Ma. 02655 4/21/2011 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2007 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 26"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10'+feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank(locate on site plan): Depth below grade: 19"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 gallon Sludge depth: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments °M •'" 40 Barnard Rd. Property Address Irene Bagley-Heath Owner Owner's Name information is required for Osterville Ma. 02655 4/21/2011 every 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 26" Scum thickness 6" Distance from top of scum to top of outlet tee or baffle 3" Distance from bottom of scum to bottom of outlet tee or baffle 8" 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 tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments °w 40 Barnard Rd. M Property Address Irene Bagley-Heath Owner Owner's Name information is required for Osterville Ma. 02655 4/21/2011 every page. Cityrrown 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 40 Barnard Rd. Property Address Irene Bagley-Heath Owner Owner's Name information is required for Osterville Ma. 02655 4/21/2011 every 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 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 five outlet Iaterals.No evidence of solids carryover.No evidence of leakage. 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.): I I Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Barnard Rd. Property Address Irene Bagley-Heath Owner Owner's Name information is required for Osterville Ma. 02655 4/21/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 5 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system T e/name of technology: 9Y: 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.Water level was 13" below-invert at time of inspection.No stain line observed higher. 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ^M •''V 40 Barnard Rd. Property Address Irene Bagley-Heath Owner Owner's Name information is required for Osterville Ma. 02655 4/21/2011 every 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.): I t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 m� i y t �'��,.� d »nr�� •*k�ri*J?t*+.�s�� ca F �vF ,fir �J� $ki}n?Tr Y7 i M�r £rVS I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 40 Barnard Rd. Property Address Irene Bagley-Heath Owner Owner's Name information is required for Osterville Ma. 02655 4/21/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of LC 18'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: 2005 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 plate#2 annual ranges of groundwater elevations. M Before filing this Inspection Report, please see Report Completeness Checklist on next page., t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ° 40 Barnard Rd. M Property Address Irene Bagley-Heath Owner Owner's Name information is Osterville Ma. 02655 4/21/2011 required for every 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 a - TOWN OF B RNSTABLF .LOCATION ��(, ���A� RA SEWAGE# Q f VILLAGE 0Twytv,�6 -ASSES SOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. M AN LCA "T'V'®S SEPTIC TANK CAPACITY C S OO LEACHING FACILITY.(type) CQJCwn %3A(%Tk W (size) Soo !V&005 NO.OF BEDROOMS,— OWNER- A C,LE-'/ AMJ PERMIT DATE: 3� 0 COMPLIANCE DATE: -Z ®' 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) tA h Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of 1 ching faci 'ty) Feet FURNISHED BY V ' A A- ,' � Ai'= Rs ERIA �Nhen�a AD �``39Z q(a -ul A q C- 9ro_-3 o� AH _ o 27 � � q3a ���� 5'-7" � 5 7Cli 0 01 DN fTl O , O rn N _ m N N 5'-7^ cl 3'-5" 19'-2" - 3'-5" d No. �0G/ � -- �� FEE COMMONWEALTH OF MASSANUSFTTS IBoard of Health, 1 ttj,�V: v APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct Repair( ) Upgrade( ) Abandon( ) - ❑Complete System ❑Individual Components Location Owner's Name 9 Map/Parcel# l `j Address Lot# Telephone# Installer's Name Designer's Name SUPREN J.DOYLE AND ASSOCIATES E Address q AL I- C MAMIM Address FAST FALMOUTH,MASSACHUSETTS 02 Telephone# Cszq skv�- Telephone# 34 at ding Lot Size I sq.ft. o. gT ofBedroomsrbage grinderrr- ype of Building No"of persons Showers ( ),Cafeteria( ) Other Fixtures Design Flow (min.required) gpd Calculated design flow Design flow provided gpd Plan: Date 17VIM'C-, 2s, i9 w Number of sheets Revision Date Title Description of Soil(s) 4s Soil Evaluator Form No. Name of Soil Evaluator� Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not a the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date 6d-47 D 0 UU FEE r _11 COMM®NWEALTII OF M SS961USLTTS . s Board of Health, '/1 J/4 � f 4;+4r1�'°,11�1• APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct(Al Repair() Upgrade( ) Abandon( - ❑Complete System ❑Individual Components Location 4r(9 A,��� ',Owner's Name Map/Parcel# -3q �j'� ' Address v Telephone# Installer's Name Designer's Name ES ` Address ' A.��� ,SC- � y��((� ' Address 42 CANTERBURY LANE " . n -Telephone# Telephone*Tele P 508/540-2534 Type-of-Building Lot Size k--A �� sq.ft. r CDwellhig,-No.of Bedrooms �b Garbage grinder( ) Other-Type of Building No.of persons Showers ( ),'Cafeteria ) Other Fixtures � r � DesignNflow (min.required) ;��p gpd Calculated design flow i5�1*12 Design flow provided Yf�.ti� gpd Plan: Date ;-7=104,. ''I_,. O LP Number of sheets a Revision Date Title V-VA VC11A J' V'Ve 1-.1." w.•. O 14Yt » i 4t�+.► J�C['t t�tl1�1 A Description of Soils Soil Evaluator Form No. Name of Soil Evaluator L M Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to.place the system in operation until a Certificate/off Compliance has been issued by the Board of Health. Signed (&/1.mG>.. ! /l..,s Date (/llw".A _ / tgw-7 Inspec�tioms� / ,. /� ! f(!�t' 'f mil✓ / k'�/ f'(/y� / �- / / / -' ;, No. 0 FEE Z.- �V COMMONWLALT14 OF fMASSACHUSLTTS r � !'1 1 ar Board of Health, CERTIFICATE OF C®MPLI ' Description of Work: ❑Individual Component(s) ❑Complete Systemt The undersig/n)edd herr)ebyyy certify the Sewage Disposal System; Constri cted( �f.Repaired ( ),Upgraded ( ),Abandoned ( ) b imp,l( e� �. J A �• Alf F j�� at d9AM4,6ZU kOA 'I") has been installed in accordance with the••provisions of 310 CMR 15.00 (Tate 5) an t/rhe� approved design p s/as-built ptans.relating to application No. dated Approved DestgriFlow� iG: ( d)- � 'r :Installer• �':. f� Designer: '�. t Y Inspector: e' l f 1r Ga!f n (I /�`/� i{DDate>4 /� The issuance of this permit shall not be construed as a guarantee that the system will function as designed }h No. % ti.! /fJJ(/,j�y�y t �tll ` € +� FEEIN ��� ✓ ..-r COMMONWEALTH ®L'MASSACIIUSETTS Board of Health, ^ DISPOSAL SYSTEM CONSTRUCTION PLRMIT Permission Lis/hereby granted to; Construct( Repair( ) Upgrade( ) Abandon(:' ) an individual sewage disposal system at �7�� ram.-� � � ►�!�I as described in the application for Disposal System Construction Permit No. ,dated Provided: Construction shall be completed within three years of the da e of h si perm tf-All focal conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date,./))/ Board of Health s Town of Barhstable Regulatory Services Thomas F. Geiler,Director • swaxsrnsr�. • Public Health Division 1639. �0 ► ' Thomas McKean;Director 200 Main Street,Hyannis,MA 02601 Office:. 508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form Date: =o;— Sewage Permit# Assessor's Map\Parcel ;:,1 _­F2- Designer: Installer: MAuA ,�MOW' TES 42 C URY LANEAddress: EAST FALMOLTH'.MAcSAC Address: WcTy 508/640-2534 On 211 M nrwn� �WW15 was issued a permit to install a (date) (installer) septic system at -A 0 based on a design drawn by (address) dated (2- z, C (designer) I certify that the septic system referenced above was installed substantially according to e design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. Stripout fired) was inspected and the soils- were.found satisfactory. S0 OF p CHRISTINE I' FAIRNENY (lns a 's igna e) No. 926 al C H A Q _= . __. ._ gliEPh=N .in �Q/S-Tr f esigner Signatur (Affix Designer's Stam a�a PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QASeptic\Designer Certification Form Rev 03-09-06.doc Town of Barnstable Department of Regulatory Services Public He • t Health Division Date 200 Main Street,Hyannis MA 02601 Date Scheduled_ 1/ZZ L Time Fee Pd. Soil Suitability Assessment for S wage Dis sal Performed By: a Witnessed By: Location Address OCATION M& ENERAL INFORMATION pj� Owner's Name rq,rl�� A- V���- t-/.4✓ Address Assessor's Map/ParceL. ( �j v�' r's,�A" 6 3'� Engineer's Name NEW CONSTRUCTION REPAIR . Telephone# ,_ Land Use Slopes(%) _ _ Surface Stones Distances from: Open Water Body 0 r ft possible Wet Area — LtIJ2ft Drinking Water Well ft Drainage Wayft property Line 1 J ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 1J, \a e !� ^/�45 Parent material(geologic) ���✓r' Depth to Bedrock Depth to Groundwater. Sta�Water Weeping from Pit Face Estimated Seasonal High Groundwater Method Used: DETERMI, NATION FOR SEASONAL HIGH WATER TABLE Depth Observed standing in obs.hole: in. Depth to soil mottles: Depth to weeping from side of obs.hole: Index Well# Reading Date: Index Well level in, Groundwater Adjustment ft, Adj.factor- Adj.(lroundwater Level ,,,e PERCOLATION TEST Data 1Lit ot, Uwe Observation Hole# Time at V Depth of Perc (�5•�► t�6 � Time at 6" Stan Pre-soak Time lime(9"•6") End Pre-soak 11'.1� 11=1� 11—A CAA% W*,15 Rate Min./Inch L Vri�� �" 7tiAY� Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100'of wetland,you must first notify the Barnstable Conselt vation Division at least one(1) week prior to beginning. Q:%SEPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sdil Color Soil IZ7then Surface(in.) (USDA) , (Mansell) Mottling (Structure,Stones,'Boulders. Consistencv. ve C, tT. 2 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil the, Surface(in.) (USDA) (Munseil) Mottling (Structure,Stones,Boulders. Consistency, A. 4/!. ,��a�,3��� S.I 3 �.1'3Ly G+rGA�/t�L� 1Cit.a7d Sw � . DEEP OBSERVATION HOLE LOG Hole# 3 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munscll) Mottling (Structure,Stones,Boulders. Cqistency.%Gravel) 36-i"SZI{ � �,�ac�. Sn�.at� Z��i`t'. ��A /� LYy• • Y DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stories,Boulders. on ' ten Flood Insurance Rate Map: Above 500 year flood bounds No_ 'Yes y boundary Within 500 year boundary No= Yes Within 1,00 year flood boundary No— Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervi s material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pe vious material? Certification `I- / I certify that on (date)I have passed.the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and experience described in 3 10 CMR 15.017. Signature Date o to Q\SEPTICIPBRCFORM.DOC BaA F Health Complaints Y -J3.% 3 Z 12-Jul-05 Time: 3:48:00 AM Date: 7/8/2005 Complaint Number: 18240 Referred To: DAVID STANTON Taken By: SHARON CROCKER Complaint Type: TITLE V SEWAGE Article X Detail: UNSANITARY CONDITIONS Business Name: m� Number: 30,40_ Street:_aBARNARp�RD,. Village: O TERVILLE Assessors Map_Parcel: Complaint Description: CALLER SAID BAD SEWERAGE SMELL. BELIEVES ITS COMING FROM 30-40 BARNARD RD PROPERTY LINE Actions Taken/Results: DS WENT TO SAID AREA. DS DROVE ALL AROUND THE AREA, INCLUDING OTHER STREETS IN THE AREA, AND DID NOT NOTICE ANY SEWAGE ODORS. A HOUSE WAS TAKEN DOWN AT THE END OF THE STREET, BUT IT DID NOT APPEAR THE ODOR WAS COMING FROM THERE (INCASE AN OLD SEPTIC DAMAGED DURING TEAR DOWN.) NO FURTHER ACTION REQUIRED. Investigation Date: 7/11/2005 Investigation Time: 2:45:00 PM 1 TOWN OF BARNSTABLE Y LOCATION 40 BARNARD SEWAGE # VILLAGE OSTERVILLE ASSESSOR'S MAP & LOT�.��4 INSTALLER'S NAME & PHONE.N&LIS BROTHERS CONST.. CO. 362-6237 SEPTIC TANK CAPACITY ,aC3 LEACHING FACILITY:(type)3 :F�c of S (size) I x x \ NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER k/6C-Lc-- BUIZVER OR OWNER DATE'PERMIT ISSUED: DATE COMPLIANCE ISSUED: P"� "� I VARIANCE GRANTED: Yes No t ° � o 4. i A .0- 137— o3 No.. ------- Fsa... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Alip iration for Dit.-ipniul Work.6 Cnomitrurtign ranfit Application,,is hereby made for a Permit to Construct ( ) or Repair X an Individual Sewage Disposal Sys at. o 1lr/ Location- 1 s or Lot No. ............ — -------_-----•-�.. .................. •.................................................. w cr� Address 1 -------------------------------- ----------------------••---•--------------------------••-•---•--•--••••••-----..............••.... Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms---------------------------------_-........Expansion Attic ( ) Garbage Grinder ( ) 44 Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------------------- -- W Design Flow-------------------------------------------- per person per day. Total daily flow......................................----..gallons. WSeptic Tank—Liquid capacity.-..-------gallons Length---------------- Width---------------- Diameter.-.------------- Depth................ x Disposal Trench—No- -------------------- Width-.----------------.- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by..--.--------------------------------------------------------------------- Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit......-.-----------. Depth to ground water........................ (% Test Pit No. 2................minutes per inch Depth of Test Pit........-.----.--.-. Depth to ground water........................ 9 ..................-.............................................................•--------------- ---------------------------•----------------••••.........-•--' ODescription of Soil.....................................................................------------------.------------•--------------•--•----------------•--------•-----•-----------•---. x v . x -•--••--------- ------- -- --------------------------------------------------------------------------------------------- - -- -------- ---- --- � '- ------- -- --------- - ------------ U Natur ep irs or Alterations—Answer when applicable---------- --- -- -------..-------- -------------- --:-------�------ .............. 7' gre /--------------------------------------------------------•------------------------------- ------ ----------------------------------------- Agreement: The undersiges to install the aforedescribed I' ividual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental.96de—The undersigned further agrees not to place the system in operation until a Certificate of Compl' nc s been issued by t e ® rd o alth. / g /� St ned .. - a� .. ......... K�3 Application.Approved By ....... . ................................ ......._ . . ..... ... .. --- ---------------- .....�/.. ... . te Application.Disapproved for the following rear n ._..................... ........... ............... .......... .....-- ..... ................ :. ........... .............................. ..... D .................... y ce Permit No. ...... ........^.. Issued ------------- . . >�...�� ...... { �—'+ • 1r V Fp TIE COMMONWEALTH OF MASSACHUSETTS k' BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Dig mial lVorkii Tonitrnrtion Errant Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at, - Location 81 d �1 or Lot No. w�cr Address a �� f .........................................:............ Installer Address Type of Building Size Lot............................Sq. feet 0-4 Dwelling--No. of Bedrooms---------- _________________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ______________________--_-- No. of persons------------------------- Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------------------------------------------------------------------------------------------•--•-..... ....--•---•-----...------_.. WDesign Flow............................................gallons per person per day. Total daily flow......................................------gallons. G: Septic Tank—Liquid capacity.......____gallons Length________________ Width.-.________---_ Diameter................ Depth..... W x Disposal Trench—No. ...................`1Width_ ---------- /_ Total Length.................... Total leaching area.........._.........sq. ft. ' Seepage Pit No_____________________ Diamc�tec'"'r�":4 .:".CDepth below inlet.................... Total leaching area..................sq. ft. Other Distribution box ( ) Dosing tank ( ) `4 Percolation Test Results Performed by.......................................................................... Date........................................ W Test Pit No. 1................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........................ a, 0 Description of Soil.................................:�w...........................................................................-........................................................ . x W ......-•---•--- -----------------•-------•-...............t "......... .. ► - t. x Nature o?Repairs or Alterations Answer when applicable__________ _____ •-----..�j--- / . -- =; ;p._..... ------ '" Agreement: w The undersigned agrees to install the aforedescribed In�dividual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental ode—The undersigned further agrees not to place the system in operation until a Certificate of Compliance been issued by t e b•and of . hh. Signed .. --- ----------------- Date Application.Approved BY -- -- ------------------� ............ ......... ..... ...._.. ------ - .��..... .. - - 'IJace Application.Disapproved for the following rear nj .................. ....................................................... ------------------ '" ` --- -- ------ _ ................... Permit No. . .... �. — ` �fe.....� �l� s Issued -------------- --- �.... r at 4 i t r ! THE COMMONWEALTH OF MASSACHUSETTS l BOARD OF HEALTH TOWN OF BARNSTABLE CZer#t£tett#E of Complianve THIS' S�TQ CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) 1�S�.aI ............... .....� �. . ... ,.... o 1 � .........._.....-------------------------------------------- at has been Installed In accordance with the provisions of TI fLFS o he Z�te'E;y' onmental Code as described in the application for Disposal Works Construction Permit No. " ----...---- dated ............................---..._....._. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT ONS RUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY IDATE. j.yl........' "''.. --- -�"'....._ _............. Inspecto�..,--------- 'f ._ ........... .... ---___ _---------------------------------- - ———---s———— ————--, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.................. FEE---.....__..=....... tI11SM �. t X1.1a iih�1t It "PTlnit j Permission is hereby grantedz.----- : ./ ...... to Construct ( or � r rvi. al S , rage isposal �jy em - .. r - Street as shown on the application for Disposal Works Constructi0 mit No _ ..�a. 2...... a .-L, _ c ...... -. -------- --- h DATE........•� -•................................---•------ Board of Healt FORM 36508 HOBBS Er WARREN.INC..PUBLISHERS Z 348 .641 1 S6 Receipt for Certified Mail e No Insurance Coverage Provided UNITED STATES Do not use for International Mail PoSTAL SEINICE (See Reverse) T Sent to 9� _ Street and No. 2 co P.O.,State and ZIP Code O Q Postage 1 ry CIO $ Y V) E Certified Fee O LL Special Delivery Fee �R�stt ictttdi fSibtiveryV Fee= IfFecucn A'ea'eypttsftrrw;rrgi � to Whom&Date Delivered Return Receipt Showing to Whom, Date,and Addressee's Address TOTAL Postage &Fees Is Postmark or Date I STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AWO CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address 12 leaving the receipt attached and present the article at a post office service window or hand it to j your rural carrier(no extra charge). 03 R 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return rn address of the article,date,detach and retain the receipt,and mail the article. t 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811.,and attach it to the front of the article by means of the gummed Ca ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. C 00 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, M endorse RESTRICTED DELIVERY on the front of the article. E 0 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If LL return receipt is requested,check the applicable blocks in item 1 of Form 3811. d 6. Save this receipt and present it if you make inquiry. 105603-93-B-0218 SENDER: I also wish to receive the y • Complete items 1 and/or 2 for additional services. d • Complete items 3,and 4a&b. following services (for an extra • Print your name and address on the reverse of this form so that we can fee): 3 > return this card to you. • Attach this form to the front of the mailpiece,or on the'back if space 1. ❑ Addressee's Address H does not permit. �_ • Write"Return Receipt Requested"on the mailpiece below the article number. a_2. Restricted Delivery y • The Return Receipt will show to whom the article was delivered and the date o delivered. Consult postmaster for fee. I I Cr 3. Article Addressed to: 4a. Article Number tv 1 " a 4b. Service ype o El Registered El Insured a= I y ' M Certified El COD E W x ress Mail ❑ Return Receipt for p� Merchandise o to of-Deliv y .� a �5 0i 5. Signature (Addressee) B. Addre ee's Address(Only if requested x and fee is pai ) w Uj 6. i ature IAgen ~ ` 0 PS Form 3F411, December 1991 *U.S_GPO:1883--352-714 DOMESTIC RETURN RECEIPT UNITED STATES POSTAL SERVICE Official Business PENALTY FOR PRIVATE USE TO AVOID PAYMENT US MAIL I OF POSTAGE, $300 Y I I I � I � I Print your name, address and ZIP Code here Board Of Hea ` " a•w I Town Of P.O.BOXSN Hyannis. I i ow Town of Barnstable • wtxsreets, t Department of Health, Safety, and Environmental Services 039. ��� Health Division 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean FAX: 508-775-3344 Director of Public Health May 31, 1995 TO: George Beale 40 Bamard Road Osterville, MA 02655 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE,TITLE 5. The septic system owned by you located at 40 Barnard Road, Osterville was inspected on May 5, 1995 by Lawrence Ellis a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Piping in poor condition. • Signs of hydraulic failure in cesspools. (Two feet of sludge in bottom of cesspool You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of receipt of this notice. i . You are also directed to bring the septic system into compliance within thirty (30) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER QFTHE BOARD OF HEALTH Me Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health l ASSES _, - - - ASSESSORS MAP NO:. -- PARCEL NO: ®� 2 I [Installer letter] ate M e4 TO: t( (Date) v►G aC �T41� ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at C7 was inspected on (Y'O Sys by t ce EW& a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00)due to the following: 10, Soln I�n pobf �c7n�cD1 You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of receipt of this notice. You are also directed to bring the septic system into compliance within thirty (30) days of receipt.of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health Town of Barnstable TOWN OF BARNSTABLE f LOCATION ffX12,l(X/�j� SEWAGE # VILLAGE QS-1Z-1Z /�,p� ASSESSOR'S MAP LOT I NAME 6z PHONE NO. Z I SEPTIC TANK CAPACITY5���'�' LEACHING FACILITYAtype) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: � ��-"S` SCDATE COMI LIANCE ISSUED: VARIANCE GRANTED: Yes No �:r �3 'a�� � ! �� (�iS�� 6 r 1-k�v�� � �'iU� i I �, i I �J ' � � �� k - V CAM b�� c_et��n S vti '�,�,0, zs ASSESSORSMApN a /16 J - 7 ._l 6 PARCEL N r` t, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address of property Owner's name Date of Inspection PART A CHECKLIST Check if the following have 'been done: dumping information was requested of the owner, occupant, and Board of Health. -None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of 'this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. y The facility or dwelling was inspected for signs of sewage back-up. The site was inspected for signs of breakout. pt All system components, excluding the Sig have been located on the site. The septic tank manholes were uncovered..; opened, and the' interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. i� The size and location of the SAc' on the site has been determined based on existing information or a priroximated by non-intrusive..methods. -The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of SSDS. ,:; .t ,T SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART B SYSTEM INFORMATION FLOW CONDITIONS If residential . ,2 _ number of bedrooms Q number of current resident; garbage grinder, yes or no laundry connected to system, yes or no seasonal use, yes or no If nonresidential , calculated flow: . Water meter readings, if available : . �-- •� Lit:h� 4%.��.5' Last date of occupancy L/ GENERA:F- INFORMATION Pumping records and source' of information: it System pumped as part o!':- inspection, yes or no if yes, volume pumped Reason for pumping: Type Of system Septic tank/distribution box/s'u'-i1 absorption system Single cesspool i/ Overflow cesspool Privy Shared system (yes or no) ( if yes, attach previous inspection records, if any) Oth er ex ( rlain) Approximate age of all components. )ar-e installed if known.nown. Source of 64D Sewage odors detected when arriving at the site, yes or- no t 1C SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS).: (locate on site plan, if possible ; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type leaching pits and number leaching chambers and number leaching galleries and number ; leaching trenches, number, length leaching fields, number, dimensions overflow cesspool , number Comments: (note condition of soil , signs of hydraulic failure, level of ponding, condition of vegetation, recommendations foi maintenance or repairs,etc. ) —iLS1V G�i• �/ /!07 is 7`i1ilc 2'' Si " �" - l/ /n/ ;�i/ S Y'c i' a , 7— CESSPOOLS (locate on site plan) : number and configuration depth-top of liquid to inlet invert: 1r depth of solids layer depth of scum layer �� rr,;•:; dimensions of cesspool materials of construction -.r-- �c.� indication of groundwater inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil , signs of hydraulic failure, level 'of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) '> r .h sS ��fT IL;.I4 t— !'?/!J I�G%"7'�:+? / /rr. C •.] ) ._ +�.y 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, recommendations for maintenance Or repairs,etc. ) 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION 'FORM 6 PART B SYSTEM INFORMATION continued SEPTIC TANK:44Z4. (locate on. site plan) depth .below grade: material of .construction: ___concrete metal FRP other(explain) dimensions sludge depth distance from top of sludge to bottom of outlet tee or baffle scum thickness distance from top of scum to top of outlet tee or baffle distance from bottom of scum to bottom of outlet tee or baffle Comments: (recommendation for pumping, condition of inlet. and outlet tees or baffles, depth of liquid level in relation tr, outlet invert, structural inte rit evidence of .leakage, recommendations for repairs, etc. ) g y, DISTRIBUTION BOX: /1,4 (locate on site plan) depth of liquid level above outlet invert Comments: (note- if level and distribution is equal , evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc. ) -- PUMP CHAMBER: 41 (locate on site plan) =t Pumps in working order, yes or no Comments: (note condition of pump chamber, condition of and pumps appurtenances, recommendations for maintenance or rE:pairs, etc. ) . i 12 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA { Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances. If "not determined" , explain why not) _ Backup of sewage into facility? ,F Discharge or `` t g ponding of effluent. to the surface of the ground or surface waters? Static liquid level in the distribution box above outlet invert? _1V Liquid depth in cesspool <6" below invert or available volume< 1/2 day flow? A/ — Required pumping 4 times or more in the'' last year? number of times pumped { -AVZ . Septic .tank is metal? cracked? structurlally unsound? substantial infiltration? substantial exfltration? tank failure imminent? Is an r"' y portion of the SAS , cesspool or privy: _ below the high groundwater elevation? _� within 50 feet of a surface water? - within . 100 feet of a surface wafer suppi` water supply? y or tributary to a surface within a Zone I of a public well? Al within 50 feet of a bordering ,Ve,getatediwetland or salt marsh (cesspools and privies only, not the SAS) ? within 50 feet of a private water supply well? less than 100 feet but greater than 50 feet from a private-- wit supply well with no acceptable�,water quality analysis? If the wellhas been analyzed to be: acceptable, attach co PY of well for coliform bacteria, volatile c;!rganic compounds, ammoniater nitrogensis and nitrate nitrogen. 5 1 _ 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORD PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references locate all wells within loop landmarks or benchmarks F 1.J' Cie i DEPTH TO GROUNDWATER depth to* groundwater groundwater. method of determination or approxima.': on: -- -------------- t f1 1 1 13 i • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector Company Name d=.lL_ Company Address Certification Statement I certify that I have personally inspected the sewage disposal system at this -address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade , maintenance and repair are consistent with my training and expo-ience in. the proper function and maiitenance of on-site sewage disposal systens. Check one: I have not found any information which indicates that the system fails to adequately protect public health or 11�he environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in he FAILURE CRITERIA section of this fom. I have determined that -Lhe system fails to protect public health and the environment as defined in ,?3.0 CMR 1_.r>. 303 . The basis for this determination is provided in tlle FAILURE: CRITERIA section of this form: Inspector' s Signature � � r Date Original to system owner Copies to: I Buyer (if applicable) Approving authority E . f I S-01/2" t 2'-9 1 3'-11" 1'-9` 2'-1" t5'-Y n'-B' BILCO C 1/. '-t 1 2 B SEMEN?A9CE55 MASTER Y BATH FAMILY ROOM BATH MASTER BEDROOM )I � T " E r Y-6" 5-6 1/2" E q}j ( SIES REF ___ DEC i KITCHEN 07b . 0101 UVING ROOM I € E E 12'-2 1/2" 3'UP 3'-6" 2'-7" -B" 6' g CE DININGVENT .... AREA _ . ry E0. E0. E0. E0. 19' tt 1�4 Y A If T -7 s k o,vetv c J � 53 TWO CAR GARAGE .,,. 5 6 e 2! Bagley-Heath Residence FIRST FLOOR PLAN Indesi gn LLC Osterville MA SCALE: 1/8" = V-0" December 2, 2006 c G�. 3'-0 1/2" 2'-9" 3'-3 1/2" V_9" 2'-3" 2'-6 1/2" I sib 5 ,,, s;," SAFETY GLASS ' M O I BASEMENT ACCESS -1 1 2 BILCO 'C" y MASTER 3' FAMILY ROOM BATH y BATH x 1 ,1 16'-6" MASTER BEDROOM po O o I E ilk,,, f�f a)3f. '$�x Ste+1 .,.D..,._n s' .��T..., ':€.� �. .,;�:i,.�•&�'.�£�. �'�G`, - £� fd.�aC`;Ye I £ € 5-8 1/2" € j9 jj jj i� • s I � a j � € � 1 1 11 a � i € f y a £ € 1 DN € REF N ;DECK I i i `. .. KITCHEN O E i } O� \ i 3'-6" f LIVING ROOM , ,. } i 3€ f .;.ass. ..,. .-- i 2'-9" W 3 t I ! i 12-2 1/2" 3'-5" 2'-7" 3'-9" 5' ( I GAS Q � � FIREPLACE DINING � "�-���"��"��� DIRECTVENT AREA _ . N .3 ...._....N.............m......,....._.._......:..,......._..._....m...m......._,....,,w�. ._.. . .. ..... .._ .._�. El EQ. EQ. EQ. EQ. 18• _ ..,.5 ..._." .._.._. Bagley-Heath Residence FIRST FLOOR PLAN Indesi gn LLC Osterville MA SCALE: 1/4"= V-0" December 2, 2006 _...v _._. ....�._._ .. __....�.._.,w.....v _ . .___ __ ._�.._.. �.. ......� 6'-4 1/2" 6'-4 1/2" iv f k k N Lo I V�'D- Or Loy w i BATH BATH }— .,,,r,r �-3a ,. �..� �3IY #3 ,nk•. `3Y I � a., 3' 3' \ d 00 D '� . 8 Q t H W W Uhl —9 1/2" 3'-1 1/2" 6'-3 1/2" BEDROOM 4 k , DN o i Ci ro s w e BEDROOM 2 + i Co BEDROOM 3 aft, �'.�� s� ,,�"•fit*`:?�,', f,e .h':ii 6 -6 6 -6 3 Bagley-Heath Residence SECOND FLOOR PLAN Indesi gn LLC Osterville MA SCALE: 1/4" = 1'-0" December 2, 2006 FAMILY ROOM 16'-6" f , E _ — 3'�6 5 E y [( a 3 , i E E S £ E I I DECK f Ln [ + { E E E # 5 f TWO CAR GARAGE i E ^^y3 __ _..... ... .._.... _........... .... ..... ... ...... ..._. _ .. i j _ ., _.....___..-. _..,.._.,_.. .._...._... .............._ - ...,....... .... ._...._ ._..,.... _ - 18' S _. ._. 00 �n a ...... ....... a o 5' 5' ,.. m 24' „ssE�:.._...�. K, :: "'T"K w>n Via. Bagley-Heath Residence GARAGE AND DECK PLAN Indesi gn' LLC N Osterville MA SCALE: 1/4" = V-0" December 2, 2006 4%' 6'-3.. 17'-3" 6'-3" C 4 I I 6' 8'-3 5/16" 7'-7 5/16" 7'-7 5/16" 7'-7 5/16" 7'-7 5/16" 8'-3 5/16" I m (3) LVL 1.8 � 1-3/ .. x 11L7/8,. Co ZZM I ON BIG t TYP. J 8. / — 00 _-.. ,- 2' 6=3' =:.a, 1,..._......._..... (3) 2 ..X..B. .PT.I...__i — 5'-4 1/2" 4'-10 1/2.. 12'-6' — 3" 7' 7' — Bagley-Heath Residence FOUNDATION PLAN Indesi gn LLC Osterville MA SCALE: 1/4" = 1'-0" December 2, 2006 -- - 8-s K, 6' / N r � I 24' +4 X Ln 10" CONC. PIERS ON BIGFOOT BF28 F'TG. MIN. 4' BELOW GRADE TYP. i I I .. I N �. - 5-4 1/2" 4'-10 1/2" 5" 3Lo .. I , Bagley-Heath Resi'dence� GARAGE FOUNDATION AND DECK PIER PLAN Indesi gn LLC Osterville MA SCALE: 1/4" = 1'-0" December 2, 2006 ' � I (z)iK s.o[1-3/1- z n-z/s• — — _M........._......._...............____....-_._.._._.. _.., __............_._...__........._,......._........__.__................_ J r a I I I - s A ,"ll ox N L N e tz•o.c } i t 2"X10" PT FLOOR JOISTS / 0 16" O.C. i I ON BIGFOOT 131`28 FTG. MIN. 4' BELOW GRADE IYP GARAGE 2ND FLOOR FRAME I N \ j � 11110' e ! 1 0- E X .I 2 X8p1, I: _....... i Et "1 }4 zxto' xurzx i 1><to' wsrm I i e ts•oc o Is•oc 1 Co I Co I € N N N I N I i e �.. .........................................W.....,......... ...�......,...... I - j ' I� i jPP GARAGE ROOF DECK FRAME Bagley-Heath . Residence FRAMING PLANS SCALE: 1/4" = 11-0" Indesi gn LLC Osterville MA SCALE: 1/8" = V-0" December 2, 2006 - - - - - - - - - - - - - - - - - - - -- - - - - -- - - - - - -111111111TFFIII III � I I OMMOMW I I I-/xu•�n z ancc raa b I 5 4 S e n I I I I • � I � I— I � — � I- - I � I ne I S/xi in a woc va[ I to - = I I I ,o I � I — -- L= (]J„�.X 8,,,.PT.v. OSB 1-1 9 X 11-)O TOY JOIST — ROOF FRAMING PLAN SECOND FLOOR FRAMING PLAN - 50 I-/a.Ia'LK war auc 1, 1- a.l a-K L FOICE b o re - � 1 3/4.1 In O ROE POIE p5 1 1 -4-4� 1=1=:E=H 11 TMi I I I I I I 1 o b b 3e FIRST FLOOR FRAMING PLAN GARAGE ROOF Bagley-Heath Residence FRAMING PLANS Indesign LLC Osterville MA SCALE: 1/8"= V-0" December 2, 2006 9� TYPICAL ROOF (� CONSTRUCTION 141 \ CONT. RIDGE VENT. ITS\ ROOF SHINGLES ARCH. 30YR ASPHALT 15 # FELT PAPER 1/2" CDX PLYWOOD RAFTER VENTS $ " �_ _ t s 3 �a 2" X 10" WOOD i� �- —,__ T�� } 2X10 16 O C _ - �. . �' ._ _ x_'._ �__2X8 16_ O.C.: �' _, ,� '_��f t RAFTERS � 16' O.C. � a CONTINUOUS SOFFIT VENT ' 2"X 10" CEILING JOISTS (PER FRAMING PLAN) 9" KRAFT FACED INSULATION R30 MIN. INSULATION BAY VENTS (INSULATED RAFTERS) �F 1"X3" STRAPPING TYPICAL ` ' 1/2" GYP BLUE BRD/ SKIMCOAT PLASTER CONSTRUCTION {; 00 CONT. SOFFIT VENT. CONT. RIDGE VENT. ; ARCH 30 YR ASPHALT ROOF SHINGLES 15 # FELT PAPER VB TYPICAL EXTERIOR 1/2" COX PLYWOOD + WALL CONSTRUCTION CONTINOUS RIDGE VENT CEDAR SHINGLE SIDEWALL 2" X 10" WOOD TYVEK OR SIMILAR RAFTERS ®.16' O.C. , - LPI 32W 11-7/8" 1/2" cDx PLYWD SHEATHING 2" X 8' WOOD f� � LPI 32W 11-7/8 12 O.C. r 2"X 4" WD STUDS COLLAR TIES " _ 8 ® 16" O.C. CONTINUOUS SOFFIT VENT 3" KRAFT FACED INSUL R13 MIN W/VB 2"X 8" CEILING JOISTS ON THE WARM SIDE 1"X3" STRAPPING 1 X4 STRAPPING 1/2" GYP BLUE BRD/ SKIMCOAT PLASTER TYPICAL FLOOR TYPICAL EXTERIOR CONSTRUCTION WALL CONSTRUCTION MAIN HOUSE 3/4" OAK STRIP FLOORING CEDAR SHINGLE L EXISTING 3/4" T&G PLYWOOD TO MATCH EXISTING SUUBFLOOR GLUED TYVEK OR SIMILAR GARAGE 11 7/8" TJI FLOOR JOIST (PER PLAN) 1/2" CDX PLYWD SHEATHING © 16 O.C. 2"X 4" WD STUDS TYPICAL FOUNDATION 916" O.C. CONSTRUCTION 2"X6" PT SILL SPACED PER CODE LPI 32W 11-7/8 � W/1/2" ANCHOR BOLTS TYPICAL FLOOR SILL SEAL CONSTRUCTION (3) 1 3/4X11 1/2" LVL 2.0E LP (SEE FRAME PLAN) 8" POURED CONCRETE WAIL — W/ 10" x 22" POURED 4" 3000 PSI CONCRETE SLAB ON COMPACTED SOIL Inp- CONCRETE FOOTING 3 1/2" STEEL/CONC LALLY COLUMN 2" R10 CLOSED CELL RIGID INSULATION 2"X6 PT SIL ` 1 Tl: s SPACED PER CODE FOUNDATION-AND FOOTING EXTENDING BELOW FROSTLINE AS REQUIRED W/1/2" ANCHOR BOLTS!EEO ^ 8" POURED CONCRETE WALL 1 W/ 10" x 22" POURE ly 4" 3000 PSI CONCRETE SLAB CONCRETE FOOTIN 6 MIL POLY V.B. i ON COMPACTED SOIL a`I FOUNDATION AND FOOTIN o EXTENDING BELOW FROSTLINE AS REQUIRE IA PER CODE Bagl ey-Heath _e'si ence o BUILDING SECTIONS Indesi gn LLC Osterville MA SCALE: 1/4" = 1'-0" December 2, 2006 ,•� i � .TA wi LIL EIE FIT \� _ ❑❑ �._ jI ..... =H9 �_�g ( L I .. . ,/- 9 j ' s.. � ._E.I z £ ! E E £ E £ i l _L, _ 1 i e i. I f f I '�( I I f lI I f I t € i T ! I � , 4 f €. ! 1. £ i s f M - € . .a. ' ... ... t .. '.:......i.._....., x.. i. ...... .: ....... .. .... ] : 2 ' - ,! ,.£..>. "'4 "Y P Y" `Y'""'Y _-Y 1' 'Tg..._ 'T Y T_�-J Bagley-Heath Residence GARAGE ELEVATIONS Indesi gn LLC Osterville MA SCALE: 1/4" = V-0" December 2, 2006 /L i I ` \ .:... ; /� - "� p�... 0 I ...s.. ....3 IT s j e t / € i' F #1 IIj — ----- -- w„ fE 1 1 f �. .. , l._ _ _ E E I i €.L.} s .,,` .., p,.r. ... .�.......�...i.,..4 �.,,,,8..e..f ..' „.. .we�.y ..,.:...I,...L.I t ,1 I I `� ,I 1.....�ro..L.. - <•y.. ..�.....:.„w.a.. .A ' -«-u...a. «.. .-,b... .,,.,.L ` I f - I �. rr jj' '`j] ��6 ..i...... z...� I...L. Fi...g�TNmfµY?^� .3. _�,� t .n..q 4„y,..d.,:...�..ro,.,w.,.v,.. ..'... 1,.»,.....».. S.,.i ,w... ,.. _ -,,.1...., „ .,.;::.... „ ^ 6��...5,. ,,.A-erW..a ..:,. 1 _.l I € _. i. .�� € r "L _ r z-- i 3 ( £ 3 I F ' f r Bagley-Heath Residence GARAGE ELEVATIONS Indesi gn LLC Osterville MA SCALE: 1/4"= V-0" December 2, 2006 .._.... I TA_ ........... I =� I. ❑ ,. I ❑ i ❑ I - ❑; � I . ❑ is ❑ I — � � it I I Ij l s IF 7� — -- T T l [.. I I f ._ � JOE� E II ILL _ ❑ JULL E �...I � .....� ❑ ❑El ;: I E .11 1111111_ 1I[I 11l ff I l ---- — .� I I .€.�.❑ — - — I E I.._ ..... I �s.:.. .�... .. �. _.. . .. . , ... I a._.. ...� _ .�.. E 2 E� t Bagley-Heath Residence EAST ELEVATION Indesi gn LLC Osterville MA SCALE: 1/4"= 1'-0" December 2, 2006 11 H LIE I I T:: I ❑ T ",'J", =1E� I❑�❑..�.?... _ _ri 1.._: T ..,��� �_.£,i--_J...-,..,-]III IIIIb,.. .L(^m-7dg€. ,...yi�,_.r,❑...___...�.,_�1�ll ; [yK....._..�i... '.L�jy. .....,I., ..y....�.. }(L.,,...yFj ...,,g........__ .Ly} ,..A,._...m.. r`�__� w�wi , £ _1. „„. _ .-. x t I ,,. . £ ,. ❑ -J -'r- H-'.-y--r p i .. '-`y-'- =-€" L '-`"` ". ...._i-.,�.1❑w L- -.-J .;�... _.._ _.. , ._ :., ._,•_. __. L 1 _ I 3 i 7 � ...il— j S £ -�� -,-_.., ... $ £ 1 1 f E ^p^ M„wW f e �- -� � �� �w �. x� __t. a _❑�. —_ . ❑1=^3.. ,_ ., .,. -- � , J _ 1 . _, ,_ m om. Bagley-Heath Residence WEST ELEVATION Indesi gn LLC Osterville MA SCALE: 1/4" = V-0" December 2, 2006 / \� i i \ / 71 L.1 / \ .+..,...d..., . , L / Z .a t,J . 17 JV � /, �: I .,E ,, L \\v� _I �' E ... TJ _ .,. , I I Z �� � �� A� i .. m E 3 „J 5.... I r` E £ 3 3'(�' �_ 1 _l ' LL ^--�--y^ r -ll %„ � n.. .... E q"'--3 ^- 7_T3 S i .k .1 _x..._ __ _..s.....� E _F<. ,;,a 1�.. .1 _} 7 - f L 1 L�QI I T I. 'IE ICI l' t . I < 1 ( I 1 ' E xI 3 I ;, I 11 I .I 1 _!I ' W' I_ a1 : I MU, . �' 1 FT T-0 � IiI� 1TT 11 E a .�..,.�...,..} ..5..., .2�,,..M,.. 715 ..z.I ....w. <-. _ _ t m h .,��I _ TE �. a._: .._x 1 Bagley-Heath Residence NORTH ELEVATION Indesi gn LLC OkervMe MA SCALE: 1A"= 00" December 2, 2006 3 FT i.f....z. Y...Y...Y.1. d t_.� 3t ,_. � T s I i � f .., ...e,..,,-1- .. L...t.�- T1. ... d h f 5 r,,...£... ..j.,..# ....w f jV Y W � g W L I I� W 1 ` J L i11 ` a. f ., FALSE CHIMNEY a� f.� r1 WOOD FRAME E W/ RIVERROCK VENEER _I � ._ .—..a. 31 3 ^"""Y 'T _� 'Y Y' ......p_....�.....,i.I Y• y"_y�__ ,Y"'�_� �.�F"""��'T f _f Y _ a..Y� Y.......p ............................�...m.......,,.„.....,.......r.....,...„. __�""'3' Bagley-Heath Residence SOUTH ELEVATION Indesi gn LLC Osterville MA SCALE: 1/4" = V-0" December 2, 2006 FIN. FLOOR ELEV 32 5' � a� � t � 1L. ...fL � o� JL Vi ceE� Vv- Finish Grade EL 31.5't 6 6» Finish Grade El. 3i.5 1/8 to 1/2" Washed Stone @ 3" Thick /! 1l !//f//! // 1llflflff Itfff f fi 6"I t t lttltr INV EL RISER 28 g5' O'Dia. 0Via. Finish Grade El. 31.2.k RISER ' .._ _I 'RISER ! 8.5 (2) Alin. 6" GEC.=1© C=r= 10'Aam 14" Alin. INV EL sump INV EL INV EL -_ �- INV EL 27 85' �--- ---11'- - INV EL Q�� m.m.� � �, � • •..a.• El. �5.37' 28 55, Below Flow Line 28.05' 27 37' 28.30' •'6" Stone .. 3/4"' - 1 1/2" Washed Stone Liquid Level 48" '•' 34" Pe4 24"' 2 75' 2.75' H2O LOAD DISTRIBUTION BOX '. 3..25' .-58 -1 Design Da ta: t 48" ------ 1500 GALLON SEPTIC TANK - H10 LOADING Five Bedroom 5 X 110 gpd = 550 gpd Required Row Number of Trenches - 1 PROPOSED LEACH TRENCH Number of Chambers - 5 No Garbage Disposal Allowed 1500 GALLON REINFORCED CONCRETE SEPTIC TANK Use: Chamber Trench 481 x 11'W x 2' Eff De th PROPOSED LEACH TRENCH - END VIEW N. TS: P Minimum Construction Materials Per 310CMR 15.226(2) Install Five 500 Gallon Units -- H2O Loading Bottom of Deep Observation Hole El. 20.0' Tees shall be constructed of Schedule 40 PVC and shall extend a f48 f 48' + 11 f 11J x 2.0 = 236 with 3.25 Feet of Stone at Sides minimum of 6" above the flow line of the septic tank and be on 48' x 11' = 528 and 2 75' of stone at ends. p High Ground Water <Elev 15, (GIS Topography) the centerline of the septic tank located directly under the 764 x 0. 74 = 565 GPD Total Design Flow clean-out manhole. PRECAST REINFORCED CONCRETE DISTRIBUTION BOX The inlet pipe elevation shall be no less than 2" nor more than 3" Install on a level base above the invert elevation of the outlet pipe. Minimum wall thickness = 2" Septic tank shall be installed level and true to grade on a level, Minimum inside dimension = 12' OSTERVILLE stable base that has been mechanically compacted and on which Outlet inverts shall be equal to each other and at 6" of crushed stone has been placed to ensure stability and minimum below inlet invert. EAST to prevent settling A. -''"r The distribution lines from the distribution box shall all have �r 8AY Septic tank shall have a minimum cover of 9" PAR 183 equal inverts as determined by flooding the distribution box too Two 20" manholes with readily removable impermeable covers g LOCUS 32.8' the height of the distribution line invert after all lines have b 9� of durable material shall be provided with access ports. as,35 X been sealed in place 10 Invert adjustments shall be made by filling with durable and NEc The outlet tee shall be equipped with a gas baffle. A.M. 140 Q PAR 187 �35„� nondeformable material permanently fastened to the line or POND V N-75 26 �--'' reconstructing the lines until all inverts are of equal elevation. ' 30.8' EMOVE 26' REDS .�,/�� _ \ X `C` GENERAL CONSTRUCTION NOTES LOT 23 3V p- �r�.w AAt 139 24' t{r'� Stri out Note. SEA VIEW NASOUNDET 1. All the workmanship and .materials shall conform to D.E.P Title 5 PAR 032 31 PGARA -_ es; Remove all unsuitable material 5' around SAS down to the "C" and the Town of Barnstable rules and regulations for the subsurface A�'BA=i5t58?f sP. G\��` � �� �cr\ layer and replace .with clean disposal of sewage. 30 A 2 At least one access port over tank tees shall be accessible ��.� within 6" of finish grade, with an remaining access ports brought 18 FEAfA Data: g Y g" P g to within 6" of finish grade. REMOVE Y p ; �qil :%"� �1 \ Zone 'C" - Outside 500 Yr. Flood 3. All components of the sanitary system shall be capable of EXISTING ✓ P FIRM Panel. 250001-0016-D withstanding H-10 loading unless they are under or within 10 ft SEPTIC �\ pF�� Map Revs July 2, 1992 of drives or parking H 20 loading shall be used under or within �' p 1 l Fcs Reference Plan:N ED L C. 7685F 10 ft of drives or parking unless noted Plastic equals may be av'. - 32 C,- F-L-E used in lieu of all precast units. �� / 32 2 ' __ 32 -- EXISTING CONTOUR PROPOSED BUILDING COVERAGE. 18.6 4. The excavator contractor shall call di safe and verify the location u' ELEVATION RATUAf G.IS t/ g' y py � 32 ` � \ ' 32 PROPOSED CONTOUR of all site utilities prior to any excavation, and shall be responsible for \, PROPOSED SAS PARCEL ID. 139-032 all matters relating to electric easements. 17' 31 \ CHAMBER TRENCH ____W __._ PROPOSED WATER \\ � \ � REFERENCE DEED CTF,#137507 5. Sewer pipes shall be 4" Schedule 40 PVC laid at a min. 0 02 slope. \ Ew-- EXISTING WATER 6. Any masonry units used to bring covers to grade shall be \ .> ZONING DISTRICT RF-1" mortared in place. 30 PROPOSED 32.8' SPOT ELEV. OVERLAY DISTRICT 7. Finish grade shall have a minimum sloe of 0.02 ft DwEu IN � � � � 3 LOT 14 g p per foot. .201 `` � � � \ •'� A.M. 139 X AP AND RPOD 8. Pump and remove old septic system. Dye 4T � � \ \ W PAR. 033 LOCUS ADDRESS:\ y\ 10� , <9, The excavator/contractor shall be responsible to check all grades 30.86 \ EXISTING 40 BARNARD ROAD OSTERVILLE and elevations and to contact Doyle Associates of any discepancies, GRAVEL DRIVE BUILDING SETBACKS.• prior to construction. LOT 24 / �- � \ oo \ - FRONT 30' SIDE & REAR 15' I6. \ 10. . The excavator/contractor shall be responsible to contact A.M 139 OPAR o31 � o \ � 1a° �� Doyle Associates 24 hour's prior to any required inspections. 31 \ ��0 11x �,1-TE PLAI - O�F �,AN� �/ �,tN OF s RAZE W ho ` -01 \ �'� 3Y1� ��� C14RISTINIE s11, Prepared For EXISTING W 40 ROAD ]��DWELLING W _- ��Sp.� k�� t' No. 926 Y' y H1 W �1 D VHlJ Health Agent Don Desrxlairis 33' 00 „ / �31 'f h ell - In Test Date: 11-22-06 6.{ t4�Q/ t sANiTARtia VS tE'r'VZl[E', 1Vl G�,J.J C�G'll Z.�.s�'t tS� Soil Evaluator. S. Doyle N ''� ��ROpO 4 N� Y EL. 32.o' Scale: 1" = 20' Date.• December 2, 2008 TH #1 TH #2 EL. 32.0' TH #3 EL. 31.5' TH #4 EL. 31.0 cEgN 5E PERC <2 MIN/INCH PERC <2 MIN/INCH PERC <2 MIN/INCH PERC <2 MIN/INCH of�� ►�'A"��44� Prepared By. 0" 0., 0.. 0,. gp�� rr✓✓ �r 4a`�H ar r�rtis� �r Stephen J. Boyle and Associates a) 1A A A A 31� .- ' �aQ��,�S cq cy 42 Canterbury .Lane, E Falmouth, MA 02538 SL 10YR 3/2 _ SL 10YR 3/2 SL 10YR 3/2 SL IOYR 3/2 13 '� o STEPHEN ` r Telephone.' 508/540-2534 6" \ >1 0 6" 6" 6 c� J. cn p - o c BM- C/BASIN RIM DOYLE y �' CJ'3 Z G'> `.� �' Z C7 C _k B LS 10YR 4/6 B LS 1 OYR 4/6 B LS 1 OYR 4/6 B LS 10YR 4 6 4 "315a9 - - / EIEV. 30.24 EL. 29.0' 36" EL. 29.0' 36" EL. 28.5' 36" EL. 28.0' 36" DATUM: GIS �►s 1.` S �y0� 1 v > 0 0 GRAPHIC 7�LTT A SURD PERC 65" o aEi C PERC 60" M FINE O PERC 60" V'1�A HIC SCALE C MED. TO `� MED. TO C MED. TO C ii_-`` FINE FINE FINE _ 20 p to 20 40 o SAND C SAND SAND 84" 2.5Y 6/4 (Z���a 2.5Y 6/4 0° p 2.5Y 6/4 2.5Y 6/4 s mottle 5va 5/6 E FLO86: 120" °o ci 1 132" 132" 132" {NO WATER ENCOUNTERED NO WATER ENCOUNTERED NO WATER ENCOUNTERED NO WATER ENCOUNTERED IN FEET �EL. 21.0' EL. 21.0' EL. 20.5 EL. 20.0' 1 inch = 20 ft. NO. DATE DESCRIPTION BY High Ground Water <Ele v. 15' (GIS Topography) b .a' i �f, ... 1'x. „R -,. �: .. d.,, $! : .W " - WA BENCHMARK TOP OF FOUNDATION ----- --___—_ _---_ 20 FT. MINIMUM SOIL TEST ELEV. = 10 FT. MINIMUM DATE OF SOIL TEST CLEAN SAND SOIL TEST DONE BY (ASSUMED) - -------- CONCRETE WITNESSED BY COVERS 4" SCHEDULE 40 PVC PIPE OBSERVATION HOLE 1 OBSERVATION HOLE 2 MIN. PITCH 1/8" PER FT. 2" LAYER OF ELEV.- PERCOLATION RATE /INCH. ELEV.- PERCOLATION RATE 1/8" TO 1/2" DEPTH HORIZON TEXTURE COLOR MOTTIJNG OTHER DEPTH HORIZON TEXTURE COLOR MOTn.ING 4" CAST IRON PIPE 6 MAX. WASHED STONE ; VENT i (OR EQUAL) MINIMUM �_ I ! PITCH 1/4" PER FT. i h 1 CU. FT. OF - CONCRETE _FLOW LINE 10 � ELEV. _ -TMIN. 19" o . n o 0 0 o jr-3 :M r� r3 c3 o ci 12" a L • • ° ELEV. _ ELEV. ELEV. ffi 6" SUM ELEV. _ 41 00 ° • ° o ° ° ° • • " ° DISTRIBUTION . • . ° ° ELEV. _ ° ELEV. _ _ (TO BE PLACED ON FIRM BASE) BOX TO BE WATER TESTED T 1500 GALLON IF MORE THAN ONE OUTLET SEPTIC TANK j WELL WATER ENCOUNTERED AT ELEV. _ _ _ WATER ENCOUNTERED AT ELEV.ZONE _ 3/4" TO 1 1/2 INDEX WASHED STONE ADJUST LEGEND: DESIGN CALCULATIONS BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE ELEV. - EXISTING SPOT ELEVATION NUMBER OF BEDROOMS SEWAGE DISPOSAL SYSTEM PROFILE OBSERVED WATER TABLE ( / / ) ELEV. a NOT TO SCALE EXISTING CONTOUR ----00---- GARBAGE DISPOSAL UNIT FINAL SPOT ELEVATION TOTAL ESTIMATED FLOW FINAL CONTOUR (—GAL/BR./DAY X BR.) GAL/DAY d SOIL TEST LOCATION REQUIRED SEPTIC TANK CAPACITY _ GAL- UTILITY POLE -O- ACTUAL SIZE OF SEPTIC TANK GAL TOWN WATER —W W■- _ EFFLUENT LOADING RATE GAL./DAY/S.F. CATCH BASIN `�� LEACHING AREA SO. FT. GAS LINE G "' LEACHING CAPACITY (AREA X RATE) GAL/DAY ^� RESERVE LEACHING CAPACITY GAL./DAY ' NOTES: 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. TITLE 5 AND THE OF RULES REGULATIONS FOR TOWN THESUBSURFACE DISPOSAL OF SEWAGE.D " 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN 6" OF FINISHED GRADE. ` 1 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF ' V WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN w 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. 1 " 4. ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL BE MORTARED IN PLACE. 5. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTk=TY. 6 S UTILITIES TO CALL "DIG-SAFE*AT 1 800-322E APPROXIMATE L 484-4 AT LEAST 72 HOURS PRIOR TO COMMENCING WORK N SITE. '. 7. CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WSLL AS STE 8. PARC£LN SCODI IN FLOOD ZONE PRIOR TO COMMENCING WORK ONSITE. 9. LOT IS SHOWN N ASSESSORS MAP _. .._ AS PARCEL J c}r -.4 APPROVED: BOARD OF HEALTH M, _sue 1t •.7'P � � p ,�] l.) DATE AGENT PROPOSED PLOT PLAN r' FOR PROJECT LOCATION SWEETSER ENGINEERING 235 GREAT WESTERN ROAD •, ,,.-'" 508- SOUTH DENNIS MASS. 398-3922 02660 t l ., SCALE 1 H DATE � REVISED REVISED a LOCATION* MAP '1OB N0 ^ SHEET ` OF 01998 SWuTm �+ 1�