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0040 BAYBERRY WAY - Health
40 Bayberry Way Osterville P A =.114 070 b 1I� r ( Civ V No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppliLation for Misposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(0)/Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. tyv /br,a y Owner's Name,Address,and Tel.No. CaS•ftyv:))-e. I Assessor's Map/Parcel r/070nnlC� Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms q Lot Size JWIR sq.ft. Garbage Grinder( ) Other Type of Building 4f5�1-J/-iu/ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) V"10 gpd Design flow provided gpd Plan Date f A cy6 Number of sheets I- Revision Date Title Size of Septic Tank /S-a'y l/--:2U Type of S.A.S.��'�a✓� ;� ��i1GM /� Description of Soil Nature of Repairs or Alterations(Answer when applicable) /, %�f 4 /V�, S i �v� y d� q y/w✓ B�c�ti�t%� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signe Date 2-026 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued CQ — �—� No. ' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION'- TOWN OF BARNSTABLE, MASSACHUSETTS - 01pplication for Mispo$al 6pstem Construction Ve mit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No._)t /21h-o-y . j Owner's Name,Address,and Tel.No. p Assessor's Map/Parcel A/-070 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms y // Lot Size yH3716 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 415�y `/ gpd Plan Date 6 b/2 b120 Number of sheets 2 Revision Date Title Size of Septic Tank/feO ,2c,) Type of S.A.S. x,-00t5,6& -7p �lilGiL1 /S Description of Soil r Nature of Repairs or Alterations(Answer when applicable) L4411,4i 'r /s—K, -5 f ,r a.c,-) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board ofaHealth. Signe Date ;26 _ Application Approved by Date — (C) �Z U Application Disapproved by Date for the following reasons Permit No. p� CJ� Date Issued &"(o THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance - THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(( Upgraded( ) Abandoned( )by A�f��e6 x�x at � r �, �/ 17sr/a°/url f has been constructed in accordance with the provisions of Title�he for Disposal System Construction Permit No. c? dated G—'t o v Installer !),A, Designer #bedrooms t� Approved k nIn �afO gpd The issuance ofjhiis p rmit shall not be construed as a guarantee that the systemlwill ' as desig d. YI Date � (� � Inspector � •• f No.. U �� (� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstem C ustruction Permit Permission is hereby granted to Construct( ) Repair( " Upgrade( ) Abandon( ) System located at 80 -13G y keel y "y and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. R Provided:Construction must be completed within three years of the date of this permit. Date Approved by TOWN OF BARNSTABLE LOCATION C/ �� f a SEWAGE# 2-0,20 6/7/ VILLAGE os& yr/e ASSESSOR'S MAP&PARCEL j/zf-070 INSTALLER'S NAME&PHONE NO.`D Ad SEPTIC TANK CAPACITY IC LEACHING FACILITY:(type) 3�5g B)6,a ¢d uJ (size) 42 5 3.S NO.OF BEDROOMS J OWNER �rn/foti s�" PERMIT DATE: G!0 20.20 COMPLIANCE DATE: A 1'7 ? 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 Ljn � d w e� c { s r " Y !i� Town of Barnstable ra�_z000ealatorti- Services ' `1"tBAt2rSTAELE,� 'f Richard V. Scali,�inteeim .Director- RSASS y . ; Public Health Division 4pA i639. `0 rE�h41'ya Thomas YlcKean,.Direetor- 200 Main Street,Hyannis,MA 02.6011 Office: 508-862-4644 Fax.- 5.09-79076_'04 ' Installer& Designer Certification Form Date.: 1 Sewage Permit# 0•-/7/' Assessor's ii f� "" M �L— ap�Parcel (. 076 Designer: '+ _(.��r''�,t s l�a� Installer: ,� r� �� J16 � 1�c r � Address: )Z V1l Cr• s l�f JZ� Address: On 7,A.►3d wvt Iiit.E.. tams issued a permit to install a (date) (nst.aller) _ septic system at 0 13V,y lf"rf based on a design drawn by (address) C n 'ra per n y (t1 �1 , 1k _ dated ���� (designer). --- 7---�'_ t/ 1 certify that the septic system referenced above was installed: substantially.according to the design, which may include minor approved changes such as lateral.relcation of the distribution box and/or septic tank. Strip out (if required) was'it�specteiJ and the soils were found.satisfactory. I e.erti.fy that. the septic system referenced above was installed with major changes O.C.greater than 10"lateral relocation of the SAS'or anv vertical relocation of of the septic system) but i atzy component it accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out.(if required)was inspected and the soils were found.sati.stacto.rv. I certify that the system referenCedr above was constructed in with the terms of the RA approval letters (if applicable) T. Installer's Signature) two NO.35109 = O (Designer's Signature) (Affix. esi.g.ne Gk ere) PLEASE RETURN TO BARNST4.BL.E PUBLIC HEAL:TH.DIVIS.ION: CIERTIFICATE OF C0IIPLIAivCL �i ILL 1N T BI ISSLED UNTIL BOTH:' THIS FORM AND AS BUILT CARD ARC R:E:CEIVED BY 'FH.E BARNSTABL,E PUBLIC HEALTH DIVISION-. ILIA\N YOU Q ScPu v sinner C:eitificatiun Fornt Rev 3-14-13.doe Engineers note:This certification is limited to an as-built inspection of system components as installed prior to oacktill.The engineer did nbt.supervise consbuction o€'the syslern.The installer assumes responsibility for all materials,%vorkmanship,backfiAina io specitied grades with proper compaction and setting risersrcovers as sho,,n on the design plan. I Commonwealth of Massachusetts �d w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Bayberry Way (garage only Property Address .. owner Pancoast information is Owner's Name required for Osterville ✓ Ma 02655 5-20-2020 every page. Cityrrown 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. Inspector Information When filling out p 61*- forms on the computer, use Douglas A Brown only the tab key Name of Inspector to move your D.A.Brown Inc cursor-do not Company Name use the return key. P.o Box 145 Company Address Centerville Ma 02632 City/Town State Zip Code 508-420-4534 S14297 fa°O0 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5(310 CMR 15.000); 1 have personally inspected the'sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails !/ 5-20-2020 Inspoolfrrs 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts �v I Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Bayberry Way (garage only ) Property Address Owner Pancoast information is Owner's Name required for Osterville Ma 02655 5-20-2020 every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 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: Garage system only. System passed. This report can not predict the future performance under the same or increased usage. This report is for the garage only. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System j 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 FIND (Explain below): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 I Commonwealth of Massachusetts �m Title 5 Official Inspection Form I� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments t 40 Bayberry Way (garage only ) Property Address owner Pancoast information is Owner's Name required for Osterville Ma 02655 5-20-2020 every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N FIND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if. the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts �m p Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Bayberry Way (garage only) Property Address owner Pancoast information is Owner's Name required for Osterville Ma 02655 5-20-2020 every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): , ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N FIND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts rm l? Title 5 Official Inspection Form 1° Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Bayberry Way (garage only ) Property Address owner Pancoast information is Owner's Name required for Osterville Ma 02655 5-20-2020 every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or j more from a private water supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: I I 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Bayberry Way (garage only ) Property Address owner Pancoast information is Owner's Name required for Osterville Ma 02655 5-20-2020 every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. 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 t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts ►F Title 5 Official Inspection Form /III Subsurface Sewage Disposal System Form Not for Voluntary Assessments 40 Bayberry Way (garage only ) Property Address owner Pancoast information is Owner's Name required for Osterville Ma 02655 5-20-2020 every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts �v i? Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Bayberry Way (garage only ) Property Address owner Pancoast information is Owner's Name required for Osterville Ma 02655 5-20-2020 every page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 1 Number of bedrooms (actual): 1 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 110 Description: according to as-built card this system consists of a 1500 septic tank distribution box and 1 500 gallon chamber with 4 ft of stone. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: System not for usage with garbage disposal Sump pump? ❑ Yes ❑ No Last date of occupancy: unknown Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts �v 113 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments L� / 40 Bayberry Way (garage only ) Property Address Owner Pancoast information is Owner's Name required for Osterville Ma 02655 5-20-2020 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts �v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Bayberry Way (garage only ) Property Address Owner Pancoast information is Owner's Name required for Osterville Ma 02655 5-20-2020 every page. Cityfrown State Zip Code Date of.Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 3-26-02 per as-built Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 16 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments L � 40 Bayberry Way (garage only) Property Address Owner Pancoast information is Owner's Name required for Osterville Ma 02655 5-20-2020 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: 2+feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 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 How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): recommend pumping at time of transfer and every 2-3 yrs there after for maintenance. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 l Commonwealth of Massachusetts �m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4� ^ � 40 Bayberry Way (garage only ) Property Address Owner Pancoast information is Owner's Name required for Osterville Ma 02655 5-20-2020 every page. CityTTown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Bayberry Way (garage only ) Property Address Owner Pancoast information is Owner's Name required for Osterville Ma 02655 5-20-2020 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): I *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): box was functioning properly at time of inspection 15insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 c Commonwealth of Massachusetts w I Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^ � 40 Bayberry Way (garage only ) Property Address Pancoast Owner Owner's Name information is required for Osterville Ma 02655 5-20-2020 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ 'Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 1 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number. ❑ innovative/alternative system Type/name of technology: l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts lip Title 5 Official Inspection Form ISubsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Bayberry Way (garage only) Property Address owner Pancoast information is Owner's Name required for Osterville Ma 02655 5-20-2020 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts IP Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Bayberry Way (garage only ) Property Address owner Pancoast information is Owner's Name required for Osterville Ma 02655 5-20-2020 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 cam, Commonwealth of Massachusetts �v l Title 5 Official Inspection Form 1" Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Bayberry Way (garage only ) Property Address Pancoast Owner Owner's Name information is required for Osterville Ma 02655 5-20-2020 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts �v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,l 40 Bayberry Way (garage only) Property Address Owner Pancoast information is Owner's Name required for Osterville Ma 02655 5-20-2020 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: greater than 5 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: design plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts �m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Bayberry Way (garage only ) Property Address Owner Pancoast information is Owner's Name required for Osterville Ma 02655 5-20-2020 every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Assessing As-Built Cards Page 1 of 2 L/ a T RN OWN OF BASTABLE LOCATION /� 13k (144iY0 SEWAGE# 20O2-015 VILLAGE_ D 5-&LJj//L ASSESSOR'S MAP&LOT!1q-070 INSTALLER'S NAME&PHONE NO.14*01 A Zc U-X.*(5jd2' 41d6 SEPTIC TANK CAPACITY �SGo LEACHING FACILITY:(type)_Ti 6)540cj NO.OF BEDROOMS r BUILDER OR O R V PERMIT'DATE: ly 6Z COMPLIANCE DATE: G L 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 We d and Leaching Facility(If any wetlands exist within 300 of leaching facility) Feet Furnished by �? o 61 � 2 =0 3 A � C 33t-oy 11q19 Ay https://town.bamstable.ma.us/Departments/Assessing/Property_Values/HMdisplay.asp?ma... 5/22/2020 Assessing As-Built Cards Page 2-of 2 https://town.bamstable.ma.us/Departments/Assessing/Property_Values/HMdisplay.asp?ma... 5/22/2020 No. �� FEE COMMONWEALTH OF MASSACHUSETTS Board of Health, ✓ 5�u-""�` MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct(-I"Repair( ) Upgrade( ) Abandon( ) - ©'complete System OIndividual Components e Location Z/® AA AC JA Owner's Name Map/Parcel# 1 70 Address Lot# Telephone# Installer's Name sot, 4 , ay Designer's Name ekes S U vvp- 6 cAv Uc f-q 17� Address gQ� C'�. !`�L Lam. Address�U 1�T,484"` 6- Ab , M1-4914TUAS mtL/S Telephone# 5-6, - y — C1 Telephone# O,,°j"- 8—bo S"S Type of Building Lot Size�� sq.ft. Dwelling-No.of Bedrooms &-V 6-4RA0-6 Garbage grinder WO Other-Type of Building No.of persons Showers ( ),Cafeteria( ) Other Fixtures Design Flow (min.required) / /O gpd Calculated design flow d Design flow provided oZ gpd Plan: Date Number of sheets Revision Date Title Description of Soil(s) See Loll►v yy, a e Soil Evaluator Form No. Z®P 10 � Name of Soil Evaluat {`UCH' r Y of Evaluation a Z/ 0 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 luNkr,agrees to not to place the system in operation until a Certificate of Compl'ance has been issued by the Board of Health. Signed Dat s -- 1 - ;(:7- No. v V D' r t FEE OF SE .a � •� Board of Health, MA. APPLICATION FOR DISPOSAL-SYSTEM CONSTRUCTION PERMIT Application for a Permit to Con11tr6ct(1o)'00Repair( ) Upgrade( ) Abandon( ) - �omplete System ❑Individual Components # Location 410 AA 11` iZ ww wner's Name Map/Parcel# ' •.... '�� Address Lot# Telephone# m ,,,.-- Itistaller'sNam Iq s Zi Designer's Name v¢AILlee Sv,,Ve C SuG�A� r I 'AddressAo'e �C-5,z3 C. G��7� `�l'(<.e� \ Address Telephone# stj - fd _ G�t,� r �• Telephone# 0,3- Type of Building Lot Size �7 / �' sq.ft. Dwelling-No.of Bedrooms ^ " �' `fJ"'}9��G` Garbage grinder W " l Others Type of Building : ' No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow(min.required) gpd Calculated^design flow / /0 Design flow provided gpd ' Plan: Date Number of sheets Revision Date Title i Description of Soils) 50e 6A JU Soil Evaluator Form No. /O{ rl 0 c� Name of Soil Evaluat UCr y+ Y e f Evaluation a. O DESCRIPTION OF REPAIRS OR ALTERATIONS X , The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and fur, a agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Sign:ecl R / Dat -lnspe4- C V f :��+'-�. :�. , ,•`s-. _ _.�,., $-_��..: _,..-:- .....cap=—-._�+ .r x r.:�+.}F _._- r,: -y- { � No. FEE f COMMONWEALTH OF MASSACHUSETTS { Board of Health, /J C'k, t^ S�`�-`/� MA. :// CERTIFICATE OF COMPLIANCE *. Description of Work: El Individual Component(s) ©- omplete System The undersigned hereby certify that the Sewage Disposal System; Constructed�o<kepaired ( ),Upgraded ( ),Abandoned ( ) F by: at 410 8Ay -eV/-ul W A�� has been installed in accordance Vth the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No.2 oU 0 1 S dated 111 9161 Approved Design Flowa Ya (gpd) c Installer // �t,� p t1 Designer:VAtt-Gf-e S�� `n eo"A CIL40 Inspector: 2 'E • Date: 3 26 -0--- The issuance of this permit 'll not be construed as a guarantee that the system will function as designed. No. / .. FEE C®MMONWEALT14 OF MASSACHUSETTS Board of Health, �.�V K S�'�-��2' MA. 3-� DISPOSAL SYSTEM CONSTRUCTION PERMIT1 Permission is hereby granted to; Construct4o<Repai�,.,4 jUpgrade�(�)�-Abandon( ) an individual sewage disposal system at / A e4 A �69 �. /�!+� �Ls�" as described in the application for Disposal System Construction Permit No. ova-415" dated Provided: Construction shall be completed within three years of the date of is pernlit. All lqcaj conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date ov`V Board of Health TOWN OF BAMSTABLE OCATION �® �� � Y' SEWAGE # ZO®2'0(_5 VILLAGE D �',/"t1f��� ASSESSOR'S MAP & LOT INSTALLER'S NAME& PHONE NO. 'Z1—A5Z'0-A •cScU-Z. '(Se� SEPTIC TANK CAPACITY �SGO LEACHING FACILITY: (type) T%�� Vz 6) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: 4 � COMPLIANCE DATE: 2 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) Feet Edge of We%dandeaching Facility (If any wetlands exist within 30aching facility) Feet Furnished b 3oi` D`' O 61 TOWN OF BARNSTABLE LOCA' ON � YDf/� / '� /�%J�� SEWAGE # A,1LLAGE(JL'M—V i -/%_ ASSESS MAP &LlO�T �"074 NAME&PHONE NO. r ' l�ti SEPTIC TANK CAPACITY LEACHING FACILITY: (type);�? �i .Si; 1�_(size) id/ •• S"5 NO.OF BEDROO BUILDER OR OWNER h,o r t i PERMIT DATE: COMPLIANCE DATE: I I S Separation Distance Between the: s Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching faci ' Feet Furnished byjr'" / t � -�\ j� ����,��. ��, o� � \' �p � � �� r '� .. f TOWN OF BARNSTABLE VZ LOCATION SEWAGE # VELEAGE ASSESSO• 'S MAP& LOT ojo �d 9 a p1Q NAME&PHONE O. O SEPTIC TANK CAPACITY Sd LEACHING FACILrrY: (type) C``/J -(size) /_ 00 NO.OF BEDROOMS BUILDER O OWNE PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by --- // V . �� � � �c � - - -_ -- -- � � �� � � , ' 4 , LOCATION SEWAGE PERMIT NO. VILLAGE G0.q f3 tl-rry O S INSTA Ll R'S NA E i ADDRESS i �iC�(�"r►� BUILDER , OR OWN DATE PERMIT ISSUED DATE COMPLIANCE ISSUED � _ 6 a NO s' l�%�lcl�i►o Se���-e - 7� z-7 7 ''j 'ZONE;. PERMIT NO: 7 7 7 4VWAk— I LOCATION: 4�40 BAY VeRY WAY -2 -OS22T�iC4� 640 ER OF RECORD: �iCffi�/R� f E-'f; f6a& E LOT #: FRONTAGE: 2 3a DEPTH: TYPE OF SYSTEM: [ ] Septic [ Cesspool Pit CAPACITY: /'Ua0 6-Alf 'h OF BEDROOMS: 1 TOILETS SHOWERS_ WASHMACHINE DISHWASHER DISPOSAL DISTANCE OF UNIT FROM SURFACE WATERS WELLS II AVERAGE MEAN WATER TABLE PUMPING FREQUENCY DATE LAST PUMPING DATE LAST PERCOLATION & LEACHING SOIL. TEST MAXIMUM ALLOWABLE RESIDENTS NSrAL�it's MAs14pkt- AM REMARKS: . �v -p'EF� - FReP &V 601 l Guru IT MA, i -- ---- - -. � '. �� N, i Qy �s 0 s� R� �, ��, �d b � � - - �� ? �- �. � -� �� �� o � ��, � � � ., ,�_ ' � � r �;, �c_v . .-f3AY�,�,��Q�Y �i�V TOWN OF BARNSTABLE _ LOCATION /® 13� 4-�Y SEWAGE # ®Z�O�S t ASSESSOR'S MAP & LOT VILLAGE D ����� �� INSTALLER'S NAME&PHONE NO. J A:%o A ZS u-x SEPTIC TANK CAPACITY LEACHING FACILITY: (type) T� ���J size) NO.OF BEDROOMS BUILDER OR 0 R PERMITDATE: ® COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of We d and Leaching Facility (If any wetlands exist Feet within 300 of leaching facility) . Furnished by `2 )=5A 14 i !ty r '..: B +"y ��+*.:t•'-.s• .� , _. ' `e"-�s' ,a;;r , ,l , '1 sR ,n,a ti�tg n��r ..f•�O�B' r• -,��, �I • . w. � ,.`� .'psi"'� ,�8 G!!f BORTOLOTTI'CONSTRUCTION., 765 WAKEBY ROAD,MARSTONS MILLS, WA 02648_ 508-771-9399 508428-8926 FAX: 508428- a:.399 —' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: iJ � Date of Inspection: I pector's anac: Owner's Name and Address: Aj CERTIFICATION STATEMENT: I certify that I have personally inspected Sl e_sewage disposal system at this a3dress and that the informa- tion reported below is true,accurate and complete as of the time of insp^ 1i :..The inspection was per- formed based on my training and experience in the proper function and inniavenance of on-site sewage disposal stems. The System: i Passes` _ Conditionally Passes Needs Further E_v tioll tl Local Al roving Authority Fails .. ,. :,,w, .. 1'�=" ���'��7�� Inspector's Signature Date.!_ The System Inspector:shall submit a copy of this inspection report to the.Approving authority within thir- ty(30)days of completing this inspection. If the system is a shared sysan :rs'has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report Ica die appropriate regional office of the Department of Environipental Protection. 'fhe original should a sent to the system owner and co es sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: A)SYS"PASSES: V I have not found any information which indicates that the s vmc.r1 violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criter a7 ai)t evaluated are indicated below. B)SYSTEM CONDITIONALLY PASSES; One or more system components need to be replaced or repa4tol. The system,upon comple- tion of the replacement or repair, passes inspection: Indicate yes, nor,or not determined(Y,N,OR ND). Describe basis of 6ee.t..,tnination in all instances. If "not determined",explain wiry not. —Theseptic'tank is metal,cracked, structural!, unsound,sho,,,is,:.ubstantial infiltration or exfiltration,or tank failure is imwinent. The system will pass,inspection if the existing sep. tic tank is replaced with a conforming septic lank as a' p"ivtrl by The Board of Health. Sewage backkup or breakout or high static water level obsei tOf [n the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled,.:;j• i. :even distribution box. The system will pass inspection if(with approval of The Boars of`3.ealth): � • . 41, r SUBSURFACE•SEWAGE DISPOSAL SYSTEM INSPE( '1'IUN FORM PART A CERTIFICATION (continued) r Broken pipe(s)replaced Obstruction is removed Distribution Box is levelled or replaced ' The System required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of•I'he Board of I1calth): Broken pipe(s)are replaced Obstruction is removed 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 the public health,safety and the environment. 1)SYSTEM WELL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 Feet of a surface water Cesspool or privy is within 50 Feet of a bordering vegetated wetland or a salt marsh. 2)SYSTEM WILL,FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,&APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTION- ING IN A MAN$ER,THAT PROTECT THE PUBLIC IIEALTII AND SAFETY AND THE ENVIIRONMEN')r:.,., The system has a septic tank and soil absorption system and;is lviihin 100 Feet to a surface water suopl�or tributary to a surface water supply,; The system has a septic tank and soil absorption system and is wilt a Zone 1 of a public water supply well. ` The system has a septic lank and soil absorption system and is within 50 Feet of a private water supply well. The system hasa septic tank and soil absorption system and is lass than 100 Feet but 50 Feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from the facility and the presence of anunonin nitrogen and nilrate oitrogen is equal to or less than 5 ppin. . D)SYSTEM FAILS: ` I have determined that the system violates one or more of the foilowiiig f'allure criteria as defined in 310 CIAR 15.303. The basis for this determination is;dentified belo'ty. The Board of Health should be contacted to determine what will be necessary to correct,tho'-failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. -. Discharge or ponding of efluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. a . Static liquid level in the distribution box.above outlet invert due:,to an overloaded or clog- ged SAS.or cesspool. 't Liquid depth in cesspool is less than 6"below:invert or available�volume is'less than 1/2 day flow. r Yd f a Required pumping more than 4 times in the last year NOT doe>to clogged or obstructed pipe(s). Number of times pumped -2- F SUBSURFACE SEWAGE DISPOSAL SYSTEM•INSPECTION FORM PART A CERTIFICATION (continued)' Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater . elevation. ' Any portion of a cesspool or privy is within 100 Feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone l_of a public well Any portion of a cesspool or privy is within 50 Feet of a private wafer supply well. Any portion of a cesspool or privy is less than 100 Feet but greater d4ian 50 Feet from a private water supply well with no acceptable water quality analysis;- if th.well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. ' E)LARGE SYSTEM FAILS: The following criteria apply to a large system in addition to the criterun at-,ove: The design now of a system is 10,000 gpd or greater(Large System)mid the system is a significant threat to public health and safety and the environment because one or raore of the following conditions exist �': The system is within'460 Feet of a surface drinking water su y - The°system is within 2. Feet'of a tributary-to a surface dil-akVig water supply R The system is located in a nitrogen sensitive area Interim Wei itr ad Protection Area (IWPA)or a mapped Zone 11 of a public water,supply well. ' The owner or operator of any such system shall bring the system and facility 1040 full compliance with the groundwater treatment program requirements of 314 CMR 5.()0 and G 00 Pd•.ase consult the local regional office of the Department for further information: 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .F PART B CHECKLIST Check if the following have been done: ' _Pumping information was requested of the owner,occupant,arrd board of Health. _None of the system components have been pumped for atl st't:vo weeks and the system has been receiving normal flow rates during that period. Large trolurb�es of water have not been introduced into the system recently or as part of this inspection: l"As-built plans have been obtained and exanrined:�.Note if they arc rot available with N/A. The facility.or dwelling was inspected for signs of sewage back;-rip The systern`does not'receive non-sanitary or industrial waste llov! , The site was inspected for signs of breakout. All system components;excluding the Soil Absorption System, have been located on site. _ The septic tank manholes were uncovered,opened,and the ini eric r of the septic tank was in- spected for condition of baffles or tees, nraterial.of construction,dimensions,depth of liquid, depth of sludge,depth of scum. The size and location oC the Soil Absorption System.on the s..ie hp been determined based on existing information or approximated by non-intrusive melatod�, ' -3- . y , •SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CIIECKLIS•r(continued) >/The facility owner(and occupants, if ditrerent front owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPP CTION FORM PART'C t SYSTEM. INFORMATIUid FLOW CONDITIONS Oesign Flow:;;?,W__gallons Number of Bedrooms: Number of Current Residents: o? Garbage Grinder: Laundry Connected'i'o System:Qa— Sensonal Use: A;e Water Meter,Rea gs,if�ailable: Last Date of Occupancy: (10g)ArIx-.A 41 COMM .RCIAIJINDLISTRIAL! _ Type of Establishment: } - Design Flow: aallons/day Grease Trap Present: (yes or no) Industrial Waste Holding Tank Present: Non-Sanitary Waste Discharged To The Title V System: - Water Meter Readings,If Available: - Last Date of Occupancy: . _ ..OTHER: Describe) ',Last Date of Occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: r System Pumped as part of inspection: .Ay-) ICycs,volu a Pumped. gallons Reason for pumping: TYPE OF SYSTEM: Septic Tank/Distribution Box/Soil Abscrption System Single Cesspool Overflow Cesspool Privy Shared System(If es,attach previous inspection records, if any) =Other(explain): APPROXMATE AGE of all componet ts,date installed(if known)and source mf information: Sewage odors detected when airs ilg at th ite: a SUBSURFACE SEWAGE DISPOSAL SYSTEM Br" ` ECT10N FORM PAR'l'C 'GENERAL INFORMATION (:oast i►iued) SEPTIC TANK:_ Depth below grade: Material of Construction. concrete__Inutal FRP_Other (explain) Dimisions: _ Sludge Depth: Scum Thicknct;s: Distance from top of sludge to bottom of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Comments:(recommendation for pumping,conditioi'of inlet and outlet tees far baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc,'<_, GREASE TRAP:_ a Depth Below Grade: Material of Construction:_concrete:__..,.e.ketal_,__FRP_Other (explain) Dimensions: Scum Thickness: _ ..__._. Distance from top of scum to top of outlet tee or Baffle: _ Comments:(iecoinmendadon for pumping;condition of inlet and outlet tecTF,c rbafl'lbs,depth of liquid level in relation td outlet invert structural integrity,evidence of leakage.et o.i;. •T TIGHT OR HOLDING TANK Depth Below Grade: Material of Construction:_concrete_nce9a",; F1tP_Other(explain) Dimensions: Capacity: gailons Design Floiv°_ gallotidday . Alarm Level: Comments: (condition of inlet tee,condition of alaran and float switche:,,e1.: ' ' LL� DISTRIBUTION BOX: Depth of liquid level above outlet invert: _....._...._ Comments:(note if 1 land distribution is equal,evide ce of solids can;r 't r,evide ce of leakage into or out of box,etc.) F'• PUMP CHAMBER:' Pump is iri working'order, Comments: (note condition of pump chamber,condition of pumps anc!i-pp:. ..atenances etc.) n� f } e 'SUBSURFACE SEWAGE UI$PQSAL SYSTEM:04SPECTION FORM PART C SYSTEM INFORMATION (conlhiue4) . 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,number-�J 'Leaching cliart►bers, number: "'` 'Leachirig'galleries;nuinber:> Leaching trenches, number,length:_ Leaching fields,number,dimensions: Overflow cesspool,number: Co RUN]nts:(note condition of soi ,signs o bydr lic failu�e level of p ►ding, condition of vege on, `etc. > �.x /_7 c� �i { y CESSPOOLS: P Number and configuration:@ ` 750`' 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(cesspool must be pumped as part of inspection) Comments: (note condition of soilk,signs of hydraulic failure,l vel of ponding"'condilionof vegetation, z etc. PRIVY: Materials of construction: Dimensions Depth of Solids_ t .. Comments: (note condition of soil,signs of hydraulic failure, level of polling,condition of vegetation, etc.)— -6- C ' f SUBSURFACE;SEWAGE,UISPOSAl SYSTEM INSI'.i":.CTION FORM PART (:, SYSTEM INFORMA'i'lON (conabnI+ : ) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to adeasl two permanent references, landmarks or benchmarks.':` Locate all wells within 100 Feet. 09 DEPTH TO GROUNDWATER: Depth to groundwater:, / Feet Method of Determination or Approximation: ��'0 v�1 '' _ /� zel, ' - -w_ _ //00o" BORTOLOTTI CONSTRUCTION,INC. 765 WAKEBY ROAD,MARSTONS MILLS,MA 02648 508-771-9399 508-428-8926 FAX: 508428-9399 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION'FORM PART A CERTIFICATION Property Address: r C d (-/Z) Date of Inspection: Inspector's Nast : '1 Owner's Name Address:�/s CERTIFICATION STATEMENT! I certify that I have personally inspected the sewage disposal system at this address and that the informa- tion reported below is true,accurate and complete as of the time of inspection. The inspection was per- formed based on my training and experience in the proper function and maintenance of on-site disposal stems. The System: Passes Conditionally Passes Needs Further Ev ation By the Loc Aproving Authority Q Fails / FC Inspector's Signature: ` Date: i8 , N , The System Inspector shall submit a copy of this inspection report to the Approving authority w, ty(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 4 x office of the Department of Environmental Protection. The original should be sent to the system owner` ,.' ' and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY* A)SYSTEM PASSES: 1/ I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B)SYSTEM CONDITIONALLY PASSES; One or more system components need to be replaced or repaired. The system;upon comple- tion of the replacement or repair,passes inspection. r ', Indicate yes,nor,or not determined(Y,N,OR ND). Describe basis of determination in all instances. If not determined",explain why not. f , The septic tank is metal,cracked, structurally unsound,shows substantial infiltration or �� x exfiltration,or tank failure is imminent. The system will pass inspection if the existing sep- tic tank is replaced with a conforming septic tank as approved by The Board of Health. Sewage backkup or breakout or high static water level observed in the distribution box is due ; to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. The ,F system will pass inspection if(with approval of The Board of Health): 'k t < tY , t A SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Broken pipe(s)replaced Obstruction is removed Distribution Box is levelled or replaced The System required pumping more than four times a year due to broken or obstructed pipe(s). `' .The system will pass inspection if(with approval of The Board of Health): Broken pipe(s)are replaced k Obstruction is removed w _ ..s 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 ;tr the system is failing to protect the public health,safety and the environment. 1)SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE _SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE °F PUBLIC HEALTH AND SAFETY.AND THE ENVIRONMENT: * Y CCesspool or privy is within 50 Feet of a surface water Cesspool or privy is within 50 Feet of a bordering vegetated wetland or a salt marsh. 2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER (SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTION- ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE < ! ENVIRONMENT: 'y The system has a septic tank and soil absorption system and is within 100 Feet to a surface',rti ' water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is with a Zone I'of a public water supply well. The system has a septic tank and soil absorption system and is within 50 Feet of a private , water supply well. The system has a septic tank and soil absorption system and is less than 100 Feet but 50 Feet or more from a private water supply well,unless a well water analysis for coliformm�; bacteria and volatile organic compounds indicates that the well is free from pollution from,, the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. D)SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined Yw` in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health. should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS k ' or cesspool. Discharge or ponding of efluent to the surface of the ground or surface waters due to an... a overloaded or clogged SAS or cesspool. 'Y Static liquid level in the distribution box above outlet invert due to an overloaded or clog- ged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 y day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed $ .h pipe(s). Number of times pumped `44 „ 4 , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 Feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. r 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 x water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. , E)LARGE SYSTEM FAILS: The following criteria apply to a large system in addition to the criteria above. "= The design flow of a system is 10,000 gpd or greater(Large System)and the system is a significant ±}<' threat to public health and safety and the environment because one or more of the following conditions exist: i ` The system is within 400 Feet of a surface drinking water supply ti The system is within 200 Feet of a tributary to a surface drinking water supply f The system is located in a nitrogen sensitive area Interim Wellhead Protection Area (IWPA)or a mapped Zone II of a public water supply well. , The owner or operator of any such system shall bring the system and facility into full compliance with the k5' x groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the'local regional office of the Department for further information. i� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM `': 3 PART B CHECKLIST ; ; ,cis ,f� ' 7f�a;�. i. Check if the following have been done: , ' _Pumping information was requested of the owner,occupant,and Board of Health: _None of the system components have been pumped for atleast 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. _VAs-built plans have been obtained and examined. Note if theyare notavailable 'A with N/A: ,:•.�, ,, _ The facility or dwelling was inspected for signs of sewage back-up: The system does not receive non-sanitary or industrial waste flow. dThe site was inspected for signs spec gns of breakout. . _ All system components,excluding the Soil Absorption System,have been located on site. 'he septic tank manholes were uncovered,opened,and the interior of the septic tank was in f/I spected for condition of baffles or tees, material of construction,'dimensions,depth of,liquid, �epth of sludge,depth of scum. air# he size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. -3- f�V rk, L .a. 1 AAA.. - 4 ..Aft>§x• SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST(continued) & The facility owner(and occupants, if different from owner)were provided with information on ! the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C k SYSTEM-INFORMATION , , FLOW CONDITIONS RESIDENTIAL Design Flow: 13e) allons Number of Bedrooms: : Number of Current Residents: Zla'361 - } Garbage Grinder: Laundry Connected To System: e-.S Seasonal Use: Yf, S Water Meter Readings, if available: r,! Last Date of Occupancy: � �/ COMMERCLAS/LNDUSTRLAL: Type of Establishment: Design Flow: gallons/day Grease Trap Present: (yes or no) Industrial Waste Holding Tank Present: r, Non-Sanitary Waste Discharged To The Title V System: Water Meter Readings,If Available: Last Date of Occupancy: ° �1 OTHER: Describe) Last Date of Occupancy: ' GENERAL? RMATION PUMPING RECORDS and source of information: A/6 System Pumped as part of inspection: /VU If yes,volume pum Rallons �' Reason for pumping: TYPE OF SYSTEM: Septic Tank/Distribution Box/Soil Absorption System , w Single Cesspool ' Overflow Cesspool Privy Shared System If es, attach revious�pection records, if any) `f y c , s p ,LJ—moo �, ether(explain): ` ' O�� X oL L.P4 C i y � ROXIMATE AGE of all components,date installed(if known)and sourceof 'nformaGon: a Sewage odors detected when arriving at the site: XIA -4- I 4; as"r: i�' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C GENERAL INFORMATION (continued) SEPTIC TANK: C) Depth below grade: Material of Construction: concrete metal FRP . Other (explain) — Dimisions: Sludge Depth: Scum Thickness: Distance from top of sludge to bottom of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping,condition'of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) GREASE TRAP: Depth Below Grade: Material of Construction:. concrete metal FRP Other (explain) — — — ;;; -. Dimensions: Scum Thickness: , Distance from top of scum to top of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity,evidence of leakage,etc.) = n TIGHT OR HOLDING TANK: Depth Below Grade: Material of Construction:—concrete metal_FRP—Other(explain). Dimensions: Capacity: gallons Design Flow: gallons/day Alarm Level: Comments:,(condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: Depth of liquid level above outlet invert:-t Uri Comments: (note if level and distribution is equal,evidence of solids carryover,evidence o leaka into or out of box,etc.) Sir ' ��' orizl) zea PUMP CHAMBER: ! Pump is in working order: Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) -5- =� 4r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SOIL ABSORPTION SYSTEM(SAS):_/ (Locate on site plan,if possible;excavation not required,but may approximated by non-intrusive methods) If not determined to be present,explain: "i Type: Leaching pits,number:_ Leaching chambers, number: Leaching galleries,number: Leaching trenches, number,length: Leaching fields, number,dimensions: Overflow cesspool, number: Comments: (note condition of soil, si ns of hydraulic failure level of ponding ondition of vegetation, etc. C. nvv � �'Ck C/ . / _ ?r- / / 1 '/1 T Gci� - 2 r ;fY V. CESSPOOLS: 'I / A Number and configuration: Deptli-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of Cesspool: Materials of construction:(�'yak'8/�lndication of groundwater: Inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soilk, signs of hydraulic failure, level of ponding,condition of vegetation, etc.) Z/-S 0-40 '-\ ���i/,L eo'7��a i o✓� . . 4L �7i:�t �a�� �l��iiJi%ICE f;}i' PRIVY: Materials of construction: Dimensions: ::>, Depth of Solids: Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, y ; etc.) ;. �rK b _ -6- q't � 3 t f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent references, landmarks or benchmarks. Locate all wells within 100 Feet. DEPTH TO GROUNDWATER:N u. Depth to groundwater: 7 Feet /' _G Me od of Determination or Approximation: /¢ /�'4/y'Q1 Y�44f . S, � O T.. t y'f No..__d Q.:.21 .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH o o FC . . . . ......................... 1H Appliratiou for Dhipo al Workii Tomitrudinit ramit Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at- ... ? a.. ................ -------------------------------------- L ation-Addre t No. �y AA L .fit , I �l.j.J�i �^ ....n r`s =f-Q . ....... ...............©a�..!.1. .!J'... iA..........------....................---.......... Owner Add es a •--l .l �r........ .C-w-�.5.---•----------------------------- -----------------Q •--------•---- 3-- .. tt t. �` Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................. .Expansion Attic ( ) Garbage Grinder ( ) a Other—Type T e of Buildiii ............... No. of ersons........................____ Showers — Cafeteria Ga YP g ------------- P ( ) ( ) a' Other fixtures ................................. W Design Flow............................................gallons 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �Tq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 -----------------------------------•------------------------------------••••......................--------------- •.......................................... 0 Description of Soil........................................................................................................................................................................ x V .....-----•--••----•--------•-•-------•-------•-----------••------------------------••-•-•••...-••----------------------------••-----•-•------...-------•--•-•••-•...--------------•---.•--------••---- ---------------------------------------------------------------------------------------------------------------- T-- ---------------------- -•--- U Nature of Re airs or Alterations—Answer when applicable._-_____ _ _�-.PL�P.%�?�._.__-___PX/_$ j/l, �a----------------------------------------------------------------------------------- -•-- A- Vent: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of 1TTLE, y g g p y S of the State Sanitary. — The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been issued b the board of health. Signed 1"1 -------------- ------- .?�... �. Date Application Approved By......... . . .... ........ Date Application Disapproved for the following reasons:.............................................................................................................. - ------•------••--•••---••---------------•-•------•••-•--•---------•-----•-----•---------•--•-••-••-•------------------------•-•-••-•-----•••----•••••---••------•-•-••--•-----------•---••••------------ Date Permit No.......................................... Issued... - ��..L-0 No...1692-! N. Fps:` ....... ...... THE COMMONWEALTH OF MASSACHUSETTS .�,..- BOA R Dd,OF H E L H ............_OF. '-;��- . ..'Pla-Al ------__---_---_-- Appliration for Uiipoii al Workii Tomitritrtion thrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at - • I /( ;. ! '°' 7 .. r/ J��^^ (J- : j.:/�l J -----•----•------ { )y ....... <.' . ..�.......• -------•--^......•••-••-•-•.............•. tt L capon Tp resfs / t r t No. f .Owner .. ...�.............. Address •- ... pl. -?._a.. .................................. ........................ v� d�_l.�...�.------............................•--••- Installer Address Type of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ............................ No. of persons Showers ( ) — Cafeteria ( ) a Other fixtures ....................•--•--•---•• . wDesign Flow............................................gallons 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 ( ) 0-4 Percolation Test Results Performed by........................................................................... Date,.,...................................... aTest 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....................... .........................................................-------- •.......................... •--------- ---------------------------------------------------- ..... ODescription of Soil......................................................................................................................................................................... x c, w ,e U Nature of Repairs or Alterations—Answer when applicable------- �`_. '� .! ...._.___�"�-'----!_-!{h_ .. a��r?;� Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT L• y g g p . y of the State Sanitary Code— The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been issued b the board of health. 14 Signed.... 4---e...................... `=.Jj.................. ... ate --.... T Application Approved By......... !---�.� -------•------------•• '. .Q....--•- Date Application Disapproved four the following reasons:................................................................................................................ ....•---...•----•----•-•------•-•----•...................•------------•---•---••-•.......--------------•••---------•-••-•--•-----•-•-------•----••-------•••••-•••--••-•-•------•---------•-•--•-------- Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......... `:..r �r�...........OF..... �.r.." .. ...' .. .'................................ Trrtifiratr of Tontplitinrr THIS IS TO� ERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired Y » r ............................ . ---• r Installer 0 has been installed ir/accordance ' ii the provision of TI LB j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No--- ....... _ ' e............... da.ted-.----------------.............................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS UE® S A , ARANTEE THAT THE SYSTEM WILL FUNCjION SATISFACTORY. DATE..........���� ....•-•-...... Inspector.. ... L..ei� k ..............•______________•_•____........... _ ..............--•- •_-_____•_ •_� THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH t�� ...............OF... .. .. :� ( d:.!:.!............................ m FEE...: ................. '� �i��o��t1 work Cho �tr�rtion rrutit Permission is hereby granted ��...... .-- -- ------ ` --------------•-----------•------------•----------•-•-•-------------...................--- to Construct ( ) or );repair (6)ran Individual Sewage Disposal System atNo. tx ° - .its -- - r"y` - ..�. ........... ....................................................................... Street as shown on the application for Disposal Works Constr&tion it No..................... Dated.........................._............... Board DATE................. "- of H t FORM 1255 -HOBBS & WARREN. INC.. PUBLISHERS " =Q` �� No •-•- 7 _� `� F:Ds....... .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA T l ------- OF.......... .. ApplirFa#ion for Disposal Works Tonstrnrtiun rnmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individ wage Disposal System a : — af> �Lct xj, �J ... A . . . .LEA - '` :� --•--.........•---..._ . q........................................................... .... ... - cation dr ss or Lot No. ----------_ .----� ----.. st, ............................................. - Owner r n�Q Address ..............�l.�.l�r- ............................................................ ..........aA5. 7-�°-/7�7kt.•.•.•.•• ---------------............................ Installer� Address Type of Building Size Lot............................Sq. feet �., Dwelling—No. of Bedrooms......... ................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ............................ No. of persons............................ Showers — Cafeteria P4Other fixtures .------••------------------------------------- W Design Flow............................................gallons 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 ( ) Percolation Test Results Performed by.................................................:.--•....---•---------•_. Date---..................................... ,..a Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water.......--.....--.------. (i, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........---............. ODescription of Soil........................................................................................................................................................................ .............................•----------...•-----•---•-..................•----••-•---•----.....••--------••----•----•----•--•-••-----•---------•-•---•--•--........................---•••---...•--...... UW ........................................................----••----•----------------••-•----•-------------•----- -•----•----•---... •--......-•-•-------- . ------.------......--•---•--- Nature of Repairs or Alterations—Answer when applicable.----. � '..6..... ......� 1�°t ....`— e ..... ----------------------------•----------------------------------•-••-•-•-----•------• $- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iIT .: 5 of the State Sanitary Code— The undersigned'further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sign .......................................... •. .Da.t e........ . f Dat Application Approved B.y---•---��0 ..........._.. <<- 7 ......------ Date Application Disapproved for the following reasons-------------•-•-----------------•---------------------------•-•------------••-•••---------- ---•••---•......._ Permit No......................................................... i Issued---.1/._J-------- I--------- •Date...--- `�� Dare No.............? .... t Fps...... ............... ? THE COMMONWEALTH OF MASSACHUSETTS BOARD 3 ,.. Allpliration for 14sposal Worka Tonstrurfivit Prrutit Application is hereby made for a Permit to Construct ( ) or. Repair ( ) an Individu Sewage Disposal System .y - ------------- ,... capon d ss or Lot N o. Owner Address Installer Address d Type of Building Size Lot............................Sq. feet V Dwelling—No., of Bedrooms................_...........................Expansion Attic ( ) ' ` Garbage Grinder ( ) a`4 Other—T e of P'uildin No. of ersons____________________________ Showers YP g ------•--•-----•------------ P ( ) — Cafeteria ( ) dOther fixt-ires -----------•--•-•-•--------------------••-------•-----.•-•---------••-----------••------ --•-----------••------------=-----------.....-----••---_._... W Design Flow............................................gallons per person per day. Total daily flow............................... ..............gallons. WSeptic Tank—Liquid capacity............gallons Length________________ Width................ Diameter________________ Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------------------____.Diameter..................__ Depth below inlet.................... Total leaching area......7...........sq. ft. Z Other Distribution'box ( ) Dosing tank ( ) aPercolation Test Results Performed"by.......................................................................... Date........................................ Test Pit No. 1.................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fX4 Test Pit No. 2................minutes per inch Depth of Test Pit____________________ Depth-to ground water........................ P4 •--------------------•-•-•----•--..............---------.....-------......------•-•---•••--••--•------ 0 Description of Soil.................................:.......................••-----.:.....:-•-•-----•-------------•------•-------------• -:..: x W -•-----•--•-----------------••-------•---------._--------------------------------------••------------------- � ------••. __-••••-----•____----- ---._. UNature of Repairs or Alterations—Answer when applicable.____ o�i�►--.:fit _..--.....I�A�. #: ... 01 K. Agreement: A The undersigned agrees to install the aforedescribed Individual Sewage Disposal.System in accordance with the provisions of:TT LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certifa�cate of Compliance has been issued by the board of health. Sign ____-•------•---------------•-•••-•------••--—••--•----••--•- -•-------•----•_-•---••••-- Date Application Approved E; Date Application Disapproved for the following reasons:..................................,----._....................................................................... ....................................................................................................................................................................................... Date PermitNo......................................................... Issued......................................................- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Trrfif iratr 4n$ Toutpliattrr THIS ISTO.0 RTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( by .. .. -------------- .........= ---------••- -----•-••• _--- •-•-•------•----._.......-----•.............--- ` - �1yr� Inst er at _ {� __ .k_....__._'/ :�.y __. ______________________________________________ has been installed in ac dance with the provisions Hof T .: 5 of !N+Cie State Sanitary Code as described in the application for Disposal lNorks Construction Permit NO ........X 7.7________________ dated_-.1'1�t/--1"7_?.� ... .... THE ISSUANCE OF THIS CERTIFICATE SHALT:NOT BE CONS 1� AS UARANTEE THAT THE SYSTEM WILL-FUNCTION SATISFACTORY. � I DATE_�✓....��r-2..---•................................................. Inspector..... THE COMMONWEALTH OF MASSACHUSETTS `y BOARD OF HEALTH 7 7 : .�"'t�e? 'Z.........OF._... .-........................... No.......... FEE........................ Disposal r o':no#rudivit antic Permission is hereb anted a "".' y gr ---a................. ............................ to Cons ct . ' ) Repa ( 1"f n Individual elV t Disposal System Street as shown on the application for Disposal Works ConstructiA.Z. p. ____ _ _____ Dated::__ _:Ply............. _---_ ... •---- � --- ---•••-----••-•---•--......--••---•----- Board Hof H DATE................................................................................. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS " " ' r q c-r -a /Zoq � � a WAIJ 2� d �J Y (p O :f e t C�rL T t F•t�p P t..t7"t" Pt-�s.�.t_ L 6GA T I U" 4c part. ill,'1 I c�czT�t=� TNAI- TI- C-- -VjL:DIQ6w �-lEQ Et�►,l Gt�vVLPt_�r'S v.!� '� -rt.%JE: 09 Ai.it7 SETBtitbC WC4"ZEAAaWT4 QI= T"e -TOW U cF + A ' t�" �k IJ J Vi 1�. Pt..A•Q pxIrc l t I l 1 ' I C�✓i B a xTStZ. 4 W-I'a Iujr- tza61 rctzSu L-A.W10 TMtS pt_AI-t t5 +-toy' ��SE'r-' �"-t Au csTs;tz.v��� � tiCass. it+ISt�2el���•1T 'eivZVr-- ( a� ai=G'S�t4 Si-1awt.x� APPL-IcA.wT + 1 r es u->eo To oe`Tev-mt c-- LOT LIwas _ - .el f ie wanYacnte b j Cp p� Wianno E 2662-'7C6 r> S 17*51'14" E 131.00' � .".-y ay ' �: zorow i LOCUS MAP NOT TO SCALE LEGEND --90--EXISTING CONTOUR In + 94.23 EXISTING SPOT GRADE N W EXISTING WATER SERVICE LOT 209 w �1GW- UNDERGROUND WIRES 44,518tSF G EXISTING GAS SERVICE IS TEST PIT PARCEL ID: 114-070 BENCHMARK EXISTING SEPTIC SYSTEM-2 TO REMAIN (GARAGE ONLY) I � 0 00 O I •+•98.17 o r �- -J N 00 N x 98.26 _ Z of Mgss9cyG Z 98.02 98.03 o PETER T. x 9e.0e +98,24 McENTEE GARAGE CIVIL N Q No. 35109 w/apartment DECK Foc�o F GISTER� :•;'9a.la ;"_,':; DECK I +.98.60 98.21' �2 . EXISTING HOUSE(140) 6 �y o. I DRAIN < T.O.F.=98.4f1 98.12 97 85 / I +TP-1 HOLLY CELLAR /^ t-3 !y CRAWL gyp, 98.55 ;".. 98.19 it•.. O ::.. x 97.95 16' - 0 PROPOSED S.A.S. ;QAVEO; - 76 EX. SEWER p psi 3-500 GALLON CHAMBERS INV=96.4t TP-2DRIVEWAY.. ADD CLEANOUT :98.63 SURROUNDED W 4' STONE fl SET ® G x 98.18 try>: 1f 8.53 98.29 9 x �p0 + 6 98. x 99.37 x 99.02 x 99.60 PROP. 98.82 ` x 98.39 °o SE raj 98.88 I 98.85 99.07 x 99:55 98.85.. . . . .�. . 99.03 °PAVED:• + 29 'LAMP DR/VEWA SLAM 230. 0 99.39 99.87 S 17'51 14 E P.. 0 99.07 L 99.06 99.25 EDGE OF 99.30 PAVEMENT" 99.44 99.57 99.82 99.83 99.79 BA•YBERR Y WAY PK sE 100-°Dr EXISTING CESSPOOL BENCHMARK INV.(IN)=94.8+ MAG. NAIL SET TO BE PUMPED, FILLED EL.=98.53 WITH SAND & ABANDONED PROPOSED SEPTIC SYSTEM UPGRADE PLAN 40 BAYBERRY WAY, OSTERVILLE, MA ti Prepared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02537 OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO. PANCOAST, KATHLEEN G TR Engineering Works, Inc. 1"=30' P.T.M. 191-20 KATHLEEN G PANCOAST REV TRUST 24 DOCKSIDE LANE #153 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. KEY LARGO, FL 33037 (508) 477-5313 6/2/20 P.T.M. 1 Of 2 rr - NOTE: TO PREVENT BREAKOUT, FINAL GRADE SHALL NOT BE AT, OR BELOW, EL.=95.0 FOR A DISTANCE OF 15' FROM THE EDGE SEPTIC TANK PROPOSED D-BOX OF THE PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER PROPOSED S.A.S. OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE INSTALL RISER & COVER OVER ONE CHAMBER AND T.O.F.=98.4t SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT tADDCLEANOUT .=98.Ot F.G. EL.=98.7t F.G. EL.=98.6t F.G. EL.=98.6t MAINTAIN 2% SLOPE OVER S.A.S. 32' L =� 13' L = 23' (MIN.) ® S=1% (MIN.) a� S=1% (MIN.)PVC 4"SCH40 PVC 2" LAYER OF 1/8" TO 1/2" 6" 4"SCH40 PVC DOUBLE WASHED STONE 101 6 aaa9aaa (OR APPROVED FILTER FABRIC) 14" 2' EFF. 6aa66a6 INV.=95.80 48" LIQUID DEPTH aaaaaaa -3/4" TO 1-1/2" DOUBLE LEVEL WASHED STONE ADD INV.=94.90 PROPOSED INV.=94.73 4' 4.8' 4' INV.=95.55 D BOX EFFECTIVE WIDTH = 12.8' • .... . .. GAS BAFFLE • _ 3 OUTLETS INV.=94.50 PROPOSED SEPTIC TANK H-20 RATED 3-500 GALLON LEACHING CHAMBERS H-20 RATED SURROUNDED WITH STONE AS SHOWN H-20 RATED CONNECT TO THE EXISTING SUITABLE SEWER AT HOUSE, INV.=96.4t(VERIFY) TOP CONC. ELEV.= 95.6t BREAKOUT ELEV.= 95.00 NOTES: INV. ELEV. 94.50 momm aaaaaaaaaaa '! 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE Baaaaaaaaaa BOTTOM ELEV.= 92.50 INVERTS, PRIOR TO INSTALLATION. 4' 3 x 8.5' = 25.5' 4' 2) SEPTIC TANK D-BOX SHALL BE SET LEVEL AND TRUE 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH = 33.5' TO GRADE ON A MECHANICALLY COMPACTED STABLE PERVIOUS MATERIAL BASE OR SIX INCH AGGREGATE BASE, AS SPECIFIED 5' (MIN.) ABOVE G.W. IN 310 CMR 15.221(2). LEACHING SYSTEM SECTION 3) INSTALL INLET & OUTLET TEES AS REQUIRED. BOTTOM OF TEST PIT, EL.=87.3 4) A GAS BAFFLE SHALL BE INSTALLED ON OUTLET TEE AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. SEPTIC SYSTEM PROFILE SOIL LOG DATE: MAY 29, 2020 (REF#TPT-20-100) SOIL EVALUATOR: PETER McENTEE PE(SE#1542) GENERAL NOTES: WITNESS: DONALD DESMARAIS R.S.HEALTH AGENT 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL ELEV. TP- A I DEPTH ELEV. TP-2 DEPTH BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 98.2 FILL 0 98.3 FILL 0 OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: 97.6 Ab 7 97.6 Ab $ -310 CMR 15.405(1)(b): CONTENTS OF LOCAL UPGRADE APPROVAL LOAMY SAND LOAMY SAND 1) A 4' variance, S.A.S. to crawl space, for a 16' setback. 96.9 10YR 4/2 97 0 1 OYR 4/2 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR B 16" B 16" TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE LOAMY SAND LOAMY SAND PERC DESIGN ENGINEER. 10YR 5/8 -1OYR 5/8 12"/30" 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 95.2 36" 95.4 35" FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN C C ENGINEER BEFORE CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF MED. SAND MED. SAND THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 2.5Y 6/6 2.5Y 6/6 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE.. 8. THERE ARE NO WELLS WITHIN 100' OF THE PROPOSED S.A.S. 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS 87.2 132" 87.3 132" AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. PERC RATE 2 MIN/IN. "C" HORIZON 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY NO GROUNDWATER ENCOUNTERED THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND GARAGE NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. w/aportmen t 14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC DECK SYSTEM COMPONENTS NOT SHOWN ON THE PLAN DECK 6S�, DESIGN CRITERIA EXISTING NUMBER OF BEDROOMS: 4 BEDROOMS (MAIN HOUSE) HOUSE(140) E T.O.F.=9&4f E SOIL TEXTURAL CLASS: CLASS I (LOADING RATE=0.74 GPD/SF) cE�iA�R/ a DESIGN PERCOLATION RATE: <2 MIN/IN CRAWL DAILY FLOW: 440 GPD 5, DESIGN FLOW: 440 GPD g0 53.r 5' GARBAGE GRINDER: NO-not allowed with design �2.4' �g3 LEACHING AREA REQUIRED: (440 GPD) = 594.6 SF .74 PROPOSED SEPTIC TANK: 1500GGADLLON H-20 SEPTIC LAYOUT PROPOSED D-BOX: 1 INLET, 3 OUTLET (MINIMUM), H-20 RATED USE 3-500 GALLON LEACHING CHAMBERS IN SERIES PROPOSED SEPTIC SYSTEM UPGRADE PLAN SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 40 BAYBERRY WAY, OSTERVILLE, MA SIDEWALL AREA: 2(12.8' + 33.5') X 2 = 185.2 S.F. Prepared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02537 BOTTOM AREA: 12.8' x 33.5' = 428.8 S.F. Engineering by: SCALE DRAWN JOB. NO. TOTAL AREA:.... ......................................................... 614.0 S.F. Engineering Yorks, Inc. N.T.S. P.T.M. 191-20 DESIGN FLOW PROVIDED: 0.74 GPD/SF(614.0 SF) = 454.4 GPD 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. (508) 477-5313 6/2/20 P.T.M. 2 of 2 ,77 1/26/2005 8:23 AM - 25•-0. k N > O h r , - � !CELLARVEM 0 ------------ O t _ (2) 3/4 91/ LVL 2) 4 x 1/4 f2)1 /4 x I/4 VL A c-----� r------' ci----- A zX� � Np s $� s 'A 8uW �P � =s 3 'p aR r LELLAR VEM h T a ---------------------______________ _i.. V r z 12'-3 1/4'.. qY 3/4' j - 4'-1 5/B•:.; t'-1 5/B' l'-l5/8' S'-I VB' a O 3)3/4 51/ LVL DR, 3)I 4 x V2 N ��tt •' P Pyyy@Zy@ srs CM-15SR tEW) 3-0I/2 x6-01/B - A r-----. ---__ __ _- Q -_ 2%2RI 2x r I Z 1 _____ i� r E%IIST'G RIDGE 3-0-155 64) ________Z_ - ram_ . A v` i r Z o o u -Em _ m m ® b o • Z _ c16Y1 x MP P • LVLvLx - ro o gad ' 4'-1 5/B' t 12'-3 1/4' 12'-8 3/4' - - 25-V 155UED FOR GON5TRUCTION Archl-Tech Assocbtes Inc hereW - 0 0 � Q � 0 0 of�heee trawrve5«he odµpqlo�I - PANCOAST RESIDENCE C'9hnhlte rpi Wpks ARCH ASSOCIATES G 19ht Protcctlon Act'of reprowctmn orPalsirro„uon of - 1 N t g 40 BAYBERRY WAY,05TERVILLE,MA h�bb wp U - urltlen consent of Archl-Tech o u A—Iotes,1 .is-,,F,gc a re u p, ent of that act.Any m0 - errors om1s51ons o d15- - - o E4-11 on these drove 6 aeFlool atrccb tel-508-420-5335 inq sho11 be h th—[to the tF lEentbn of Arch Tech A55oc, FLOOR PLANS/FRAMING PLANS PnI prlpr to pe lnnin9"orl t cotult.ma A2635 fax-508-420-9304 D r e_T ns pre to I_osed, - do not—plc d—Ir s /\ � V fll a ' 1 1/26/2005 H:22 AM I :a R °>o h mm ' D ----- — z rn rn t < P P�o s - •�• - ` '�° .max '_' yx ak 'fix m�� X I� ~ r - - --- D. rn c A rn rn -- ---- — — ° rn rri rn z di EHI' I 1551)ED FOR GON5TRXTlON - - - Pre I-Tech A55ocb[ Inc hereec/t/t,��, ' S. om 'm 4 n v o or�ese wa rgs otch`coglo PANCOAST RESIDENCE ne Ar°nite°`urgl or ARCH I-TECH ASSOCIATES ° copyright Pro[ectloI A['or N Iq''1100 Any copy,01[eratlon, r pr°WctiOn Or tlletrlF flOn of l- N � $ 40 BAYBERRY WAY,05TERVILLE,MA twee pla's wrtno�t the a=press 4 urlflen consent.1 Arch-Tech ° N � Azsabfeb,Inc..,�n�,Irl � �rchi-tec ur_-ziI dezigri, ine. -� ent oo rho[—t AA", - O e rare, M(551 re or al.- 'MCI—508-420-5335 EXTERIOR ELEVATIONS /SECTION a°g` Inc p for to bel bn ng k eotult,ma 02635 fax-508-420-5304 OimenslOne ore 0 be Sea, ao not scale arawln s OSTER VILLE (WIANNO) NECK PARKER POND A.M. 114171 _ POND CB/DH oa N72°08'46"E WEST �90 ace o ,�. '- 175.0 �.�. LO U --J BA Y - RIVEWAY ,,.�cAl .., SHED A. M. 114170 ppVED D „GARAGE;: �, AREA'44,518 L S.F. . VIEW 1-BEDROOM 1 0 a SEA A1`�i� 7t7P OF SLAB o + �0 -� ELEe=loo,o; 5 0 �i PAL 16.5 I ' •1 t=j — ' ` SEPTIC NoLEV.=ioao I TP I _—__--------' GSYSTEM °o ® 'oo o LOCUS MAP ' �ER TIE ............ O�1 WARD yy C ►wy , ��` ..#40 .,,. DECK #v • + , , PLAN REF. 2664-106 ............ i b .., ,,.......... . 3-BEDROOM;p;"" «F ZONING. "RF-1 �w �' � w •a:oo: `� FLOOD ZONE: "C" 5 16.1 PANEL 250001-0018-D y 41.5� 12.2 19.1 --- -------- c3` CB/DH � o , 08'471 147.17 I A.M. 114104 PRO✓EC T L OCA TON 40 BAYBERRY WAY OSTER VILLE,, MA. ' 1 APPL/CANT- CAREY GRO VER efluCE YANKEE SURVEY CONSUL TANTS , .. .� .5 � G. =; P.O. BOX 265 AU a ' `� MURPHY "' UNIT 5, 408 INDUSTRY ROAD A. -! No.749 MARSTNS M . MA. 02648 S 9c a PH.(508)428-0055 ILLS F X(508)420-5553 s SCALE.• 1 =30 DA TE. 12 20 01 RE REV.V. JOB NO. 52920 SHEET 1 OF 2 3 EL. =_I_00._0 _ 719P OF GARAGE SLAB . 20" MIN. 10' MIN. CONCRETE COVERS {' 4" SCHEDULE 40 P. V.C. VENT MIN. Pl7rH 1/8 PER FT. 2"LA YER OF EL =100.0 CONCRETE CO VER WASHED S719NE r";� / / i r r / / / B MAX i r r r i r� r r r r r r � EL. =100.0 BMAX i / i r r r i / / i 4" CAST IRON PIPE (OR EQUAL MINIMUM PI7tirH 1/4 PER FT. RISER CLEAN �y FLOW LINE SAND p 96.0 /NVERT 1 10"N. 14" + MIN. �AMIP � oo ° — 98.5 0 00 = _ _ _ = _ _ ° 1 EL. CAS INVERT e _ 93.25 BAFFLE ' 6 ° ° o = _ _ _ _ _ _ o c°INVERT EL.=97 75 INVERT /NVERT o 0 0 - EL.=�9 0 EL.= 97. 0_ EL.=9_6_75 4� 4' INVERT 1500 __GALLONS DISTRIBUTION EL. PROPOSED SEPTIC TANK BOX TO BE WATER TESTED -16.5' X 12.8' TRENCH FORMARO IF MORE THAN ONE OUTLET PLACE ON 6" S719NE ,SOIL ABSORPTION PROFILE OF DOUBLE WASHED/STONE SYSTEM (SAS) SEWAGE DISPOSAL SYSTEM ; BOTTOM OF TEST HOLE OR USCS PROBABLE WATER TABLE ELEV.=_87.5_ NOT TO SCALE NO OBSERVED WATER TABLE (12/04/01) ELEV.=_87 5 OBSERVATION HOLE I ELEV.=_100.0_ r PERCOLATION RATE _< 2 MINI INCH AT 60 INCHES. DEPTH HORIZ TEXTURE j COLOR MOTT. OTHER 0'-3" 0 ORGANIC 3"-9" A LOAMY SAND lOYR 5-1 9"-4' B LOAMY SAND 10,YR 6-6 4'-12.5' C MEDIUM SAND 2.5YR 8-3 PERC — GENERAL NOTES __ NO WATER 1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. P # = 10,102 SOIL TEST TITLE 5 AND THE TOWN OF _Z RNSL4RLE_--- RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO DATE OF SOIL TEST 12104101 SOIL TEST DONE BY BRUCE C. MURPHY , R.S. WITHIN 6" OF FINISHED GRADE, OTHERS WITHIN 12' 3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITNESSED BY: DAVID STANTON WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN DESIGN CALCULA TIONS.' 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. NUMBER OF BEDROOMS (GARAGE). . 1 4) ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL GARBAGE DISPOSAL . . . . . . . . NO BE MORTERED IN PLACE. TOTAL ESTIMATED FLOW 5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH INSTALL ONE (1) ACME 110 GAL/BR./DA Y x _1__ BR.) 110 GAL/DA Y DEEDED OR ZONING RECULATIONS. . OWNER/APPLICANT IS TO 500 GALLON LEACHING CHAMBER ( _L112 OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. WITH FOUR FEET OF DOUBLE PROPOSED SEPTIC TANK CAPACITY 1500 GAL 6) UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR WASHED STONE SIDES AND ENDS IS TO CALL "DIG- SAFE" AT 1-800-322-4844 AT LEAST 72 HOURS SOIL CLASSIFICATION . . . . . . . . I PRIOR 7b COMMENCING WORK ON SITE. 16.5' X 12.8 DESIGN PERCOLATION RATE . . . . . < 2 MIN./IN. . 7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS EFFLUENT LOADING RATE . . . . • 74 CAL/DA Y/S.F. SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. LEACHING CAPACITY (AREA X RATE) 242 CAL/DA Y 8) PARCEL IS IN FLOOD ZONE___"C"_____ RESERVE LEACHING CAPACITY . 242 GAL/DA-Y 9) LOT IS SHOWN ON ASSESSORS MAP _114_ AS PARCEL _70 ___. (16.5 X 12.8 X . 74)+(16.5 + 16.5 +12.8+12.8 X . 74 X 2) SHEET 2 OF 2 JOB NUMBER__ 52920 ______