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HomeMy WebLinkAbout0075 BAYBERRY WAY - Health 5 8a bQrc �wa , os�ecv►�i� �¢°x � �� � ��� f>r lt.f 'xz a zn x..b.=; f. �s.4.`s' a �a �! s f{�' �., � r � a•- , ��'� a �,� g'� - lsrS, .f1 i"•. ,:p.r_. awA-'.da ...,a',& �1.,".:� .�, y.`,:,�'� S{'+ + d" `.t.. .n - ,. . .. p �! ' ,-n - •' < ... � - ., o � p o s* r x, J LL c F s m _ F r c .,.•'4 r r i "Ir _ . M1 � ,rt .. p d 4 a i u � N �.A r s e : .. a .. r n n p: 14 r� •P 9 r i � a M .� �� j ��` ° x L , i. , s t 6 , a ` .n p w F..+ -�° �_. � a: -, ®f' -C,." �y ...fie ,nn c:F n� u� - �, •, �, s �"� '�.;� _ + � :�gl p a14, 4 RS s T r l n s t d A• - f k p . axe a `N 4 o ». _ `r � of ,, h ,� e a u m �, � ,, a p, �n N,- ', �� "� .0 as c. o . a. '• � •: A m� n.'', u ...• s ,a1�`Tf 'p c r 6�"0� ua � -4 y"�Y'. � 1 ` y V 6 s` C1�`' � �51 - K - . x _ 30 Z r 2vo �. �' G 6 b� . 6 1 Commonwealth of Massachusetts d R I , 00 4- Title 5 Official, Inspection Form Subsurface Sewage Disposal-System Form-Not for Voluntary Assessments UV 75 Bayberry Way Property Address Ruddick Owner information Owners Name is required for every page. Osterville MA 02655 5/11/18 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. A. General Information 4* 1. Inspector: Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Cityrrown State Zip Code 508.272.6433 13010 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 16.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 5/11/18 InspecWs gnatu Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 ka IL Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 75 Bayberry Way Property Address Ruddick Owner information Owner's Name is required for every page. Osterville MA 02655 5/11/18 Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: New system in 2007, per BOH record all previous sytems were to be removed B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ,•''p 75 Bayberry Way Property Address Ruddick Owner information Owner's Name is required for Osterville MA 02655 5/11/18 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y w❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ 'N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system, is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 75 Bayberry Way Property Address Ruddick Owner information Owner's Name is required for every page. Osterville MA 02655 5/11/18 City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health,, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 75 Bayberry Way Property Address Ruddick Owner information Owner's Name is required for every page. Osterville MA 02655 5/11/18 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore.the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ [I- the system is within 400 feet of a surface drinking water supply ❑ ❑, the system is within 200 feet of a tributary to a surface drinking water supply " ❑ ❑ the system is located in a nitrogen sensitive area (interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ' 75 Bayberry Way Property Address Ruddick Owner information Owner's Name is required for every page. Osterville MA 02655 5/11/18 Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® E 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)] D. System Information Residential Flow Conditions: Number of bedrooms (design): $ Number of bedrooms (actual):' 5 DESIGN flow based on 310 CMR 15.203 (for example:'110 gpd x#of bedrooms): 880 t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 75 Bayberry Way Property Address Ruddick Owner information Owners Name is required for every page. Osterville MA 02655 5/11/18 Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ® Yes ❑ No Water meter readings, if available (last 2 years usage(gpd)): Detail Sump pump? ❑ Yes ® No Last date of occupancy: Seasonal ,Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per y(gPd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M s. 75 Bayberry Way Property Address Ruddick Owner information Owner's Name is required for every page. Osterville MA 02655 5/11/18 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: No recent pumping per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: . ® Septic tank, distribution boz, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) El Innovative/Alternative technology. Attach a copy of the current operation.and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 75 Bayberry Way Property Address Ruddick Owner information Owner's Name everyage.ed r Osteryille MA 02655 5/11/18 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 2007 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3'feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10'feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 216„ Depth below grade: feet Material of construction: r , ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) H-10 tank, outlet cover to 18"of grade ` If tank is metal, list age: years f Is age confirmed by'a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 2000g Sludge depth: 2" t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ` 75 Bayberry Way Property Address Ruddick Owner information Owner's Name is required for every page. Osteryille w MA 02655 5/11/18 Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle >12' Scum thickness trace Distance from top of scum to top of outlet tee or baffle >21, Distance from bottom of scum to bottom of outlet tee or baffle >2„ How were dimensions determined? measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping suggested every 3 years to prolong the life of the system Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 75 Bayberry Way Property Address Ruddick Owner information Owner's Name is required for every page. Osterville MA 02655 5/11/18 Cityrrown State Zip Code Date of Inspection D. System.information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions:: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: . Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 75 Bayberry Way Property Address Ruddick Owner information Owner's Name is required for every page. Osterville MA 02655 5111/18 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): H-20 D-box is in the driveway, 2'6" below grade, very good condition Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y 75 Bayberry Way Property Address Ruddick Owner information Owner's Name is required for every page. Osterville MA 02655 5/11/18 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 8 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): SAS was probed and soils are compact and dry, no indication of past hydraulic failure Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , y 75 Bayberry Way i Property Address Ruddick Owner information Owner's Name is required for every page. Osterville MA 02655 5/11/18 Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privylocate on site Ian ( plan): Materials of construction: Dimensions - Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 i Jan. 20. 2009 8: 59AM No. 8907 P. 2 IS TOWN OF BARNST"LE LOCATION 71 i,.P SEWAGE#2�f�n VILLAGE ©S ezy We _ASSESSOR'S MAP&PARCEL R a i INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 2002 G4� LEACHING FACILITY:(type) Soo G„ Cl�a- b tpp (size) co 3 0A 1 NO.OF BEDROOMS OWNER 2 0 COMPLIANCE DATE: '9 PERMIT DATE: Separation Distance Between the: N - feet Maximum Adjusted Groundwater Table to the Bottom of Leaclvn9 Facility i Private Water Supply Well and Leaching Facility(if any wells exist feet on site or within 200 feet of leaching facility) . Edge of Wetland and Leaching Facility(if any wetlands exist N� feet within 300 feet of leaching facility). FURNISHED BY 0 C\4-Q zn 9v4 1 •Eh-A6 C g a� T� - 1 s 2 4 o 0��4� 2 s 31,o So•.o a 0-6 Olt 3a 72•° �'D F, i Li M-20 .IV-13aK e� s=90 Q' .0 S Lech r�- e�b 4 s ' i . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 75 Bayberry Way Property Address Ruddick Owner information Owner's Name is required for every page. Osterville MA 02655 5/11/18 City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope z ❑ Surface water ❑ Check cellar ❑ Shallow wells >132" Estimated depth to high ground water: 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: 2007 NGW 132"6ate ❑ 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: TOPO mapping site is at 23'msi and nearby surface water is at 2'msl You must describe how you established the high ground water elevation: see above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 75 Bayberry Way Property Address Ruddick Owner information Owner's Name is required for every page. Osteryille MA 02655 5/11/18 City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information- Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION 75' Ray 6Q" W qj SEWAGE# ZOP -51:1 . VILLAGE 0s-4eCy,V-e- ASSESSOR'S MAP&PARCEL�RI INSTALLER'S NAME&PHONE NO. N®c*.ecn Pavino, rSe�B� 398-9�i7� SEPTIC TANK CAPACITY 2-000 LEACHING FACILITY:(type) S-00 64A C,Qk—b V1 (size) a` NO. OF BEDROOMS OWNER '7,:!'; 62,�IjAvN Q" 20O-7 TNS-f— PERMIT DATE: 2 Log COMPLIANCE DATE: $h t/ o? 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) fv f A feet Edge of Wetland and Leaching Facility(if any wetlands exist within 300 feet of pleaching,facility). NIA feet FURNISHED BY r � io G � o � F r� T TOWN OF BARNSTABLE LOCATION —?J IJA 7tofe WAV SEWAGE# IVIILL GE Osfe,fvsl� ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY SW C"S W LEACHING FACILITY:(type) T (size) NO.OF BEDROOMS /S OWNER kA 14 PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 1/J sAc�Ti o^ � o H � � D , Q I C) A Q a 0 3 21 3®� I No. d / ;.: � Fee l7� THE COMMONWEALTH Entered in computer r"W , � EA;LTH OF MASSACHUSETTS .PUBLIC HEALTH DIVISIQ:I°�.TOWN OF BARNSTABLE, MASSACHUSETTS Ye f ZIpp ration for �Diq;ponY i�p!tem Cow5truction permit Application for a Permit to Construct(,-r Repair( ) Upgrade( ) Abandon( ) 27Complete System ❑Individual Components Location Address or Lot No. 75 1'-y0r W Owner's Name, re Address,and Tel.No. oAeNa1t►t 75 3�bernr l Zpc, 0,11A7 -Tr' Assessor's Map/Parcel O -00 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 20 Cow bit WftSal\w4v� Er►9u+e¢r1n9 Peha:•P 3t ►+�ii ot.63K gog-3�-q`tl'� 1'� 0 ��iZB-33 Type of Building: Dwelling No.of Bedrooms Lot Size 3.1Z AcwA— sq. ft., Garbage Grinder (NO) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 090 gpd Design flow provided 88 gpd Plan Date Nomnbtlr 17 -200? Number of sheets c` Revision Date Title S 1q►1 �i1�0.SRa� �.MfP�b�2xv►�n3� Size of Septic Tank '3004 (Dt%A s 7-iLatV lw►QA15 Type of S.A.S. 8-SOO GkV6n (lnamV,-eS ►n dx3B► Fja4 Description of Soil '?4trC. * IZ,OZS 0-3" 0 !ANar 3-6► A cmm joYd 3/1 SPtMN CP" %-W' E LA-W IINK 4IZ LOAF" Sty II.14"Ew LMO, 10)&, 31 SAM9 LaArh 144a 51L 4WD, ID3&SIB Ujou wt� u-13e, C L-A-ucr ZSy (n14—MAD SAME Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the constr and i of the afore described on-site sewage disposal system in II accordance with the provisions of Title 5 e E ntal a and not to place the system in operation until a Certificate of Compliance has been issued by t "s-BoardWAA --- ate Application Approved by Date Application Disapproved b): Date for the following reasons Permit No. f Date Issued - No. � fit 'o„": �� ` Fee 'JQ J {' ; Entered in computer: V i - THE COMMOt''WtA.LTH40F"MIASSACHUSETTS PUBLIC HEALTH DIVISION',YTOWN OF BARNSTABLE, MASSACHUSETTS \ application fotlot of al �&pgtem Cow5trUctioli permit Application for a Permit to Construct(-)*' Repair O `Upgrade O Abandon O Complete System ❑Individual Components Location Address or Lot No. 1 �✓�`) 't W��y Owner's Name,Address,and Tel.No. r'"' _�'�-,._ us�ePv\1�,,., rrl� � V•�y�rr%Wr*.� �ad1 ��h`�/ r Assessor's Map/Parcel p _b 0 t- Installer's Name,Ad/dress,and Tel.No. r NO(4UtA N\11-y 1"t-' Designer's Name,Address and Tel.No. ' 2.O C.A•"'�V t,.jV�l�^l.-trite. ',;_.yf2c�.� �t.�:-�.a eJ +�� yr Yl C�rc��n e 2 P,n� ''... tae.�,,.� Py.�"�h o t+��� so�_.39�-q`t'lti � ����Y,e� Y�oRr•1 �0�-�-I�.`d-�3yy Type of Building:—_-.,_ -_; t�,�ery ��Q N)A- Dwelling No.of Bedrooms Lot Size .%-L Ac tR sq. ft. Garbage Grinder (IV(), Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures DesigwFlow'(minrrequired)I o gpd Design flow provided ` cq gpd Plan./Date Wemy; `r j t'ZOO Number of sheets k Revision+Date Title :S%A-C PI�s� 1�capo5�� .MQr�ue„r.M)� t Size of Septic Tank -?�OoQ 6,,%^ - 'Z t or• e,Ay,,an% Type of S.A.S. oQ (n��1�o/, [h�rnb.p�S �./ �S r P �ie1 Description of Soil �C C 1Z,OZ a 0- O 1��y D ?- AC,var I 0"lam Ilwil Lc��ri1 ; LA`iC-9, ID` '117.. LoATA-4 5A.Z 104" 6w LeNycK I0\1 1 k? :_19-2.Z"' AIL- L.,N,It Ira'118 Nature of Ripairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the con .ti�andm i�ntena'o f the afore described on-site sewage disposal system in accordance with the provisions of Title5of the En�trontmntal Co e and not to place the system in operation until a Certificate of Compliance has been issued by.tthis-Bo�o.f' a'llh Signe'rd r t , 0 ✓ ate Application Approved by v �J ' l "!r'1//�� 1, Date V/� / r Application-Disapproved by: Date l t r , for the following reasons Permit No. /• ) ''` ( / Date Issued7 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIF that they On-site �S/ewa/ge, /Dispos�al/,System.Constructed ( �'� Repaired ( ) Upgraded ( ) Abandoned( )by � !`�?/i,.sr z`U '>i+' !'/ �� f� ���.� � .has .een constructed in accordance, , with the provisions of Title 5 and the for Disposal System Construction Permit No. L dated vr Installer Designer #bedrooms Approved design-flow [ A gpd p The issuance of this peGrm�its/h/alJl n(opbe construed as a guarantee that the system wiU1, ctionas designed. U �IDate U ( {�'/ Inspector (// rl. No. 1 s� /� ———— r Fee nHE'COMMON COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS i5ponY 6pgtem Construction Permit Permission is hereby granted to Construct (--'') Repair ( ) Upgrade ( ) Abandon ( ) System located at 1�F, Ike t f t.J,,, and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. : �� �( Provided: Construction must be com lend wi in three years of the date of this e' rmit. Date / � � ;t Approved by / - --- ------ JVLL1VMIl r-.3 llV, No, 8910 P. 1- el Jan. 20. 2009 9: 38AM • Town Of Barnstable Regulat6ry Services . : Thomas F.GeQer,Director ,�. . Public Health Divlsfou Thomas McKean,Director 200 Main Street,$Yannis,MA 02601 01MCC 508-862-4644 F 508-7404304 Installer jQesiamer Ce ._c„a Date: (� ..... ..... . Designer: $ gn �►a � Installer: n.T�c�.N i9✓�+,; iZ�ji�� ,w , a Address: .V• bL�X, Address: •0 .6 UA .- --4 _.._ . u.bu Joe Uz63 .? on was inued a permit to install a (date) installer) septic Ercm at t,l.. ) based on a design drawn b `' vy dated, Wfm)a� �z.ZooaL, ( lgaei (Y-%4 71t`tle8 1 certify that the septi.c'systom referenced above was installed substantially according to the desig; wbich may include minor approved changes such as lateral relocatio of the distribudon box and/or septic task_ I certify that the septic system referenced above was installed with major c (i.e. greater than, l0' lateral rel6cation of the SAS or may vertical relocation of�y c neat Of the septic system)but in aceordsmce with State&Local Reguiations. plan r sion or cmriified.as-built by dosigaer to fellow, 16% OF A,), F LTER ( er's Si SULLIVAN 7 gnattuc No. 29733 • v (Maigaa's Sigp8t[tre) Wr=Designers sump c*D7. , PLEASE RE1'VR� BARN LE IC H F O-N L T E SS B 3'HIS OUT BY-THESTAB AL I Q.E3dawseptiaDedpw ca %ificalinm Farm Town of Barnstable: .: °f o Department of Regulatory ServicesSAMWAKA T 1 Public:llea1th Division Dace Mau a6 100 Main Street,Hyannis MA 02601 yq. � Date Scheduled, Time 51161b Fee rd. Soil Suitability Assessment for Sewage Disposal Performed By Witnessed By: aRna I�t 1�4M11 I V�� LOCATION&GENT'RAL INTOItMA1`ION Tr�t� Locatlon Address ' j ^^r� , �`y Owner's Nmne ( t{Ott7 7 Address . , - Engineer's Nama S�lh►�n '�1S r�eRi ,,t�C: . Assessor's Map/Parcel' O'N 7007 N13W CONSTRUCrION REPAIR Telephone N 11�a�tl «1 Slopes(%.) o-11361l Surface Stones Land Use. A- Distances from: Open Water Body (0 0 _tt Possible Wet Arts — It Drinking Water Well n Ar c.T Drainage Way It Property Gins Other it ►SICETC11:(street name,dimensions of lot,exact locations oftest holes&pere tests,locfale wetlands in proximity to holes) I .e ..•�. Z Depth to Bedrock SooParent material(geologic): � .. �R�•- DepUr to Groundwelcr: Blending Water in Hole Weeping from l'it taco --r7l Estimated Seasonal High Groundwater Iq _ (EC.ZS PEK 4a3•(awl� D TI' NATION FOR SEASONAL fuGH WATER TABU+; c7= Method Used: ht. Depth to soil mottles: in Depth Observed standing(nobs.hole iln;°..Groundwater Adjustment - E Depth to wogping Ibm side of obs hole: Reading Date: index Well level Ad1 ndwa factor__Adj.Grouter Lcvcl index 1*111 A _ PERCOLATION TEST . , . Date.tl og Time S O Observation Time at 9" �_ J Hole 0 3 Depth of Pere 30 3 Z Time at 6� . —.. Time(9"-6") Start Pre-soak Time Q End Pro-souk 15 4 I hale.MlnJInch 1 n. Site Suitability Assessment: site Passed t Site Palled: Additional Testing Needed(YM) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- k ***If percolation test is to be conducted within 100, of wetland,you must first notify the Barnstable Conservation Division at least one(1)weep prior to beginning. Q:I IEALTI UW PIPERCPOItM DEEP OBS RVATION HOLE 1OG Hole# Depth fi um Soil I ludmn Soil Tcxlure Soil Culur Suil Ulhcr 9urthco(in•) (USDA) (Munsoll) Mottling (5h•ucture,Slums,lluuldeis, Caoslstoaay °�edravcl),,;,_..,_, 0--3 p lt-1 w i� ON&31 �e LoAv'k l z2 � � � tZ-713 Z cd, s A 2.S DEEP OBSERVATION HOLE LOG Ilolt:#_` Z Depth from 5011 Horizon •Soil Texlore: Soil Color Soil Other Surface(in.) - (USDA) (Mansell) Mottii g - (Structure,Stones,DqulJcrs. cmpsistencv %.Graver ED-to�� 10 k c' 1613 lawAj carte. 1 -38 /c_; L. luyR s/8 8 DEEP OBSERVATION HOLE LOG Hole# 3 _ Dcpth from Soil Horizon Soil Texture Soil Color Soil. Other Surlhce(in.) (USDA) (Munscil) Moldhig (Structure,Stones,Boulders. ConsI MICv:%Grnvcil (o�l ion (0710�� to 1- IONK 518 5 31 hog, YWd,S�kJ z S Y h 14 UI';LI' OBSERVATION HOLE LOG Hole/I` _ Depth liven Soil Iladwil Soil.Tcxlurc Sull Color Soil Other Surfi�cb(in.) (USDA) (Munscil) Mottling (Stniclure,Sloues,Douldcrs. Consistency.%Grovel) LO A^ 1446g, La t��,•, b lL t_��Y wlZb., S� 2. Flood Insurance Rate Man:_ Above Soo year flood boundary No Yes Within 500 year bumdary. No'. Yes - ofl 5,�G F� Within 100 year flood boundary.No Yes Deuth of Naturally Occurring Pervious Material. Does at least four feet ornaturally occurring pervious material exist ut all areas observed throughout the area proposed for the soil absorption system? S If not,what is We depth of naturally occurring pervious material? Ccrtit)caliot I certify that on I d (date)I have passed the soil evaluntor examination approved by the Department of>7nvirotmr ntni.Protection and that the above analysis was performed by rno cons'fstent with the required training,exp ' o and experience described in'310 CMR 1.5.017. I Signature Dale l ° Q:11 9ALT1-1/W P/PERC FORM f Jan, 20. 2009 8: 59AM No, 8907 P. 2 TOWN-OF BARNSTABLE �IO _ C.�� � SEWAGE# g LOCATION. 7� e �-� 11 VILLAGE ©S er�l �e- 77 ASSESSOR'S MAP&PARCEL a� o INSTALLER'S NAME&PHONE N0, Nafesn Qoo1��1e, Svc) 3 SEPTICTANKCAPACITY 2QOp Gad C4,p«�b� LEACHING FACILITY:(type) Soo 6-\ (size)�`� �� a1 I NO.OF BEDROOMS OWNER PERMIT DATE: 2 o COMPLIANCE DATE: '9 Separation Distance Between the: N feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility i Private Water Supply Well and Leaching Facility(if any wells exist ivI A feet on site or within 200 feet of leaching facility). Edge of Wetland and I:_aching Facility(if any wetlands exist feet within 300 feet of lleaching facility). � FURNISHED BY o"i- dF +o dJ`e 'ten i 2 o-Oom 3= 7 0,°�, L gZ 1, 9 i M.20 17-6,0- e V 0 90. i l LCT`ION SEWAGE PERMIT NO. -VOL fAGE 6-0,-It,-1,V,t�4 r I N S T A L L El I NAME 8 ADDRESS OR OWNER DATE PERM1 ISSUED DATE COMPLIANCE ISSUED !-��, a ca I � I 10 4 h I 4 i i COMMONWEALTH OF MASSAC.HUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 75 Bayberry Way 2 SYSTEMS Osterville, MA'02655 Owner's Name: Virginia Kalat � Owner's Address: L\ �q Date of Inspection: August 1, 2007 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: (508) 862-9400 �'> C=' CERTIFICATION STATEMENT t ' I certify that I have personally inspected the sewage disposal system at this address and that the information reported"-' below is true, accurate and complete as of the time of the inspection. The inspection was performed}based on my training and experience in the proper function and maintenance of on site sewage disposal systems-I am a DEP cn approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The systdrn:'� .. p ✓ Passes ` (Title VS 0 Conditionally Passes Need urther Evaluation by the Local Approving Authori ✓ Fails (Original Cesspool System) Inspector's Signature: Date: August 14, 2007 The system inspector shall sub a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner.shall submit the report to the appropriate regional office of the DER The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page.l yy Page 2 of 11 OFFICIAL INSPECTION FORM.- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 75 Bayberry Way Osterville, MA Owner: Virginia Kalat Date of Inspection: August 7, 2007 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓(Title V Syste»z) I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board.of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance. indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: . 2 • Page 3 of 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 75 Bayberry Way. Osterville, MA Owner: Virginia Kalat Date of Inspection: August 7. 2007 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to detennine if the system . is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 5.0 feet of a bordering vegetated`wetland or a salt marsh 2. System will.fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has aseptic 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 rnore from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 75 Bavberr•v Way Osterville, MA Owner: Virginia Kalat Date of Inspection: August 7, 2007 D. System Failure Criteria applicable'to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is.less than 6" below invert or available volume is less than ''/2 day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. Any portion of the SAS,cesspool or privy is below high groundwater elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspooF or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is'free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. .A copy of the analysis must be attached to this form.] Yes (Cesspool) (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15,303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve alacility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no".to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive-area(Interim Wellhead Protection Area-IWPA)or a mapped Zone ll of a public water supply well If you have answered"yes"to any question in Section E the system.is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 75 Bayberry Way Osterville: MA Owner: Virginia Kalat Date of Inspection: August 7,2007 Check if the following have been done: You must indicate"yes"or"no"as to each of the following:. Yes No ✓ Pumping information was-provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous.two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large.volumes of water been introduced to the system recently or as part of this inspection ? ✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ _ Was the facility or dwelling inspected for signs of sewage back up ✓ _ Was the site inspected for signs of break out? ✓ = Were all system components, excluding the SAS, located on site ✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction, dimensions,depth of liquid, depth of sludge and depth of scum? ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption.System (SAS)on the site has been determined based on: Yes No ✓ _ Existing information.. For example,a.plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. t 5 Page 6 of I OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 75 Bavberry Way Osterville, MA Owner: Virpinia Kalat. Date of Inspection: August 7, 2007 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n/a Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 Number of current residents: 2 Does residence have a garbage grinder(yes or no): Yes Is laundry on a separate sewage system(yes or no): Yes [if yes separate inspection required] Laundry system inspected(yes or no): _ Yes(cesspool s stein) Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): ______�gpd: Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes.or no) Non-sanitary waste discharged to the Title 5 system(yes or no).' Water meter readings, if available: Last date of occupancy/user OTHER(describe): GENERAL INFORMATION Pumping Records „ Source of information: Never puritped-per owner Was system pumped as part of the inspection(yes or no): No If yes,volume puinped: _gallons How was quantity pumped detennined? Reason for pumping:. TYPE OF SYSTEM ✓ Septic tank, distribution box,soil absorption system Single cesspool ✓ Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of inforination: Title V system installed on 4128181: overflow cesspool(original)was approximately 1950s Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of l l I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 75 Bavberry Way Osterville. MA Owner: Virginia Kalat Date of Inspection: August 7;2007 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction,line: Coniments(on condition of joints,venting,evidence of leakage,etc.): . SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 12"(Title V) 8"(cesspool acting as aseptic tank) Material of construction: ✓(Title V) concrete _metal _fiberglass _polyethylene ✓ other(explain) Cesspool block(cesspool) If tank is metal list age: Is age confinued by.a Certificate of Compliance(yes or no):. (attach a copy of certificate) Dimensions: 1500 gal. (Title V) - 5'W x 7'T x 10.5'bottom to grade(cesspool) Sludge depth: 2"(Title V) - 10+"(cesspool) Distance from top of sludge to,bottom of outlet tee or baffle: 30 (Title V) = -- (cesspool) Scum thickness: 2"(Title V) = 10"(cesspool) Distance from top of scum to top of outlet tee or baffle: 6"(Title V) - -- (cesspool) Distance from bottom of scum to bottom of outlet tee or baffle: 10"(Title V) - =-(cesspool) How were dimensions determined: Measuring stick Conurnents(on pumping reconnnendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related.to outlet invert,evidence of leakage,etc.): Title V: Tees ivere present. The liquid level was even with the outlet invert There did not appear to be any sib of leakage Cesspool: The liquid level was above the outlet pipe and backing up. The system is in failure NOTE The systeni has never been pumped or maintained. The cesspool cover was cemented on GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction:. _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,.liquid levels as related to outlet invert, evidence of leakage,etc.): . 7 Page 8 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSUR FACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR M PART C SYSTEM INFORMATION(continued) Property Address: 75 Bayberry Way Osterville MA Owner: Virginia Kalat Date of Inspection: Aurzust 7, 2007 TIGHT or HOLDING TANK:'' None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal_fiberglass _polyethylene ._other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day. Alarm present(yes or no):: Alarn level: Alann in working order(yes or no)° Date of last pumping: Comments (condition of alarm and float switches,etc.): DISTRIBUTION BOX: None (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 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.): PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no):. Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): i 8" Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 75 Bavberru Way Osterville, MA Owner: Virginia Kalat Date of Inspection: August 7. 2007 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: I (Title V systeni) 6'x 6'(1000 a� 1) leaching chambers,number: leaching galleries,number: leaching trenches,number, length: ✓ leaching fields,number,.dimensions: 1 (per info on overflow cesspool) overflow cesspool;number: Innovative/alternative system Type/name of technology: Comments (note condition of soil,signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): The leach pit had 6"ofliauid on the bottoms The scum line was ]'up from the bottom There did not appear to be any signs of failure. 1 did not dig up the leach field Liquid was backing up into the cesspool CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and.configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: . Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Commnents (note condition of soil,signs of-hydraulic failure, level of ponding, condition of vegetation,etc.): PRIVY:. None (locate on site plan) Materials of construction: Dimensions: Depth of solids: ' Comments (note condition.of.soil, signs of hydraulicfailure,level of ponding,'condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 75 Bayberry Way Osterville, MA Owner: Virginia Kalat Date of Inspection: August 7. 2007 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Db J C, uv M (3&k C -- M a r0Sq l3U S�►�S 10 f );age 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART,C SYSTEM INFORMATION (continued) Property Address: 75 Bayberry WaY Osterville, MA Owner: Virginia Kalat: Date of Inspection: August 7, 2007 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high groundwater elevation; Obtained from system design plans on record If checked;date of design plan reviewed: ✓ Observed site(abutting property/observation hole within,15.0 feet.of SAS) ✓ Checked with local Board of Health-explain: Topographic and water contours maps Checked.with local excavators,•installers—(attach documentation) Accessed USGS database-explain; You must describe how you established the high ground water elevation:. , At the elevation of the cesspool, ground water was at.10.'. A transit was used for the cesspool depth The cesspool was in ground water: This report has been prepared only for the septic system and.cornponents"described herein. This.septic systent has been inspected as.of the date of inspection. This report is not a warranty or guarantee that thexsystem will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the septic systeni,the inspection,this report and/or any components of the septic system which.have not been located and inspected. Town of Barnstable � OF THE t�L Regulatory Services g Y sxs►na Thomas F. Geiler, Director 039. � Public Health Division rEn�r A Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report;this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. 1/ z 1. lift €� Z No................ ...... F��.. .. ............... THE COMMONWEALTH OF MASSACHUSETTS ) B®AR® OF HEALTH60ro Ono : ..... OF.............. ApplirFation for Diapaii al Workii Tomitrurtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair (�an Individual Sewage Disposal t System at: /.........0 ---•-•--••---••-------- -•-- ..................................... r Location-Address or Lot No. --------------------------------------------- ................................ ------ ner Address 4lr.�. ..... �.1.�.�... --------------------- -----•--.-------------••.•---------•------..----------.---..------•-•------•--.---•-••--•-- Installer Address PQ Type of Building/ Size Lot............................Sq U Dwelling No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( Other—T e of Building No. of persons............................ Showers — Cafeteria `\ Otherfixtures ............-_=................................................................... 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--_-_.--_____•_--_--_... f�. Test Pit No. 2................minutes per inch Depth of Test Pit. ................. Depth to ground water........................ a • ........ Description of Soil :: d741—,:' ............................................ x W --------------------------------------------------------------------------------- t+F t { ----- ---------------- ------- ---------------------------------- - UNature of Repairs or Alter tions wer ryw)jen applicable._____ .Ql�1lt —..................... ....-___. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TT y a g p y 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. Signed ---------------•---- : Dat Application Approved ...... 3. 1---------B Date Application Disapproved for the following reasons______________________________________________________________________________________ .... . ........... ..........•--------------------------------------•----------------------------------........---•----------....---------------------...---------------------------------------------------•--.......... Date PermitNo..................... .............................. Issued.... ...... -----•------•--............ \ Date No. -----._....... ...... .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OFI/HEALTH ......OF...............` F Apptiration for Uhip aal Works Tom3trurtinn unfit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at , � S y'�`�� � d�":X a t y •-- at �1' v^ c Location-Address or Lot No. ..............— .... -----------------------•----------.-----------•-- ---------.--------------.-------------•--- ...................................................... f , Owner Address A pp� W %L.� `i-_ i ! _ '........................................ .•-••---•-•-•-•-•••-••------••-......•--......------•----....••-••-............•---...-•••••••---- Installer Address U Type of Building, Size Lot............................Sq. feet Dwelling No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ............................ No. of persons.........--................. Showers ( ) — Cafeteria ( ) a Other fixtures Q - ----------------------------------- 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 Ne.-_-.--_-:._----- Diameter.................... Depth below inlet. ................. Total leaching area.................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results... Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.....................Depth to ground water........---............. Test Pit No. 2................minutes per inch Depth of Test Pit....................... Depth to ground water..----.................. O Description of S oil------------------------4 --"C7t 4 p-' 1 V --••-••--•--•--•-•••-•-•-••--•••----•--•--•-•--------••-•-•..................••--•-•...... -�..,-----�� •... ---•-----•-•--•----•--••-•---•......•. x -- r e U Nature of Repa rs o. Alterations AK`wer,.waen applicable' ✓ ".................................. --J-40,!f---4�..... ---- s ............ j- ---—. : , ,r+�" ,a' Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions o='TTLE 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. Signed -•••-•---••-•-•--•••... ..................•- �7 Date Application Approved By...... ''�` L_ �..... ✓'� �r��� '�'..��'�` ��."`.�" .. Date �_�...--•-•- Application Disapproved-for the following reasons:........................................ .........I.......................................... ---------------•-••••..••-••----•-----•••••---•-•-•----••••--••---•-•----•------......•---•-••-••--•---•----...•-•--•-•--••••••••••------••••---•••.................................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.............. , ....................... nrtifiratr of Tontlilianrr THIS IS T(CERB� Y, Th1at jth Individual Sewage Disposal System constructed ( ) or Repairedby..._. ... .sSa /` gl �s`o Install d - ---..•. lay,, ....... 3 , . { ' �!. B .....^_.• { P .............................. t ....... -- y r x z....... sC._ has been installe3 in accordance with the provisions ofr T �LL 5 of�The State Sanitary Code as described in the application for Disposal Works Construction Permit No.: .......--4_1.................. dated.....;___ _.._..`...�.- ._...._..._. THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................... ----------•--•--------------_. Inspector......................................................... 't THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH '- .........:.:. �""�'' '`............OF..... ► " r .................................................... . No.................:....... FEE.•...= ............... Bilipulln1 k 1 nn rnr ion "unfit Permission is hereby grante .......... .. . ......:� to Construct,( ) o>rrRe air ) ad Individtual Sewage Disposal System ��° atNo. +s .:F� .... a �* ` I .. •••. f ................................................. Street ' as shown on the application for Disposal Works Construction er�mit"No -• Dated..__fk ............ Fri .... ?� ,=' .:. s' 3 a i�aw :,d z�l�`r'� Board of Health DATE......-----=--........ ...`----•----•----- -------------------••-----..,..:..... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS r � 2W-d 77_p- 3=_r W-o• .34'-e. _ - _. 1K-0•`-r s'-D' S-r 4!_4. a< sv oR 000R s'[s ox 000R --- i -- via � i< a gppa •T — � �� a� � � AM 2M ZP 3/4'zSi J/r - f { lei a AID UN y b ot 20 3/r.N 3/4' - - o 1 P Via - ) Ix FL an o n a a ®® j ,, t� (4)23aJ � Ix g ----- — aka. . �y' g faa r-r as U HURN at a } I as�g M3sYsF Saw � I I I 3s 3/r�ee- L-«J L 1 } An 311M R - - ' ACC 202s I a gigI I " 35 314W - Ra 29 3/4'x2s 3/r _} } Ea I! a} 111 Il 4- -4 --- �_�•,. 1 fir---� -- e R o $ o "-$is AR 3 F ��".._-..._...v__-,�..,-..._:_, ' « � .,ti..� •.w:b .:_._�-.�--�- -;� .�:.:-._,.,,_-,--+-.. _. ._ I..}..w u-•.. ase.w.- rt�} _ _".-_.e. s"`�}'"�.^`� '� �� - - ---- - - �.1/r.MIS".--"' ---"— ... An JMs R�ram— _____� il AM ACC 2e2o � I 'w, laid- a�a, AD it S-Y ie-4' PI III m s 11 b Aq 300 F Cl (' AM b - - �I-_ 34 J/r.W � o III bi An J/r►ss J/r Q j 3m R - _ u 0 3s 3 4;�r Q at b FkC -III d �� fIII w FµiTI I , Ir Lk nAaw or Ap1E _ AM €aa- q 29 J/r—i0 3/e p <a a �. f2 N D •`` p I g AUK 470 x a 47 3/rxM 7/U" g Am 4M _,. w +-. ... 1 - (2)Aw Yeas 47 3/,V.W J/r - L •p I a - Os N - 2D J/ts6s 3/r + [,• Xb g _ .. Qom. , a! ATD 2sSs b 20-3/4W 3/4' - t0. aaIle, aaa - Ur L%L 13 1 � 3'_r _ .. M 4 p p €a 1 . a a - 20 3�rx 9 /• Kcl cl k. IEa aI 4-D' 24'-0• n •- f 16-r. PRICING SET NOT'FOR CONSTRUCTION 0 RUDDICK RESIDENCE R AYIS 75 BAYBERRY.WAY OSTERVILLE, MA v ID E BUILD [NG INC . s 3 ;BAYBERRyrr SQUARE,. CENTERVILLE, MA 02632 u PLAN PHONE: '508-771 -1040 r FAX 508-775-0155 x . BSA �la �A �x - it al it r _ I 4 dig g a 3 CL - rr. N q I e-e• ► °Z AM n43 AVD 3m R (�1r LYt/bBf - I _ + a�2 .. q » 3 -3♦,M p ® Am 2BSB - Cl ci Am 25N a 2253 a m I p N.. 25 3/C l� Am x43 3/C � _ - _ IS w- b b - - 1�Ifcln 3/r OW 311C as afa I n # a I!�Is 4� • Am 2WcA+r�k wul BFAY a n 311r.63 3/r Am 2W 1 _ 2'-e. 3'-0. g-0•- I C-0' C-e' -0• 1 1 r 22 3/r�3 S/r _ a 2e-o' r-r r-2' Y > L N Am 200 • A ,,,5 I -s• x te'-v Y YI 4 q p• - - --.- —-—-—-—-—-00 - x aaE K r. Am 2W CL 2e 3/^14 3/4' _ F w' • W DM 32xf6 BWMB OBt57Ot ' N- p 1R e0 ro n . .ABOVE O063/CxW 3/C - -- -------- -- --------- -� 3 9' c. E/ O` N 3/m I Y e p y r s/rxn s/a• Ic MG ct ci 33 3/♦'1A3 3/C go CL ATD 2W 4 m 3/rx%3/r — o �L. Am 2W p m 29 3/rAM 3/4' _ 4 ct m PRICING SET NOT FOR 'CONSTRUCTION> . . ),- ;a 0 RUDDICK RESIDENCE B. AYSIDE, RU I L D IN G I N C . 75 BAYBERRY WAY'OSTERMLLE, MA a 3, BAYBERRY SQUARE, CENTERVILLE, MA 02632 7,2 PLAN u PHONE: 508-771 -1040 FAX:, 508-775-0155 FT n- •� e a � i _ 401 ZONE: k Area (min.) 87,120 SF (RPOD) a � ti cY K.,Y- nr• � .r. a I \ �o I Fron is a (min) 20 tsx ,r rv',ry I .r3• >+ N Wid th min) 125' m N Setbacks: V Lot 237 -' _N ' L� L _Y 4�'xs.e'er �s'x�5�y i'} is'iyu '3° • ab p.;�_.xl . -\ Fron t 30 y u J O 5 r \'� Os Side 15' 1 r!'7jtit are �t �F + v t N of I m m Q N75'03' ---'t \ Rear 15' '� , ,ar x �t r �, '• ' II tt. 1R• FEMA Zone Lines 1�W- / r I. as per FIRM f'onel Nolde .12°w79 P 1/ CB H ,-- r' �� \ FLOOD ZONE. Cert 250001 0018 D �� Fnd rev July 2, 1992 Zone A11(EL11), B & C - ; �•.• o • to \� CommunityPanel No. N \ 344E \ \ - ,/ r 12 .15 nsg # e3r� •'., f <, y s��" : t W \ \N? '0 \-' °j `• i \� ' 1 250001 0018 D r rat x cti T 84• .r ,..�- .....• rn - CoY t l Jul 2 1992 ? 1 y ' \ S 4 ` \ Bvw 14 t 5 , / f w Qo P X \ OVERLAY DISTRICT..Q) AL Q) ( �` �"''\ \ / ��'�\ '` : \ \ �\ if I ' ' P PR�C i IPRO�SED '�: P U. AP - Aquifer Protection District LOCATION MAP q� AL Scale 1 2000' l p,NK " = ac JL Edge Of Saitmarsh Tidal Marsh as Flagged i ¢ �.�1,►r 2' \ \ \ \ \ \ 1 I ° r Bordering Vegetated Wetland h �--•"•""" \ Z: � 1� f \ \ \ t \ ` M,••' \\ \ j to as nagged �vw it �,...- \ I t ` p t -p3.5 •3: '� ,g-�`°�`= \ � �I� � a � � �� � � �°� `\ y \ � �� � = ASSESS. OR_S REF -' - - _ I � g t /� \ \ r N 91, Parcel 007 ' '. .... ... Len►n\ .. � �• Map 0 \' ...:.... ........r-. - ) i. 1 ,ILAL \ !: Maw.... / / / .''� \ , ` i \ , ` -" -o ✓�. .. ,f. 1 r 1Z3' to or+.e B = Ze W . Edge•..... �•.. . /� _,.,•r' ..... � 8 TO BE REMOVED ��. 1 W �-_�„�,' , - DIRECTIONS. 1,Rr B / I 7SM E7 7.2' (IYG 29) ' ...'.�.`•........•• Top of C8/bH r . 2: 2 • i / / �r v \\ �^�o / :il I N o Nz o i�'f / •....•.••,,. .' -� :. / \ - '- -\ ore`\ea o ( (SEE t5� �o) \ �,o l ,� a �� From Hyannis - Take Route 28 into Osterville. At the \ ! j 1, ;-/ '�s�_•- s -,e�- ,6' �\ ��_,. csH �� E ,� \ I ! rn \ \ 1 f� li his by White Hen Pantry take a left onto Osterville- 7�-- .� r _•-�''- � ,5 / \ � ) i I °�o I*, ` I '•. \ \ I � I West Barnstable Road an follow to the end. Take a Burt 4 ,-'' '` � - / // °t \ to left onto Moin Street. Take a right onto Parker Road, Lot 2'59 f , �-4 / \i '" ,� i t � 'l ;'' \ \ o ?` I ;'� -e see and follow strai ht through a sfo sign to true end. -xu 1,o , \ litetK / g P •9 30 / ;/ [� vw a 125,750fSf 2.89tAc Upland / -I- - 1 r I ,� ' \ \• o t i \ o Y Take a ri ht onto Sea View Avenue, and then aright \ ( j I •--�-�"- / 9js5afsF o.23-+Ac Wet►ond / - - ��'/"\ r \ \ I \ ` a, ,a' \ a l onto Bayberry Way. Property is on the left, #75. �. I / / •� // I 135,700ISF 3.12.+Ac to MHW, T 125 p0, E - l \�-- \ / I t \ I , yt^z ''r / 22r 'sir s� / N 74.54'45-1. \ ; /� \� I \ s x \ ! ( ` o \ 4a0;r vKho. ° ' - -`'�-� `I 2:24.2 I I \ Access AL AL � Bordering Vegetated We and �/ gyw:y as nagged \ �' /'" \ I \'• \ ( r > ,r i 1 I A `\ Edge Of Saltmorsh �14 ��i'' '���' 11\' ds l / as Flagged � � � \ \ (j \ '1 ` ` ''�, O pro ! / rde. Si11 s:' f,•'/ / '��� /'�. \\ ! �\ Are i;: `Lien \ ` .� .....1�• ''• PROPOSED /,/ ' Bea IP x'1 \ \\ 1 i 1 \ / \ \ 11 \ o DRIVE ; _ , , SEPTIC NOTES l / \ / / / Ek SEP i7C� i z 4 co a �\ e t e d / \\ \ \ \ , /' 1.Location of Utilities Shown on This Plan Are Approx.At Least 72 Hours - I \ , ('SEE�NOTE 10) Lawn , / �.•�• J i ��/' t f \ \ / Prior to Any Excavation For This Project the Contractor Shall Make / t\ N the Regained Notification to Dig Safe(1588-344-7233). 1'reeline , 4 % 2.The Contractor is Required to Secure Appropriate Pem»ts From Town Low" Agencies For Construction Defined by This Plan. M.-Sw I co' ' .' .' / / \ f \ // / / / / f i �� 3.The Water Lane Shall be Constructed in Coordination With •bock P wK .�'' d / \ " / \ �'"�^ / :\ S � ' � / COMM Water,and Shall be to Accordance With 248 CMR 1.00-7.00 P / ate •� / } / 5/ � / o �/ // :(+ � �,� , / �• / 8t 310 CMR 15.00.The Wales Line Shall be Sleeved Where Required. - 4.Install Risers to Within 6"of Finished Grade(5 Required). \ Landward Edge i / 7 / i' + % 5.All Structures Buried Three Feet or Moue or Subject CD 3� Of Coastal Dune ' \ ` as Flagged ' � N°/PE� tNet \x\ \ 1 / / / / / ` % �ti / gin / - _ to Vehicular Traffic to be H 20 Loading.It is the En eeer's cHerti3s2 / -- \\ \\ L `-- / "// \ \ I % , Recommendation that H-20 Always be Used. / �/ / �'\ \,�`��\`l�`` -','" _�'_ _ -•�T�- e CO#1041136) C8/bH i _ - _ / ,,ti- r r \ \ %�/ �/ ( \ //Z`L,/ 6.Septic System to be Installed in Accordance With 310 CMR 15.00& ern en t FND - ( 8 I -- :�� '� `\\ \ 248 CMR 1.00-7.06 Latest Revision and the Town of Barnstable os i c+ """No��EXistin�65$ ?Ost do Roil Fenc /ry %r Board ofHeal@i Regina iGns. \ / �8 / �• f ! \ I `'" N 80.3 �- �' -' ,, / J t<b �d � / 7.All m be Sch.40 PVC. t pall K tt -p F •, a 8.Net Tees Shall Extend a Minimum of 10" CD i \ /f �, i �, 10-,� -- \ etd J \ Y \`\� \ QO� Below the Flow Line. /... / " s •-;-"'"" �1 tr.. � 9.An Outlet Tee Shan}Extend 14 Below the Flow Line, _.. .._. - _.. ..._. ..,, I" _.. ..a•s vLe,JII�d r.<�>..vx-vL�'k;'t�i a...d.wc.+..as. .... ,: ,..n.: .- p, i %// / e• owed or Abandoned<... , . / / 10.Existing Septic Systems Shall be Rem f, /f y,,, w Nw \1,r•• �,,,. ••• O�J lo,�, i � / /, /. `�J e ' r �r�l .12 J r �/ \ ••'' �s r yQ in Accordance with 310 CMR 15.354. g\1 / GB N/F N.R°.r° 1 \ \' •.. 1� % / F 1 r�y aria" �,� r� X / // i N \f ! j" c°� / / r--T J ' `/ j%jZj % y��' / vo DESIGN DATA r -, � ' i ,' � .••- - .� lg 1, '•' � •,-,• .•� '' \\ �''•., % � // / < Q� Single Family-ExistiBg 8 Bedrooms /Y -- "' / \,� \\ �'•. ,,/ With NO Garbage Grinder g ' r '' \ J \ \\ \ .• '\ ( ` Flow=110 x 8=-$80 GPD / / i ,,.. '' � � ' J '' "-- ,,, � f -- ••,r \ •;( ✓ // � Septic Tank:880 GPD x 200%=1760 Gallons Use 2000 Gallon Septic Tank Finatb Grade / Lot 2rs / , - r 1 / _ , / LEACHING AMA 9.1� c j ,� Flow 880 GPD/0.74=118S SF RequiredFeb"° Use a 12'X 77 Chanter System r Sion Sidewall=2(12'+7211'=336 SF 3 3a1-1 1/r Bottom Area=(12'x 72)=864 SF r LEACHING r�owrhed 1200 SF Total Provided CHAMBER PERC TEST. 12,025 Is,s Viso �, ,� ; LEACHING CHAMBER DESIGN PERFORMED BY-IOItN O'DFA,E17'-SULLIVAN ENGINEERING _ N No / r .` �,• WITNESSED BY:DONNA MIORANDI,R.S.-TOWN OF HARNSTABLE ' ��\ ` ` �,/ `�� ` / p+F 2 �O % , All Pipes to be Schedule 40. Use NOVEMBER 8,2007 w ..•. /• ..�' .` �\ !�(,` 1 � � O�t3 � •` 2 � dry• �, $-500 Gal.Leaching Calambtas in a �• / C ti cry , i Washed Stone Field as Shown. CROSS SECTION OF CHAMBER TEST HOLE-1 EL 21.0 TEST HOLE-2 EL 21.2 TEST HOLE-3 EL 215 TEST HOLE-4 EL 21.a `" f /•`� '' r P NOT TO SCALE O LAYER O LAYER O LAYER O LAYS 3" 20.8 3" 21.0 4" 212 4" 213 ..--- A[AVER 10YR 3/1 A LAYER I OYR 3/1 A LAYER IOYR 3/1 A LAYER I)YR 3/1 VERY DARK GRAY VERY DARK GRAY VERY DARK GRAY VERY DARK GRAY 8" SANDY LOAM 203 6" SANDY LOAM 20.7 6" SANDY LOAM 21.0 8" SANDY LOAM 21.1 ' `� \� ' \ ` / Vest-rod LoombfioutobeDetermI E LAYER 10YR 4/2 E LAYER IOYR 4/2 E LAYER l OYR 4/2 E LAYER I iYR 4/2 \ } � � , at Timeottaata6rrbbe DARK GRAYISH BROWN DARK GRAYISH BROWN DARK GRAYISH BROWN DARK GRAYI:H BROWN / ./ \ \ , . , r ttKmupieuow r Pb®"Cle LOAMY SAND 20.1 0" LOAMY SAND 20.4 0" LOAMY SAND 20.7 14" LOAMY'AND 20.6 ` \ " BW LAYER IOYR 3/6 BW LAYER IOYR 3/6 B LAYER 10YRY 518 BW LAYER OYR 3/6 � DARK YELLOWISH BROWN DARK YELLOWISH BROWN YELLOWISH BROWN DARK YELLOW SHBROWN ?S \ a \\ pekfO$O q" SANDY LOAM 19.8 SANDY LOAM 21.1 " LOAMY SAND 18.9 SANDY i DAM 20-5 �� / Lot 260 ���� B/C LAYER 10YRY 5/8 B/C LAYEIt 1 OYRY 5/8 C LAYER 23 ER Y 614 B/C LAY I WRY 518 FP.BL.22s Z. - _ / \\ \ ` F.C.EL.21.0 See Nats 4pypy YELLOWISH BROWN YELLOWISH BROWN LIGHT YELLOWISH BROWN YELLOWiSbBROWN Ok \ \\ F.G.111.210 22" LOAMY SAND 192 38" LOAMY SAND 18.0 MED.SAND " LOAMY't4M 18.8 fir / \ \ t C LAYER SY Y 32" 18i C LAYER:SY 4 SEE NOTE 7 � LiGHT YELLOWISH BROWN LIGHT YELLOWISH BROWN 25 GALLONS iN 15 MIN. LIGHT YELLOWISH BROWN MrO.SAND l20" MED SAND„ >� 12Q"�. <2MINlIN. 113 120" MED. 18 \ ' .._-_�y _tl Pt;;t:'tEST. i83 NOGROUNDWA7ERLTJCOUNTER3D NuCRCSUNDWATEREN('.CiUNT-dlin� NOCROUNDWAT7;R iNCOUNTERBD / 25 GALLONS iN 15 MIN. i \ \1, •IrltllerbCeoPom 1 <2MRdJQJ. .0 / \ \�� / PriortobI TOP ELI&a0 NO GROUNDWATER BNCOUNTL•RHD \ 1` Lot 251 2000Cnlltxi \ Septic Tank Flaw Equiliaaa 9 _ / t"I (�x ^I Chamber Do.EL 15,410 PET�R "� a�A, Bedding,"T"s,dt BaBels J ! SULLIVANT a !a as Per Tide S try000tewma Remove 3 Repire ,R A,lunmtebt*SD&Vrg oyof C 'j is Min.-VAb (See Notes 9&9) T,Ow«Paimeter ornm syaem N0. 29733. 1N Min.-ftw6doo ! l� Lot 250 e .. s DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM ^ BL23 Lend: 0 NOT TO SCALE Per"T 09.Oroudwekr Map QS Sewer Manhole ® Holly Tree I Modified S.A.S. as Required Woter Manhole ® Catch Basin REVISION: & Elimate Oversized Tank DATE: 07124108 T1 TLE PREP ARED BY NOTES: - PREPAR D FOR: �° Hydrant Site Plan � E 0 . ° Cuy Proposed Impro vements CapeSurvl Guy Deciduous TreeUtility Pole � Sullivan Engineering, Inc. ,, # Light Post At PO Box 659 7 Parker Road 75 Bayberry Way 2007 Trust 1.) The property line information shown was ,, h Wetland Flog Coniferous Tree Osterville, MA 02655 Osterville MA 02655 compiled from availoble record information. o © Water Gate (round) 75 Bayberry Way (508)428-3344 (508)428-3115 fax (508) 420-3994 (508) 420-3995 fox 2.) The topographic information was obtained 0 as Gate (round) - Overhead Wires ca es G ( o ) OHW TP -25- - Elevation Contour PSuIlPEt4Yrol.com p urv�apecod.net from an on the ground survey performed on Barnstable MaSS, or between 091AUG107 and 21/AUG/07. Test Pit ..........5.........: Underground Utility Line OSterVllle -� Draft: JOD Field: WHK/DWB/RRL 30 o 15 30 60 120 3.) The datum used is NGVD '29, a fixed mean DATE SCALE: rr r Review: PS Comp.: RRL sea level datum. November 12' 2007 � -3� Project: 27019 Drawing C532_1G1 �, g # _-