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0153 BAYBERRY WAY - Health (2)
53 BAYBERZRY`WAY Osterville A = 091 =010 s rm E No.2.153LGN UPC 12134 smsad.com • Yads In USA �trct� � 1�4litaCltiCi�T11a &Fl �tflfCOfiM1LM c J C0 No. P 6 7- . Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in corn uter: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2ppliLatlon for -Misposaf *pstrm (Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /S'3 134y /3,C/z.:EY w9}`/� Owner's Name,Address,and Tg1.No. o s/Cnv.//& F io r rarer c Assessor's Map/Parcel 091 010 i53 3n 13ev2.LtY wA Installer's Na e,Address,and Ted.No. Designer's Name,Address,and Tel.No. _r?cnvG� //ro � 6sd 4 2Q7 STie D ivi 4 Type of Building: Dwelling No.of Bedrooms /V Lot Size sq.ft. Garbage Grinder( ) Other Type of Building by 5,E No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) -fjDP r^j A 51A=,0rvc_ e-1— .4—c c—Po -01 H> L 0�jf&4 pad r— /moo,)C4 ?o ThU£ i 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 o Health. �y Signed Date ///fit lc3 Application Approved by: Date s — (3 Application Disapproved by Date for the following reasons Permit No. O' Date Issued ` I a4 No. v I + — Fee4k . THE}COMMONWEALTH OF MASSACHUSETTS $nteied in cute> Yes PUBLIC HEALTHDIVISION -TOWN OF_BARNSTABLE, MASSACHUSETTS x;r application for Disposal.6pstem Construction Permit F r .4 i.-Application for a Permit to Construct( ) Repair(•.,).Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 3 0 13iz�c y w A�j� Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 0 9/ D✓D x iti 6101/ �j F�L�z y �,�y Sir- h r Installer's Name,Address,and Tel.No. Sad 3� Designer's Name,Address,and Tel.No. rvGP C� `1,'7� / SS S Type of Building: Dwelling No.of Bedrooms L'ot Size /, F _sq.ft. Garbage Grinder( ) 1 Other Type of Building i-A4,,,S x No.of Persons Showers( ) Cafeteria( ) X. Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan~• Date Number of sheets Revision Date "- Title ti Size of Septic Tank r Type of S.A.S. Description of Soil g 1 o Nature of Repairs or Alterations(Answer when applicable) /¢Dp c c i.-� •' �•� %/-/,% '^jF iL ro, i A b 1 COO' 7-C) TF/,r f X/C>i�v �..4 Date last inspected: J 1, Agreement: t f (Q ( ( 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 o Health. 4 2 Signed / "x'� / _ Date ��j �,all f Application Approved by Date S — I(3 f Application Disapproved by Date ` for the following reasons Permit No. po) r p Date Issued S` THE COMMONWEALTH;OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance R019 X- A THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by �f�. � �� ,r 7 at 1`i , �i� l _r �,-, �ti�, f`S 1 ri,_. �� has been constructed in accordance with the proo�visions of Title 5 and the�or Disposal System ConstructionPermit NocM3— 16 t dated Installer,y;>rr..a 1"I';_ r. ,�s �� Designer #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed.. Ins am, e / / v Inspector � 1,�!!-D { at i / // P ------/--------------------------------------------------------------------------------------------------------------- No. �17 7" I(0 T Fee 1 /w THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at /5 55Aj)rr1 1 ki,I6;? �J�P +e,// and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with i Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this perm" / ^ ' n n Date 13 Approved by TOWN OF BARNSTABLE ' 11,0CATION 5-3 i9 DCI'r SEWAGE# c20/3 VILLAGE 04 alai ram,Ite ASSESSOR'S MAP&PARCEL• INSTALLER'S NAME&PHONE NO. hpX.kL&_mr Sbl* Yd8 SSoZq SEPTIC TANK CAPACITY 1-'Z)601 LEACHING FACILITY.(type) (size) NO.OF BEDROOMS / OWNER IE/la1 PERMIT DATE: COMPLIANCE DATE: 6 13 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 Qd £ y rp yw ti l} l� TOWN OF BARNSTABLE LOCATION ` S� �� t om, r. r C.k 1,114 SEWAGE# i nS VILLAGE OS��e rti,', l+-� ASSESSOR'S MAP&PARCEL 21 1 p INS�RsS NAME&PHONE NO.V,,, ," SEPTIC TANK CAPACITY I J O LEACHING FACILITY.(type) C",,,kkc size) s -(:3"X 3 6 f NO.OF BEDROOMS S OWNER L�--cq IJ,A, PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility > S 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<; ,.Qe- . c, L D7 ` 3 3%z Y Lf s 53Cf sT TOWN( Ffry B&ARNSTABLE C . D:XtATION Gtt SEWAGE # i VILLAGE n sf«vd1 ASSESSOR'S MAP& LOT E STALLER'S NAME&PHONE NO. C A �y i quit-�2�5 SEPTIC TANK CAPACITY IS Oo M do LEACHING FACILITY: (type) Sod =,ez (size) NO.OF BEDROOMS BUILDER OR OWNER C Gf c f PERMITDATE: S- �'Lh COMPLIANCE DATE: S'"— t 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 wetlinds-exist within 300 feet of J4ching far�ij / " Feet Furnished by ,, y� i 7 y3 � ��� I � � �� � � ., �� P .�( TOWN OF BARNSTABLE LOCATION SEWAGE # VILi,AGE ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: ,.m Maximum Adjusted Groundwater Table and Bottom of Leaching Facility'. Feet Private Water Supply Well and Leaching Facility Vf any wells exist on site or within 200 feet of leaching facility) Feet z Edge of Wetland and Leaching Facility(If any wetlands exist within 300 fe of achi acili Feet Furnished w ' � a z So . P111A- J POOL AS BUILT NOTES - UMERAL NOTES: - u.„t•,RW��E�E ro�.�.m..,tw,L BAXTER NYE o R JtaaKeeeea� Ae�e,wem ., ENGINEERING& Lmgmata a m�t,m,e° ..w.w� wAatRHealtmawmlo,ra"E"a"t"Ma SURVEYING �eEnewrRaAted�.talem,;W ,.taE n rot,R L�a..,alkla°,W cafe - ��'t�xm°roit�o,� � rJ taWsvm1 w ter t ri n ���tNvyy„a n[raiun0,yxE rent Regtsleree Pr°les�and Engheers 0:\2012\2012-016 SURV °` aaWaaae � s nn. a „mnro d .H� m,a�RR ertatees�en,\ GRAPHIC\T ,.Pm.®'°"w.`W`rr` xmM *.,a ton,.tW 1 ... _ m.+[°1R ut.wo svin a ]e NM-SI 1-Ae F.O.1 r meToa smnc ttc Wu v wiaa Oa°o,W"RA tovw0 tirN¢aaw Hpn,,N nnse11,02601 _ a t I mwc wE ones rtlr wm,irouY rm t-o-w mwnbn amp I /!" ,ar✓wwul � )nWlsv v NwIpnOYw ,I Pnene-(506)]]I ]601 SF' :,.M.W,fIRgq M°RaR �Yvel°W,p.. . � detaA,Weuw,Wn<ael.maRrv. �'msasmtwTwAmveo mea me aE:eLm a";e m;,"a",�1°„t�IE���n1.:la'�" «w" (50)771-7622 -I y/i: rya..® nurxE'a sra e:.o a/,. J rm nWt.r.o.n«eta rum ws"e.'mmiWtrm"��'m �•mww�`nr.°�`�,mr°:wrmi'wi>u mwn.��•'ve I% I .wrv�rn,a:O6,m .w„°„tovemeeAe a,Ra e.-e..eov taRawmW.T H,M.WL TAMP TArvP 1 4 ,a�� oElwta Rm w Rm>a aam,w tElwu:- m m,w,tte aamAa reA t asae rm,me, LOCUS MAP SCALE:1"=1000 CO.IULTAII s \ J t PRE—El EPAREa FOR 1 ' 77, 3�JI �T4/.F Y i 153 Bey YN6W RT, (' F L Lewin,Tre 77 ! r w - /. ` _� ...°. �� \. .:j)•.- 1 ��� / /..•, 55 old Bedford Road Lincoln,Mass 01773 :ar , Q r OF If A. A. GD / 1 r. 1.. U.EA�r File pSE 3-5 041 6 /4x4 / LOMEWA}OH Will, - /��,� � roAY s�ERN Io C�W�iiK��H yyyyl�jtrYMRLD 71 A p o Pool AS-Built - � ; / !'.;• "msY°1G�tma"na cd:°ka�,a�T '^OWrtEaLws,t,.,mr,mr, IIR Y-drts tOUMY Os.w0.OWY OOM IEMI Irt 9wt H IORFMRD 9 M E E T N O `I .0 �E\' ro M COVSt'M.tne LbwWmh er rM ro4 cSMMcloa. f .I� 10 - • �a4..'II n + _ SCALE:•• 6CALE IN EEET , ,vnf � ♦w•,n a e"Oe. wne"n "r. 6k �R�SIDENCE,,�• TATELMAN RESIDENCE RENOVATION 153 BAYBERRY WAYrt OSTERVILLE, MA GENERAL NOTESro 5/ NICHOLAEFF ISSUED FOR PERMIT ARDHITECTURE-DESIGN 11 OCTOBER 2012 ARCHITECTURAL ABBREVATIONS GRAPHIC SYMBOLS DRAWING SYMBOLS PROJECT DIRECTORY DRAWING LIST TA�TELM IV "•m•--_ -- T • -+�cmecrwac vaa',,=3: .#'RESIDENOE MR.&ER Tlo rrtli exraT T R'/c+C ,���i .. w 16'.,_:•`9 w.w. .a. • y� ClD E]D9TCOUTE:PIAN E/C o- SITIVIL DI:1 :deer lLD01 DIDtO pAN q»'Ect,ura°m ..- _ _ c. "���� avu Y�a:'•c,_..M.. 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II � / � / r \ �e •$ !!�35�f'.��9 �g� 5��s :1��: €�@�d@td I II / 1 ;:1 1Jig ¢ @ Nila 1 ° R �M��L o� 1��!$• t'pro _ lib 8I 96�0'' I5�3 3 } a�RR 19 @ 6nir qA d G — 8 OF d o= T. VARNUM s \ PHILBROOK MECHAN�C'AL No. 30690 GENERAL NOTES: .. IL 0 S a / ———— Oar'` MI NI OLAEFF ARONREOTGRE.DESIGN - I g IL � I t _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ KEY ——— -- si . 1 NEW FIRST FLOOR STRUCTURAL '' it QZ Y< v, �t��i �� a 6��N ° � � { q • =ct,; tt�1yy i ` py CM IS t1 m O Q �'`•s M ZO¢crZ s >J0cXLU cr -i Q cr -+- �@ I O - - 01 co s �°� I I I ag - - — _ 4 ' a u ao"aa o 8SRI MIT r�l \ HEdip�p i w a Y IT�3 _ es F II i &wed•' \ sEs \ � 5ii� � i .� e; I s I �li 8 5:� •e 8F Aa � E Re9�_ �- � ?s r• �� e�A� S °ae`ss,I � IT 31, J Ix mill LA Hai$ I 8 2. .d' I9 89Y@ �_+.� • :ai 8s -° �3 s: y e° r •p gg - Fill 56 s lei&f3i'R} d Y io9k IS pin I• ` 0 r��� ,MAP, IN Mm .� •�'.��N� , ;.-•boy ID � � , � �i/�� .a: rr:����tiaz �' �-iy-�i�����!��+'ta ''�� � � ►//''.::, ��y��. ii�iil■ ... �.- ._._... A v ■�.� o ��u11u I _. tat ■�V ■w1�� 1 11■�,-� O AsBuilt _ Page 1 of 1 TOWN OF BARNSTABLE i LOCATION 1 5-� a r�C� �4 SEWAGE# insr� �a VILLAGE ASSESSOR'S MAP&PARCEL c1 ( O INS ER'S NAME&PHONE NO. ncQ,aAC. TcJT ter G05 SEPTIC TANK CAPACITY ,�r-O o LEACHING FACILITY:(type) NO.OF BEDROOMS S owNER L cep PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility > S 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 r FURNISHED BY +act-A 0. " \ 4 � ` � a7` . 3 a 3r• 3 7� 3�t y r r data/ rebuilt.as x?ma ar=091010&se =2 5/3/2013 fitt ://iss 12/Int anet/ o p q P P p P Pp q t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 153 Bayberry Way , Property Address Leo Van Munching Owner Owner's Name , information is required for Osterville MA 02655 ,April 11, 2012 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any ` way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the „ computer,use 1. Inspector. t r only the tab key to move your Patrick T. Sullivan use the return 71 I� cursor- not Name of Inspector key. Ready Rooter, Inc. Company Name P.O. Box 371 Company Address f : Sandwich MA 02563 City/Town State Zip Code 508-888-6055 ' S112843 _ 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 sewagef0sposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of C - c�_ r-,j Title 5310 CMR 15.000).The system: ® I Passes ❑.Conditionally Passes ❑ Fails , Fes-• � _ - .• , , . • ❑ feeds FurtherYEvaluation by the Local Approving Authority • Aril 18 2012 .' - • - Insp tor's Signature -�� . Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-11/10 , Title 5 Official InspVonForm:Subsurface Sewage Disposal System-Page 1 of 1 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° 153 Bayberry Way Property Address Leo Van Munching r Owner Owner's Name , information is required for Osterville MA 02655 April 11, 2012 .every page. City/Town State Zip Code Date of Inspection' B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: - ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 316 CMR 15.304 exist.Any failure criteria not evaluated are, indicated below. Comments: B ) System Conditional) 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/nk etermin d" (Y, N, ND) for the following statements. If"not determined," please explain The septic tank is metal anyea old*or the septic tank (whether metal or not) is structurally unsound, exhibiti infiltration or exfiltration or tank failure is imminent. System will pass inspection if the ek s replaced with a complying septic tank as approved by the = Board of Health. *A metal septic tank will pation if it is structurally sound, not leakingand if a Certificate of Compliance indicating that s less than 20 years old is available. ❑ Y ❑ N Explain below): r p t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 153 Bayberry Way Property Address Leo Van Munching Owner Owner's Name information is Osterville MA `02655 April 11 2012 , required for every page. Citylrown State Zip Code Date of Inspection B. Certification(cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): . - J, 1- ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ 'ND (Explain below): ' ❑- obstruction is removed ❑ Y ❑ N • ❑ ND (Explain below): ❑ distribution box is level 'd 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 Requirede Board of Health: re ❑ Conditions exist which quire f Zrfther 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 unles Board of Health determines in accordance with 310 CMR s 15.303(1)(b)that the yst in is not functioning in'a manner which will protect public health, safety and the environ7ent: ❑ 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•11f10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page'3'of 3 - a r 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 153 Bayberry Way a Property Address Leo Van Munching Owner Owner's Name information is required for Osterville MA , 02655 April 11, 2012` every page. Cityrrown 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 t utary to a surface water supply. ❑ The system has a septic tank and S S and the SAS is within a Zone 1 of a public water supply. • ❑ The system has a septic tank an SAS and the SAS is within 50 feet of a private water supply well. _ ❑ The system has a septic tank and SAS nd 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 wat analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent a d the presence of ammonia nitrogen and nitrate nitrogen is equal 'to or less than 5 ppm, provided th no other failure criteria are triggered. A copy of the analysis must be attached to this form. a . 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: No Yes r - , 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 Y2 day flow t5ins-11/10 _ Title 5 Official Inspection Form:Subsurface Sewage Disposal System"Page 4 of 4 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 153 Bayberry Way Property Address Leo Van Munching Owner Owner's Name information is Osterville MA 02655 A nl 11, 2012 required for P every page. City/Town State Zip Code Date of Inspection, B. Certification (cont) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ' ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply,or tributary to a surface water supply. ❑ ®. Any portion of a cesspool or privy is within a Zone 1 of a public well.. a ❑ ® 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 x. ❑ ❑ the system is with' 400 feet of a surface drinking water supply ❑ ❑ the system is thin 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system i located in a nitrogen sensitive area (Interim Wellhead Protection Area—IW A) or a mapped Zone 11 of a public water supply well If you have answered"yes"to ny question in Section E the system is considered a significant threat, or answered "yes" in Sectio D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate'. regional office of the Department. t5ins•11/10 Trtle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 5 •° Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - 153 Bayberry Way Property Address Leo Van Munching Owner Owner's Name information is Osteryille MA 02655 A nl 11, 2012 required for p - - every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No - ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ , ® Were any of the system components pumped out in the previous two-weeks? ❑ ® Has the system received normal flows in the previous two week period? El ® Have large-volumes of water been introduced to the system recently or as part of this inspection? ` ® ElWere 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 Peen determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® Determined in the field (if any of the failure criteria related to Part'C is at issue El approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 5 Number of bedrooms(actual): 5 'DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 GPD t5ins-11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 6 of 6 Commonwealth of Massachusetts Title 5 Official Inspection Forma o Subsurface Sewage Disposal System form -Not for Voluntary Assessments M 153 Bayberry Way Property Address _ Leo Van Munching Owner Owner's Name information is required for Osterville MA 02655 April 11, 2012 every page. City/Town State Zip Code Date of Inspection D. System Information ° r Description: Permit for system installation has 5 bedroom.As-built states 6 bedrooms., Number of current residents: 0 k , Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ YesP 0 No Laundry system inspected? ❑ Yes' ❑ No Seasonal use? ❑ Yes ® No *2010=1067GPD Water meter readings, if available (last 2 years usage (gpd)): 2011= 1041 GPD = Detail: *Very high water usage during summer months due to irrigation.- Sump pump? ❑ Yes,® No Oct. 2011 Last date of occupancy: Date s Commercial/Industrial Flow Conditions: . Type of Establishment: , Design flow(based on 310.CMR 15.203) canons per day(gpd) z Basis of design flow(seats/persons/ ft.;etc.): r Grease•trap present? ❑ Yes-,❑ No Industrial waste holding tank pr ent? ❑ Yes ❑ No Non-sanitary waste dischar d to the Title 5 system? ❑ Yes'❑ No Water meter readings, if available: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 7 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System.Form -Not for Voluntary Assessments 153 Bayberry Way ; Property Address Leo,Van Munching Owner Owner's Name r information is Osterville MA , 02655 April 11 2012 required for P every page. City/Town # ., State Zip Code Date of Inspection D. System Information (coat.) < Last date of occupancy/use: Date Other(describe below):_ _• General Information Pumping Records: Source of information: No records found 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 box, soil absorption^system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes;attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ `Other(describe): t5ins•11/10 TrUe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 8 Commonwealth of Massachusetts UM Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 153 Bayberry Way Property Address, Leo Van Munching Owner Owner's Name information is Cisterville MA� 02655 April 11 required for p �il , 2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Approximate age of all components, date installed (if known) and source of information: System installed May 21, 1999. Certificate of Compliance on file at Board of Health. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 4'8;, Depth below grade: feet Material of construction: ' ❑ cast iron ® 40 PVC ❑ other(explain): ' Distance from private water supply well or suction line: N/A ` feet Comments (on condition of joints, venting, evidence.of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass.; ❑ polyethylene ❑ other(explain), r If tank is metal, list age: yeas • Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No � Dimensions: - 11.5'X 5.5'X 5' 1500 gallons, 2 Sludge depth: * t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal-System•Page 9 of 9 f - Commonwealth of Massachusetts . Title 5 Official Inspection Form b Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 153 Bayberry Way Property Address Leo Van Munching Owner 0 ner's Name requir atifo is Osterville MA 02655 April 11, 2012 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) f 3711 , Distance from top of sludge to bottom of outlet tee or baffle. o„ Scum thickness 6" 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? Tape measure and dip tube. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, ' liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet and outlet PVC tees in place. Liquid level at outlet invert. Inlet viewed with mirror, Access under paved driveway. Outlet riser brings cover within 2"of grade. • ' 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 to of outlet tee`or baffle - `Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date , t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal.System-Page 10 of 10 i ' T Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 153 Bayberry Way Property Address Leo Van Munching Owner Owner's Name informatioor n is required f Cisterville MA 02655 April 11, 2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,. liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑metal = ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: _ Capacity: gallons Design Flow: gallons per day Alarm present: ❑, Yes ❑ No 'Alarm level: Alarm in working order: ❑ Yes'. ❑ No Date of last pumping: Date Comments (condition of alarm'and float switches, etc.): Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 153 Bayberry Way. , } Property Address , Leo Van Munching Owner Owner's Name information is Osterville MA 02655 April .11 2012 required for P , every page. CityTTown State Zip Code Date of Inspection D. System Information (cunt.) Distribution Box (if present must be opened) (locate on site plan):'" on 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.): One inlet,two outlets. No.solids carryover. Speed levelers are in place. Root intrusion into D-box. Not affecting system operation at this time; however, may be issue in future. No sign of past high water staining over outlet inverts. Riser brings access within 6"of grade. : . - Pump Chamber(locate on site plan): - Pumps in workingtorder: ❑ Yes ❑ No, Alarms in working order:' /amber, '1 El Yes , El No Comments(note condition of pumpcondition of pumps and appurtenances,.etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: z t5ins•11/10 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 12 of 12 Commonwealth of Massachusetts " Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 153 Bayberry Way Property Address Leo Van Munching Owner Owner's Name information is Ostetville MA 02655 Aril 11, 2012 • required for P every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: 2 rows of four ® leaching chambers • _ number. units w/4'stone ❑ leaching galleries number: ' ❑ leaching trenches number,.length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding; damp soil, condition of vegetation, etc.): No sign of past ponding. No sign of,past hydraulic failure. Cesspools (cesspool must be pumped as part of inspection) (locate o'n site plan): Number and configuration Depth—top of liquid to'inlet invert Depth of solids layer - F ' Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ .Yes ❑ No t5ins•11/10 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 13 of 13 Commonwealth of Massachusetts ; Title 5 Official Inspection Form' '-,'- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •''� 153 Bayberry Way " Property Address , Leo Van Munching Owner Owner's Name f information is April Osterville MA 02655 A 11 2012 required for P • , every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): • Privy(locate on site plan): Materials of construction: /si�ns.of DimensionsDepth of solids Comments(note condition draulic failure, level of ponding, condition of vegetation, etc.): S t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 14 of 14 f Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 153 Bayberry Way PropertyAddress "F" Leo Van Munchingz kiwi Owner owner's Name information is required for OsteNllle every page. City/Town MA 02655-i April 19,2012 ` Stge p Code Date of Inspection D. System Information (Cont.) Sketch Of Sewage Disposal System:Provide a view of the sewage disposal at least two g posal system, including ties to Permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the taxes below:' ® hand-sketch in the area below ❑ drawing attached separately 47 l , . � 1 , .. .~ lam; J / • ;i. � a7. 3 3e= 3G r ' 4i A - 3Q ' a; 41`l b3� �taj O r t Title 5 Official inspection Form:Subsurface Sewage Disposal system is of is Commonwealth of Massachusetts . Title 5 Official .Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . 153 Bayberry Way Property Address Leo Van Munching Owner Owner's Name information is Osterville MA 02655. required for - April 11, 2012 every page. City/Town state Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high groundwater. feet Please indicate all methods used to determine the high ground water elevation:V ® Obtained from system design plans on record : May 1999 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: ma.water.usgs.gov terraserver-usa.com You must describe how you established the high ground water elevation: Test hole found ground water at 11.2' beolw grade (elv: 6.8) 1999. Base of SAS 3.5' beolw grade. Accessed local ground water contours and topo mapping. z Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11110 Tide 5 Official Inspection Fond:Subsurface Sewage Disposal System•Page 16 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 153 Bayberry Way Property Address Leo Van Munching Owner Owner's Name information is Osterville MA 02655 Aril 11 2012 required for p every page. City/Town State Zip Code Date of Inspection " E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked inspection Summary D (System Failure Criteria Applicable'to All Systems) completed ® System Information—Estimated depth to high groundwater "® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file , k t5ins•11110 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 17 of 17 n No. Fee rl THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 0[ppfication for �Dioponl *pgtem Cowaruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. w� Owner's Name,Address and Tel.No. Assessor's Map/Parcel / �y Vefef vht4 wife-be pI /' {D f���`^'_ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �96y IA-VAAES Or few(A& Type of Building: Dwelling No.of Bedrooms -4;0* Lot Size A F3. sq.ft. Garbage Grinder Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow SS O gallons per day. Calculated daily flow gallons. Plan Date S 94. Number of sheets Revision Date Title Size of Septic Tank a?Ooo Type of S.A.S. ~'"Description of Soil .SAItel G. C. a Nature of Repairs or Alterations(Answer when applicable) t2 cat o w e - all s f Q AF,* �lr��s1 wtiek.,4 td Ac� 441 14 ,03 h l k !tro d �,4 i.fir f few- Date last inspected: 9 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 Certifi- cate of Compliance has been issued - this B alth. / Signe Date >! _ Application Approved by Date Application Disapproved or the following reasons Permit No. Date Issued No. _ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ZX1 Yes PUBLIC HEALTH DIVISION -TOWN,OF BARNSTABLES MASSACHUSETTS Z[pprication for ,M gpozaf *pgtem (fow5truction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components 'L• cation Address or Lot No. Owner's Name,Address and Tel.No. r a ?,nfrf Vh14 vetvcbcj. q Assessor's Map/Parcel f Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. y ,Type of Building: Dwelling No.of Bedrooms Lot Size A !F,3 sq.ft. Garbage Grinder Other Type of Building No. of Persons Showers( ) Cafeteria( ) �. Other Fixtures Design Flow S5 D gallons per day. Calculated daily flow gallons. Plan Date S 19s. Number of sheets Revision Date Title K Size of Septic Tank o2 60 0 Type of S.A.S. Description of Soil S hat'd G ! . Nature of Repairs or Alterations(Answer when applicable) 12 capi rs w e:: ,2 2,a `f tr r, !),e&;. r rg s r kt.r i" � s ?• • la°L"c >n-. 1�_ �o c. �t.�.( a ty.1 Furl- �t v Date last inspected: Agreement: {� j The undersigned agrees to ensure the construction and maintenance of the afote'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 Certifi- cate of Compliance has been issued this B hlth. -> tr y= •!Signe v � '` .ti ' t Date�� >/ e" Application Approved by Date Application Disapproved for—the-following reasons rp - Permit No. Date Issued 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 at a be n constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit N . led Installer Designer. The issuance of this p--rmit shall not be construed as a guarantee that the system will function as designed. Date - 1 , -! � Inspector • j { —// — -- --------------------------- 9— No. Fee, THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS x1h6po0af 6potem (Construction Permit Permission is hereby grantedto , truct Repair( )Upgrade e k�) bando 01 System located at �/ v Z V_/� i and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction t be ftt leted within three years of the date oft 's�ert�i it Date: I Approved bylj!/iG%( 4 sattivaw N010 IRA 7 Plate►Road, OMWVUk 42"344 van MAXhing 133 Bayberry Way Osterville Maas, Design Data Summary I. One leaching galley field 13' x 70' OR 2-13'x 36'leaclt ag galley fields. 2. if two fields are used then Spacing between the two fields is to be at least 13' 3. Leaching galley chambers to SOU-gallon capacity. Eight are mquir6d. 4. All components to be$f S. Leaching galley field to have Mur fabric in addition to pm stot►e. 6. System must be vented. The vent pipe to be 4"diameter and can be place in an iaconspicuous location. 7. Existing d-box can be use however it Abe moved out ftom under the proposed tennis court and it shall have s.cost iron frame and cover to finished grade. Option would be to locate Mime and oovar 12" below finished grad*. k- r, G e s UM 0 Cowa" Ya&CAOC, 6 1tt� u7"a�' 'T1C,wa��to ax z�� £xt�t•�.f�eo fief,!I` PW°Tit�'d DEVELOPED_ PROF E_O?F PROPOSED SEPTIC SYSTEM Not to SCQ16 _ A'' Ai17S; W Patttint'teP6 �G�`S itt*C.tlO► 8vf�f�.. FlniMe �.c�ttSip folio d fill Pea 3110" :r Choohing e 3/4"-1 1/2" �y Double VOW too Stone } -I s CROSS SECTION OF CHAMBER IjAT m scnt.of OTES -DE$I I.WOr Supply ForThis Lot is Q" R&TA Single Family-.TBsdroom 2 Location of Utilities Shown on This Nn Are Approx. With no Garbage grinder At Least ?2 Hours Prior to Any ExcavatioA For This Daily Flows 110 a .a 57!;oOPO Pro Septic TOW SSI>QPD a R00%= I IOCGPD Notlect The ContractorShall Make The Re d f ication to Dig Safe 0 800-322-484irfs Use lsb6 Galion Septic Tank I The Contractor is Required to Secure Appropriatc, LEACHING AREA Permits From Town Agencies For Construction 5-`C Defined byThis Plan. GPD/0.74274A SF Required 4. Install Risers as Required to Within 12!'of Bottom Area* rS. %?a e t� SLIF Finished Oteds. 9%0 S-F Total Provided S.All Structures Otirl6d lIg blare Feet or ate or Subject' LEACHING CHAMBER DESIGN to Vehicular Traffic to M-20 Loading. Ai I Pipes tO be Schedule 40. Use 44 T. a Se,Ptic System to be Installed In Accordance Wlih 500 Gal.Leaching Chambers Ina 310 CMA IS.00 Latest Revision And The Town of Washed Stone Field as Shown Barnstable BOOM of Health Regulation 7 Al I Piping to be$ch. 40 PVC. 70f 7 F 10. 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) 9�:aI, hereby certify that the application for disposal works construction permit signed by me dated , concerning the property located at 1 vv� �J/ meets all of the following criteria: • The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There are no wetlands within 100 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] • If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surf Elevation(using GIS information) Iq B G.W.Elevation +the MAX.High G.W. Adjustment. ®`0 _ g J DIFFERENCE BETWEEN A and B 6 SIGNED : DATE: 5� /`> (Sketch proposed plan of system on back], q:health folder:cert TOWN OF B•ARNSTABLE (� Z LOCATION _/ r/_ �1yYc/ SEWAGE # VILLAGE s f«�,lL• ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS G BUILDER OR OWNER C /' PERMTTDATE: l `t L, � 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�/aChing fa i-lity) Feet Furnished by r COMMONWEALTH OF MASSACHUSETTS ID Z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS _ C DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTON, MA 02108 617.292.5500 P I 07� � � � � µ'ILL1.4.%1 F.'AELD TRL'Dl'CO.X Govcmor Sccreta ARGEO PAUL CELLUCCI DAVID B STRU Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commission PART A CERTIFICATION C.H.Newton Property Address:1 53 Bayberry Way Ostervi1le MA Address of Owner: Date of Inspection: 2/10/9 8 (If different) Name of Inspector: Joseph P_Macomber Jr. I am a DEP a proved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: .P.Macomber & Son Inc. Mailing Address: Box 66 Centerville,Mass. 02632 Telephone Number: 5OR-775-333F3 CERTIFICATION STATEMENT I cenify that I have personally inspected the sewage disposal system at this address and that the information reponed below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: asses Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature. zl Date: "ld'W Z4. 1�*at4a The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (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 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: Check A, B, C, or D: A) SYSTEM PASSES: 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. COMMENTS: B) SYSTEM CONDITIONALLY PASSES: /06 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. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or ex-filtration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 o1 10 DEP on the World Wide Web: http://www.magnet.state.ma us/oep +� Printed on Recycied Paper L< t t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 153 Bayberry Way- Osterville,Mass . Owner: C.H.Newton Date of Inspection: 2/1 0/98 B) SYSTEM CONDITIONALLY PASSES (continued) Sewage backup 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 system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping chore 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 obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: No 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 WILL 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, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. 11� The system has a septic tank and soil absorption system and the SAS is less 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 that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 153 Bayberry Way Osterville,Mass . Owner: C.H.Newton Date of Inspection: 2/1 0/9 8 D) SYSTEM FAILS: You must indicate ei;-.er "Yes" or "No" as to each of the following: 1 have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303 Tne bass for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to corre< the failure. Yes No Backup of sewage into facility or system component due to an 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�q r clogged SAS or ces pool �e acl, 7r�uclKt S,+sre�r., Y.s dry ,-J- ;20 r Liquid depth in ee»povF►is less than 6" below invert or available volume is less than 1/2 day flow. �— Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s) Number of times pumped -. Any portion of the 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 wafer suppis Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. L 11 Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with nc acceptable water quality analysis. If the well has been analyzed to be acceptable, anach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: _IVO The system serves a facility with a design flow of 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. Yes No 4 the system is within 400 feet of a surface drinking water supply ALLI 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 11 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 groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. )revised 01/75/37) Vag• 3 of 10 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 153 Bayberry Way Osterville,Mass . Owner: C.H.Newton Date of Inspection: 2/1 0/9 8 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No / Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. large volumes of water have not been introduced into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. _f,/6Nt The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components, a*cluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: f _ The facility owner land occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. _ Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Pan C is at issue, approximation of distance is unacceptable) (I 5.302(3)(b)) (revised 04/25/97) P&q• 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 153 Bayberry Way Osterville,Mass. Owner: C.H.Newton Date of Inspection:2/10,//J98 'OrVAex FLOW CONDITIONS RESIDENTIAL: Design flow: p.d./bedroom for S.A.S. Number of bedrooms: ,, ��_ Number of current residents: t4oll k-4 e, )'aevk ) Garbage grinder (yes or no):" Laundry connected to system (yes or no): Seasonal use (yes or no):_iO Water meter readings, if available (last two (2) year usage (gpd): i(U ez� ' Sump Pump (yes or no):,&& Last date of occupancy: /LA COMMERCIAUINDUSTRIAL: Type of establishment: IJ,4 Design flow:AWallons/day Grease trap present: (yes or no)/VA Industrial Waste Holding Tank present: (yes or no)1f'('� Non-sanitary waste discharged to the Title 5 system: (yes or no)Aziep Water meter readings, if available:�(1/ft ZIA Last date of occupancy: OTHER: (Describe) 'V4 Last date of occupancy: t11q GENERAL INFORMATION PUMPING RECORDS and sourcg of iyormation: System pumped as part of inspection: (yes or no)" If yes, volume pumped: gallons Reason for pumping: iJ1if;/ TYPE OF YSTEM Septic tank/distribution box/soil absorption system A>0 Single cesspool X) Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology eS4 Copy o up to date .Contract? Other NI" /L�SL°�/� "5 r '-�1P APPROXIMATE AGE of all components, date installed (if known) and source of information: llle� Sewage odors detected when arriving at the site: (yes or no) (revlsad 04/25/97) Page 5 of 10 .` u 6' Hi yrl •,i.r ., W i `` `v WaJ` J /'i/�yL. 4tN -i•"` S.G (,.(/✓ AtD":A "�; D 1 / :f c � � __ ._ _� W 21 `` ., ProPo�d yyater erv� 17 ' \ — w 4y W-- 2 A P s 1500 Ga• eptic TTkcet g 800 (;d. Yy'Yy-Y'Y-r V-®-Y _� *aching PH ` \ emovod osed Y -..� ,V• ' p — BOX 4 Gal. \ 5 — putle 1500� L �Ing r as X �� Lc qY 1 �,d tingTank To \ ov�ed 2 — 3 �e X �- peeA L 1 And r I P� P A. ston e, Drive & forking (0 �G 18 ! 500 0 00 el 00 Tank Oe \ o Be RSMo�� p e \ +�5 I O.H. Tag G i g e Ed9 F. a L5 st n ` \ 5 g o�0r c, `. .ode \ / �► /// ility pole--, \ / Guy , a f �• & ervice par 9 rive e en t i s, 5 r Bituminous r C / i _ — Meter .,ter Pit SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 153 Bayberry Way Osterville,Mass. Owner: C.H.Newton Date of Inspection:2/1 0/98 BUILDING SEWER: (locate on site plan) Depth below grade: A�—f Material of construction: 4zcast iron - 40 PVC _ other (explain) Distance from/private water supply well or suction line Diameter Comments: (condition of joints,vnting, evidence of leakage, etc.) /� _ i /i O V SEPTIC TANK:4!70—d (locate on site plan) Ir Depth below grader Material of construction: �eeocrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age //A�j Is age confirmed by Certificate of Compliance 414(Yes/No) Dimensions:L�I,;/ Sludge depth"` Distance from top of sludge to bonom of outlet tee or barfle;in_,, _ Scum thickness:_ _ �jW y Distance from top o scum to top of outlet tee or baffle: / Distance from bonom of scum to bonom of outlet tee or baffle-.,,O. How dimensions were determined: s Comments: (recommendation for pumping, conditi of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) J J /ZA,4 Awl GREASE TRAP:_,&jWe (locate on site plan) Depth below grade: X1,-4 Material of construction 44concreivLlAmetaKJAFiberglasso(d Polyethylene i4other(explain) 14 Dimensions: Scum thickness:�� Distance from top of scum to top of outlet tee or baffler Distance from bottom of scum to bottom of outlet tee or baffle: '04 Date of last pumping: 2.21-4 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.) (revised 04/25/97) Pag• 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 153 Bayberry Way Osterville,Mass. Owner: C.H.Newton Date of Inspection: 2/1 0/98 TIGHT OR HOLDING TANK:A4*4'C(Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of construct ion;aconcrete Udmetal4�1,Fiberglass�VA Polyethylenev&other(explain) NA AM Dimensions: A)A Capaciry X,% gallons Design floe j gallons/day Alarm level. A!t4 Alarm in working order )'es:yL Nu Date of previous pumping: .VA Comments (condition of inlet tee, condition of alarm and float switches, etc.) T.ra AMP ,DES tv-t/T DISTRIBUTION BOX: (locate on site plan) Depth o- liquid level above outlet invert:�� Comments (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) rg wwa PUMP CHAn1BER:XIAW� (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 appunenances, etc.) (r•v;s•d 01/25/97) P.q. 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 153 Bayberry Way Osterville,Mass . Owner: C.H.Newton Date of Inspection: 2/1 0/9 8 SOIL ABSORPTION SYSTEM (SAS):k 4;444 ;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: ..�i 06�1�WiL; �G _5 l! /✓� rE+,ryfdd�i� �'�'�g / ? T leaching pits, number: i leaching chambers, number: leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: !� overflow cesspool, number: Alternative system: N Name of Technology: Comments: (note condition of soil, signs of hydraulic failur , level of onding, condition of ve etation, etc.) It'& 14-11 ---— JS vrvs�Ad CESSPOOLS: (locate on site plan) Number and configuration: i!/A y Depth-top of liquid to inlet invert: l/4 Depth of solids layer: fw Depth of scum layer: to Dimensions of cesspool: Materials of construction: '&zg Indication of groundwater: A//9 inflow (cesspool must be pumped as part of inspection) EC�: ,P s ea^y 4,0,- 5eVZ Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:AbUL, (locate on site plan) Materials of construction: .A//¢ Dimensions: ti/9 Depth of solids: Comments: (note condition of soil, signs of-hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/35/97) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 153 Bayberry Way Osterville,Mass. Owner: C.H.Newton Date of Inspection: 2/10/98 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) v . >u Q) 1 - (revised o4/2s/97) Page 9 of 10 I�' SUBSURFACE SEWAGE DISPi L SYSTEM INSPECTION FORM I C SYSTEM INFOI.".. ;ION (continued) Property Address: 15 3 Ba yberry Way Osterville,Mass . _ Owner: C.H.Newton Date of Inspection:2/1 0/98 Depth to Groundwater _ Feet Please indicate all the methods used to determine High Groundwater Nc-,a;ion: Obtained from Design Plans on record Observation of Site (Abuning propem, observation hole, basemznh sump etc.) f etermine it from local conditions heck with local Board of health Check FEMA Maps heck pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High GrouncKvxer Elevation. Must be completed) Used Groundwater Contours Map, Gahrety & Miller Model 12/16/94 (rsvia•d 04/25/97) P&C• of 10 TOWN OF Barnstable WARD OF HEALTH! Sl1IlSURFACF SF.HAGF DISPOSAL SYSTEM I NSPECTION FORM - PART D '- CF11TI FI CATION `1 �_ �•.•-•-•r•.•.. --..-^-.--n.r.-n•r,.�rn'.r.-rrrrrrr,-.�-•.�-+rrw-�mmrrc'�w.�ae ma's man-.+nrrr.rv-rrr'..r+r.:—rrrr--. ._..A . -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 153 Bayberry Way Osterville,Mass . ASSESSORS MAP, BLOCK AND PARCEL OWNER' s NAME C.H.NEWTON PART D - CERTIFICATION C NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber & Son Inc. COMPANY ADDRESS Box 66 Centerville,Mass. 02632 Street Town or City State ZIP COMPANY TELEPHONE ( 508 ) 775 _ 3338 FAX ( 508 1 790 - 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposa`1 system at this address and that the information reported is true , accurate ) and complete as of the time of .inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : _2_/System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or Lhe environment as defined in 310 CMR 15 , 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* The inspection which I have conducted has found that the system fails to protect the public health and the environment in accordance with Title 5 , 3.10 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature �/ Date One copy of this ert.ification must be provided to the OWNER, the BUYER ( where applicable ) and the 130ARD OF 1rEALT11. * If the inspection FAILED , the owner or."operator shall upgrade ' the system within one year of the date of the inspection , unless allowed or required otherwise as provided in 310 CPIR 16 . 305 . partd . doc l 1 -C; ti THE COMMONWEALrI H OF MA.SSACIMSETTS DEPARTMENT OF ENVLRONM:ENTAL PROTECTION BE IT INN O WN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualificatiQns as required and is hereby authorized to use the title CERTHiU D TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21 A of the General Laws. Issued by The Department of Environmental Protection. )unc - nrunK Dircctor of the t i ,on of W�tcr Pollution Conuol o r -L O,C AT ION /53 Sgyg" 4-)Ay S E W A G E. RMIT NO. <� VILLAGE INSTA LLER'S NAME i ,ADDRESS 3UIL0EIII OR INNER DATE PERMIT ISSUED D A T E , COIAPLIANCE ISSUED _ _ � _� � ,, ��� -� � ,, �o� K �� , • � -� � �; K c � � �� � y � � � � - a `� ��� h . . �� LOCATION SEWAGE P RMIT NO. /,�3 ;&Ayrmeeg pia S R `Y14LAGE INSTALLER'S NAME 0 ADDRESS - 9 9 TLI TD•�/J' /C.LJ O ZCo ® UILDER OR MER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �_�� � M O " � � -.� �° "! � = (, Y � < ,�► `\ � J � ,� � - 47 ' � ' �, � :� o e� � .� o x� � \ � J Zs a>,- � � � � C� �; �ti,�' -� ^-- �6• -Y, Pam. "o No....... ........... Fps.. ..................... THE COMMONWEALTH OF MASSAgCHUSETTS BOARD ®F HFFF HEALTH H pplira#uan for Dispaami aarkti CInmu:d �ou a nit Application is hereby made for a Permit to Construct,;( ) or Repair ( } an Individual Sewage Dispo al " System $t ... .4R ....... �... ._ �✓ �A i lJ •- r� .!'r' ... .. � ..._. .. _.__.A ._...... ._. .................. ...._. Location-Address 2 or"Lot No Owner Address W Installer �_.. "�_/- ' Address _ � ---------------------------•• - __ ---------------------•---• •--- d Type of Building Size Lot___d—��.. ............. eet Dwelling—No. of Bedrooms............... ..._._........_--..._Expansion Attic ( ) Garbage Grinder (V) Other—T e of Building ............... No. of persons...._....................... Showers — Cafeteria Other fixtures ---------------------------------------------- W Design Flow........... _......�----------gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank-AZ--Liquid capacity/..gallons Length................ Width---------------- Diameter_.-_ __-• Depth.. ...... Disposal Trench—No...../............. Width....../4.-.-.--- Total Length---. ..LZ..... Total leaching area.._4Z_i ._.'.sq. ftr Seepage Pit No.....Y--------- Diameter..../Z__.)......... Depth below.inlet..... .......... Total leaching.area_!Y1V_®._..sq. ft.- Z Other Distribution box ( ) Dosing tank ( ) ,.., a Percolation Test Results Performed by---,�'�4X_f`�. !Z7.�........................... Date.....A�.�� �.................... Test Pit No. I----------------minutes-per inch Depth of Test Pit.................... Depth to ground water-------..__-______... .. Test Pit No. 2...... .:_minutes per inch epth of Test Pit-------------------- Depth to ground water .................................... . ...... � ................ . .................................. ® Description of Soil.........• � l U w ••-----------------------------------------------•---------------------------•------------•----•----------- ---- ----- ---'- . •--•--.-•--- •-•--•. UNature of Repairs or Alterations—Answer when applicable._ mo d, - .......................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'T T L p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has issued by the board of health. igne ........... .............................. Dat Application Approved BY...=�--A - -*1, '----------••--.................. � -------- .,...: - Date „-. Application Disapproved for the following reasons-----------------------------------------------------••---- ... .................................-................................................................................................------------------ PermitNo......................................................... Issued_....................-- ----•-- .ate ..... Date c' Od t No.........f Fes$.........................._. THE COMMONWEALTH OF M` $SACHUSETTS '} Al 'BOARD OF` HEALTH ........ ................................:OF.....................................:' ----•---.......................... s ' A r irtt glant.fo�r Bi i po at ,arks T mitrnrtinn .ermff J, Oi Alt 6�a T149VA:WLkiet ( ) or Repair ( ) an Individual Sewage Disposal Sys . J ., - •--------- ---- ---•------ ►-LdE'dilbff�l�e}ress �ic'�y{i+�v�"Vt ��7/�+i.i } Owner ':a Address Installer Address Ty pe of Building Size Lot............................Sq. f�,t�'y � Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p, Other—g pe of.Building/�.................. No. of persons.............. :::.__-____ Showers ( ) — Cafeteria ( ) her s ... .-�b'0 --- / ----------- ._.. W Design Flow.....:.............:.................::.....gallons p�r ?erson per day. Total i flow...............................:. allons. W Septic Tank—Liquld capacl y___.._..__ gall�I'f Length................ Width..------------- Diameter._.............. � NI _ .... x Disposal Trench—No ,_.. ......_.• Width............... Total Length.................... Total leaching,area----.----------... sq. ft. v Seepage Pit No-------�------ Diamefer. .............:... Depth below inlet.................... Total leaching area......_...........sq. ft. ( ) Y Dosig k ( ) 0-4 Percolation Test Re_ults Pe r Other Distribution box n / med by ���� .. ... Date /e 6 a G1 a Test Pit No. 1................m>futes per inch Depth of Test Pit.___:____.____.____. Depth to ground water........................ fTq Test Pit No. 2....e-6.......minutes per inch Depth of Test Pit.................... Depth to ground water........................ .........................................................................................................--......................... ODescription of Soil _: .........!...mt. -•----••-••-.....----•-------•-------•- -- ------• -•--•-----•----------------------------------------- x I�' C�.vG: �� v = w --------------------------------------------------- -----------------------------------•-------------------�, U Nature of Repairs or,.Alterations—Answer when applicable;,.__-_-_--------------------------------------------------------------------------------------- --------•------------•------------------------- .......................................................... .---------•--------------------------------------------------.....-•--•-------. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of 1 i 7, y g g p y 5 of the State Sanitary Code— The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has b e issue board of health. , • - S' ned gat.. �� Date a Lam=rf dFij/� j-� 2•+- '/ Application Approved BY Date Application Disapproved for the following reasons----------------•-------•------------•--------------------- ................................................... 3 -rnn _. ---------.................................-............._== ---••...........................................................................................-........................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS 3 BOARD gO HEA H ...........7;� ... OF........... '...._.......:...._.. . - C�rr�gfgrtt#r laf fP�unt�li�anrr TH i1 0 ER Ya�t the Individual Sewage Disposal System constructed ( ) or Repaired by ` � ri�J_ L+G "r ` --- BInstal r -- '- --• •- has been installed in accordance with the provisions of 'I'I r " 5 of Mate Sanitary Code as described in the application for Disposal Works Construction Permit No:. .... ........ _.._......... da.ted__----_�'-._�,?_�_�./......... THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ff ..:.....:......... •-----....... Inspector....-- --•--•-•----=-------•---•-- L ...127------------------- THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HEA �_. ` ......... .........t.............OF........: .....-:.. ... .. r No. ......... FEE..... Permission is hereby grante to Constr a( ) Ao epair an tI� idu 1 Sew a Disposal st h at No. . �. 'y treet f ;— a Works ,. : shown on the application for Disposal orks Construction Per its No.._....• ..... ated..... .-.,�.�.-.. ' ...... Boar o ea th DATE................................................................................. FORM 1255 HOBBS & WARREN. INC., PUBLISHERS _, - N011--110 r Fss....�r�_��_....._ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH �11 Q10 TOWN OF BARNSTABLE Appliration for Disposal Marks Tonstrudion Prrnti# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal iSystem at: -•--....1 .5.�a�r �xry.-hl�,y.,...Q . �.rv.i.]..1�}fMA-L-•-=-------- ---MAP_..91.%..P�.r..U]..-1 a......_..............-•-- Alan J. & Diane`atl n �anVart 75 Barnes Hill Rc�r.1°tedlicord, MA. 01742 •--------------•--------. ._..... ...................... ---•...----------------•-•---•-•--............ .......................... Owner Address W Installer Address U Type of Building 5 Size Lot-97 x 13 9+ _ -_--Sq. feet �-, Dwelling_No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No, of persons............................ Showers — Cafeteria d Other fixtures --------------------------bed.r©4m--------------•------------ Design Flow....:.1:10 _ gallons per P�VsPA per day. Total daily flow............................................gallons. W . WSeptic Tank—Liquid capacit .15 00 gallons Length..l_..±_-- Width....6.�+.._.. Diameter................ Depth.4' min., x Disposal Trench—No.......... ....... Width.......3.......... Total Length....22........... Total leaching area...._3Og--_-_--sq. ft. l� Seepage Pit No_____________________ Diameter.................... Depth below in t........___._._.._.. Total leaching area..................sq. ft. Z Other Distribution box ( x) Dosing tank ------ Date-------- 5-92 Percolation Test Results Performed by.._`�___��__�_Y.:...P:.E.:.............................. 5�..f.__........__._..___.... ,aa Test Pit No. I................minutes per inch Depth of Test Pit--------14........ Depth to ground water......14_'............ rs, Test Pit No. 2...............minutes per inch Depth of Test Pit........ ...... Depth to ground water__-n o..Wcl to r-- Description of Soil.......0 2 Top and subsoil ;_.. 2 -12 clean_-medium_ .-_sand........................................ x U -------------------------------------------------•-----------------•--•-------------....-•-••-•----.................................---------- W U Natur f Re airs Altera 'o —Answer when applicable..____Exi Sti ng System _t0 be rem0_ved__dnd.................. re$?aced wi 6 new ilsl e 5 system. ------------------------------------------------------------------------------------------••---.....--------•-------------------------------•-------------------------------------------....•--•-••----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Corn hance has b n issued b the board of health. ' I Signed --------------------- Z g Date .I Application Approved By ... C� --------------------------------------------------------------------------- --- .... fig . Application Disapproved for the following reasons- --------------------------------------------------------------------------------------------------------------------------------- --------------- ---------- -- ---"..------------. ---- -- ---......------------....---...---------- ---- --....---------------------........................------------- .................. ........................................ p /a� Date ...... Permit No. .---1�."J..... ..�V-C----`-(y- - -------------------------- ---- Issued ........................ -- ------------------------................. - Date yy© - THE COMMONWEALTH OF MASSACHUSETTS 3 BOARD -OF HEALTH TOWN OF BARNSTABLE Appl ration for Disposal Works Toustrurtiou 1hrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ........155 Ei�gb�rru Way.:_,Q�t rui-11.Q:...�!1A.----------- ---M o 9�-� P rcei•.?.� ............_. Alan J. & Dioaeat'on K. Address 75 Barnes Hill Ra;°tOncord, MA. 01742 -----------------•..-__-- -- - ............................................... ..........--..................................................................................... Owner Address W Installer Address Type of Building Size Lot..97 J 9+---------Sq. feet Dwelling'.—No. of Bedrooms---........................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers — Cafeteria C4 Other fixtures ..........-•--•-•------••------• -•Laapc.- - -- W Design Flow......-1.-_o..............................gallons per pef �l;t er day. Total daily flow.......... 9 Septic Tank—Liquid cap it __1500 gallons Length._-1. +- Width-._6�+...-- Diameter................ Depth-.� '...ml Gl. Disposal Trench—No..........�...._.. Width........3.I-------- Total Length-----22 I.-....... Total leaching area..--..3..0........sq. ft. Seepage Pit No--------------------- Diameter.....---.---........ Depth below inlet..................... Total leaching area..................sq. ft. z Other Distribution box ( x) Dosing,tank ) % ((o ~' Percolation Test Results Performed by.... ....0....Y a-..P E....................................... Date........ 15/ ................. a Test Pit No. l................minutes per inch Depth of Test Pit.------- ..... Depth to ground water......14'----------. LL, Test Pit No. 2........2_.....minutes per inch Depth of Test Pit......... Depth to ground water....nO..Wdte... --------------------- O Description of Soil......_......"...`•...�o_p__and__subsoil _2.' - 12' clean medium..sand chi •-t, ----------••------------------------------------------------------•------------------------------------------------------------ ----------------------- ------••-•-------- ' W , UNature of Repairs.or Alterations—Answer when applicable--...Existing system to be removed and ►�eplaceU with new Title 5 system. --------------------•--•--••------•-•••••-•---------•••-------•-•••-•••••---••----•---•----•-•_...•-----••-•--•••-••--•--•----•-•••-••••--•-----•---...-•--•------•-•--••--•--•--•••-••-----•--------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance'with 1 the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b en issued by the board of health. Signed G Z� Application Approved BY ... �v ..... . '--'------- ..- Application l to Disapproved for the following reasons- ---------------------------------------------------------------------------------------------------------------------------------------- -------------------- ------------------------------------------------------------------------------------ --...---...----..................................... q ---------------------------------------------mate Permit No. ------ - - -.I-"....�.g...l-.�- - Issued ---- ----- --- -- -- ---------- Date Jr THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Celr#tf rate of Contyliunre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( X ) by.. ............................ ......_----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 155 Ba berr W Installer at- -----------------y------------y------aY,---Oster---i-lie- MA.------------------------------------,----- - has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .......� ..... ...' ------ dated ................................................ THE ISSUANCE-OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION pSATISFACTORY. a� i DATE '"">.--�.---/.. .... Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No../.. ......3.....r., FEE......6Q r). Disposal -works TFAInstrudion rrmit Permissionis hereby granted.............................................................................................................................................. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No........ b5 Bayberry Way, Ostervi l l e,__MA..•.____. . Street as shown on the application for Disposal Works Construction Permit No. ..a r-�a Dated..... ......•-•••.................••-- -r-'�=�-•-••---•••-----••......•-- p Board of Health DATE................e.......�--.I".......7---.------- FORM 36508 HOBBS 6 WARREN,INC.,PUBLISHERS I + A.M. WILSON ASSOCIATES, INC. LFE UEEM Q(F UG3MSEMM 911 Main Street OSTERVILLE, MASSACHUSETTS 02655 DATE JOB NO. I� 6/13/94 2.0544.0 (508) 428.1450 ATTENTION RE: TO Jerry Dunning Septic Plan for Alan Bankart Town of Barnstable Health Department Bayberry Way, Osterville Septic Permit #92-402 367 Alain Street 8/18/92 Hyannis, MA. 02601 > WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order [X Revised Plans COPIES DATE NO. DESCRIPTION 2 6/13/94 "Wetlands Permit & Septic Repair Plan" THESE ARE TRANSMITTED as checked below: QR For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution > ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS JERRY: Plans have been revised to lower the system by 2 ft. All grades have been changed to reflect this. Bottom of -leaching will now be 7 ft. above the adjusted High Groundwater. Please call with any questions. COPY T0. Don Perkins, Hickey Const. SIGNED: Chri Jo11y,P.E. PRODUCT2402 Dees Inc,Dmmn,twa 0I421. If enclosures are not as noted, kindly notify us at once. TATELMAN ° RESIDENCE 1.53 BAYBERRY WAY OSTERVILLE,MA n1u rNu 22'-13�4 2'-6° 6'-63/4 - 13�4 15•'9y4 2'-23/�' E. ' 0 O O it ic Is GENERAL NOTES: - Olot 4 3 104 0 warod wo..rwonm.n,e,.nr.«m.ra - 10 LAVA CRY CHAI1 G v crew a•m..�.mm« a•mwe®'..m•a \ 2 W.C. - � ... O v — � - I I I I I I�I 'I I I � v � om.,,m„•.,.mm«a.,���.m,,. mm®w. ^w+ 0 0 404 I m N 811-MG ROOM 406 ., v • STAIR v 407 a , tat STCR c a.. .. C�� • 33 "�3 a �, OP�\O3 1 3 POOLHOUSE FIRST FLOOR PLAN SCALE: 1/4=1'-0. y NICHOLAEFF ARCHITECTURE+DESIGN _ 812 Main Street - Oet—lie,MA 02655 T 508 420 5293 F 508 420 2240 2 3 2 3 rHu nwa n�u ww.a 8'- 3 4-13/4 4-13�4 910 n1P 6 - 0 ? 8 8 PROJECT NUMBER: a4 — -- -- ------1, r — —————————————— - PRAWN BY:ON,GM,AH gO � \ / / O i O \ i SCALE:AS NOTED O O II DATE:APRIL 30,2013 u it O 0 9"'3 Ada I I TITLE: POOL HOUSE FLOOR PLANS P \ I A I I N 1t PH1 A POOLHOUSE SECOND FLOOR PLAN SCALE: 1/4=1'-O` 2 POOLHOUSE ROOF PLAN SCALE: 114=1 3 , TATELMAN RESIDENCE d' 153 BAYBERRY WAY OSTERVILLE,MA I 3 0 O F F I GENERAL NOTES: ---- -- ---- ---- ---------- 0 u O o rc Av a 4. m m.wrn m w..mw.a u».�nma ma.m. MP OF SNONDSi OOR ror or scmuo wan.aa+_— ------------- D....wn..Am m�.a.m..e.�.,w•nom®.a. 621 O 3 tQ l 3 of 0 O r r Q_ ' O roP OF RRSf SUBROOR m roP Cf FlRSL SUBROOR _ �_—_ _—_— (C� • i i I i i i OP�\O a�3 • I I I I I I I I I I FpJ� i 'Q I I I I •Q I f I I I - _ - m — _ - forofFoonnc II - -rar or roonuc.- -- --- > — -- -- 1i ------- . rL---- -------------- -- '— POOLHOUSE WEST ELEVATION SALE. 1/4=1•0" POOLHOUSE SOUTH ELEVATION SALE: 114=1'-D 2 - NICHOLAEFF ARCHITECTURE+DESIGN •" 812 Main Street Osten lle.MA 02655 T 508 420 5298 F 508 420 2240 nicholaeFf.cam 0 O PROJECT NUMBER: '�" V"` • / \ // \\ SCALE:AS NOTED O - 0 r DATE:APRIL 30,2013 �O gb a rov OF SErnRo suBMOR - rob OF sEcoxD aV12RR_—_—_—_ —_— O 0 0 ror pi OF Fl.,s...... —_ m ror of SRsr suartaOR —_� — TITLE: __— _-- _—_—_—_- — POOL HOUSE ELEVATIONS I I I I I I I I I I I L------- I I I I I I I I I I I I I I I I I I I I I I I I •,� I I I I I I •Q I I I I I I I I M I I I I I I I I I I I I I I I I I I I I I I I I I I I I I �oresFaos•nRc rL— rl—rl---�-- I I -------------iL---------J---L---------------- PH1 . 2 POOLHOUSE EAST ELEVATION SCALE: 1/4 3 POOLHOUSE NORTH ELEVATION SCALE: 14=1 D 4 W W Q W € e 9 vO� LL J '� m O w N Q S S O d LLH Imo 2 z O w W cc /n mJ J s-egg e WLI �5i a J O Z J QvJ mW W $Fa,CE O= �vavm w z w W ujJ W mN w S &g� tg p@ 2� UCtc "��� a 3 a t0 '!p 0 ._$a$ $8£ & O ZQ m"o�wz a o y o ra N n a i II i i a m l7y"p•j'of o .o uq�Lsau M gg S1rcn- a Za I IOy7 YX L p y w y F 2 W n �s I as Q�Q y I�~�o�w 4 Qp O ua ..�WT�yQatt2 W JO SOU O�o 4 R0 ��3,T,, I.aO w5 I OwO px uas °�.O� Op OQ o=°�p�a5 I wuarCi �WQ ��:x yo, � n�Qao- OJ�3LL ,30o r J JV aFw .-oo, - E =V wRS oQu w-aa J�K�yIuuJWUsS II w ute O OOOO Rxa Q o 0° m° (1Wn11 �o u3a rca� 3✓Tf000�i3�a i a��n auo SO ama r3� d riSO aw i3m II � I j . I j i j - a� -Mal.yS-,L I II T co 5 II i I I II i I j N II I I II _ I II I II ji I z I II i z IA w II j W i U) ww i O i ' I i i i II I .. II I.� I • II i I III 'M'O'1.tS-.L t I 11/SCI-, Kol.9-1-11 I II I i I • 1,3 TATELMAN RESIDENCE 153 BAYBERRY WAY OSTERVILLE,MA rFlu n«s 30'-6. 6•_63/4. 5'-10yq: 22'-13�4' 1 GENERAL NOTES: - . V j� � Y �_ � —. � I a " unm or nvwnma m>.h•.n n�nw..eepMoe.ieorwl 0 LLI I r — — , I 2 ��,,c�10. a'hss� J = t3 {�E�RiG J.p� v - I I - cartaO�+oerts io n wta vuwu< N f' CLDER l4�iY1 N \\ ••La•• ® STRUCTURAL ry h I�B=18' p� p /��y ! TOP OF SUB I TOP OF WALL IVO. 38962 FLN_=8.85• ITOP OF F0071NG F \O'sAL� TOP OF TJI SHELF _ FIN.=1].68' TOP OF WALL 3/4•T6G PLYWOOD SUBFLOOR RN= SCREWED AND GLUED ? TOP OF FOOTING p 2X6 UNTREATED SECOND PLATE - _ PRESSURE TREATED 2X6 (DR F� PLATE OVER SILL SEALER _ - K h FIRS SUBFLOOR_ __ FIRST tSOBFLOOR POOLHOUSE FOUNDATION PLAN SCALE: '^_''° 7 - E. — —A`'BG° -roP GF weLL NICHOLAEFF TOP Oj�--_ F WALL' EIEV.=17.68 - - - - E�LB/.=n.6e' a ARCHITECTURE+DESIGN 11.876'FLOOR JOISTS R. _ n ( Iy O _ 812 Man SVeet (2)34 BARS CONTW.O TOP Oster ill,,MA M655 T�82, e - T 508 420 2298 TOP O SHELF — — A n c 08 420 2240 .(3)tt4 BARS ICONTIN.O TOP 81L O holaeR.ccm BOLTS SPACED O 32'O.C. MAX.EXTENDING FROM THE SILL PLATE DOWN TO AND ENGAGING THE HOER. qo.II WALL STEEL 2X4 P.T.BEARING PLATE CONTI FASTEN.WITH POWDER ACTUAT D .. CONCRETE NAILS O 32'O.C. TUF-N-DRY FOUNDATION TUF-N-DRY FOUNDATION - WATERPROOFING AND 1-1/2' PROJECT NUMBER: la WATERPROOFING AND 1-1/2' WARM-N-DRY FOUNDATION aib WARM-N-DRY FOUNDATION INSULATION CONTINUOUS ql l. INSULATION CONTINUO UP _ TYP. ' l dii' O - DRAWN BY:ON,GM,AH 0 m m SCALE:AS NOTED tt4 VERTICAL BARS O'IB'O.C.CONTINUOUS ' I DATE:APRIL 30,2013 :4"HORIZONTAL BARS O•IB'ORC.CONTINUOUS 10.O.C.CONTINUOUS - ' I�d tt4 VERTICAL BARS O 18'O.C.CONTINUOUS 4 CONC.SLAB W/ 4'CONC.SLAB W/ 6X6-W1.4XW1.4 FOR W.W.F. ` 6X6-W1.4XW1.4 FOR W.W.F. ��� OVER 6 MIL POLY VAPOR OVER 6 MIL POLY VAPOR �ii I��,q 6ARRIER _ BARRIER tt4 VERTICAL DOWELS 34 VERTICAL DOWELS O 18.O.C. O 18' 1/2'EXPANSION JOINT 1/2'EXPANSION JOINT Q ] e. e. Y TITLE: .. .. 111 s4 O BOTTOM POOL HOUSE FOUNDATION PLAN 111 4 O i0 TOP OF SUB u IIa I� TOP OF$NAB E. 9.IB ELLV.=9.18 d'a i e_. ______ ___ By ___—_TOP OF FOOTING --_ _ih_OP OF FOOTING_,_-__ - ELEV.B.BS —V EI.EV:B.85 e CONT.KEYWAY CONT.KEYWAY N - d' - _a-_�� 12'X24-STRIP FOOTING 12'X24'STRIP FOOTING W/(3)-a4 BARS CONT. BARS CONT. 3 3 2-0. _ w.LLmaa 2_0• —— PHS1 A FOUNDATION SECTION SCALE: 1•=1'-0' 2 FOUNDATION SECTION SCALE 3 . 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Od N V ale, 7 _ --- - ---_---+-I Date. 1 ,� X-Y, it "ell I C 1 _?, 5 �L-T - - i tA PIC, C-'1 I r / . x Six, I t Z TV fw s, f �ee C ( y I _ _ �' I tj d + M ECEIVEO i 1 : I /Z S Fib ,•+- _,•�.• I jARNSTA°LE GONSERYMICt Z �___---.— commiSS10ll I4 t -. _ ,,, f�+• J _ -i__ - I Z ,OAK \j Z Tif 'JAN' , � 4 ,� vw/e! it N W vw `.�f�t_.)5A t.. C) 1 L F 3 tom.! VAC �Y �`l..r'a�,,�._/ .-� A t l� _ �-4r� G.t' .� �!U� -= �3c� �. t,�; = 4�5� ���- t� rl -11c. T&► .aK q,4 X 2 - �eF,� GD��- _-`' Wit: 1�C._.___ __! . IT Ra F GLt5 490 �LU JX � � � > �� f'' �J 4- r7ct:,:!,4 L L. L l �. L C> L�._a = ��r!,�t Jam,�%a _.: �� 1>� G i7 b � # ) / 4 4 .�:. _ I-) G ✓ r , . `emu��C- C ! a I�C..1�►.� ucJ vc �' C 1 �5. Nc l�__�__ Qeh/ Revisions: Zone A Test Pit Data Well TSW-89 Parcd 12 ; �,� ;!'' � 6/!3/94 PROFILE, GRADES Adjust. 20 Koneb, Pau/ D. & Jill M. Indicates Indicates 682 Ocean Rd. - Johns Island w STBAY Perc • Groundwater EST 8 A Test — ' i Vero Beach, Fl. 32963 / I I Property L I n e Ground D.= 14.5 T 1.x5 1 \ Qom_ O Pit No. , , e Test By. aJaar 1 1 I \ 6' High '7tockade Fence Test Dote: s��_ / I ( I � \ � \ � 21 �/ I � Witness: D. Ukran� B.QH, Scaler 1�2083' - MeaWeMn Perc Rate: < 2 Mh.A 1 1 I,, \ \ - - I LOCUS MCl17 References: sand • \ ?-Z Assessor's Map 91 Parcel 10 r e, e , �c 4�, c u 2.23E Ac. Land Court Plan 2664--95 \ 16 Bottom W 0-5 Proposed Water Service I ZOn a RF-1 TP 1 I W W W W i Minimum Lot Area 43,560 S.F. Ground El.— ) Minimum Lot Frontage 20 Ft. ` j QL \\ Minimum Lot Width 125 Ft. i Pit No. 2 go i \�\ '� W _ / ) Minimum Yard Setbacks: Test By. a'bpy I I ® 1 - - _ _ Front 30 Ft. I \ _ ` W J ; 0 _ Side 15 Ft. Test Date: s/s/92 i I 3 11 P ,,,�� �r 2 Rear 15 Ft. wedwm► Witness: D. mkxnnd Bo.H. l I ` P sed 1500 Ga. • Maximum Building Height 30 Ft. ` \ ucet d ( eptic Tgnk e Perc Rate: dg :� et ) 10 sand �--E g Boo Gal. ' \ I ` W \� \ \ 3► To So Renovrrd Existing 6" Project Title: 1 Rork MZWrh\ Are 4 Water Main � , h. ( Typical) Oa•d rope osed 1 ! I I (T)p) Ex! ting 1500\Gal. - I 11 1 r S'ap Tank To 5 - Outle D - Box • ' I I WORK LIMIT i . =_�. - Punpp And oved l 2 - Ldpch/ng Trenaftes c 3' Wj e X I' Deep X 22' Long k Bankart Fixed pier _ / rr '-�. kfts ?'F,X ; r-,A. Residen Stairs 7�,' I ® p, U► "Gv V'a .,each - - :...i ♦ +S p y � , R �f. r— - I 275'f Td Leachin c,'I �w o \ o ) On So �, b , ® / o p\� i Lre l ,C: 0 ° e � Stony r B c b e rr x! Drive & �arkrn9 O Faucet ° G e/ 01l Tank i G°(\°µ / existing I Wo W o Be Removed � 18 n_ter ! . 0 4 O.H. Tag 12 o e �- \ ® l 3 1 M t.t r r Pi t l In I r I Ostervi/le, No I I I I ! I I �l \°� e(ed ,tone Ed g or i U 1. Unless :otherwise noted, all construction I ! ' ill,/; a �� �' 4°tG methods and materials shall conform to TTt/e V of the state environmental code I I / l - - - - �/ �e /� L •` 0 1 I and any applicable local regulations Ex/st/ng 1000 Col. Z. Precast concrete septic tank, d-box, I /�- Sep tic Tank To Be b r and leaching facility to withstand H-10 I ) "�-b'`' o Pumped and BackRl/ed \� eye I t gnt \ i r y Pole loading unless under pavement, drives, I ) ! f �a / p - _ _ ' 70 �� Go ��\ 0��5 rive & For ,4 / -uy __ _ r _ _ I �* PREPMIED fOR or travelled ways where H-20 loading 0 � i �/ '� •� t �j P r Bituminous etp6nt �v ervice . I �' shall aPP/Y \� \ 3 All pipes in the system shall be schedule Existing Rip Rap _ p 40 or equal. I o / Coa,C. Block Room O - ? Alan J. & Diane k. 4. No Reid modlRcations to the sewage o W�'�tx(khead �' Bcick ^= disposal system shall be made without I o i �i. & StoUs- -' -- - / I� Bankart prior written approval of the engineer I !l \ ? j' !' � ' ` and the local board of health. Existing Plantings J �� / I ' 5. This system /s not designed for a (Typical) off'' �; Ground / Existing Water Meter it garbage disposal unit l �' 15 15 Existing 500 Gok— Lights --� v g lcaJ \ TO anan Ce ed - 6. Property Lines Shown Heron Were CompNed ./ % fY ' J ,b Fy 0# Tank (,TAF Aq!�s i I I From A Pion Recorded At The Bornstob/e County �•I r!l �I O r l To Be R 6ved / # . �F ,nee Registry Of Deeds In Land Court Plan 2664-95 �•� Faucet Existing f7owdiffusers D H• T�9 ,�`'E13 And Do Not Represent An Actual Survey On The Ground �� ' 2 4 x 8 To Be 7Elevations Are Based On N.G. V.D. /r u / - -- pl Abandoned t, /' y 21 �Qc \01 1 1 �. � h � � I 1 a This Site /s In F.E.M.A. Flood Zone A 11 (EL.-11.0) _ A.M. Wilson 9. All roof drains to be directed to drywells ! I /P �Z, \`� l // �� Proposed Retaining Wall �� - I. 1 Legend Associates / r / / Eisting 2" Iron �ipe `'\ I Inc. 10. Pool Water To Be Dispersed Over Lawn Area It Shall Not Run Over Bank. o t I 1 Existing Contours 18 - - - - 18 11. Location Of Existing Utd/tles /s Approximate 4 / ! � l /r; � _- - - - _ / 911 Pain Street 11012141 1 1R P r o p e r t y L I n • Proposed Contour Contractor To Verify Exact Location Prior � 18 i Pa�•cM 9 i till ._ie 1 \ oP 20 Oat*-Ab/MIA 0205 To Excavation. Leghorn, Richard S. 508-428-1450 40 Bayberry Way I Proposed Spot Elevation 18.5 Osterville, Ma. 02655 Drawing Title: WETLANDS PERMIT AND O SEPTIC REPAIR PLAN Design Flow: nnE 5 Fn/shrd Grade With Minimum 3/4' - 1 1/2' Washed Stone Access Covers Brought TO Slope Over Leashing Of 2�' 2" Pearsfone .L 5 Bedroan • 110 Cd/isabom = 550 C�P.D. Within 1' Of Finished Grade Top Of Foundation El.= 1&0 Sep tic Tank Requirements: 2- 22' Long x 3' Wide v- .•. ,• - -•. • -c -. • � � f s 2 Deep W1th 4 ° In �l ° o o D a? ,` 11 P. .v Perforated P.V.C. 1 0 55o QP.Q x 15OX = 825 Gat 4' P.KG Pipe o ��/ o F1 • .01 Ft/Yt slope (To.) First 2' Feet To P/pe O .005 FtlYt. Min. use 15a0 GaL Tank Be Laid Lev+ei 13.0 Sep /c 2' Lgpw Of Peostone `P LeachingFacfflt Requirements. Tank ` ` 2' y q I Q Bo L,1,t,r� '� QRD. 1500 Gal. ►` ` Base of Perc < 2 AIL/l ch Use I I 1 1.62 11.45 3 w ' r)�le 1 qv SkWW kffl vtlan of 25 G alSf. I 7 5 Outlet Scale: 1 = 20 25 12 30 ?' Of 3/4' — 1 1/2' Washed Stone 9.45 Bohan AnNtrotlbn Of 1.0 Gads,/SY. l 1.56 SECTION A - A 0 20 40 50 FEET Leaching Facility Provided. TYPICAL LEACHING TRENCH W 22' Lang x 2' Dean x J' w>Fd. LeaMhg Trunchee �-- 53 --� �-- 51' --� �-- 8.5'--"� Ad' steel High - NOT TO SCALE - Date: AUGUST 10, 1992 Dwg No: Side: 4 sY./Ll. x 22' x 25 Gd./S1I.) = 220 C%P.D. Foundation — Tank g Design: • ,,/ = Tonk — D—Box TOTAL 1. "IsTrench = ?BB C.P.D. Groundwater 2.4 Check: A.M.W. Drawn: J.KB. C.P.J irurAL PROWED : 2W GP.D. x 2 — 572 G�P.D. SEPTIC SYSTEM PROFILE N. T.S. Job No: 2.0544.0 1 Sheet 1 of 1