Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0214 BRIDGE STREET - Health
214 Bridge Street A= 093—024 / Osterville 1-. I a o -- ryry TOWN OF BARNSTABLE / LOCATION- SEWAGE# ;2, /0 l if ;Z VILLAGE 0 Y-r-4-1 V' U t 11 try ASSESSOR'S MAP&PARCEL 3 INSTALLER'S NAME&PHONE NO. sca 9 3 6q yJ,FS SEPTIC TANK CAPACITY 0 0 C-c2• (. LEACHING FACILITY:(type) /0 j'r (size) .�si:s d ✓� NO.OF BEDROOMS OWNER %,,1JM 0^/"f M ( ic 0 c PERMIT DATE: CJ �' COMPLIANCE DATE: C 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) /Y 0 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching ility) Al Q Feet FURNISHED BY n!C"' �:4 A Jae cr�y,g b - s 37 � org .5" 3 No. O� 11 p t�J Fee �r✓ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Y S Zipplitatlott for Misposal 6pstettt Construction Permit �Y Application for a Permit to Construct:.( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �V/ 'c—,-.Sly Owner's Name,Address and Tel.No. Assessor's Map/Parcel ` ®� �r °J' � 7 `g 7.. S l 0 Installer sVame, ddress and Tel.No. 'Designer's Name Address,and Tel.No. E®f. of 11y h e,0/ 1- L4F A^ a a 4,f 8' Type of Building: Dwelling No.of Bedrooms Lot Size 46 Sq.ft. Garbage Grinder( ) Other Type of Building e rap No.of Persons Showers(,� Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title ,ram Size of Septic Tank /0©® �� Type of S.A.S. p 14- IF I, r model Description of Soil Nature of Repairs or Alterations(Answer when applicable) ;6hk 6"kej, Z.,w-th sm stealic -i,&.dg 1 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued"by this Board of Health. S' ed �_ — Date Application Approved by Date d Application Disapproved by Date for the following reasons Permit No..20/ a Date Issued i � �( v ��� � � � ��� ��� , ��� �� � �� 7 lU , Fee THE COMMONWEALTH-OF MASSACHUSETTS Entered in computer: Yam. PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS M �pIication .for -Disposal 6pstem Construction Vermit Application for a Permit to Construct( ) Repair. r Upgrade( ) Abandon( ) ❑Complete System, ❑Individual Components 4 Location Address or Lot No. d rj $`S - Owner's Name,Address,and Tel.No. /3$ k9i 0S��v'iVe llt�'� ISM 0—.1 5'� Assessor's Map/Parcel M X�� � � 7 7 41-5 N?7..AS--7 j5 Installer's Name,Address and Tel No. -»► ®� ,, / .S`'� 3LSh,-107c F Designer's Name,Address,and Tel.No. , d�C A 4#9* � Type of Building: . ,. Dwelling No.of Bedrooms Lot Size *4 4F7 sq•ft. Garbage Grinder( ) Other Type of Building aDe- No.of Persons Showers(VI.) Cafeteria( ) ` Other Fixtures �- r Design Flow(min.required) gpd Design flow provided` Plan Date ;Number of sheets Revision Date + Title Size of Septic Tank A /000 d1vZQ4. Type of S.A.S. P 1-t- Description of Soil „�q,y`, 4,.e s Nature of Repairs or Alterations('Answer when applicable) l- a �rsGl"Ps`•-. (A/tr" y / 602 � Eel; / t +aQk, �w..n� 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., F Compliance has been issued by this Board of Health. _ Sig --- Date 4116.1 Appltcatinnlpprovedy> (! f Date Application Disapproved by for the following reasons Permit No. ���"073 Date Issued THE COMMONWEALTH OF MASSACHUSETTS f BARNSTABLE,MASSACHUSETTS 1`` Certificate of compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ,) Repaired( Upgraded( ) Abandoned( )by at - 14 13 y e ale- t T- 10 X T--e%.-V t Y)t has been constructed in-accordance with the provisions ofTitle/5 and the for Disposal System Construction Permit No «- dated Q 4�0 Installer - e0,V /1#1,4O �oaJ!"�lrr/c�/0� Designer r #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will function designed! Date ! Inspector r - - - _ ^^�•��/,, No. �� "o� /t4 Fee :�/U® THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Zisposar lOpstem Construction Permit Permission is hereby granted to Construct( ) Repair ) Upgrade( ) Abandon( ) System located at �' / �.i crf�,-C�t r: 0 S T C v U I //e Nt Ot. t7 and as described in the above Application for Disposal System Construction Permit. The applicant'recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:jConstruction must be completed within three years of the date of this permit. Date Approved by` TOWN OF BARNSTABLE LOCATION ; / � _ S. SEWAGE #'F6 lot). InLLAGE ( ? �i�� ASSESSOR'S MAP Cz LOT 1 ®2� INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) 2 rf (size) / � i�C✓Ei NO. OF BEDROOMS PRIVATE WELL O C- PUB IC WAT BUILDER OR OWNER p. j DATE PERMIT ISSUED: L3 1 " DATE . COMPLIANCE ISSUED: C) Zc7 J VARIANCE GRANTED: Yes No x' .� '� � � � i �� � �_ � �- / � ��� ��.� � � _.. \ l � -/ l �"� L � � �, i -.�, ,� � � J � � ��� .,� - � �., -- No. � Fee 4 !00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftPhration for Misposaii6pstem Construction Permit Application for a Permit to Construct( ) Repair�) Upgrade( ) Abandon( ) ❑Complete System PIndividual Components Location Address or Lot No. C ®r•. O 's Name Address,and Tel.No. i nI'�w���ti G U x n &vat 6,Cr+0 Assessor's Map/Parcel Installer's Name,Address,and Tel No. : , It\ FrC,,j,< Designer's Name,Address,and Tel.No. c. l�3 C74� yr�c�.a�M tt6 �rn,g Eo�er_� iss— GeG 2yj v !Ld S. Type of Building: ���t t70 bcl Dwelling No.of Bedrooms 3 Lot Size\7 L,a 4 sq.ft. Garbage Grinder M Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) .33 G gpd Design flow provided Js?0, 0 u gpd Plan Date_ _/ / 13 1 IV Number of sheets \ Revision Date Title Size of Septic Tank \000 p Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) b201p�G •C,f t°kk1siA n.Gt "b4 Csw�. C_�n �.•s c�� t�is� J'�•S' x a u X fc�.�t Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Hea S' ed Date Application Approved by Date Wpva Application Disapproved by Date for the following reasons Permit No.` 019 ;jw Date Issued No. 0— 10 f ` Fee «! ,/ THE COMMONWEALTH{OF MASSACHUSETTS Entered in computer:" Yes f/ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 4plication for ]DIS0biMl1*pstPm Construction Permit Application for a Permit to Construct( ) Repair(V Upgrade( ) Abandon( ) ❑Complete System ['individual Components Location Address or Lot No.;:�.7 �" OC r e G `O t: Owner's Name,Address,and Tel No. Assessor's Map/Parcel (� Installer's Name,Address,and Tel.No. :4 T t-o"'v- Designer's Name,Address,and Tel.No. ;. k,%3 010 �ar�.av1'�. Rd liycv,r%.5 r'coker-k, IT-T- Geo PLY0v �d � ✓,. G rn Type of Building: d$ a C1 tip lob Dwelling No.of Bedrooms Lot Size\-) q V sq.ft. Garbage Grinder A Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures P. .Design Flow(min.required) 33 o gpd Design flow provided 326; b L4 gpd Plan Date j 0 p � ) ! Number of sheets Revision Date Title r Size of Septic Tank t OC,�p Type of S.A.S. Description of Soil ` Nature of Repairs or Alterations(Answer when applicable) A,n rz (-�k�5 1 rt G, �� $ 1t,kh(A 41 Is-INK �� - Ix *4 X oft co Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of . " Compliance has been issued by this Board of Health: Signed° •.. Date Application Approved by ...a �f r""Y s"%1 "" y; ', ,�; _.. a.,_Date 7: ' 9 Application Disapproved by P Date -f -, for the following reasons t Permit No.�7-A/R j�-ry 2gil Date Issued THE COMMONWEALTH OF MASSACHUSETTS ' r. ;BARNS T%ABI ,MASS���A.CHUSETTS Certificate of-Co m Ytance THIS ISPTO-`CERTIFY;thaf the On-siteiSewage Disposal system Constructed( ) Repaired( yr Upgraded( ) Abandoned"(s )by I O c-N, k cw -- _ rr, r k-fs`mi has been constructed in accordance- with the provisions of Title 5 and the for Disposal System Construction Permit No 19—Z% dated Installer Designer gft_� ��� #bedrooms Approved design flow gpd The issuance of this pe°,rfm)it shall not be construed as a guarantee that the system willctionl as designed. Date � U 6 1 9, Inspector I ��V�,r- Zh? V aC _ -- --- -- --------------------------- - = No. - � . . Fee "� l✓l! THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS x Nsposal 6pstem Construction i9Prmit Permission is hereby granted to Construct( ) Repair(VOle Upgrade( ) Abandon System located at C j .k.0 Q C"_ C 6 and as described in the`above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and.the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this perm . _ * , Date q rB {} / Approved.by ' - 1 � ..ram• T©wn of Barnstable oFi>ie;t°k> � I Regulatory:Services # Itrchttrd V. Scali,Iate6tr Director q� .aS& Public Health Division iDrFo Maid Thomas McKean.,_Director 20.0 Main Street,Hyannis,.MA 02001 Office; 508-8624644 Fax: 508=790 63.04' t Installer,&Designer Certification Forriy Date: 9/24/18 S;eivage Permit# '� d LK— ssesso0s IViap11 arcel 168/45-2 Designer: David D. Coughanowr RS Installer: 5cdAA CYO =aAj�, .Addressz 155 George Ryder Rd South Addrtss:. n Chatham, MA 02633 1 11'0i� On S�\A M qc2su.- was issued a permit to install.a (date) ¢ (ianstallec) septic system it 57 Bent Tree Drive basedreln a design drawn by (address) l David D. Couighanowr, R.S. dated 9/13/18 (designer) X I certify that the septic{system referenced above was.`itistalled substatntially, according Io, the design, which may"include minor approved changes such as lateral relocation at th`e distribution,box and/or#septic:tank. Strip out (it required) was inspected- and the soils were f6und satisfactory: I certify'th7t the septic system.referenced abo\c W. alled with major cliangcs (i.e: �ncatcr'than 1;0'.lateral-ielocation;of the'SAS or any vettcal-relocation ofany component of the septic system,)but in;aecordancc with State &.Local Regulations: Plan revision or certi ied'as-bruit by des;finer,to follow: Strip out.(if recluireci) vas inspected'and The soils were found,satisfa'ctory I certify that the systein referenced. above was constructed in compliance with the terms �of the I`A approval letters.(if applicable) QAVIQ ,e"s DAVID: $. Installers ure ,- i u D D ( ' ) G UCIi NG i .. COUGHANOldR �o (Desibi er's Signature) brier's Stan Q iF PLEASE RE'rURN 'r0 BARNSTABLE-PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE W'rLL 'NOT 'HE'ISS'UED UNTIL BO'IN 'r'I-IIS FOIt7V1 AND AS BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU, t, Q!\Sel?tic\Dcsigner,Certifieation t;ortti itev 8.-14 i3.doc. i. �)v 01 2016 19:14 Jim The Inspector Man 5085349919 page 1 ® Comrr onweallth of.Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments O C. - 214 Bridge Street Property Address 'y Olive Crosby . Owner Owner's Name information's Osterville j MA 02655 10-28-16 required for every lU page. City/Town, j State Zip Code Date of Inspection A. rV 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. mpgoutf When A. General information f fillip out forms �puulnlrHr�� on the computer, \`\����� �SH aF use only the tab 1. :Inspector: key to move your cursor do not' JAMES James DSears =� use the return Name of Inspector key. . Capewide Enterprises,-LLC *' Company Name TTr •.•G� `,�. 153 Commercial Street �'�/Fry5„I1pp\``��� Company Address �.o Mashpee MA 02649 Cityrrown State Zip Code 508-47.7-8877 S1623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails El Needs Further. Evaluation by the Local Approving Authority - 10-28-16 ;4 f spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,;the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use . at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use., 15ins.doc•rev.6/16 - Title 5 Official Inspection Form:Subsurface Sewage.Disposal System•Page 1 of 17 I t�D dvs VU Nov. 01 2016 19:14 Jim The Inspector Man 5085349919 page 2 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 214 Bridge Street Property Address Olive Crosby Owner Owner's Name information is Osterville MA 02655 10-28-16 required for every page. City/Town State Zip Code Date of,lnspection B. Certification (coat.) Inspection Summary: Check A,B,C,D or E/always complete all of,Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system is a 1500 Gal. Tank D Box- Block pool and.pit. B) Systems Conditionally Passes: One or more system components as described in the "Conditional Pass' section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration orexfiltration or tank failure is imminent. System will pass inspection If the existing tank is replaced with a complying septic tank as approved by the Board of Health. ' A metal septic tank will pass inspection'if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): 15ins.doc•rec.6/16 "rr: Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Nov 01 2016 19:14 Jim The Inspector Man 5085349919 page Commonwealth of Massachusetts Title 5 official Inspection Form a Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 214 Bridge Street Property Address Olive Crosby Owner Owners Name information is required for every Osterville MA 02655 10-28-16 page. City/Town , State Zip Code Date of Inspection B. Certification (cont.) ❑. Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): . ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken.pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping;more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below):. ❑ obstruction is removed ❑ Y ❑ N ❑ NO (Explain below): C) Further Evaluation is Required.by the Board of Health: ❑ Conditions exist which require further evaluation by the Board.of Health in order to determine if the system is failing to protect public health, safety or the environment. 1,. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh- t5ins.doc•rev.6116 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Nov 01 2016 19:14 Jim The Inspector Man 5085349919. page 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 214 Bridge Street Property Address Olive Crosby Owner Owner's Name information is Osterville MA 02655 10-28-16 required for 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 tributary to a.surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone.1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet.of a private water supply well. ❑ 'The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: *" This system passes if the well water analysis, performed at a DEP certified'laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. I Other: D) System Failure Criteria Applicable to All Systems: You,must indicate "Yes"or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ® Discharge or ponding of effluent to the surface of the ground or surface waters due town overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/a day flow PtT t5ins.doc•rev.6116 TRIO 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 17 Nov. 01 2016 19:14 Jim The Inspector Man 5085349919 page 5 Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 214 Bridge Street Property Address Olive Crosby Owner Owner's Name information is OSterville MA 02655 10-28-16 required for every page. Cityfrown State Zip Code Date of Inspection �. 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 privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,. provided that no other failure criteria are triggered.'A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 1.0,000gpd. ❑ ® 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 E] ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5lns.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•P19e 5 of 17 i I Nov 01 2016 19:14 Jim The Inspector Man 508b34991 J page e Cortvmonwealth of Massachusetts Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 'y 214 Bridge Street Property Address Olive Crosby Owner Owners Name Informatrequired is Osterville MA 02655 10-28-16 required for every p page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been idone. You must indicate"yes"or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? 0 ❑ 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.($AS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. I ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) 131D CMR 15.302(5)J D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 l5ins.doc•rev.6l16 Title 5 Official Inspection Form:Subsurface sewage oisposal system-Page 6 of 17 Nov 01 2016 19:14 Jim Me inspector Tian ou6364yy 1 y Ndye r Commonwealth of Nlassachuietts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 214 Bridge Street Property Address Olive Crosby Owner Owner's Name information is required for every. Osterville MA 02655 10-28-16 " page. CitylTown State Zip Code Date of Inspection D. System Information " Description: The system is a 1500 Gal.Tank, D Box , Block pool and pit. 0 Number of current residents: - Does residence have a garbage grinder? ❑ Yes ® No Is laundry on_a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Gal Water meter readings, if available last 2 ears usage d 2014-11,OO 's g ( y g (gP ))� 2015-0 Gal's Detail: Sump pump? ❑ Yes ® No NA Last date of occupancy: Date Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 115.203): Gallons per day(gpd) ' Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? El Yes ❑ Nq Water meter readings, if available: l5ins.doc•rev.6116 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Nov 01 2016 19:14 Jim The. Inspector Man 5UnJ49y'113 page in Commonwealth of Massachusetts Y Title 5 official Inspection Form A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments' "H 214 Bridge Street Property Address Olive Crosby Owner Ov ner's Name information is Osterville MA 02655 10-28-16 required for every page. City/Town : State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancyluse. Date Other(describe below): General Information Pumping Records: Source of information: 7/13114 Was system pumped as part of the inspection? ❑ Yes ® No if yes, volume pumped; gallons How was quantity pumped determined? Reason Tor 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.doc•rev.6116 Title 5 Official Inspection Form Subsurface Sewage.Disposal System•Page 8 of 17 Nov 01 2016 19:15 Jim The Inspector Man 5085349919 page 9 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 't 214 Bridge Street Property Address Olive Crosby Owner Owner's Name information is Osterville MA 02655 10-28-16 required for every .. Page. City/Town' State Zip Code Date of Inspection D. Systeitn information (cost.) Approximate age of all components, date installed (if known) and source of information: NA D Box is New 10-2016. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below.grade: 21 feet Material of construction: i ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line* feet Comments (on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan): Depth.below grade: 14" feet Material of construction: ®concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) j If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal. Precast H-10 Sludge depth: 211 t5ins.00c rev.6116 - - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Nov 01 2016 19:15 Jim The Inspector Man .5085349919 page 10 Commonwealth of Massachusetts _ Title 5 Official I0spection Form Subsurface Sewage Disposal System Forme-Not for Voluntary Assessments 214 Bridge Street Property Address Olive Crosby Owner Owner's Name information is required for every Osterville MA 02655 10-28-16 page. Cltyrrown State Zip Code Date of inspection D.. System Information (cunt.) Septic"rank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? Asbuilt Tape Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank and covers at 14"below grade. Inlet tee, outlet baffle. No sign of leakage or over loading. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): i Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date f5insAoc•rev.6116 - Title 5 Official Inspection Form;Subsurface Sewage bisposal System-Page 10 of 17 Nov 01 2016 19:15 Jim The Inspector Man 5085349919 page 11 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 214 Bridge Street Property Address Olive Crosby Owner Owner's Name information i e required for every Osterville MA 02655 10-28-16 page. Citylrown State Zip Code Date of Inspection D. System Information (cost:) 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: i 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.): i Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 15ins.doc•rev.6116 Title 5 Official Inspeeion Form:Subsurface Sewage Disposal System•Page 11 of 17 Nov .01 2016 19:15 Jim The Inspector Man 5085349919 page 12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 214 Bridge Street Property Address Olive Crosby Owner Owner's Name information is required for every Osterv-ille MA 02655 10-28-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): D Box is new 10-2016. Box is 16"x16"-26" below grade w/cover at 8". Two line's out. I i Pump Chamber(locate on site plan): Pumps in working order ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): . * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 15ins.doc•rev 6r16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Nov 01 2016 19:15 Jim The Inspector Man 5085349919 page. 13 Commonwealth of Massachusetts MK Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 214 Bridge Street Property Address Olive Crosby Owner Owner's Name information is required for every Osterville MA 02655 10-28-16 page. Ciylrown State Zip Code Date of Inspection ®. System Information (cont.) Type leaching pits number: 1 leaching chambers number: El leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: Z overflow cesspool number: 1 ❑ in nova tive/alterna i tive system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is a block c. pool and precast pit. 6' block c.pool at 1' below-dry. 4' H-20 pit 2' below grade w/cover at 16". Pit is clean and dry. Pit like new. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer - Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No 15ins.rloc-rev.6/16 - - Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 or 17+ Nov 01 2016 19,15 Jim The Inspector Man . 5085349919 page 14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 214.Bridge Street Property Address Olive Crosby Owner Owners Name information is Osterville required for every MA 02655 10-28-16 page. i5l/ .own State Zip Code. Date of Inspection D. System Information (Cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, . etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.Joc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17- Nov 01 2016 19,15 Jim The Inspector Man 5085349919 page 15 Commonwealth of Massachusetts Tile 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments i 214 Bridge Street Property Address Olive.Crosby Owner Owners Name information is required for every Osterville MA 02655 10-28-16 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks..Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below.- hand-sketch in the area below drawing attached separately �--a - l� 3- Sill ' c lie 14,q r 3o,-10 0 D: 3 7' c c� PG(v i t5ins.doc•rev.Gil Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Nov 01 2016 19:15 Jim The Inspector Man 5085349919 page 16 t Commonwealth of Massachusetts Title 5. official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments _ 214 Bridge Street Property Address Olive Crosby Owner Owners Name infbrmation is OStefVllle required for every MA 02655 10-28-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20'+ feet Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans on record If checked, date of design plan reviewed: Date Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) . ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: Abutting property 20'+ no G.K. i Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins.doc rev.6llfi Tille 5 Official Inspedion Form:Subsurface Sewage Disposal Sys:em•Page 16 of 17 Nov 01 _ 2016 19:16 Jim The Inspector Man 5085349919 page 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposa[System Form-Not for Voluntary Assessments k . 214 Bridge Street Property Address Olive Crosby Owner Owner's Name ref required for every ormation is Osterville MA 02655 10-28-16 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C. D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.00c-rev 6/16 Title 6 Official Inspection Form.Subsurface Sewage Disposal System•Page 17 of 17 No. �" ' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN.OF BARNSTABLE, MASSACHUSETTS Yes Rpplitation for Disposal 6pstem Construction permit Application for a Permit to Construct( ) Repair(k Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. g jq OjLI 5 T c)5-t, Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel Q ®�C/ {q orS1 0 r6P_v(LC: Installer's Name,Address,and Tel.No.5019 V Z7-f8?7 Designer's Name,Address,and Tel.No. C. ?6 W 1 DC-_ 6;7Pr&4DK1S1ES u.c- i S C t�ttuesr'�G�e l�l N IA Type of.Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building (06)LJTt/k-f_ No.of Persons Showers( ) Cafeteria( ) Other Fixtures / \\ Design Flow(min.required) /V 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) ff ic� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of HeallL Signed l CC A nDate Application Approved by �34) Date "" l Application Disapproved by Date for the following reasons Permit No. W,01,b - Date Issued No. b N b Fee THE COMMONW—EAUTH,OF.MASSACHUSETTS Entered in computer: _ PUBLIC HEALTH N =•DIVIS1b TOWN OF BARNSTABLE, MASSACHUSETTS Ye application for �Disposat *pstem Construction Permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. ar4 Owner's Name,Address,and Tel.No. a�I .sT vsr, Assessor's Map/Parcel OLt ve CP.OSB Ix v. I _ Installer's Name,Address,and Tel.No.'So Designer's Name,Address,an e. o. CAP& .4 DC �1JT-9W 'No. u.G77-$�77 4 Type of Building: s Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 4EX7 No.of Persons Showers( ) Cafeteria( Other Fixtures Design Flow(min.required) A Z 147 gpd Design flow provided�� , gpd Plan Date Numberof sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1 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 of Health. I. Signed 'r Date { Application Approved by Date I AV Application Disapproved by 6 Date for the following reasons r Permit No. of 616 71 15 Date Issued I()- / _ xi = THE COMMONWEALTH OF MASSACHUSETTS x BARNSTABLE,MASSACHUSETTS U\f Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired ) Upgraded( ) Abandoned( )by,; v ( r3 F has been constructed in accordance s with the provisions of Title 5 and the for Disposal System.Construction Permit No. s dated ?7 Installer Designer Ald Approved desi ow 1 1i d. #bedrooms Pp � The issuance of this pe it shallnot be construed as a guarantee that the system wil'1 fu o ion ! designed. Date U �' k7 1 6 Inspector � I / C1. 1 ------- --'---'---- -- -------------------- ---------------- ` t� 'i j([`J - ` ---------- Fee------------------------------ ti ti�- No. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS 3Disposaj 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair ) Upgrade( ) Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. 1 Provided:Construction must be completed within three years of the date of this permit.� t2 1 —77— Approved Ad by ✓ / Date ' lJ v AsBuilt Page 1 of 1 -TOWN OF BARNSTABLIE LOCATION *I �/'��� S 1 -SEWAGE VILLAGE .7i'pf/i�� " ASSESSOR'S MAP & LOT ) 0 INSTALLER'S NAME& PHONE NO. / /` I <- SEPTIC TANK CAPACITY �'�G D f LEACHING FACILITY:(type) i� NO.OF BEDROOMS-PRIVATE WELL O PUB IC WAT BUILDER OR OWNER t DATE PERMIT ISSUED: U j DATE COMPLIANCE ISSUED: f O I z VARIANCE GRANTED: Yes No k Yo /' }9 r % NO .fir .11y t - b http://issgl2/intranet/propdata/prebuilt.aspx?mappar=093024&seq=l 10/28/2016 ASSESSORS MAP N0: PARCEL NO.:( 'io" No ?.r 1 1 00 THE COMMONWEALTH OF MASSACHUSETTS BOARD 0FHEA TH � � 4 � / /............ OF. . / � / Appliratiou for Disposal Works Tomitrurti n _ rrmit Application is hereby made for a Permit to Construct ( ) or Repair (�an Individual Sewage Disposal Systemat— - -- --_:( ! ........................................ -------•- ..... --Lot-No- -----•----•--•-------- ----- ion-A - ss .......-•-----•-•-------------or . W Address a ---------- ---------------- --- --------- ---------•=---------••••-•-----••- ------......-----------•------•--•---......_........_..-----------••-•-••--•-•----•---....._•----- Installer Address Type of Building Size Lot____________________________Sq. feet Dwelling No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons____________________________ Showers — Cafeteria. dOther fixtures -----------------------•--.--._-- •------------•-----•---------------------••--•---------------------------•----------------------------------------. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. $Y4 Septic Tank—Liquid capacity------------gallons Length................ Width................ Diameter---------------- Depth................ W Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area.--_--_-____-_______sq. ft. x Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1...........:....minutes per inch Depth of Test Pit.................... Depth to ground water-----..--..-----___-_--- ;%4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -----••---••--•----------------------------------------......................................................... Descriptionof Soil --------•---••----•---•--------•---•--------------------------•-------------------------------------------------._.._._......._. x xW -----•-----------------------------•--•---------..------------------------------------------------------------------------. --------- -� f --------------------------- U Nature of Repairs or Alterations—Answer when applicable-----,l.=.l.. � �� e -- ----------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iT 11,p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by e and ,f health. Signed--- -- ......... 4- --•--------- •. Application Approved BY----- ------- '' `' ---------------------------------------- Date Application Disapproved for the following reasons----------------•----•-----------...---------------------------...---------------------------------------_------ ..----•--------------------------•-••---...--•--•----------•----------•---•-------------......--•---••••------•--.._._..._..-----••------•-•--------------------•--------------------•••••------••-••-- Date _.Permit No.. .tc?.------u..C>.o............. Issued........................................................ Date ------Lao Fmglo? :._01.22-.......... THE COMMONWEALTH OF MASSACHUSETTS BOARD O- F HEr,&_%'_TH 0 F .........�__n_f. . .................................. Appliration for Dhiposal Works Towitrurtivit rrrmit Application is hereby made for a Permit to Construct or Repair �an Individual Sewage Disposal System at . ............. ..... . .. ...... ... .................................................................................................. al ! tion- es or Lot No. ............ . .. .. .......... ........ .. .............. .................. ................................................................................................. Address ins ta!er Address ype of Buildi Size Lot............................Sq. feet Dwellin U "';VNo. of Bedrooms............................................Expansion Attic Garbage Grinder a Other—Type of Building ............................ No. of persons........_.__................ Showers Cafeteria Otherfixtures ...................................................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width__............__ Diameter.............._. Depth................ Disposal Trench—.\Io. .................... Width...._............... Total Length.._................. Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.._.........___._._. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date....................................... Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water--____-.-____-__----_--.- L14 Test Pit No. 2................minutes per inch Depth of Test Pit___.............._.. Depth to ground water......__._...._.....__.. M ................. ..................................................................................................................................... 0 ---r-�; Descriptionof Soil......_....�:,> ---- --- ---------------------------------------------------------------------------------------------------------------------------------------- ...........................................................................................................................................................................U I----------- --------------- W ------------------------------------------- .................................................................... ............ U Nature of Repairs or Alterations—Answer when applicable.__2 5� ivl�t----------I-------------------1-1------ ----------------I...... ................... ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TT:f.7-,4, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in in operation until a Certificate of Compliance has bee issued by/ I,tXe oard.of healt 7 Sign .... ... . ......... . ........... . ................... ...............el... r. ApplicationApproved By..4—.2—, ............................................................. ..............%...........------------- Date Application Disapproved for the following reasons:.................................................................................._......................... ......................................................................................................................................................................................................... Date Permit .......1j..Q.0------------- Issued...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEA...... j.. .... ....... ................OF.... . ..........:..................... TOWrtift ab of Toutpliattre T,YIS IS TO ERDT, at the In' *dual Sewage Disposal System constructed or Repaired (4o5oo' by-.. ............... ................................................................................................ at. ................ ............ ................................................................................................................................. has been instailed in actor ante with the provisions of TLILl!E j of The State Sanitary CodwsQdyipbed in the application for Disposal Works Construction Permit No....�t' -,.ted------ ... . ...................... d, ............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL F.PNC7IONS ATISFACTORY. DATE...................A rz_ g�........................... .......el .. ............................................................................ -�3, 14 Inspector. THE COMMONWEALTH OF MASSACHUSETTS BOARD QF HEALTH .....OF... ........................................ ............;..... Dispo I for To ion Up it 1 11 t Permission is hereby granted. .. .......... .... ......... ....................................... to Construct ( or_pair Indivi.,U'... ewage,pair ystem atNo.. ........... ....... .. . ....... ...... ------ ............................................................. ... ....... Street as shown on the application for Disposal Works Construction Permit NC=4_L.PQ_? Dated...... ............................... ..../J.....................-- • Board of Health ATE............ .............. J FORM 1255 HOB13S & WARREN. INC., PUBLISHERS ROUTE 28 FALMOUTH ROAD ' I `GF QOPo N U T§L o TIE 9� r �p WATER LINE SEPTIC DUv�� AT NOT WATER GATE O e ��0-T E o NJ� Q?�Q�aF,�, SLOE f - 0 GAS LINE OVERHEAD WIR off UTILIT AU Y UMN DRIV POLE � E CENTERVILLE, MA P - - LOCUS MAP INSTALLER� TO l VERIFY LOCATIONS I OF ALL UNDERGROUND \ ! UTILITIES BEFORE j EXCAVATINGSYSTEM. FOR EM. \ OO 34 \ <\ ,v GARB G \ � G R I 34 / OT 32 \ e / A OWED 30ll— Fo .O 0 i v l \ P Ire vj, 28 A \ O 26 \ Qp x 32 � f 24 22 F� co 30 PROPOSED SOIL 1 2 �� I 0 ��� ABSPT!n _ �o� OR nl l ��; �� '- , SYSTEM \ \ �\: �. _:>F \ PARKING f -SEE DETAIL i s� 1\ AREA ON BACK \ ti 19 �J . � \ �p�T\ 6, 9 � 26 , 1 J \ • \ MINIMAL \ \18 GRADING 24 PROPOSED \ / w \ , 22 L Oo T 35 Lo AREA = 17694 sf+— Lo LAND COURT PLAN 31043-A ; LE GIS �EL`EVA TIOTN 18 152.02 ft —— ASSR MAP 168 Pa 4�5-2 19 A 30. 19 . 20 —_ Op OF FOUNDP�\ PLAN f LEGEND h SEPTIC COMPONENTS SCALE: I in = 20 f t EXISTING O 20 40 OF MASS P` OF4f4Ss IOQO GAL SEPTIC AM DAVID 9`yGs o� DAVID 9oyGs 0 10 20 D. D. u COUGHANOWR H COUGHANOWR N LEACH PIT/ PRINT O N 11 x 17 in No. 1093 No. 461 CESSPOOL PAPER FOR PROPER SCALE DISTRIBUTION BOX SgNR ER`�� SO�gPPROVEO TEST PIT THIS IS A NOTE COLOR PLAN SEWAGE DISPOSAL ti SYSTEM PLAN INSTALLER. MAY MOVE SOIL ABSORPTION USE COLOR PLAN ONLY ITO SERVE EXISTING DWELLING -- - SYSTEM UP TO FIVE (5) FEET LATERALLY FOR INSTALLATION IN ANY DIRECTION. ELEVATIONS SPECIFIED FULL DETAIL IS BEST GUALB PAULO ON FLOW PROFILE MUST BE MAINTAINED. VIEWED INERTO ^ ��;' fo FULL COLOR PINER(S) OF RECORD EXISTING LEACH PITS TO BE 57 BENT TREE DRIVE PUMPED AND FILLED OR REMOVED 155 Geo R der Rd S I CENTERVILLE, MA y PROPERTY ADDRESS Chatham, MA 02633 DavidcouOHotmail.com D�IATE: SEPTEMBER 13, 2018 508 364-0894 0 P�.ii2 109� ETE-4326 i�ecoe —_� -- - --- f poi rEs� Loy �. a' g D181011 CALC UL 4Doa8 SOIL EVALUATOR: DAVID D. COUGHANOWR, ASE #461 WITNESSED BY: DONALD DESMARAIS. HEALTH DEPT. DESIGN FLOW: 3 BEDROOMS X 110 GPD = 330 GPD j NO GROUNDWATER ENCOUNTERED SEPTIC TANK: 330 GPD X 1 .2 DAYS = 6160 GALLONS TEST PIT PERC AT 46 in - 2 MIN/INCH IN C SOILS USE EXISTING 1000 GALLON SEPTIC TANK IF IN ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER SOUND STRUCTURAL CONDITION. IF NOT, INSTALL i INCHES HORIZON TEXTURE (MUNSELL) MOTTLES NEW 1500 GALLON SEPTIC TANK. 19.35 0-12 FILL DISTRIBUTION BOX: INSTALL UNIT DEPICTED BELOW. i 17 68 12-20 B LOAMY SAND 10 YR 4/6 NONE FRIABLE SOIL ABSORBTION SYSTEM: s 20-52 Cl LOAMY SAND 10 YR 5/4 NONE FRIABLE THE LONG TERM ACCEPTANCE RATE FO; A CLASS ONE 52-132 C2 MEDIUM SAND 10 YR 6/3 NONE LOOSE SOIL WITH A PERCOLATION RATE BELOW 5 MINUTES 8.35 PER INCH = 0.74 GALLONS PER DAY PE SQUARE FOOT. 4 NO GROUNDWATER ENCOUNTERED THE 24 ft x 12.5 ft x 2 ft LEACHING GALLERY I TEST PIT 2 2 MIN/INCH IN C SOILS DEPICTED BELOW CAN LEACH: ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER BOTTOM AREA = (24 x 12.5) = 300 s f INCHES HORIZON TEXTURE (MUNSELL) MOTTLES q• t• 19.15 0-10 FILL SIDEWALL AREA = (24+24+12.5+12.5)x2 =146 so. ft. 17 48 10-20 B LOAMY SAND 10 YR 4/6 NONE FRIABLE TOTAL AREA = I 446 sq. ft. 20-48 Cl LOAMY SAND 10 YR 5/4 NONE FRIABLE FLOW CAPACITY = 0.74 x 446 = 530.04 gal/day 48-132 C2 MEDIUM SAND 10 YR 6/4 NONE LOOSE INSTALL A 24 ft x 12.5 ft x 2 ft GALLERY AS CONFIGURED 8.20 BELOW. FLOW CAPACITY = 330.04 gal/day WHICH EXCEEDS THE 330 gal/dog REQUIRED FOR A THREE BEDROOM DESIGN. �OoO���ALLOoN .`�EP.:TIC TAN �A5,Im RrT1 �N TANK TO BE PUMPED DRY AT TIME OF INSTALLATION T E M '4 .` AND EXAMINED FOR STRUCTURAL INTEGRITY. INSTALLNORM NEW PVC OUTLET TEE EQUIPPED WITH A GAS BAFFLE. 1 REPLACE WITH A NEW DWELL 24.0 ft UN I in Q 1500 GALLON TANK co I TAPER IF CRACKED, ROTTED00 OR OTHERWISE y COMPROMISED. w co U? ® ® co 'n O C (V N CID I �� O I�. NOT co 14- TO STONE 3.5 ft 8.5 ft 8.S ft 3.5 ft Ln SCALE 500 GALLON DRYWEL 8 ft-6 in DIMENSIONS & DETAIL INSTALL ONE INSPECTI ITHIN THON RISER USE \ INCHES OF FINAL GRADE INLET OUTLET H_10 & IND LATE LOCATION CO VER CO VER UNI r ( ON AS-BU/L T IN DROP FLOW LINE aD� 33 OD FROM = - OyO�a ' in �f OOD BUILDING 10 in = 14 TO DOOJ D—BOX 48 in �0 5� LIQUID GAS 2 in L'E VEL- _:4 BAFFI E _ �J CROSS SECTION VIEW j INSTALL AN APPROVED GEOTEXT/LE - FABRIC OVER STONE l , b In STONE BASE IF NEW SEPARATION BETWEEN INLET & OUTLET i TEES NO LESS THAN LIQUID DEPTH 28 "3/4 In TO ' 24 In CROSS SECTION VIEW in 1-I/2 GRAVEL DEPTH/VE I-I/2 In GRAVEL d 46 in 58 in I 46 in 750 in D0l R TO : O • 0 DIMENSIONS • D-BOX TO PUN LEVEL 1 DETAIL FORBEFORE DOWN -INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE �I STARTING WORK. -ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM 12 in O REQUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC C MIN CODE (310 CMR 15). —� -INSTALLER TO VERIFY LOCATIONS OIF ALL UNDERGROUND c _ —>► T UTILITIES BEFORE EXCAVATING FOR SYSTEM. c I N TANK to to TO -ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION sas OF LOW FLOW FIXTURES & APPLIANCES, AND PERIODIC a O r PUMPING OF THE SEPTIC TANK. �Oo�o �004 -SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. I b in STONE BASE DO NOT PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. (I .2 ; 2� CROSS SECTION VIEW I I. F L� 0p G j e TOP OF FOUNDATION RAISE COVERS TO WITHIN ALL PIPE TO BE 4 in SCH. 40 PVC EL = 30.19 +- zm in OF FINAL GRADE AND TO PITCH AT 1/8 in/ft MIN 19-20 -B®r 3• EMST IG N USE H-20 - 17.25 MAX EXISTING 1000 GALLOON I, 1";2, PRECAST SCUP= TANK 18.32 16.63 6 in DRYWELL � EXISTING REFER TO DETAIL BOX STONE SOL QBSO������ jli+ 16.80 BASE 16.50 EXISTING b /n STONE BASE IF NEW SYST EM -REFER TO o 22 ft 5-72 ft DETAIL BOX NO GROUNDWATER 14.50 MOTTLING OBSERVED _ 8.20 BELOW SEWAGE DISPOSAL SYSTEM PLAN 57 BENT TREE DRIVE a- �CENTERVILLE, MASEPTEMBER 13 2018 ETE-432J PG 2/21 -