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0070 CAILLOUET LANE - Health
70 Callouet Lane I Osterville i A = 141 113 w f� r: t F,, r No [/`�""aL(Q Fee 5 v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for Disposal 6pstem Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) complete System ❑Individual Components Location Address or Lot No. 0 Cc`f\iave (..A4\t— Owner's Name,Address,and Tel.No. as}erv�l�r� K�t�}�rtlhtS Assessor's Map/Parcel (tA\ 12 InstaJlgr.'s N e,A ress,and Tel.No Designer's Name,Address,and Tel.No. Type of Building: 0Sj aV�`1,L �ar- Dwelling No.of Bedrooms Lot Size i S L,72�2_ sq.ft. Garbage Grinder(lam Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided q 3 gpd Plan Date�Z'�, fPt ZyZU Number of sheets Revision Date 8-ZV^ZoZU Title fis gn Tcvtu_�<_&_ d�LweC S Size of Septic Tank 7—Wo Type of S.A.S. �' (1 �k( Description of Soil o-(o" Nature of Repairs or Alterations(Answer when applicable). Date last inspected: Agreement: The undersigned agrees to ensure the oon`struction and maintenance o,�the-afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environme a and not to place the system in operation until a Certificate of Compliance has been issued by this Board He Si Date Application Approved by Date 9Z Application Disapproved by Date for the following reasons Permit No. '�'tlp� Date Issued J�y„�a�'.-'�„pr.R-rw:y: , �'•'.k..?^6- r- -__ ...r µ�+�;-,,,�.�7+�-.tr _ •�t `�� � F �vr�� "".�c""'� _.-r .� d.'.,-.•..r�'�' F �— », t lz`t f Fee # �-�o 1. THE COMMONWEALTH OF MASSACHUSETTS Bnteredincomputer: Yes PUBLIC HEALTR-DIVISION- TOWN OF BARNSTABLE, MASSACHUSETTS ftpl ation for disposal psterit editstruttion Permit Application for`a Permit to Construct O Repair( ) Upgrade( ) Abandon( .) �,Complete System ❑Individual Components Location Address or.Lot No. �0 C,%Akuue-�' (,cAAIC } Owner's Name,Address;and Tel.No. dserv\ll C. lr' K°�P�C' Assessor's Map/Parcel Installer's Name,Address and Tel.No Designer's Name Address,and Tel.No. i (,l %Clie� '711 rUvvl,F I k,rs.bi tc1� ' Type of Buildmng! f , Ocwvc Dwelling No.of Bedrooms Lot Size t S Z, ]37_— sq.ft. Garbage Grinder(1 k), Other Type of BuildingNo.of Persons Showers yp ( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �1�o gpd Design flow provided �(�j gpd Plan Date'Ajl� tP; ZvZU Number of sheets '] Revision Date 8'ZU-7029 4 Titler1c �tin Size of Septic Tank U04 Type of S.A.S. (ol}l �4Q S I n Id,�1U^x 1Z �, Description of Soil—A-* 2 0-k S 1, 0-h Ct An!!+ Nature of Repairs or Alterations(Answer when applicable) r Date last inspected: F ' Agreement:` - Thle undersigned agrees to ensure the construction and maintenance o the afore described on-site sewage disposal syst m in y , accordance with the provisions of Title 5 of the Enviromne tal-Gode�t to place the system in operation until a Certificate of µ 'Compliance has been issued by this Board o Health ,� Signefl __ Date , Application Approved by ( Date Application Disapproved by Date for the following reasons t ! Permit No. Date Issued ----- --------------- --------------------- : - - .- --- - ------------ =---------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS �ertlflL�te-of Compliance THIS IS TO CERTI+1flY,that the On=site Sewage Disposal system Constructed Repaired( r) Upgraded( ) Abandoned at �c���n�.f (_ � has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Nqt� c0&'? dated Installer Designer '.. #bedrooms Approved design flow gpd The issuance of this permit hall not be construed as a guarantee that the system will fugotion-as_designed- Date ( Inspector l/- 'Q _ T No.�- (eat�/"..c-�lf1J, Fee �� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Nsposar 6pstrm Construction 3permit Permission is hereby granted to Construct(,�� Repair( . ) Upgrade( ) Abandon( ) System located at 7 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 permit ,_ Date Approved by a TOWN OF BARNSTABLE LOCATION-'. SEWAGE# ZV' v 7 VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO, Ila CC- 0 ® C.ES' SEPTIC TANK CAPACITY r LEACHING FACILITY: e (tYP )(?) NJ (size) �3..� �. 1.2 NO.OF BEDROOMS g, OWNER id�Y ?ti PERMIT DATE:® L - 7-o COMPLIANCE DATE: -7- 2 J"F 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 j ; ;.'1p CA, j -A.,— t�3�S�o 6(4 V% Town of Barnstable Inspectional Services Health Public H h Division t • BAtweew" • MASS. Thomas McKean,Director t679. 200 Main Street,Hyannis,MA 02601 4 rti: Office: 508-8624644 Fax: 508-790-6304 I 1 • it Installer& Designer Certification Form Date: Sewage Permit## ZMO- .26-7 Assessor's Map\Parcel 140 l/3 Designer: Installer: °SC2 (1J�Al�yp,�i� C. Address: ,r�.rPoxS`� Address: tGl CJ'S-E erk 4e_ r f4anS M,'l�s dZ!CY9 On Tie C�nc�.�c ,`�, . was issued a permit to install a (d•te) (installer septic system at 70 �Q '�o `£ �4 °ram r �- based on a design drawn by /, (address) &,6clt FA ;A eer.Aocamu dated Zo 202 0 (desig er) r �ertify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box an oor septic tank v Stn out if required) was ins ected Wdte soils were found satisfactory. e-q:; ` `iO, w161 44- 14iper+ed -6,w L�lvmei`�f i�ls�Fvl�� I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out'(if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was conIstructe 'ance with the terms of the I\A approval letters (if applicable) �P�tti vv MAS'D o?� CHARLES T. �. ROWLAND o CIVIL =� ' Ls Signature) " No. 52699 CJS i.ER ANAL (Designer's Signatur (Affix Des>g er s Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNST BLE PUBLIC HEALTH DIVISION. THANK YOU. Utoaldepts\HEALTIASEWER connect\SEPTIC\Designer Certification Form Rev 8.14-13.DOC i s >�I 1 13 ue' Commonwealth of Massachusetts , - ;� Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments -- °� 70 Caillouet Ln (System 1 of 2 Main House j Property Address p t Peter Sellars Owner Owner's Name information is required for every Osterville ✓ MA 02655 10-11=18 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. A. Inspector Information 1 159S(o Shawn Mcelroy Name of Inspector Upper Cape Septic Services - Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S 13971 Telephone Number License Number B. Certification I certify that) am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000);1 have personally inspected the sewage disposal system at theproperty address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed`based on'my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: `f 1. ® Passes . 2. ❑ Conditionally Passes - 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 10-11-18 Its pector'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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 F Commonwealth of Massachusetts y Title 5 Official Inspection Form �-r A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Caillouet Ln (System 1 of 2 Main House) Property Address Peter Sellars Owner Owner's Name information is Osterville MA 02655 10-11-18 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. 2) System Conditionally Passes: " ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal,and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 i 4 „�� Commonwealth of Massachusetts Title 5 Official Inspection Form I! Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Caillouet Ln (System 1 of 2 Main House) _ 'J Property Address Peter Sellars Owner Owner's Name information is required for every Osterville MA 02655 10-11-18. . page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) : . 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑N ❑ ND (Explain below): ❑ obstruction is removed -❑ Y ❑N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑Y' ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑Y ❑N ❑ ND (Explain below): ❑ obstruction is removed ❑Y ❑N ❑ ND (Explain below): 3) Further Evaluation is Required by the'Board of Health:, ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if 'the system is failing to protect'public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ' i-f Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Caillouet Ln (System 1 of 2 Main House) Property Address Peter Sellars Owner Owner's Name information is required for every Osterville MA 02655 10-11-18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. c. Other: t 4) System Failure Criteria Applicable to All Systems: - w_ You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ' ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts 1� Title 5 Official Inspection Form 01 Subsurface Sewage Disposal System Form-Not for Voluntary.Assessments lid 70 Caillouet Ln (System 1 of 2 Main House) , Property Address Peter Sellars Owner Owner's Name information is , required for every Osterville MA 02655 10-11-181 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable.to All Systems: (cont.) ,Y Yes No ` ® Static liquid level in the distribution box above outlet invert due to an overloaded El or clogged SAS or cesspool . Liquid depth in cesspool is less than 6" below invert or available volume is less ❑ ® than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: - . ..• ❑, ® -,Any portion of the SAS, cesspool or privy is below high 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. + ElT ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. - ❑ [E ' Any portion of a cesspool or envy is within 50 feet of a private water supply well. ❑ 70 Anjr"portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well,water analysis, performed at a DEP certified . laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd•' EJ , ® ' ' Tlie system fails. I have determined that one or more of the above failure criteria exist as'described in 310 CMR 15.303,therefore the system fails. The system owner should contact the.Board of Health to determine what will be • - - necessary to correct the,failure. 5) Large Systems:To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. ' " ' For large systems, you must indicate,either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well t5insp.doc-rev.712 812 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts 1� p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r r�" 70 Caillouet Ln (System 1 of 2 Main House) ' Property Address Peter Sellars Owner Owner's Name information is required for every Osteryille MA 02655 10-11-18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section C.4 above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the.Department. 6. You must indicate "yes" or"no"for each of the following for afl inspections: Yes No „ ❑ f ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ ' Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Wasthe facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 i Commonwealth of Massachusetts v !- I Title 5 Official Inspection -Form Subsurface Sewage Disposal System Form =Not.for Voluntary,Assessments 70 Caillouet Ln (System 1 of 2 Main House).•u ,i : n> ` Property Address Peter Sellars 1 Owner Owner's Name information is required for every Osterville MA 02655 10-11-18- page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 6 Number-of bedrooms (actual): 6 DESIGN flowbased on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 660 Description: Number of current residents: 0 Does residence have a garbage grinder? .- ❑ Yes ® No Does residence have a water treatment unit? ,- - ® Yes ❑ No If yes, discharges to: Septic Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? -V.1'. , .> a. . ® Yes ❑ No Last date of occupancy: - . ,- ,. , Unknown Date t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 7 of 18 1 Commonwealth of Massachusetts Title 5 Official Inspection form . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments e 70 Caillouet Ln (System 1 of 2 Main House) Property Address Peter Sellars Owner Owner's Name information is required for every Osterville MA 02655 10-11-18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) . 2. Commercial/Industrial Flow Conditions: Type of Establishment: . Design flow(based on 310 CMR 15.203): ` Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): } 3. Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason.for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts a Title 5 Official - Inspection Forni.' 1 Subsurface Sewage Disposal System Form--Not for.Voluntary Assessments 70 Caillouet Ln (System 1 of 2 Main House), Property Address , Peter Sellars t Owner Owner's Name information is required for every Osterville - ' MA 02655 10-11-18, page. City/Town State Zip Code Date of Inspection D. System Information (cont.) t 9.t 4. Type of System: ' ® Septic tank, distribution box, soil absorption system ❑ Single cesspool f ❑ • Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 2002 Were sewage odors detected when arriving.at the,site? !❑ Yes ® No 5. Building Sewer(locate on site plan): _ Depth below grade: 60"feet s Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): ' Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts p Title 5 official Inspection Fora 11 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Caillouet Ln (System 1 of 2 Main House) Property Address Peter Sellars Owner Owner's Name information is required for every Osterville MA 02655 10-11-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: - - 48" feet Material of construction: ® concrete ❑ metal ❑ fiberglass, ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: F 1500 gal H-20 Sludge depth: 12" Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 4" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Tape 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 is in good condition with baffles installed and no,sign of leakage. Recommend pumping for solids. t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts - w Title 5 Official Inspection,'ForM ?,y r�i Subsurface Sewage,Disposal System Form-Not for Voluntary Assessments >" 70 Caillouet Ln (System 1 of 2 Main House). �_' r �• Property Address ti Peter Sellars , Owner Owner's Name information is required for every Osteryllle MA 02655 10-11-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) �.. �,.. 7. Grease Trap (locate on site plan): ., , a y4 Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene • ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to-top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping:. Date' Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons . Design Flow: gallons per day t5insp.doc-rev.7l26f2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments > r , 70 Caillouet Ln System 1 of 2 Main House) Property Address Peter Sellars Owner Owner's Name information is required for every Osterville MA 02655 10-11-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) - Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened)(locate on site plan)` Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level and no sign of back-up from field. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts r Title 5 Official Inspection Fora �i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Caillouet Ln (System 1 of 2 Main House)., +; i Property Address Peter Sellars Owner Owner's Name information is required for every Osterville MA 02655 10-11-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) - 10. Pump Chamber(locate on site plan): _ Pumps in working order: ® Yes ❑ No* Alarms in working order:• ® Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump chamber in good condition with pump and alarm tested. * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: , Type: t , ❑ leaching pits ' r 'number: ' ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1-75'x12' ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts ` Title 5 Official Inspection Form �i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Caillouet Ln (System 1 of 2 Main House) Property Address Peter Sellars Owner Owner's Name information is required for every Osterville MA 02655 10-11-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach field in good working order with no sign of back-up into d-box or surrounding stone. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and-configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure,,level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 ti Commonwealth of Massachusetts ;w;. Title 5 Official Inspection form �i Subsurface Sewage Disposal System•Form -Not for,Voluntary Assessments r � ; 70 Caillouet Ln (System 1 of 2 Main House) Property Address Peter Sellars Owner Owner's Name information is Ostefville MA 02655 10-11-18 required for every - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): ' Materials of construction:" f Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts ' Title 5 Official Inspection Form N Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Caillouet Ln (System 1 of 2 Main House) Property Address Peter Sellars Owner Owner's Name information is required for every Osterville MA 02655 10-11-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) ° 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet..Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ' ❑ drawing attached separately oY. f +5P d - t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form%Subsurface Sewage Disposal System•Page 16 of 18 r Commonwealth of Massachusetts -. R Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Caillouet Ln (System 1 of 2 Main House) .. Property Address Peter Sellars Owner Owner's Name information is Ostefville MA 02655 10-11-18 required for every - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) t 15. Site Exam: - ❑ Check Slope . . _ . ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 3 10, feet Please indicate all methods used to determine the high groundwater 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: Original design plans show groundwater at 10'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspecton Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts ' Title 5 Official Inspection Form ? �C-'1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Caillouet Ln (System 1 of 2 Main House) Property Address Peter Sellars Owner Owner's Name information is required for every Osterville MA 02655 10-11-18 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp,doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 Commonwealth of Massachusetts -, y� " 43 , j, Title 5 Official Inspection form w, ht Subsurface Sewage Disposal System•Form,-Not for Voluntary Assessments h[IC• 4MF 70 Caillouet Ln (System 2 of 2 Garage Apt) Property Address Peter Sellars Owner Owner's Name information is Osteryille 1� MA 02655 10-11-18, . required for 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. A. Inspector Information �Sl i3�a Shawn Mcelroy Name of Inspector ' + pp&Cape Septic Services Company Name P.O. Box 73 ,. Company Address E. Falmouth MA ` . + =02536 City/Town State; .' , :: Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that:l am a DEP approved system inspector in full compliance with Section 16.340 of Title 5 (310 CMR 15.000);I have personally inspected the sewage disposal system at theproperty address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience,in the proper function and maintenance of on-site sewage disposal systems:After conducting this inspection I have determined that the system: - 1. ® Passes 2. ❑ Conditionally Passes, 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 10-11-18 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to a r the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 , Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts - r Title 5 Official Inspection Form i pal Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,.7� >` 70 Caillouet Ln (System 2 of 2 Garage Apt) Property Address Peter Sellars Owner Owner's Name information is required for every Osterville MA 02655 10-11-18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ' ® 1 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: System is in good working order with no sign of failure. System has tree root intrusion. Recommend regular maintenance to keep under control. 2) System Conditionally Passes: " ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System 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): t5insp.doc•rev.W26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 c� Commonwealth of Massachusetts . r r� o, Title 5 Official Inspection Foam i.l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Caillouet Ln (System 2 of 2 Garage Apt),F-• fi Property Address Peter Sellars s Owner Owner's Name information is required for every Osterville MA 02655 10-11-18 page. CitylTown State Zip Code Date of Inspection C. Inspection Summary (cont.) r 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will passrwith Board of Health approval if pumps/alarms are-repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection-if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑N ' ❑ .ND (Explain below): ❑ 'obstruction is removed ❑ Y ❑N •❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑Y ❑ 'N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or-obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑Y ON ❑ ND (Explain below): ❑ obstruction is removed ❑Y ❑N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official - Inspection form --i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments >" 70 Caillouet Ln (System 2 of 2 Garage Apt) Property Address Peter Sellars Owner Owner's Name information is required for every Osterville MA 02655 10-11-18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ,I ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑The system has a septic tank and,SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure.criteria are triggered. A copy of the analysis must be attached to this form. c.-Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool v 7l 61201 Title 5 Official Ins ection Form:Subsurface Sewage Disposal System•Page 4 of 18 t5insp.doc rev. 2 8 p g p Y 9 Commonwealth of Massachusetts Title 5 Official Inspection Forn1 _ ISM Subsurface Sewage Disposal System Form =Not for Voluntary Assessments - , ,a>' 70 Caillouet Ln (System 2 of 2 Garage Apt) 1J _`rt� Property Address Peter Sellars Owner Owner's Name information is required for every Osterville MA 02655 10-11-18 - page. City/Town - State Zip Code Date of Inspection C. Inspection Summary (cont.) 4). System Failure Criteria Applicable to All Systems: (cont.) Yes No 0 Static liquid level in thedistribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2'day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑l. Z Any portion of the SAS;cesspool or privy is below high ground water elevation. ❑ ®, Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is,within a Zone 1 of a public water supply 'well.'" ` .t ❑ ®' 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.] E] ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. . ,® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems:To be considered a large system the system must serve a facility with a design flow of 10,000 gp`d to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in;Section CA.- f Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area- IWPA) or a mapped Zone II of a public water supply well t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 r Commonwealth of Massachusetts . Title 5 Official Inspection Form IQ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Caillouet Ln (System 2 of 2 Garage Apt) Property Address Peter Sellars Owner Owner's Name information is Osterville MA 02655 10-11-18 required for every - page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑' Has the system received normal flows in the previous two week period? ❑ ® - Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ®1 Wasthe facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® '❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official_ Inspection -Ford 0I Subsurface Sewage Disposal System Form Not for Voluntary Assessments 70 Caillouet Ln (System 2 of 2 Garage Apt) J Property Address Peter Sellars Owner Owner's Name , information is ill terve OS < required for every MA 02655 10-11-18 ,t page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: , Number of bedrooms (design): 2 Number of bedrooms (actual): 2 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Description: Number of current residents: t 1 Does residence have a garbage,grinder?. ;�-,t.. ❑ Yes ® No Does residence have a water treatment unit? t ® Yes ❑ No If yes, discharges to: Septic for main house Is laundry on a separate sewage system? (Include laundry system inspection El Yes No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: t Date 18 Date t5insp.doc-rev.7/262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 6 Commonwealth of Massachusetts Title 5 Official Inspection Form Cbi Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r" 70 Caillouet Ln (System 2 of 2 Garage Apt) Property Address Peter Sellars Owner Owner's Name information is required for every Osteryille MA 02655 10-11-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): - Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date r Other(describe below): 3. Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 i Commonwealth of Massachusetts , Title 5 Official Inspection-0=oi ref Subsurface Sewage Disposal System Form =Not for Voluntary Assessments a 70 Caillouet Ln (System 2 of 2 Garage Apt) -f Property Address Peter Sellars Owner Owner's Name , information is required for every Osterville MA 02655 10-11-18• page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: E ® Septic tank, distribution box, soil absorption system ❑ Single cesspool , ❑ Overflow cesspool ❑ Privy ❑ Shared system (Yes or no) (if yes, attach previous inspection records if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1980's Were sewage odors detected when arriving at the site?, ❑ Yes ® No 5. Building Sewer(locate on site plan): - Depth below grade: 18"feet ' Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form C�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Caillouet Ln (System 2 of 2 Garage Apt) '�Sn•Ty'!d/ J Property Address Peter Sellars Owner Owner's Name information is required for every Osterville MA 02655 10-11-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑ fiberglass El polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 12" Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape 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 is in good condition with baffles installed and no sign of leakage. Tree roots in tank. t5insp.doc•rev.7t2612018 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 10 of 18 I L c Commonwealth of Massachusetts Title 5 Official . Inspection. Form r�i Subsurface Sewage Disposal S stem Form -Not for Voluntary Assessments .�� g p y ry 70 Caillouet Ln (System 2 of 2 Garage Apt) Property Address Peter Sellars Owner Owner's Name information is Osterville MA 02655 10-11-18 required for every _ ,•` ` page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage;'etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts ,µ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for.Voluntary Assessments 70 Caillouet Ln (System 2 of 2 Garage Apt) Property Address Peter Sellars Owner Owner's Name information is required for every Cisterville MA 02655 10-11-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened)Qocate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level and no sign of back-up from pit. t5insp.doc•rev.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Iw Tine 5 Official Inspection Forte p Subsurface Sewage Disposal System•Form.-Not for,Voluntary Assessments 70 Caillouet Ln (System 2 of 2 Garage Apt)' Property Address Peter Sellars Owner Owner's Name information is Osterville MA 02655 10-11-18 * } required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): , . • - Pumps in working order:' ' _ ` ' ❑'Yes ❑ No* Alarms in working order: ,❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or a[arms are not in working order, system is,a conditional pass.- - ^.1 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type ® leaching pits ° ' " ' " number: 1-600 gal ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: IEl innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 y.>. - Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form i-lI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments >" 70 Caillouet Ln (System 2 of 2 Garage Apt) Property Address Peter Sellars Owner Owner's Name - information is required for every Osteryille MA 02655 10-11-18 page. City/Town , State Zip Code Date of Inspection D. System Information (cont.) - f 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Six foot diamenter four foot tall pit in good condition and holding 12"of water with stain line at 18" below inlet invert. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018• Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 cam`• Commonwealth of Massachusetts - • ° �, ', Title 5 Official Inspection 'Form %I; Subsurface Sewage Disposal System Form-Not•for Voluntary Assessments 70 Caillouet Ln (System 2 of 2 Garage Apt) > Property Address Peter Sellars Owner Owner's Name information is required for every Osterville MA 02655 10-11-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: r Dimensions Depth of solids f Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): A r - �a t5insp.doc°rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts r� 3 Title 5 official Inspection Fora C�'l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments :. •S� ' 70 Caillouet Ln (System 2 of 2 Garage Apt) Property Address Peter Sellars Owner Owner's Name information is required for every Osterville MA 02655 10-11-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 0. t.. A�3 *6 r r dir-� :,, rr • t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 r Commonwealth of Massachusetts - r r� Title 5 Official Inspection Form • .... r�l Subsurface Sewage Disposal System Form-Not for Voluntary Assessments <. 70 Caillouet Ln (System 2 of 2 Garage Apt) 1 " Property Address Peter Sellars Owner Owner's Name information is required for every Osterville MA 02655 10-11-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar t ❑ Shallow wells Estimated depth to high ground water: 1 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:, * TDate' ' ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database explain: You must describe how you established the high ground water elevation: Design plans for main house show groundwater at 10'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 " Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts IC Title 5 Official Inspection Form •m Subsurface Sewage Disposal System Form -Not for Voluntary Assessments f � rrJ 70 Caillouet l-n (System 2 of 2 Garage Apt) Property Address Peter Sellars Owner Owner's Name information is required for every Osterville MA 02655 10-11-18 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Ti ht/Holdin Tank—Pumping contract attached 9 9 p 9 For 14: Sketch of Sewage Disposal System drawn on . 16 or attached g p Y P9 For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 Bruce Macallister SHORELINE CONSTRUCTION 87 Pond Street Qsterville, MA 02655 508-428-5529 Mr. Richard Sellars March 12, 2004 70 Caillouett Lane Osterville, MA 02655 On March 10, 2004, 1 investigated, located and uncovered all the septic-system components for the garage system at the above address. The systern included the following: 1 ,000 gallon precast septic tank Distribution box-cement (1) 4'x6' precast pit-approx. 2' of stone around pit All piping= schedule 40 PVC Septic tank- in good condition with proper inlet and outlet tees water level in tank even with outlet invert No scum-obviously system had little use Distribution box- Good condition-no signs of any problem Precast pit- Good condition, dry, bottom of pit is not in ground water Bruce Macallister RN�i�:Sf d c� t-�w) 6-X%S71 rdG- 35 ��vi' TANK %NLET G A rz/k(a ��' ,�K ®urt ET" ;L3 LO 14 a9, t Imp t 41 i 10 TOWN OF BARNSTABLE LQCATION '�O C} SEWAGE QOQ-05,3 ci VILLAGE 05 t;cn,..l ASSESSOR'S MAP & LOT q" INSTALLER'S NAME&PHONE NO. �tA-e-0-tC)-�CS- SEPTIC TANK CAPACITY _/J 6tl �6&f- ' LEACHING FACILITY: (type) �c�t r1%TST&AC (size) '7f-� t NO.OF BEDROOMS-6 BUILDER OR PMlER e-1(6c PERMIT DATE: COMPLIANCE DATE: 7 /O 0 2- Separation Distance Between the: ' Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on-site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by �6o�c a Scene w��( ( � Q 6y' - q <L - 70 �,a TOWN OF BARNSTABLE G q G E S'1 she LOCATION y �A11'Ovc7/ LAn e- SEWAGE# 3-7)JP eC VILLAGE � ((e ASSESSOR'S MAP & LOT RISTA&EER'S NAME&PHONE NO.9ruce HO-CC 1/s �29 5S29 SEPTIC TANK CAPACITY LEACHING FACIL=: (type)��e��'� ��� (size) 4 X NO. OF BEDROOMS BUILDEROROWNER 214 DATE: l7AeCN/0 o?DOy COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by r 3S d�= ► a6 1 y - _:T4W1�T OIF�AtaTABL _ . aS-e. LOCR'&`i0N lO :Co`1: 1 d eAGE oMSESSit� MLaVILLA x --- --�-�-- f iIItSTA�..LF,R.'S NARK&�t�QNB NO z $E1 C,WANK CAAPACrrY _ t sixe X LE�►g311►TG PACII Tt K ( ) e { ) I !BUILDS OR D iZ MRMW sq)-mtiatl tsWoe Between f 11 xitnuml i}ust tlOtpoudwjwUbtstoiheBoitdrnofY,s#a,�hFn�R citify :. .,..., J, k prh►a4c,'9N k r$uyply V1a61' aid Y.ataCua$1?Aciuty .(if osy rrao exist as site ae.wltbin'�AR feet of tenatuo$f ciltty) Feel, C � l i cy�'Wetlaad_a id l cad)tt�$I i'd, ty.(tF��ny.wetlands exist 1. W, Id it 3do fae ..aX. 0- —%;-4 S�ne wu�1�a o 3 0 70 , TOWN Q F B 1STA,BLE_ { G � t Loc�Ttoiv /O�c�f Lam # I vt a; SESsoR�s Lmr�...... ..�..., 1NuT�.L1~Lt'S NAA�8c�fiXQ1dE I+IO �, SEZz`I C TANK CAP�CTTY i DO � �I�BRF/LtT��e'Y'E: . pptatiaaistAnectv�eeea t3za: MaX iia i ttarnofLMdligFocility. 'Fall ;l?t�va4+� tat r 5up+ly `Js i1`r c�L..=..Was p i6wty .(7f any wells exist ,; a�:ait�s ac.wlthstt�0p feat a�leacbia►�fucllitY) 1Fea9 06doi;cy�W.Nd ntd 00d Uacitiaj Vawri*(Ua"y wit ods exist € ivitlaftt 304 feet v leacl�itas�`acilxty ftalshad.by /` �p'c 0 �J i - 1 -3Sd r Fee No.i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0[ppfication for nigaal *pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade 0<)Abandon( ) ®Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 7 0 �,"l/bu e� La ru , Os fca'v�11 �,C/+a�r�L 6 v v o r�S S• Sellars Assessor'sMap/Parc 1Ipa 71 CQ.,'/J6Get !-gene, Q�C ✓��l t pV n ' 6d Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. -3,3 V q d',c-ll,"rant' G- hgi•/2 _o_rj",F Zr►c. jo.G • Bcvc/rs� Type of Building: 2 Dwelling No.of Bedrooms Lot Size 9.,73 / Garbage Grinder VC? Other Type of Building No. of Persons Showers(. ) Cafeteria( ) Other Fixtures Design Flow 660 gallons per day. Calculated daily flow gallons. Plan Date F-1/3. 1 . 2 0 O`Z- Number of sheets Revision Date N/A Title PRoPoSiTD s,--pric L1pC_rpD6 Size of Septic Tank /500 G)QL . Type of S.A.S. 12'X7s' LCAc.NiWe- 13450 Description of Soil 0-2"-O - OROAwic. 9j/1fE2iAk- P `2. ^-7 -E - 13Rv. 6,AfsESAWD Ifs YR 513 7`f Z 1, g StRoP6 6rN Co.4 xE s/4iyp 7,,fYk 6�L 7 21$` &'-BC Y6ijsk jarn�. i d SA/D y 8= fsG'1 E 1 13[aIV 514 YEL. cv,0/'SE SA 10YR/✓D f4A 86-lot" c2 1-t. Yhre15N BrN CoA/'56 5ANY) 10ypZ , Nature of Repairs or Alterations(Answer when applicable) 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 Certifi- cate of Compliance has been iss ed by this B azd of He It / Signed - Date �� b �'o200. Application Approved by�__. 7 Date .7- P'Z'L� Application Disapproved for me following reasons Permit No. 9d ? Qs3 Date Issued a 0 -t� • - ..a � �:' ' •w.i}V<. z i�'• • fit. :�:%.. -' g.. -,. No.. M �...a Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes 1 PUBLIC HEALTH DIVISION'- TOWN OF BARNSTABLE., MASSACHUSETTS ' 01pprfcation for �Digogar *V!5tem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade(x)Abandon( ) ©Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. ,jo (faj"i/oue¢ Large , O�c r✓��li �,Ghccr� L3 9 L�or�S 5• Assessor's Map/ParQ r / c GO (6s �0 a�il�4Gf �QU , aS ° l>P, f71!�_ s Installer's Name,Address,and Tel No. Designer's Name,Address and Tel.No. 1'/lti Q I CG�'• S / `5jLj/,,(a/f V-0 • f«r r Gs r rd l a rrt A Type of Building: Dwelling No.of Bedrooms Lot Size 3,17.3 Add-_-tt. Garbage Grinder Iva Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 644 gallons. Plan Date Ft513. q , Z O O'L Number of sheets ( Revision Date LI/M Title PROPOSED S'Ep*ic L/PGr•ADE Size of Septic Tank /500 GAL • Type of S.A.S. 121X7s` LCAGN1NG" 13E0 Description of Soil 0-2 -0 - ORGANt& MA1E2iA 'Z y� -E ' L3Ry. C4,A1sES,4ryD LU YR 513 t St12oA,6 bra CoArce 5/JVO 7,5y'2 s/L :2.o"4e, Be yL-'e.'tsls grN. e,�- &G�t ' YCL• cew/-SE SAwn I0Y2 G�L j 86-102" CZ t_rt yEo"sN era Coq/'SE sAan IOyRG� Nature of Repairs or Alterations(Answer when applicable) /5d)L S U t i C 14- 2 U Date last inspected: b 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 iss ed by this B and of Heq lth� Signed JIti Date --- Application Approved_by ` Date Application Disapproved for the following reasons Permit No 1 - u S3 Date Issued a U - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Eertificate of (Compliance `�.. THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded()() Abandoned( )//b�y :5kC"J k3 t Cc niT at 70 Iflou t t_ /-e , r has been constructed,in ccordance with the provisions o �\f Title 5 and the for Disposal System Construction Permit No. 2� - US ) 1 3 dated - 0 2 Installer Designer 54L41X1--1/Y G/!/GiNi:E21Iyy IIt/ The issuance of his 'ermit shall not be construed as a guarantee that the syst will fuliction as signed. Date �� Inspector .d --------------------------------- No. 0 d 2 OS Fee S THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS ltgpogal *pgtem Congtruction Permit Permission is hereby granted to Cgnstrufit( )Repair( )Upgrade ,X)Abandon / ) System located at �"C".1 h i!r 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 must be completed within three years of the date of thisvermit. B Date: °�" C) Approved by 4 See Plan V i ew For Alternate Concrete Risers W/M.H.FromeSCover D-BOX LaCatlan to Within 6"of Finished Grade t Vent BaffleorTee FG.15.0 \ :......-° .......: .:...... ... Too EI.14.0 x7- 9 13.7 5'Min.to Adjusted Ground-Seater 1500 Gollcn Feb.2002 E1.7.6 Connect Septic Tank to Septic Tank Pump I Chamber Adjusted Ground Water -_xist.House Sewer 4 t0 House I/2HPPumpbyMyers' Bedding as Foundation or Approved Equal Per Title 5 DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Not to Scale 2.4 0Cpening Abcva Fcr,tit.,;. NOTE: Waterproof/Seal Concrete Septi 1/2Q Galv.Pipe Fcr Frame aCaver. Tank 8 Pump Chamber With 2 Ficct Suppor Coats of Approved Sealant. 1 Pump PcwerS Float Contrcl To D Box Cables lrsiclledinAccordance (�0� � _ With Lccal Bldg-6 Eiec.Codes. c"0 From.Septic =reCCSi Pump Tcnk.Sch.40 PVC Chamber 10, PLAN Finished Grad Concrete Riser With Lch.40 PVCM.H. Frame,SCover To D-Box Min. eptic Tank Finished Within 6a of 2'Cover. Finished Grade. Ccnduit Thru Chamber •' I Emergency Storage —r For Pawer&F!oct Chain Vclume 660Gal. I Cables. , `Inv. 9.37 � A1crm on EL 7.61 G PSI 2 0 Lac on El. 7.11 Mercury F ICC, I 1 cdedi PVC z i I ��) Y Thredz rpe LecdanEl 6.61 witch= � v zumc cff E!.6.11 I C)II Check Vcivz Sac re PipectTCpa Ccitcm or Chamber 8cttcrn El.4. 62 6 rc;cr,e 777 > pe r '•LL2G!"e T .. ECTION 1500 Gallon Septic Tank PUMP CHAMBER DETAIL :vc, ro Sccie Cwt y SHEET 2 of 2 SELLERS d OSTERVIL LE,MASS. - SULLIVAN ENGINEERING INC. OSTERVILLE,MASS. JUNE4, 2002 L _ TOWN OF BARNSTABLE LOCATION '7 0 /�/ c�CL F SEWAGE #a.11'Q-0:5_3 VILLAGE ©S R_m,L(c ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.`t IL$tCLe ( -6:�i 9 SEPTIC TANK CAPACITY /56d 6&f- LEACHING FACILITY: (type) X T n ui t sT4 A C (size) 2,f`�U NO.OF BEDROOMS 6 BUILDER OR QMMR (2LC c}A-41 S e- PERMITDATE: COMPLIANCE DATE: 7 Jo D Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by I y �N 1e1 _R> o ?"""P Ivy, _' � � coast y/ 6 6J / oy 7o � La .. Y .. t N Fps Z . THE COMMONWEALTH OF MASSACHUSETTS MAP BOARD OF HEALTH PARCEL 1_ 3 _.__------n,..............OF..... -+Yt,;,; .�2.................................LOT Appliration for Mapoiiai 19orkii Tomitrurtion unfit Application is hereby made for a Permit to Construct (14 or Repair ( } an Individual Sewage Disposal Sstemt' 1 ............... -••- LoQpbW ddress or Lot No. : - ... s------------------------------ A�.__ .� _.a.. . .._... El ....._._ er O ,' .................................. ............ -+f"Y�'�uu•.Ad Installer Address Type of'Building JJeed� Size Lot jo. S%'40__.._.._Sq. feet U Dwelling—No. of Bedrooms................ _14f.......................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building r _ Now f persons 1 a YP g $ ----•--- P �••••--•-•--••--••-•-- Showers ( ) — Cafeteria ( ) Other fixtures *±_, -q Design Flow___________________________________________gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacitylW gallons Length................ Width---------:._.... Diameter-------------.__ Depth................ Disposal Trench—No. .................... Width..........---------- Total Length.....................Total leaching area----------_.........sq. ft. Seepage Pit No.....I............. Diameter__:;l........... Depth below inlet...... ........... Total leaching area'?T64_ . ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_.___._____._-____...__. Test Pit No. 2.........._.....minutes per inch Depth of Test Pit.................... Depth to ground water........................ -...--•----•-------••--•-•.._..•-•.._.._...--•-•----•-•----••-••••••-----•--•-•-----•----------•----......................................................... 0 Description of Soil......................................................................................................................................................................... V •---------------------------------------------•------•_________-----•----•-••-----•----......._._._._....._---- W •-•----------------- ............................................................................................ -----------�-n'--.......................... Nature,of Repairs or Alterations—Answer when applicabl _.•j-_ r� _. --• -._.-+_______�_. ................ . ___---•--••-••-••---•__________________________________________•---__-______._--•- � Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLZ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. /- -- ---------------------•--• .....f Appcation Approved By-____••.................s'-••• -•-^.........•--•-••-•--•----•--•-••-•-••••-..._..--••••••-- Date Application Disapproved for the following reasons:_...•••-----••••••••---•••-•-••-----••••••--•••-••-•-•--...--•----------•-•••---•----------•----•---•.._..-•-•-- ---------------------•-___..........---._..._.._...._----•---------------•-------•-----•---------•--_-___.__.___----•--•--•---•-•--__.___-___.__----•--•--------•-_._._._••-_._-------------__________--- Date PermitNo. ..-...�.•.....�.�......---•-•--. Issued....................................................... Date n Fimy.............. THE COMMONWEALTH OF MASSACHUSETTS BOARS OF HEALTH ...............0-... .....................0 F............................................. ....................................... Appliration for Bisvosa' l Warks 'Tonotrurtion "trutit V Application is hereby made for a Permit to Construct q//) or Repair an Individual Sewage Disposal st ........................................... .................................................................................................. Address or Lot No.................................. ... . . ..................... L - /..I- _%. ", . ....................... *40,vs QMer Ad es.s ................. .......1. *1 ................................... ................................. Installer . Address Type of Building Size Lot.............._..........Sq. feet Dwelling—No. of Bedroom ......Expansion Attic Garbage Grinder...................................... Other—Type,pf Building, 1% �V&........ No f ersons.....I............j-------- Showers Cafeteria 7 Z----------------------------------- dihe�' fixtures .....4 Design Flow___________________________________________gallons per person per-day... Total daily flow............................................gallons. Septic Tank—Liquid capacityl.04.0.gallons Length ............... Width___.__._.___.._. Diameter................ Depth._._._________.. Disposal Trench—No_ ____________________ Width__.___..__._..___.__ Total Length___________________. Total leaching area......... .........sq. f t. �4 .............. Diameter... ......... Depth.below inlet.....jC........... Total leaching ar; --------sq. ft.Seepage Pit No...../ Z Other Distribution box Dosing tank Percolation Test Results Performed by,---------------------------------------------"-------------------------- Date........................................ Test Pit No. I.........:------minutes per inch Depth of Test Pit____________________ Depth to ground water..____._.__..__.__._.... Test Pit No. 2................minutes per in'th Depth of Test Pit__-_________________ Depth to ground water..______._.__________... ........................................ I.......................4.................................................................................. 0 Description of Soil.........................................................................7............................................................................................. ---------------------------------------------------------------------------------------------------------------------------*------------------- ------------****.....................*--------- U Nature of Repairs or Alterations—Answer when Applicablet----- &- ----------------- ................1!sue_-T 4P.a ----......1,00. ................ .......................................................................................................4-4- --- Agreement: The undersigned agrees to install the-aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees, not to place the system in Compliance operad n until %Cert*-cat has been issued by the board of health. Signedc: .,Ie ................... ...... ...dr ApplicationApproved By................................................................................................. -------........... Date Application Disapproved for the following reasons:................................................................................................................ ......................................................................................................................................................................................................... Sci, Date PermitNo. ....................................................... Issued..................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOA OF HEALTH wto 44=;:-Mit1�7AP ur� ..........................................OF..................................................................................... Trrfifiratr of Tomptiaurr TNI)W,10 C 7�A That the Individual Sewage Disposal System constructed or Repaired by---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ,v- C, Installer at. 7.b..... ----------- - LI ---------_--:....................................................................... has been installed in accordance with the provisions of TLITTR 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No-___ dated------:j_,_ =--- /.im........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FU I. FACTORY. DATE................. ..................................... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOAR-OL,OF HEALTH -A . .............OF.7.�Tl 90" ................................................................................. ............... FEiE ................. Permissionis hereby granted-B!... .................................................................................................................................... to Construct'( or Repair an Individual Sewage Disppsal System at ..................... ----------------------------------------------------------------- No............T&----- :....Lev.... '-Street as shown on the application for Disposal Works Construction Permit i��945S_ Dated.___ ............ ....................... ...................... Board of Health DATE......................I- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS k08 2 Fxs.. 5.00 THE COMMONWEALTH OF MASSACHUSETTS ( �LI1115 BOARD OF HEALTH Town..............OF.....................Barn$table......................................... ApplirFation for Klispniial Workii Tnnitrurtinn. Vautit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: 70' Caillouet Lane, Osterville,IA 026.`1_?... .................................. ................- .... ....-••••-•-------- ................ Location.Address or Lot No. R. B. Sellars 70 Caillouet Lane. Osterviile,...MA----_02655_ .---.._._..-•--•-. .-- ... Owner Address W A & B pool••Sew! CQ........................................... M..RishDps..T.nrs�ce,._Hyart��,s,.._l�[A••-•--02fi©�•--- a .......................... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms..............4_..r2..._..._...........--..Expansion Attic ( ) Garbage Grinder ( ) per, Other—Type of Building ............................ No. of persons..........3............... Showers ( ) — Cafeteria ( ) a Other fixtures .-----•----•---------------------------•------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid*capacity............gallons Length................ Width................. Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length....-.-............. Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.-:......---....- . Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank Percolation Test Results Performed by............----=----••--•.......................••-•----•---------------- Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.....................--. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..---.--................ W •---..._.-•---------•---•---•-•-•..................•-------•------------....._...••----••••--........._._..._...--------•.....--•---•--__...._..._.......--•- 0 Description of Soil.....Sand W �., ....._••-- ------------------ x ----••••--•----------------•-------------=-••••••••----••----•-------------...--•-••....---•-•......---••-•--......................................................................................... U Nature of Repairs or Alterations—Answer when applicable------install.atlQn--of-.a._1.,0Q_0..gallon.,...pre-cast, st-one..packed-%>i�__leach--•Pit--•(-gJ xf],QK)----------------------------------------------------------------------------------•----------••-------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI'i U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the boarq of h th Sig = -•--......_ _ . 10/14, 2-----••-------. D to ' 10 Application Approved B .. --- ----•-•--••-•--•••--••-•--•------••.. ................................•. •------......, - ............. L i Date APPIIca.tion Disapprove f or a following reasons:.......................................----•-------------------------------------------. -•-•------•----••--- l' ............ ....------------------------------------------------------------•---------------------••----------------------------------------------------------------------------Date-------------- Date Pei•.lit No.---.82 •------------------•----------------- Issued--------------101i /82 .� Date No.82- dPl:.. FES...$...5.00........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH T awn parr.stable ..... �j ...........................................0 f"...................... .. .. . Appliration for Disposal Warks Toustrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: I'R 70 Caillouet Lane, Osterville,' qi 02655 ... ........ ... -.... .......---------..... ..... Location-Address or t No. R. B. Sellars 70 Caillouet Iane (8sterville, 02655 ......................--.......................................................................... -•....--------•------•........-••--•-•---•--..............._..---•- ...---•--- Owner , Address a ... .&- B Cesspo.ol...Service,-•--•--•----------------•------........-•. ,.--.Uannis,..Yt� .....D2L01.--- Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms...............X..5:_....................Expansion Attic ( ) Garbage Grinder ( ) pa-, Other—Type of Building ....... ................. No. of,persons............3_............. Showers ( ) — Cafeteria ( ) Q' Other fiktures .................................. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid'capacity........__._gallons Length---------------- Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....:.......:.:..:... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1.................minutes per inch Depth of Test Pit.................... Depth to ground water--_._._______-__•-__---. f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Sa -•-�+ - ----•--------------------------•---.....•-•-.....--------------••-•---------•--•--...............----------....•........--•••--•---------•----••---...... 0 Description of Soil......................................................................................................................................................................... x M. ... U Nature of Repairs or Alterations—Answer when pplicable........insta1ation of_a__l,_000-__ 11on1 pre-cast, stone packed XdN leach pit werflow� ' ...................................................._...--- -•...--- -•-••••. --•--...---•--..••--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board-of health. Sig -• h ....... ...... .:...: ese 10/14�2 10 14Dp�2 ApplicationApproved By_ `` •-•---------•----•---•---------•--------------•--------•---•--••- •--••---•---• ..../.....-----•------ Date Application Disapprove f or e f ollowing reasons-------------•....---•------...-•----•---------•--------•------------------------•-•-•-•••-••-•----••--•---••---- ....--•-•-•---•............................... ................••--------------•--•-----------•-•------.._...-•--•--•-----------•----------............................................................ Date Permit No.......82------------_- 10�14�82 ._.. Issued • ............. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HRICALTH ................... .........i own....O F....Barnstable.................. (9rdifiratr of TootpliFatta THIS 11,5 OC CERTIF1Y A hq the I��IialhSewag; Di osal *Vstem�constructed,,,,�(„1) or Repaired ( X) ' esspoo S.rv�ce, �.s..ops �erRce, yar vso�Vv by------------------------------ --v--c-e.._..... - -------------.---- s,___•-A-----• •--•-----.-----------•-------•------------ , 70 Caillouet Ln., Osterville, MA 0&�J'- R. B. Sellars 4 at.........................-•--- i has been installed in accordance with the provisions of TSIZ LE r of The State Sanitary Co� ribed in the application for Disposal Works Construction Permit No......... ...................... da.ted-......................... ..._.._..._....._.... lam THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. // DATE......................................•----......---.......-••-••-----------•... Inspector.. I e THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1` 82- .. L aan......OF................�arnstable $ 5.00 ' No......................... FEE........................ Disposal Works TwOnstrudion Prrutit Permission is hereby grante A & B Cesspool Service dd ------------------------------------------ to Constru („� Re� it ) �stier'vil e SeKAageO gsp�sal c"T T. Sellars o „ iji R- L. .., 77 . at No.. ---- ......... Street 82-g 10/14�2 as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... 1o/ /F2 •••.....................•... ....---------Board of Health-------------........... .--------------— DATE................................................................................ I FORM 1255 HOBBS & WARREN, INC., PUBLISHERS a r BOARD OF HEALTH • TOWN . OF BARNSTABLE A.ppiitation-ftlVell Con5tructionpermit ; Application is hereby made for a permit to Construct Alter ( ), 'or Repair ( )an individual Well at: Location — Address Assessors Map and Parcel _M�.—�t_�Lo,s----- _----------- (' / Owner / Address �+ J� JLUnLn,�G __ � ��cJmlve.> �t✓ �C�,VdX /lib /4asG •�(�o+ttCk. Installer — Driller Address Type of Building Dwelling—____ ---- — - --- - ----- Other - Type of Building-------------------------- No. of Persons------- ----" Type of Well—���JL---___ __---------------____-- Capacity------------------------------------_______ Purpose of Well--t-�! �!�^?______ —_---------____-- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate of 1 ompliance has been issued by the Board of Health, Signed. - - -- - - - --- - - - ----date -— _ Application Approved By ---- - date Application Disapproved for the following reasons:------_____—___—_____-------_--- --------------------------------------------____-- date Permit No. : --- ------- ---------- Issued------------- ——— date BOARD OF HEALTH TOWN OF BARNSTABLE Certifirate Of Compliance THIS(IDS TO CERTIFY, Tr the Individual Well Constructed (�, Altered ( ), or Repaired ( ) .vr- e `` t f Installer has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit N ^ �.�1-Dated--- -`� --` THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE---- --- - -- - -- - - --- --- Inspector— - ------ - --_— -- --- —-- No. ----- ------ Fee----------- - BOARD OF HEALTH TOWN . OF BARNSTABLE Appiication-*rVell CContructionPermit Application is hereby made for a permit to Construct (�, Alter ( ), or Repair ( )an individual Well at: ?O �CJ 1_l(6we — /N------0-S-T w/v_(ln r , -. --------------------------------------------------------------------------------------------------- Location — Address Assessors Map and Parcel Owner Address ,f�—SG�I•v..� l 3/ , o� �10,.� l' /'cr��.,. /`'CG /l.<"S G �s ru u - ' --- -- - -------------------------------------- - - - - - - - - - - !� Installer — Driller Address Z Type of Building Dwelling---------------------------------------------------------------- Other - Type of Building ---------------- No. of Persons----------------------------------------------------- Type of Well --- -------------------------- Capacity --------------------------------------------------------- Purpose of Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certi icate of��ompliance has been issued by the Board of Health. Signed----- --------------------_____----- ---------------------------- date Application Approved By-------------- date Application Disapproved for the following reasons:----------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------ �l date Permit No. - --------------------- Issued----- -- r 7 at 9 . date 4 BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS ISTO CERTIFY, That the Individual Well Constructed (+j, Altered ( ), or Repaired ( ) - -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Installer at-------------'---------------__'_-�------------------------------------------------------ has been installed in accordance with the provisions of the Town of Barnstable ��Board �of Health Private Well Protection Regulation as described in the application for Well Construction Permit N�fv-"- -_!""_`�/--/Dated--�-~'�-�-'-�� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. + DATE----------------------------------------------------------------------------- Inspector----------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Yell CContruct ion Permit f No. ---------------------- Fee------------------- ,��Scc•^'�f �� Permission is hereby granted - - ----- -- - - - - - - to Construct ( <-); Alter ( ), or Repair ( ) an Individual Well at: No. _29---=-CC. , ///o w. — "' ------- -------------------------------------------------------------------------- Street as shown onfthe fa�pplication for a Well Construction Permit No.- —`�l/�' -7_ _��_ --------------------------- Dated ' -��'4 - -- - Board of Health / DATE------ Hi Isl u t, % \ i .W• of CTV k a ) •\ •@ 2 o .. i ,•� ��/ST/. ,<.'V`-�' n �' .. ": cam`/ �i ii i• /,r'11` k'�� '��' � •'A.- \ •East B y i;%�--�, � �__�"\� •'.-•-`i -•_h:lll .\ ram+ �'�..... O l '117�'"l� \ LOCUS P LAN/ �.. u ,: �'�,- iI i i ( `-- �,� \ NOTES DESIGN DATA Scale : i = 2 ,0;C• \'r I. Water Supply For This Lot is Municipal Water. Single Family-6 Bedroom i, i J 1 } r ` < `;'• 2.Location of Utilities Shown on This Plan Are A rox. With no Garbage Grinder Assessors-Ma 141 — — 1 i Pp Dail Flow=110x6 =6 6 0 d p' t / j /'\ At Least 72 Hours Prior to Any Excavation For This Septic Tank 660 gpd x 200%= 1320gpd Parcel 113 I Project The Contractor Shall Make The Required Use a 1500 Gallon Septic Tank. NotlficationtoDIGSAFE-I-888-344-7�233. P p,N`P /� {'`� j/ 3.The Contractor is Required to Secure Appropriate LEACHING AREA Permits From Town Agencies For Construction d/0.74= 892 s.f. Defined by This Plan. 660 gP Required Use Bottom Area Only., / 4 GradeRisers as Required to Within 1211rf Finished Bottom Area=121x 75+= 900 s.f. _ ) 5.All Structures Buried Four Feet(4)or More or LEACHING BED DESIGN Subject to VehiculartobeH-2-0 Loading. All Pipes to be Schedule 40 PVC Perforated 6.Sept ic System to be Installed in Accordance With With Capped Ends.Use 3-4110 Distribution 310 CMR 15.00 Latest Revision And The Town of Lines in a 12 x 75 Washed Stone Bed as Shown. / / �// \ 1• W U _ {� i j' Barnstable Board of Health Regulations. 7 All Piping Lobe Sch.40 PVC. �� 0 W W ^ /e- tiyd}�� V ? ! i` 9„(Min.) I 1 t 4 l _J 1('0 Li �� 3 Max.) Finish Grade y 1 �I i / 7 !'- ` ��• 2'1- Filter 4��0 Perforated /' Compacted Fill N S1 '1 f' % � f Fabric r PVC Pipe ` •<I � � i -fir l � �1 O � 1? / l iv I Pea Stone 141 3/4"-1 I/2" \ti �, O , iC U fr' °,p I I Double Washed r••�i / -� i s---• / vi I �' �'•\ J` Stone i r 1 r - 1 � t v� � \ i � 1 ! .�'\ 3� 0� 3 0 3 C 3 0� li t V ` / IF \ '� '1 `1 �, /'� / �•_ ` f % CROSS SECTION OF LEACHING BED y t \ �' ,i �• / Not to Scale FP SULWO LOT ARCA \/ / T.1a. E•LEV, 3 -6 A 0 ORGANI G M4TEf2t4L. ...�i SRN. C_pARSG SANG l� STRONa SRN COARSE O ^ 9 / \ 1 \ —� / / / J / �C SANG IOYRS/(� (�_J I ,! �,-_____—/ / / I SHEET. I o f 2 1 s � t� � � /i �+a—.._.—_�,�N'�s�, YL'.L. G.OARStS 1 -- / � C1 SAND SO YR /°/6 s \ I > PLAN VIEW / / a __._.._.__.____—_-_._ -- SITE PLAN 1 L� Y E L I SH S R N Scaled = 50 C2 _a-NV IOY ('/'y PROPOSED SEPTIC UPGRADE H• E.NG, I NC - AT .� tom. ! j \ / / pA�-E : 02/O�•I�o z , 70 CAI LLOUET LANE - 1 _,' \ / ii/ GROLINO�NATER 1021 OSTE.RVI'LLE MASS. FOR. WATLIZ LO-TC�STMCNT i GROUND wATC2 GL. 5+0 2;5�___� �! INDEX W M L L 1 'Z4 -ZONG A RICHARD B. SELLARS r / AD7w5T1.nLNT Z.L. SAN,.2002 'A OS. G20 D uN —/ATtL L R E , '. -7. 6 SCALE: AS SHOWN DATE: JUNE 4, 2002 1 � \ SULLIVAN ENGINEERING INC. O$TERVILLE , MASS. a 1 0S`� I- yA LD Fn _ vva }} _ w __ Z IIJ '.Oa/sR sAd f E O I - I C P H . � ! I =_ � 24a:p 3•-I•'r 4'-I-C.c, 24 azo. :— .. - . l— ! - 2oov - _ - t - GA2a.G= S-Tub10 - 'S_L_L,A2S Kcr: Dt G= . GRAW�-I By C 42oG=25.`•1i.�T\Af=:1c. - - r i J - J rm rF = - II I I -TT 1 I I I T I ------ I ....� r r 1*i.I --J. ll J II _ 3 T e I I I - EM --- I LA I i _LI I J I 1 1_.1.._ _—I I T -- L... I 4_ I� _LL I_Lf 1 11)_I LITLL — ------ i$ Ll EXIS7(NG r EXISTIhIG -- - ---- i III ( J I -- -- EXISTING b PROPOSED i PROPOSED PROPOSED e FRONT E.LEVAT/ON SIOE_,.. ELEVATION RR ELEVATION 3� Fffi 10 - FOVNO�T\ON i D w d B• .. EX1ST1 NG STORAGE N EXISTING o 5.- EXIS-iNG o ------- ROOF 5 C PO\G 1 D N r0 1 - .D - 2 DUST coYE\t 1 1 - • 3�i IT F �R sr' a N L O / FL OOP - I_ ! - " PLAN e --' _a _FOUNpAT/QN P1NT°E.ar:wb Fr+OTN. ' I I ti BEDROOM # z IVL FRAME _ —PLC-h'--... -- - - -- - -- - -- 1 1 _ .R'OGc vE wT 2%6 P.T. 70:STS-1�O.C. 2F�'b"cLT O 1 I 1 r Cfi:uvb Bee/1X ap FE\.T - 1 - a pr oy. ys' cox GtlE,.r»;N°: 'I KITCHEN LIVING ROOM .x• .. le�+ .?X5 C :Mb.TGLT I 1 'T-9 - ,` Ib O.G. - -� R.�.T." \6 0 � EXISTING......... 01 _ , BATH i p I _ 2+6 GEII\"Ib, Ln:O -O is Ib"O.C. 70KT '-LID 1\CnoeR-Tro- � - . I I u _ r p > -- III Y PI z%v sT�os 'b'o.a EX/S'TiN G- - 1, I 77ft tl ONa' FLOOR' --PLAN SEC T_Y L. ..Y ..l _T _'_ .. Pe¢ CAOC BciF. - N I • I � l\ \l _ S E L L A P S . 0' cO..C. FOVNI>nT.O.. Z 12e — — -_-_._ JJ .- ROOF • 2 oV•.T Gov R_¢ - _ _.. 2 o FLOO 4 _ ' -- -- — PLAN eezz w ow. PPOPOSED ADDITION " 70 CAILLOEUT LANE Ae:.°/..°. ' + ,u s � Hi eoll 40 ITW1 CUS East B 11 J,,• 3)••,' .... 3 LOCUS PLAN u i NOTES DESIGN DATA Scale I 2000 , -' i •r( f ' F,- �� . ik I. Water Supply For This Lot is Municipal Water. Single Family-6 Bedroom QSSe550f5 Ma 141 J With no Garbage Grinder l t .., % 4 2:Location of Utilities Shown on This Plan Are Approx. p r' ' r _ '/. h ?` Y - At Least 72 Hours Prior to Any Excavation For This Daily Flow=I10 x 6 =660 gpd PafCe1113 Project The Contractor Shall Make The Required Septic Tank 660 gpd x 200/o= 1320gpd Notification to DIG SAFE-1-888-344-7233. Use a 1500 Gallon Septic Tank. 3.The Contractor is Required to Secure Appropriate LEACHING AREA pi \off / ?� Permits from Town Agencies For Construction 660 d/0.74= 892s.f.Reuired / J / Defined by This Plan. 9P q Use Bottom Area Only. 4.Install Risers as Required to Within 12"of Finished q Bottom Area=12'x75= 900 s.f. Grade. LEACHING BED DESIGN 5.All Structures Buried Four Feet(4�) or More or Subject to Vehicular to beH-20 Loading.. All Pipes to be Schedule 40 PVC Perforated 6.Septic System to be Installed in Accordance With With Capped Ends.Use 3-4"0 Distribution 1/ IX\ ( <-' ' � i 310 CMR 15.00 Latest Revision And The Town of Lines in 12 x 75 Washed Stone Bed as Shown. 1\\ f_V j (�� / i t Barnstable Board of Health Regulations. j/� . 7 All Piping tobe Sch.40 PVC. QQ i - ,�;'`^ ••% � ice.-� �• i>2� � / Z'!t/ t✓ r- r I i . \� 1 0 4 , a 1/1 i •1 9"(Min.) .Finish Grade �Y� ' r �� Filter Perforated 1 1 Il ! J �, j Compacted Fill �I 1 f f Fabric PVC Pipe (/)J �J rr XS Pea Stone �_ 0 3/4"-1 112' A IV +A Double Washed r / 1 r( f k '.,* cf: Stone J✓ / �1 \ 3-0 3-0 3-0 3-0 4 # �� f1 1. � ' -\, � '•��\. } OF =1 FP NRO SSot to aSECTiONOF LEACHING BED le 38 171 L O T AREA l \ - r` C) oRGANt G M4TE(214L 21 C3 7, X f p /' � i EC S[aNtD 10 YR.SIG / 8 - --- �--- SHEET. I of 2 ti �. i ; � PLAN VIEW r' - SRN t5\ Y COARSE SA"° \�yR �'� SITE PLAN r '\ `\� scale I"= 50' 'r r ab - Lz YE`'S� BRN — PROPOSED SEPTIC UPGRADE v / / 1OZ. 2 NC000s_ SnND 10Y G U � \ - / / tH, L3Y suLL\vAf =NG, Ir.+c AT o2id��oz 70 CAI LLOU ET LAN E R D T d GOVN �NAER toZ.' OSTERVILLE MASS. 4 i. ,. ROt..IND WAT L'1'Z �O.SLIST-MENT ' ~ j.; -GROUND WA-'E2 C2) cL, 5.o f FOR. l� ------ '/// ,� I N D E X W M L L M \W '2 R zo nt A RICHARD B. SELLARS ADTuS?MLNT Z•L SAN. Zo02. 'ADS. G2OUND A/ATLLR EL, . -7. SCALE AS SHOWN DATE' JUKE 4, 2002 SULLIVAN ENGINEERING INC. OSTERVILLE , MASS. a 1 0 Cl F.F. El. 20.00 See Note 6 (typ.) F.G. EL. 17.00* - *Final Foundation Grading To Be F.G. EL. 14.00 Coordinated With Landscape Plan Finish Grade Flow Equilizers Dwelling EL. 14.50 As Required 3' Max. Cabana EL. 15.35 9" Min Compacted Fill Filter Installer To EL. 12.25 2000 Gallon Fabric Confirm Prior Septic Tank EL. 12.00 Too EL 11.00 And Or To Any Work H-20 Required ZJ3 2" 1/8" - 1/2" (See Note 5) EL.'10.50 Pea Stone 10.00 H-20 3' H-20 314" - 1 112" Leaching LEACHING Double Washed To Be Installed On /� Chamber CHAMBER Stone bTe ompacted ase Bot. EL. 8.00 Bedding,"T"S � 4' - 10' -� Inspection Port, if Encountered Remove & Replace 12' - 10" & Baffels Ail Unsuitable Soils :Within as Per Title 5 The Du ter Perimeter of The System` CROSS SECTION OF CHAMBER EL. 2.0 No Groundwater NOT TO SCALE Per Test Hole 4 DEVELOPED PROFILE OF SYSTEM NOT TO SCALE SEPTIC NOTES DESIGN DATA PERC TEST: 20-151 1.Location of Utilities Shown on This Plan Are Approx.At Least 72 Hours Single Family PERFORMED BY:JOHN O'DEA,PE Prior to Any Excavation For This Project the Contractor Shall Make Main House SULLIVAN ENGINEERING the Required Notification to Dig Safe(1-888-344-7233)and contact 15 Rooms/2=7 Bedroom Design &CONSULTING,INC. Sullivan Engineering&Consulting Inc.(508-428-3344). (7 Actual Bedrooms) SOIL EVALUATOR NO.2911 2.The Contractor is Required to Secure Appropriate Permits From Town Pool Cabana WITNESSED BY:DONNALD DESMARAIS,R.S.-TOWN OF BARNSTABLE Agencies For Construction Defined by This Plan. 0 Bedrooms JULY 21,2020 3.Wherever Sewer Lines Must Cross Water Supply Lines Both Lines Shall SITE PASSED Be Constructed of Class 150 Pressure Pipe and Shall be Water Tested to System Designed For 8 Bedrooms Assure Watertightness. In General,Water Lines Shall be Constructed in Coordination With COMM Water,and Shall be in Accordance 8 Bedroom @ 110 GPD TEST HOLE I EL. 14.5 TEST HOLE- 2 EL. 14.5 With 248 CMR 1.00-7.00&310 CMR 15.00. No Garbage Grinder Total Dail Flow=880 GPD 4.A-M.-nimum of 9"of Cover is Required for All Componer rs y LOAM LOAM . . 5.All Structures Buried Three Feet or More or Subject Use a 2000 Gal Septic Tank 5" 14.1 6" 14.0 to Vehicular Traffic to be H-20 Loading.It is the Engineer's B LAYER 1 OYR 6/8 ... B LAYER.10YR 6/8 Recommendation that H-20 Always be Used. LEACHING AREA BROWNISH YELLOW .'..BROWNISH YELLOW 6.Install Watertight Risers and Covers to Within 6"of Finished Grade 880 GPD/0.74(LTAR)=1,189 SF Required 18" LOAMY SANA 13.0 18" LOAMY SANA 13.0 Over Septic Tank Inlet and Outlet,D-8ox,and One Leaching Chamber. Sidewall=2(12.83'+72)2' 339 SF C LAYER I OYR 7/2 C LAYER l OYR 7/2 All covers are to be maximum 18"for concrete or 24"Cast Iron. ` Bottom Area=(12.83'x 72)=923 SF LIGHT GRAY LIGHT GRAY 7.Septic System to be Installed in Accordance With 310 CMR 15.00& Total Provided=1,262 SF(933 GPD) 120" FINE SAND 4.4 FINE SAND 248 CMR 1.00-7.00 Latest Revision and the Town of Barnstable NO GROUNDWATER ENCOUNTERED 33" PERC TEST 17.7 Board of Health Regulations. LEACHING CHAMBER DESIGN `2 MINA 8.All Piping to be Sch.40 PVC. All Pipes to be Schedule 40. Use 120" LTAR=0.74 4.5 9.D-Box Shall Have a Minimum Inside Dimension of 12",and a Minimum 8-500 Gal.Leaching Chambers in a NO GROUNDWATER ENCOUNTERED Sump of 6". 12.83'x 72'Double Washed 10.The Separation Distance Between the Septic Tank Inlets and Stone Field as Shown. Outlets Shall be No Less than the Liquid Depth.Inlet Tees Shall Extend a Minimum of 10"Below the Flow Line.Outlet Tees Shall Extend 19" Below the Flow Line,and Shall be Equipped With a Gas Baffle. 11.All joints connecting pipes to foundation,tank,d-box and SAS are to be Sealed with hydraulic cement. TEST HOLE- 3 EL. 13.2 TEST HOLE -4 EL.13.0 LOAM LOAM . 6" 12.7 6" 12.5 -, B LAYER l OYR 6/8 .... B LAYER 1 OYR 6/8 9f � BROWNISH YELLOW BROWNISH YELLOW 30" .. LOAMY SAND 10.7 32" LOAMY SAND 10.3 HN O. G C LAYER 1 OYR 7/2 C LAYER 1 OYR 7/2 LIGHT GRAY LIGHT GRAY "7 132" FINE SAND 2.2 FINE SAND NO GROUNDWATER ENCOUNTERED 36" PERC TEST 10.0 <2 MINAN dd.t 132" LTAR=0.74 2.0 NO GROUNDWATER ENCOUNTERED Add Proposed Septic 0812012020 Add 4" Pool Fence Opening Sections REV. Per Con Com 0811312020 TI TLE: PREPARED BY. PREPARED FOR: NOTES. Site Plan Adam M. KOpple 1) The structures shown were located on the = Proposed Im rovements En eerie & CapeSury Brenda E. Ha nes ground by conventional surve methods onI� py y r, AtSU11"Wall ConsuIU.&W, 23 West Bay Rd, Suite G 70 Hundreds Rd. (or between) 241JUNE119 and 25/JUNE/19. � 7� Ca�llouet Lane 'pg��gg�µ•PO.Sm09-711MainSbm*.0steM11%MAMM Osterville MA 02655 WeIISIe,/ HIIIS MA 2) The property line information shown sedesullhrumon.awn •www.suilWanuon.00m (508) 420-3994 / 420-3995fax 024Q� - hereon was compiled from available record 1403 Mass. U information. o Barnstable roste rville� Draft: CTR Field: WHK/CTR/JOD 3) This plan is not for recording and is not - to 'be used for construction layout or deed July 16, 2020 DATE SCALE: Review: CTR Comp./Review: CTR/JOD description purposes. _ Project: Koppel Project#• 3800023 I • I DIRECTIONS: ASSESSORS REF: f ` From Hyannis — Follow Main Street to the West Map 141 End Rotary-, Take third exit onto Scudder Ave. Y Parcel 113 , Turn right onto Smith Street at the stop sign. • • r Continue on to Craigville Beach Road and left onto South Main Street. Continue over the bridge to Osterville, and left onto Caillouet FLOOD ZONE: Lane #70 is on the, left. X & 0.2% Chance of Flood AE(EL 12), AE(EL 13), & VE(EL 14) Based on Map # • . �, ` ` ' 25001 CO563J July 16, 2014 \ • '# , CB DH FndA r OVERLAY DISTRICT: AP — Aquifer Protection District LOCATION MAP: Estuarine Overlay t J O o Scale: 1"=2,000±' ZONE: CB/DH <y NE: _ Fnd RF-1 Area (min.) 87,120 SF (RPOD) Frontage (min) 25' Width (min) 125' r r Setbacks: o \ Fron t 30' Side 15 Rear 15' o, o , / $} 16 \/ o }}} }} \i\ a oo Cabana }? o 0 -o Z r A s 1152 Ov` \ \ TBAM E1=14.9'NAVD88 p = 49 41'30" } ! }} \ \ oo• ,1& / Top CB/oH FNo Pool R = 115.15' T = 53.32' l r o \ \ L = 99.87' } ( } P \ \ \ \ r \ e 15--'"'" --" Fnd x }} � moo/ ,d ��\ �\ �� � ..- , � \ / �, � _„ . ...•-'16— — — 6� o�I ; t } _1 } A CB/DH t QVIe Fnd ii i r O F/aa \ \ f I \ /! 4y s• F` Q° �o cn t t } \ 1, f � y ~� 1P cn } \ \ -�, nd �7i—� c„ cn l CB/DH \ \ �/r �6 S� j' co cn Fnd \ I > r f t- PR016'11 .9 a/ 72° >a , 7�R "tiX, F F/aa anC P P S.A. ^' 1 ,' z�r Y aft ri /� OPOSO�SE�� ADp to O _ ,t p �t/° ( H � �C�, I 4 rt4/2� o �\ .cS'FO�.00 Fn ORS ,'rIL 2 0 \1s.7 t\ y�•Z`� \, O l m /, t �: Brim t l ' *VERTICAL BAR FENCING w/ 4„ OPENINGS \ �O LQ) SHALL BE USED FOR GATES PROPOSED I `° C` AND AT LEAST 3 OTHER FENCE 1 .flSECTIONS ALONG THE BANK AS TERRACE ! ' SHOWN TO PROVIDE / ( r/ EL.;` 17.3 WILDLIFE COORIDORS E®c' r. f Drive > ( J tro ,, Z/ IP ndl \ ICB�DHFnq `� R s �OPO o z Pool AV ��. �� `GLEAN 1 11lf / 11 . S • yV jam,,' £s � o• \ �nP "• \ eta e ti /� 11-10 p- Fnd ; ' ((( j � � 6N 1501 \ �,•o�oc 1 / / l I M5� \ \ f \ \ l ��i Lot 16 400 /'3 Upland 115,875t SF 1 a� -o\ \• —'- / R 1 Wetland 36,860f SF Ga �� s / v P � 00 �\ ` .,,, --' t N ��• / , �' /: / f /.�li, ,ail, r P o O 15 o A toON .� moo_ o 1980 DEM Wetland Restriction Area / Doc. #286,071 / F F/oa Chonce \\ / f 6� ' / AE(e 3 Edgp of Saltmorsh as lagged by Brad Hall Jul 19, 20190 Q) Cabana AE(EL13) Pool FEMA Zon // 1 VE(EL14) LEGEND. Light Post o Cedar Tree l y r Q Misc Manhole Catch Basin Holly Tree — OO Water. Gate (round) / to j © Gas Gate (round) pQj ® Drain 0 Deciduous Tree �° Hydrant ! 0 Iron Pipe �< El CB DH + Coniferous Tree `TN 01F tf,4 El CB1DH 0 l/ O PK nail JCH C. eu, El Utility Hand Hole OHW— Overhead Wires O'D GO — —25— — Elevation Contour f at3 I IR ICV � �aF GISTER���e Add Proposed Septic 0812012020 / Add 4" Pool Fence Opening Sections REV. Per Con Com 0811312020 TI TLE. PREPARED BY. PREPARED FOR: NOTES: Site Phan Adam M. Kopple 1) The structures shown were located on the Proposed Improvements En aneerin & CapeSury Brenda E. Ha nes ground by conventional survey methods onr?91 gy m AtSullivan ConsultingjnQ 23 West Bay Rd, Suite G 70 Hundreds Rd. (or between) 24/JUNE/19 and 25/JUNE/19. y 70. Ca�NoUet Lane t��.�aPaeaK659.,lii„�ainSbvet,oa*llKMA02M Osterville MA 02655 �/1/ellSley HIIIS MA 2) The property line information shown seci�sullivanengin.com • vwvwaullivanengin.com (508) 420-3994 / 420-3995fox 02481 - 1403 hereon was compiled from available record Barnstable (OSterVllle) Mass,. information. � 0 3) This plan is not for recording and is not ^� Draft: CTR Field: WHK/CTR/JOD 30 0 15 30 60 120 to be used for construction layout or deed DATE: SCALE: "Review: CTR Comp./Review: CTR/JOD description purposes. July 16, 2020 1 = 30 Project: Koppel Project#: 3800023 MENA