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Home My WebLink About0169 CARRIAGE ROAD - Health 169 Carriage Road "'A= 071 —011 007 Osterville 7 ; - �- Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 M 01 169 Carraige Road Property Address Jean &Gerry McLellan Owner Owner's Name information is Osteryille. MA 02655. December 2, 2010 required for every page. City/Town State Zip Code. Date of Inspection .A Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out _ l forms on the I•- I /►� UU computer,use 1. Inspector: only the tab key -to move your Patr"Ick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. _ Company Name 189 Cammett Road Company Address Marstons Mills MA 02648 City/Town , State Zip Code 508.428.1779 SI 12855 _ Telephone Number- License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails [['t Needs Further Evaluation by the Local Approving Authority December 2, 2010 Job# 10-289 1 spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. ` v t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Di sat System•Page 1 o 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 169 Carraige Road Property Address Jean &Gerry McLellan Owner Owner's Name information is Osterville MA 02655 December 2, 2010 required for — every page. Cityrrown State Zip Code Date of Inspection — B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Tank is not in need of pumping at this time leaching chambers were empty with no sidewall stains. B System Conditional) Passes: Y Y on com stem❑ n One or more as described in the Conditional Pass"section need to be s components Y P 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.cpmplying septic.tank as,approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): 15ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 17 I , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 169 Carraige Road Property Address Jean &Gerry McLellan Owner Owner's Name information is required for Osterville MA 02655 December 2, 2010 - every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or,high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ 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): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 15ins 09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 169 Carraige Road Property Address Jean &Gerry McLellan -- Owner Owner's Name information is required for Osterville MA 02655 December 2, 2010 - every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a'Zcne 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 coliforrn bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloadled or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 169 Carraige Road Property Address Jean &Gerry McLellan Owner Owner's Name information is required for Osterville MA 02655 December 2, 2010 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No El 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 watersupply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysts and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. • E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 Title 5 Official Inspection Form:Subsurface sewage Disposal system•Page 5 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 169 Carraige Road _ Property Address Jean &Gerry McLellan _ Owner Owner's Name information is Osterville MA 02655 December 2, 2010 required for _ every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No Pumping information was provided b the owner, occupant, or Board of Health P 9 p Y P ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ® El information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 — DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 _ t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 169 Carraige Road Property Address Jean &Gerry McLellan _ Owner Owner's Name information is required for Osterville MA 02655 December 2, 2010 - every page. Cityfrown State Zip Code Date of Inspection D. System Information Description: 2 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(if yes separate inspection required) ❑ Yes ® No 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: Currently y Occupied 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 Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: 15ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 169 Carraige Road _ Property Address Jean &Gerry McLellan _ Owner Owner's Name information is required for Osterville MA 02655 December 2, 2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Unknown — Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? — Reason for pumping: — Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): 4 15ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 169 Carraige Road _ Property Address Jean &Gerry McLellan Owner Owner's Name information is required for Osterville MA 02655 December 2 2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Compliance date: 6/7/00 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): _ Depth below grade: 2'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.): Septic Tank(locate on site plan): _ Depth below grade: 14"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: 10.5' long x 5.8'wide- 1500 gal. 4 — Sludge depth: — l5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 cf 17 I . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 169 Carraige Road Property Address Jean &Gerry McLellan _ Owner Owner's Name information is Osterville MA 02655 December 2, 2010 required for — every page. Citylfown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28" — Scum thickness 3" — 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 How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is not in need of pumping at this time, liquid level was found at bottom of outlet invert and tee: were intact and clear. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: — Scum thickness Distance from top of scum to top of outlet tee or baffle — Distance from bottom of scum to bottom of outlet tee or baffle — Date of last pumping: Date t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 II Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w„ 169 Carraige Road _ Property Address Jean &Gerry McLellan _ Owner Owner's Name information is Osterville MA 02655 December 2, 2010 required for — every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integriti, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: — Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: — Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 169 Carraige Road Property Address Jean & Gerry McLellan Owner Owner's Name information is required for Osterville MA 02655 December 2, 2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): No solids or high stains present liquid level was at bottom of all outlet pipes. 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 169 Carraige Road Property Address Jean &Gerry McLellan Owner Owner's Name information is required for Osterville MA 02655 December 2, 2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: Four 500 gal drywells. El leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: — Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Chambers were found empty at time of inspection with no sidewall stains. 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 !Sins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 169 Carraige Road Property Address Jean &Gerry McLellan Owner Owners Name information is Osterville required for MA 02655 December 2, 2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 169 Carraige Road Property Address Jean &Gerry McLellan Owner Owners Name information is Osterville required for MA 02655 December 2, 2010 every page. city/rown State Zip Code Date of Inspection D. System Information (coat.) 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 61,91 , i / J / / / / / / / / / / / / / / /%/% % / / / J / / / I J I I / / / / / J / / 36 23 45 3 52 M�� Co. � mmonwealth of Massachusetts Title 5 Official Inspection ection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 169 Carraige Road Property Address Jean &Gerry McLellan Owner Owners Name information is required for Ostervllle MA 02655 December 2, 2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water Check cellar ® Shallow wells Estimated depth to high ground water: feet Please indicate all methods used to.determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town groundwater contour map shows water below el. 5 and topo map shows property at el 20 Before filing this Inspection Report, please see Report Completeness Checklist on next page. !Sins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 169 Carraige Road Property Address Jean &Gerry McLellan Owner Owner's Name information is required for Osterville MA 02655 December 2, 2010 every page. City/rown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C. D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ( Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file l5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 j� L -� su� �- 5 GOIX, SOS TOWN OF B(�ARNSTABLE LOCATION I(Dq ��rr��g2 SE#�✓�S�' ,,VILLAGE dS`-e�� ASSESSOR'S MAP&PARCEL IT'S NAME&PHONE NO.�e�n r�L ��aY1v�C ll LIaQ,-I'1�1 SEPTIC TANK CAPACITY i S-00 LEACHING FACILITY: (type) SCrJ �J CVA, (size) L(56 1a,5 t a NO. OF BEDROOMS L-, "r OWNER I , ,o [z lt� PERMIT DATE: C E DATETh 10 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) r tJ Feet FURNISHED BY t•h+h 4 h h ♦ 4 h 4 4 4 ♦ h h 4 4 \ \ \ 4 \ 4 4 h h t h \ \ \ ♦"4' t \ 4 4 h 4 t 4t \ 4 t t t ♦ \ h 4 4 t 4 h h t t \ h h' t t 4 4 t 4 h h 4 4 h 4 h 4 h 4 4 ♦ h h h 4 \ 4 4 h '. 4 ♦ t o t \ \ 4 \ 4 4 4 4 \ 4 4 h 4 \ h \ ♦ 4 4 ♦ ♦ 4 \ \ h E 4 4 4 h h \ t 4 \ 4 \ \ \ \ \ \ ♦ ♦ \ 4 4 \ h \ f J f J f J f J f f f J f f f f ! f f F f f ! t \ \ t \ t 4 t t \ t t h 4 t t h 4 4 t 4 4 t ♦ 4 t \ \ \ \ ♦ t77 h A 56 \ ` f F f F f f r f J f f f F f J / / 4 \ \ 4 \ h 4 \ ♦ 4 ♦..♦ 4 \ 4 h h 4 4 h 1 \ \ \ 4 1 h h ♦ 4 \ 4 ' \ 4 ♦ \ \ \ h h \ h t 1. t t t 4 \ t k t t t \ 4 t \ 4 ♦ \ \ t 36 23 ' #gym 36 45 36 52 .TOWN OF BARNSTABLE LOCATION 16 q ce1AA:fAUe /L-0 SEWAGE # r Va, :AGE ® Y ff'0 . f'f 0,Z 10y01s ASSESSOR'S MAP & LOT /o INSTALLER'S NAME&PHONE NO. 10®41-0L9 17� �I ��, SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) .X �,�n NO. OF BEDROOMS y " BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: e2®O® Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility' (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist. within 300 feet of leaching facility) Feet Furnished by e Q� 3 A q I i TOWN OF BARNSTABLE 'LOCATION Id C��d /�'!®i �� ' SEWAGE# VILLAGE ?1 �� -S ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. � � � �� ✓ 7�'`�1.3�� SEPTIC TANK CAPACITY 1 S-7� EACHING FACILITY: (type) (size) 'ND10.OF BEDROOMS ` :HUII.DER OR OWNER Iiew1 / tiCa�J4nJ PERMITDATE: COMPLIANCE DATE: 4 7_Z49kW v Separation Distance Between the: 3 aximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist n site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 1. R t A -3 3: 4 No. �l/�� = v, FEE Board of Health, ZptwS i t*"6-Si MA. APPLICATION FOP DISPOSAL SYSTEM STEM CONSTRUCTION PERMIT Application for a Permit to Construct(4 Repair( ) Upgrade( ) Abandon( ) - ❑Complete System ❑Individual Components Location wner's Name C..L 3 -I Map/Parcel# SLS es 14VP 1 L o Address 0 ' t,�'D Lot# 1` --� Telephone# Installer's Name t r- Designer's Name Y/1 t'sV,-Cr, SU?-V Address Address qo s Telephone# Telephone# 509w 2 -dJ® Type of Building W G CdIC, - Ce CT Lot Size Iq -7 S5- sq.ft. Dwelling-No.of Bedrooms Garbage grinder Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) A A d gpd Calculated design flow q(D�i Design flow provided gpd Plan: Date—7 Z(ca 19 9 Number of sheets Revision Date �►� Title 517 f, X lt`b 5 eW A G 9'. 84-Y-8,tIJ Description ofSoil(s) 6-9" Mc-D 5j\ND , 11_4Z`° Md Q 5AWS), d42" f zo`t 1'y b -5AN Soil Evaluator Form No. Name of Soil Evaluator�1 Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS UE IGI`W I`VC�'� 3ST SUPERVISE MS.—IAMAMON 7H-:.- nYF-',TFM WAS INSTALLED IN STRICT ACCORDANCE TO PLAN. /. The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to t to in n until a Certificate of Complian a been issued by the Board of Health.7 Sie,ned Da Inspections No. "'0 5, COMMONWEALTH - T �" FEE&�` TTS Board of Health, T AT.o5 MA. CERTIFICATE Of COMP ENGINEER MUST SUPERVISE Description of Work: ❑Individual Component(s) *Complete System INSTALLATION AND CERTIFY IN WRITING TV SYS BIAS I"'STALLED IN STRICT The undersigned hereby certify that the S wage Disposal System; Constructed (fit),RepagsEkl M E rladedl( ),Abandoned ( ) by: ,,�a� 22241e z1i��sr- has been installe accord with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated Approved Design Flo (gpd) Installer O 47 Designer: Inspector: Q te: The issuance of this permit shall not be construed as a guarantee that the sys function as designed. No. P 0-1-4W FEE 'l..OMMONWEALT14 OF MASSAL-,HUSETTS Board of Health, "I'j AW 51 A�, L`!�, MA. DISPOSAL SYSTEM C®NSTRUCD WP-ER' ER MUST SUPOMSE INSTALLATI� AND CERTIFY IN WRITING Permission is hereby granted to; Construct()< Repair( ) Upgrade( )T AM �) an-d a-&AllsEi0a &Tpbsal system A CORDA Ck- J PLAN. 7 �I�2iZi�G� iZE J - 131� P�1 A�f-� as described in the application for at-OAl2# t1 L-CT 1�- Disposal.System Construction Permit No. dated Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met. Form 1111 1ev.1111 A.M.Sulkin Co.Boston,MA Date Board of Health TOWN OF BARNSTABLE I LOCATION 6 q CAA./L?,Q lr-= /L-0 SEWAGE # VILLAGE O `t"s1ren, 14-44 By ASSESSOR'S MAP & LOT 7% L•+1I/' INSTALLER'S NAME&PHONE NO. 1004;f l d rl; 7� -0 �- 00 SEPTIC TANK CAPACITY I y LEACHING FACILITY: (type) (size) X .1 !s �• NO. OF BEDROOMS �► BUILDER OR OWNER 1 j L 490006i PERMITDATE: COMPLIANCE DATE: ,20ov 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 LV G � 7— FEE COMMONWEALTH OF MASSACHUSETTS (I Board of Health, ZA?-(0ST�a�Lmot/ APPLICATION FOP, ➢ ISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( Repair( Upgrade( Abandon,(') - ❑Complete System ❑Individual Components Location ` J l wner's Name Map/Parcel# Q 5L5'S0CZS MAf° 71 1..01 Address 1d Lot#, /�l ^-� Telephone# Installer's Name Designer's Name `�/�N��C.t: SU fZV P � Address Address Telephone# Telephone# 50t?_,,,,1/ Z, -c0®S-s Type of Building I G 1, - \ 7 W 64-1-1 fJ G Lot Size -7 ?5 sq.ft. Dwelling-No.of Bedrooms y Garbage grinder Other-Type of Building - No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) q 0 /gpd Calculated design flow A G� Design flow provided l� gpd Plari: Date�!Z(<a!Q 01 ,Number of sheets - Revision Date NT'{ Title; S 1-T i A N 47 5�•'-W A`�C`. t��!�1� Description of Soil(s) 6'8 M<-J.5t\n,t7 ,A" 4 Z" Mt 9 SWND, t{Z t Zo'' MO w Soil Evaluator Form No. Name of Soil Evaluator�A f Date of Evaluation 1 „ SU1.c�lV1aN �NG1t.��(ztNV. DESCRIPTION OF REPAIRS OR ALTERATIONS x is The undersigned agrees to install the above described Individual SewageDisposal System in accordance with the provisions of TITLE 5 and further agrees to t to a the'9nstem mopLeration until:a Certificate of Complian�been,issued by the Board of Health. �- Si ned ✓ a DaNA 211,417 A? Inspections r. 1 Nb. r' FEE COMMONWEALTH OF MASSAC14USETTS Board of Health, �JA�1c�S �`C��-� MA. CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) ,Complete System The undersigned hereby certify that the SSwage Disposal System; Constructed (X),Repaired ( ),Upgraded ( ),Abandoned ( ) by: at /h4,e-" 71 107- AD - -)P( JN5'TP',9sL .. has been installe accordda with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. tJ dated Approved Design Flow (gpd) t Installer ` Designer: Inspector: Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. W FEE COMMONWEALTH OF MASSACHUSETTS Board of Health, _ �R iy 431,�. , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system at /nAtO-11 L-101 1�-:7 as described in the application for Disposal System Construction Permit No. dated Provided: Construction shall be completed within three e-drsof the date\of this permit. All local conditions.must be met. Form 1111 Rev.1111 A.M.wlin Co.Boston,MA _ Date Board of Health I U%1II ul bill IISUI Department of Health,Safety,and Environmental Services oy iw Public Health Division Date � • 367 Mein Street Flyennis MA 02601 .00 I w MMAI t< I "! AOA 100 Date Scheduled-vec 2 \9� Time \D Fee Pd. Suitability Assessment for Sewage Disposal Soil y \ ljtal.t.\y EN(�iu„k- 1f. WitnessedBy:�1��1� Performed By: LOCATION &GENERAL INFOa mA owner' l:rt,r..o rV Location Address %(pJCAe(L.%JN.Cf✓ fJD JOMN as-(&C -Q0ak ! Address . f",,V 16T O's TG?)-4L":a ° Q��2sW66w� Assessor's Map/P arcs': Z • \• 007 Errglneer's Name NEW CONSTRUCTION Y,_ REPAIR _— Telephone tl AZS- S05P 4 Lend Use es a.l't1 aL Slopes VA) 6 Sufice Stones N'b', Q�a�C - �-'' R Possible Wet Area R Drinking Water Weller _R Distances from: Open Water Body R Drainage WAY ' R Property Line t_O r itOtherO `~ SKETCH:(Street name,dimensions of lot,exact locations of test holes d<pert tests,locate wetlands In pmxlmity to holes) v 1 I ' h cy $ 01 OA M cat f L 30 O� / NNVI'I7' N 1 2 83 .$,1117oF . I OUT w ASK RV ti ow Depth to Bedrock 'S0o Parent material(geologic, Depth to Groundwater: Standing Water In Hole: Weeping ft rn Pit Face t�la 1 �rw.Kw EVe N tS N►bvp Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL MOH WATE T�A�Gsv � MmvEc. 199Z 6~4-DIY 4 in. Method Uscd: 1 n � �Inobs. ��.A In, Depth to soil mottles: Depth Observed stane: in. Groundwater Adjustment R Depth to weeping Rom side of obs.hole: Adj.Groundwater Level ,. Index Well#—„ -Reading Date: Index Well level,_= Adj.rector AIK q:Z,� PEI2CCILA TION TEST 2sGa.r..,u 5 `�.b S L S r)NAry ��` N ,.,.,;,�,;; . ..,,•,! Observation , Time at g Hole N 9a�� Time st r Depth of Per; —' 6..�,n �tk. Time Start Pre-soak Time® JstC End Pre-soak — RateMlnAnch ;Lest Tt4000 Zy4%A)'9W—%"C- Site Suitability Assessment: Site Passed Site Falled: Additional Testing Needed(Y/N) Original. Public Health Division Observation Hole Data To Be Completed on Back----� Copy: Applicant - AEEr OBSER�A'I'XQ�1':��E I:�41�`>` � >' �. Depth from Soil I lorizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Doulderes. 4,! O Q t'�fF MA D- 8 r, rll c v1 ; C) to-4Z S/Z M cc? RaOTs ar- 'Z of ,g kwSo'.ts 0 tole 6& %V.G I;Ga.v Ec. IK.t9 \,IIJ A41914 Et,3 G 010TEC DEEP OBSERVATION HULE LOG Hole#. Z ... Depth from Soil Horizon Soil Texture Soil Color Soil er Surface II (USDA) (Munsell) Mottling (Structure,Stones,Doulderes. % 3"-0 Q b"_ 9•� A ��O SaK,p ►oyQ S/Z � tM ir0 Qoo'r5 3Q 12Z4, C,, CoA•ase p t0YOL4 0 St+V�I.r e�•ru I�10 p G=ta doUW Tea= Ste. C�VLO-VeI.fC DE 4S. tVA ' pN:up .E .OG yule# Depth from Soil Horizon Soil Texture Sotl Color Sotl Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Doulderes. • DEEP Depth from Soil Horizon soil(USDA) SMunsoor 01 Mottling (Structure.Stronsistency.ones,Doulderes. Surface in. ( ) ( ) Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes Within 500 year boundary No—& Yes Within 100 year flood boundary No J. Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervi us material exist in all areas observed throughout the area proposed for the soil absorption system? _ If not,what is the depth of naturally occurring pervious material? —� Certification I certify that on A011 e. 7s (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required trai 'ng,expertise and expe 'e ce described in 310 CMR 15.017. Signature o Date BARNSTABLE LOT 227 J RjDGE H 4z CB 95.0 fnd),, s e - - _ 96.6 I 283. 02 _ _ 96.0 OCUS _- - -- co WAY o L N850709 E - .96.5 - -- ca m PROPOSED DRIVE' Nr - — r r-�► PA TH WEST i - - - - -� Q�970 __-- - \ Ib BAY p' 35.0 . \ � ►i I 3 2.0 GARAGE 2.p' p \ W o LOT 226 7,5 7 4' 3.o' , 9 0 / o LOCUS MAP o AREA= o °p 126•2 43, 756fSQ.FT �? , �, I a ASSESSORS MAP: 71, LOT 11-7 fi 9, 7 3, 47 12.5 1; _5 PLAN REF' 15354-131 SH.1 � � „ O I \ 1 ► 1 � FLOOD ZONE.- C i ED to .2' 18.0 PROPOSE i 1 \ 0 100 _ \ 5 H USE M co •O' STANK ► 1 ZONING.• „RFI" ►� �q T.O.F=99 5' -�. a �U � ` O VE'RLA Y DISTRICT "AP" 10 UTILITY Rr� �18. 0 16. 0 �, � ca o - - 13.8 c� - � - _120 _ SITE AND SE WA GE PLAN c� ( — cn cm gf d)I PROJECT L OCA T/ON — I 169 CARRIAGE ROAD 293.23 � o O �- O YSTER HARBORS N83.44'47E' / 9 BARNSTABLE, MASS. `9�� rn •o BENCHMARK CB '- p \ ELE= to (AssuMED) APPL/CANT.• (fnd) BILL ABBOTT LOT 225 OF YANKEE SURVEY CONSULTANTS P. O. BOX 265 � �� VALL'A"' i UNIT 1, 40B INDUSTRY ROAD A. UEBER Q 23 FUTNEW No. , G MARSTONS MILLS, MA. 02648 I CERTIFY THAT THIS SURVEY AND PLAN WERE MADE , 1 PH.(508�428-0055 - FAX(508)420-5553 IN ACCORDANCE WITH THE PROCEDURAL AND TECHNICAL ,m g�.,a. o,�,a�sT {�� STANDARDS FOR THE PRACTICE OF LAND SURVEYING IN �� ' '` � ��®°�9 . moron THE COMMONWEALTH OF MASSACHUSETTS SCALE.' 1" = 30' DA TE.• 7/26/997 PA UL A. MERITHEW, P.L S. AA " REV REV.• 81.16199 JOB NO. 52002 FSHEE-TI OF 2 _9_9.5 EL. — _ • TOP OF FOUN9,4TION 20.' MIN. 10' MIN. CONCRETE COVERS 4 SCHEDULE 40 P. VC MIN. PITCH 118 PER FT. 2"LAYER OF ' EL= 98. 7' 1/8 w_1/2w 6" M4 / / , CONCRETE CO VER WASHED S7VNE 4- CAST IRON PIPE ' / ' ' , / E 98' (OR EQUAL] MINIMUM 15' / ' ' P/7CH 114 PER FT CLEAN SAND 36" MAX FLOW LINE 19 EL= 95. 7' INVERT\— - 1 1O" 14 w 15'MAX RUN EL.=_9_6._X' MIN ° GASINVERT �2 0 ° °° o 0 0 0 0 0 0 ° ° ° INVERT BAFFLE EL.=9s��' INVERTS 6 SUM LEVEL o ° °o 0 0 0 0 0 0 0 ° ° o ° EL._��.05' EL.= 9_5.55 =93.1 EL.=95_.3 _ INVERT 4' 4' (70 BE PLACED ON FIRM BASE) DISTRIBUTION _ MECHANICALLY COMPACTED OR 8' OF S7VNE BOX WITH "TEE ,EL. ��`�_ GALLONS 719 BE WATER TESTED 45.0' X 12.5' SEPTIC TANK IF MORE THAN ONE OUTLET TRENCH 1VRMATION tz� PLACE ON 6 STONE 3/SHED sigly SOIL ABSORPTION to PROFILE OF �' SYSTEM (SAS) SEWAGE DISPOSAL SYSTEM BOTTOM OF NOT TO SCALE DEPTH OF PERC— 48" TEST HOLE EL =88.1' PERCOLATION RATE G2 MIN./ INCH OBSERVATION HOLE 1 ELEV=_ 9_8.1 OBSERVATION HOLE 2 ELEV=_ 9_8.1 DEPTH HORIZ TEXTURE COLOR. M077 OTHER DEPTH HORIZ TEXTURE COLOR M077 OTHER '`I 4"-O 0 PINE NEEDLES 3-0" O PINE NEEDLES LEAF MATTER LEAF MATTER O-B" A MEDD, SA 1/D lOYR 512 W MED. R0075 O"=9" A MED. SAND 10YR 5/2 w MED. ROOTS 8"-42" B MED. SAND 10YR 5/ 2X GRA VELt 2X GRA VEL± 42"-120 C HER. SAND 10YR 6/4 pSINGLE GRAM 9`34" B VED 7V COARSE SAND 10YR 5/6 p GENERAL NOTES 5X GRAVEL± 122 c COARSE SAND lOYR 6/4 5NGLRAVEA-IN NO WATER ENCOUNTERED NO WATER ENCOUNTERED 1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. TITLE 5 AND THE TOWN OF BARNBT ____ RULES AND ENGINEER.• SULLIVAN ENGINEERING REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. WITNES,WD BY J DUNNING DESIGN CALCULATIONS.' 2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO P�9321 12121198 WITHIN 6" OF FINISHED GRADE, OTHERS WITHIN 12" NUMBER OF BEDROOMS . 5 3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF GARBAGE DISPOSAL . . . . . . . . . NO WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN INSTALL FOUR (4) ACME TOTAL ESTIMATED FLOW 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE 500 GALLON LEACHING ' ( 110__GAL/BR/DAY x _5_ BR) 550 GAL/DAY USED UNDER OR WITHIN 10 FT OF DRIVES OR PARKING AREAS. CHAMBERS WITH FOUR FEET — — 4) ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL STONE SIr ES AND ENDS REQUIRED SEPTIC TANK CAPACITY 1500 GAL BE MORTERED IN PLACE. SPA OT APART. .SOIL CLASSIFICATION . . . . . . . . 1 5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH r�� s DESIGN PERCOLATION RATE . . . . . < 2 MIN./IN. DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO o G . 74 OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. wu�Aa EFFLUENT LOADING RATE . . . . . . GAL/DA Y/S.F. DA Y LIE13ERMAN LEACHING CAPACITY (AREA X RATE) 586 GAL 6) UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCA VATION CONTRACTOR No. 23971 / IS TO CALL "DIG— SAFE"' AT 1-800-322-4844 AT LEAST 72 HOURS �,�F �� RESERVE LEACHING CAPACITY . . . 586 GAL/DAY PRIOR TO COMMENCING WORK ON SITE. ° E Q (45 X 12.5 X . 74)+(45+45+12.5+12 5 X . 74 X 2) 7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. 8) PARCEL IS IN FLOOD ZONE___„C" __. 9) LOT IS SHOWN ON ASSESSORS MAP _ 71 _ AS PARCEL _!l z -_. - SHEET 2 OF 2 JOB NUMBER 52002