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HomeMy WebLinkAbout0019 CESARS WAY - Health 19 Cesars Way Osterville A = 123 029 C �l T4' 1 7►F BARNSTA BTaE SLWA t. SSOR'S BitAP'4 LOT 3]kt9TA��NAd�t�;�Ctid8�1��. �. TAM CAL'ACX`i"t ��a►ciaalrrd��►c,�-rr'Y�tom) � 4 ), I)P Src +ts 'OU"Mt OR© _ com"I B IITATE: cm eel ; & tim +djpe Ut uduvl 'l 6toto cBnuom�fiLsa n� agility. mn Pdv � l' Sr Wlilud � rsa►y a? sr P. ', �a��� t.eac��amity► �ri ancl�s�st tA In, � is c 15C Ck . f D. 3 776 TOWN OF BARNSTABLE LOCATION SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL )X INSTALLERS NAME.&PHONE NO.. �r _,�Cc {� ��*`1; ^► y ��5 `3t SEPTIC TANK CAPACITY — LEACHING FACILITY:(type) s •(size) NO. OF BEDROOMS OWNER . PERMIT DATE: a- 5'0 7 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 C 17CcCIC. UC LI 3 � -5-77' 626 ' 0 T IO o�9 � S E W , �,�PERMIT NO. L C '. . Zo ,, VI L A G E � 13 WP9 Y ht�� INS AL ER'S 16ME ADDRESS R U DER OR OWNER o� er; S � DATE PERMIT ISSUED11 � DAT E COMPLIANCE ISSUED o z®1 � a LIU J No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: .PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Ye I Rpplication for �Biopoar 6psum conotruction permit Application for a Permit to Construct( ) Repair V4 Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 11 C6,SCrS LAl)j US+Ef v d k,0 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel l a a fact WG Y Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.Yd_g33-60lJ/�Type of Building: Dwelling No.of Bedrooms 3 Lot Size P0,5�4:Z— sq.ft. Garbage Grinder ( ) Other - Type of Building We»s No.of Persons Showers(. ) Cafeteria( ) Other Fixtures Design Flow(min.required) ;,�!3 gpd Design flow provided 3�'a,g$ gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank 1(_ p �Simi N,,` Type of S.A.S. 0 SM C'�,�.t�a(( la-3 xr' X 2 Description of Soil Nature of Repairs or Alterations(Answer when applicable) i k Stc, Kjcw S,A .S Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by th' of H lth. Si*by: DateApplication Approved by Date Application Disapproved Date for the following reasons Permit No. Date Issued !C ! 6 No. ..._.�.�>, Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye ' II j PUBLIC HEALTH DIVISION . TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for Oizponl bpgtem Construction Permit Application for a Permit to Construct O Repair` ) Upgrade O Abandon O ❑Complete System ❑Individual Components , Location Address or Lot No. i`1 C &SGa_($ ( l)C-11 OS+N(L 11)\p Owner's Name,Address,and Tel.No.'t-e r�.. G c�a�.y Assessor's Map/Parcel a a l V I 1 Installer's Name,Address,and Tel.No. Designer!I Iame,;'Add ess and Tel.No. Type of Building: t Dwelling .No.of Bedrooms 3 Lot Size PO,S9 1— sq.ft. Garbage Grinder ( ) Other Type of Building i-ou S& No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33C> gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank I:( p E)0 Type of S.A.S. 2 SCE Crew Com D-,XI3X2, Description of Soil 1 4 Nature of Repairs or Alterations(Answer when applicable) u Sic��� NPR S•A S Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore desciibed.on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the'sy'stem%in,operation until a Certificate of Compliance has been issued b�y�this Board of H alth. 6 �d� - t/ ;I�" r Date � Y Signe Application Approved by %/ /f _� Date Application Disapproved by: Date for the following reasons Permit No _ Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (X ) Upgraded ( ) Abandoned( )by 0 ,\c. 1 at 15 C is Sa(S W c "I has been,con tructt��))d' ccordance fo with the provisions of Title 5 and the for Disposal System Construction Permit Nov �V dated InstallerJdU . A 7)tow r~ Designer ) -w-v vr, N 1A vry -P #bedrooms '3 Approved design flow ";S_n_It 9 gpd The issuance of this permit sballf not be nstrued as a guarantee that the system(will'fu�n`cti•n-as�,de��s g,d. Date r'. � Inspector `�--z \�Y..J No. 9001.-0- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Mi5po5al *p!gtem Construction Permit Permission is hereby granted to Construct ( ) Repair (x ) Upgrade ( ) Abandon ( ) 1 System located at 1 Cl CP50 (O and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Constructi'n t be completed within three years of the date of this pe Date / ���� Approved by ) f Town of Barnstable i �,�- o Regulatory Services 'Thomas F.Geiler,Director �hRXsTAaLE, 63`'. ���1° Public Health division �a' Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: 2- /q 'a Sewage Permit# )-t)P i-O r Assessor's Map\Parcel Designer: Installer: Address: ���L�f Address: 32— On /� 5- 67 h4b491lrS AalkJ was issued a permit to install a (da e) (installer) septic system at (1101 orl_l S based on a design drawn by (address) &(Z 40,r R.5. dated /'/7 z (designer) I certify 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 and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or an vertical relocation of an component g Y Y P y of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. f N OF�yq ` nature Installer's i VON HONE -+ ( % g ) #9Dr8 y All Aix%' 00 (Designer's Signature) (Affix Designer'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 BARNSTABLE PUBLIC HEALTH DIVISION. THANK.YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doe g 5 r _ i f l { I I o0(al C)(V COMMONWEALTH OF MASSACHUSETTS c4 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION r TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 19 CESARS WAY OSTERVILLE Owners Name: BUCKLER r Owner's Address: Date of Inspection: 12/6/06a Name of Inspector: (please print) Douglas A.Brown ,i Company Name: Douglas A.Brown Septic Inspections -� Mailing Address:P.O Box 145 �jrt Centerville,MA 02632 Telephone Number: 508-420-4534 CERTIFICATION STATEMENT ' 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 Needs Further Evaluation by the Local Approving Authority X Fails Inspector's Signature: Date: 12/6/06 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. Notes and Comments PIT IS FULL SYSTEM IS IN HYDRAULIC FAILURE ****This report only'describes conditions at the lime of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different Conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Revised on 10/31/2000 Page 2 of 1 I OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 19 CESARS WAY OSTERVILLE Owner's Name: BUCKLER Owner's Address: SAME Date of Inspection: 12/6/06 inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information winch indicates that any of the failure criteria described in 3 10 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: Y B. System Conditionally Passes: one or more system components as described in the"Conditional Pase' section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes, no or not determined(Y,N,ND)in the 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. ' J ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health):. ; broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): -broken pipe(s)-are replaced obstruction is removed Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 19 CESARS WAY OSTERVILLE Owner's Name: BUCKLER Owner's Address: SAME Date of Inspection: 12/6/06 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 15.3030)(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 2.System will fail unless the Board,of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ the system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a- surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone I 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 19 CESARS WAY OSTERVILLE Owner's Name: BUCKLER Owner's Address: SAME Date of Inspection: 12/6/06 D. System Failure Criteria applicable to all systems: You must indicate"yes or no to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool , _ Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped - X Any portion of the SAS,cesspool or privy is below high ground water elevation. — X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. - X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] YES (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 3 10 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• You must indicate either"yes" or no to each of the following:` (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of.a surface drinking water supply _ the system is within 206 feet of a tributary to a surface drinking water supply — _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered yeg''m 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 f , Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 19 CESARS WAY OSTERVILLE Owner: BUCKLER , Date of Inspection: 12/6/06 Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No X Pumping information was provided by the owner, occupant, or Board of Health — X Were any of the system components pumped out in the previous two weeks ?. X _ Has the system received normal.flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? Were all system components,excluding,the SAS,located on site-? . X _ 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? _ X Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no . X _ Existing information. For example, a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3 ))(b)] t Page 6 of 11 - OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 19 CESARS WAY OSTERVILLE Owner's Name: BUCKLER Owner's Address: SAME Date of Inspection. 12/6/06 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN How based on 3 10 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 3 Does residence have a garbage grinder(yes or no): NA Is laundry on a separate sewage system(yes or no): NO (if yes separate inspection'required] Laundry system inspected(yes or no): NA Seasonal use: (yes or no): — Water meter readings,if available(last 2 years usage(gpd)): NA Sump pump (yes or no):,NO Last date of occupancy: COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow(based on 310 CMR 15203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval Other(describe): - Approximate age of all components,date installed(if known)and source of information: PIT IS FULL SYSTEM IS IN HYDRAULIC FAILURE Were sewage odors'detected when arriving at the site (yes or no)? NO r Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 19 CESARS WAY OSTERVILLE Owner's Name: BUCKLER Owner's Address: SAME Date of Inspection: 12/6/06 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron 40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_ (locate on site plan) Depth below grade: Material of construction: _concrete_metal fiberglass _ polyethylene other(explain) If tank is metal list age:= Is age confirmed by a Certificate of Compliance(yes or no): _(attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 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: How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.) OPENED PIT FIRST IT FAILED SO I DID NOT GO ANY FURTHER GREASE TRAP:_(locate on site.plan) Depth below grade:_ Material of construction:_concrete_metal fiberglass—polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels as related.to outlet invert,evidence of leakage,etc.): I , Page 8 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 19 CESARS WAY OSTERVILLE Owner's Name: BUCKLER Owner's Address: SAME Date of Inspection: 12/6/06 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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): t r Page 9 of 11 OFFICIAL INSPECTION FORM ' NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) ; Property Address: 19 CESARS WAY OSTERVILLE Owner's Name: BUCKLER Owner's Address: SAME Date of Inspection: 12/6/06 SOIL ABSORPTION SYSTEM(SAS): _(locate on site plan,excavation not required) If SAS not located explain why: Type X leaching pits,number: leaching chambers,number: - 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.): PIT IS FULL SYSTEM IS IN HYDRAULIC FAILURE r 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 or no): Comments(note condition of soil, signi 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.): Page 10 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION-(continued) Property Address: 19 CESARS WAY OSTERVILLE Owner's Name: BUCKLER Owner's Address: SAME Date of Inspection: 12/6/06 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. o�- 5G%ri �i Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM ] INSPECTION FORM PART C ' SYSTEM INFORMATION (continued) Property Address: 19 CESARS WAY OSTERVILLE Owner's Name: BUCKLER Owner's Address: SAME Date of Inspection: 12/6/06 SITE EXAM Slope: Surface water: Check cellar: Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: 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: .. Provide Riser over D-box NOTE: To prevent breakout, final grade of Top of Foundation to within 6"of finish grade minimum E L. 92.5 to be carried out a EL-99.18 " F.G.ELc'96.0f minimum 15' beyond edge of leach F.(Exlsting �t F.G.EL:98.St y Maintain Min.2%slope over [each facility F.G.EL:94.0�96.Ot facility. Install risersw/covers over inlet Minimum 2"Peastone Invert A &outlet to within 6"of finish grade or Geotextile Fabric Install riser over one chamber Existing EL.95M L=25't = � s 1 with cover minimum 12" L 5 6 /4 1/2 Double Washed Stone to finish grade. 4"SCH 40 PVC 4"SCH 40 PVC :" ~, 4"SCH 40 PVCTOP CONQ EL=93.0(Breakout EL.92.5) Invert B < 0S=4.6%(2%MI 10, , F ExlstingEL 96.23 14! @S=1.6%(1%MIN.) a ®® o ®® 7 6tS=1 ®®®®®®® . 2'EFF.DEPTH 096(1.09bMIN.) ®®®®®®®. o: L=30't Install Gas Baffle EL 93'� EL.=93.0 0 S=6.8%( I .) BOTTOM EL=90.0 EL.=g3.17 DISTRIBUTION BOX Use 2 EL=92.0 5no gal.Precast Chambers H-10 5b6' •• •••• �•� EL:94.2 •••• • •. . ••• H-10 DB 3 _ with 4'double washed stone on sides *Contractor to verify (Install PVC Inlet&Outlet Tees) and ends minimum 1000 gallon septic - - tank. Replace with minimum EXISTING 1000 GAL - , (25'x 13'x 21) EL 84.44 1500 gallon tank if H-10 SEPTIC TANK BOTTOM OF TH-2 undersized or damaged. SEPTIC SYSTEM PROFILE SOIL LOG N.T.S. N.T.S. DESIGN CRITERIA SOIL EVALUATOR: AMY L VON HONE,Ra ADDITIONAL NOTES- INSPECTOR: DONALD DESMARAIS,RS.,BOH - ti Number of Bedrooms: 3 Bedrooms DATE: JANUARY 17,2007 10.•00 AM 1. Contractor to verify soils-at time of construction. Contact PERCOLATION RATE: <2 MIN/INCH Permlt#11578 Design Sanitarian if soils differ from original soil logs. Soil Type: CLASS Design Percolati06 Rate: <2 MIN:/IN. TH — 1 TH — 2 2. Existing failed leach pit to be abandoned per Title V Daily Flow: 330 G.P.D. specifications. Design Flow: 330 G.P.D.(MIN. REgD) EL.99.05 EL.95.44 k Garbage Grinder. **TO BE REMOVED** A A 3. Contractor to verify all existing inverts exiting foundation Loamy Sand Sandy Loam prior to start of construction. Leaching Area Required: (330)/0.74=446 S.F. 10YR4/2 10YR2/2 3" 98.8 g" 94.69 I B B Septic Tank Required: IOW GALLON(EXISTING) Loamy Sand Loamy Sand 10YR5/6 10YR5/8 :. USE 2-50U GALLON LEACHING CHAMBERS IN SERIES 18" 97.55 24" 93.44 FLOOR PLAN-: WITH 4'WASHED STONE 25'x 13'x 2' N.T.S. C1 C1 - Sidewall Area: 4(251+ 131)= 152.0 S.F. Perc. Coarse Sand Coarse Sand Bottom Area: 13'x 26 =325.0 S.F. @ 2.5Y6/4 2.5Y6/4 Total Area: 477.0&F. 43" Dining/Kitchen Bath Bedroom Upper Bedroom 2 Design Flow Provided: 0.74(477.0S.F.)=352.98G.P.D. Level 1 Living Room Bedroom 19 CESARS WAY, OSTERVILLE, MA 3 VH PREPARED FOR: Douglas Brawn 120" 89.05 132" 84.44 R, associates and Lower SEPWS s MDEMNS Peter Buckler PERC RATE- Level S"d 'lions In 7:45 minutes<2 MIWIN.("C1"Horizon) 3WOOD RWd 24 "'` ,AM Garage Den Jennifer Mitchell g soeanoa� No Groundwater Observed ;Basement 19 C:eSar'S Way 1,Amy L.von Hone,R.S.,hereby certify that I am currently approved by the DEP pursuant to t, Surveying by: Ostervi I le, MA 02655 310 CMR 15.017 to conduct soil evaluations and that the above analysis has been TevrYA XwvgrP'l"£ 22 Long Road performed by me consistent with the requirements of 310 CMR 15,017. 1 further certify that Harwich. Mn 02645 DATE REVISED SCALE SHEET N0. I have successfully passed the Soil Evaluator's Exam on November,2004. (5W) 432—M9 01/17/07 1" = 20' 2 of 2 cre �l NOTE: This plan is to be used for septic system purposes GENERAL NOTES: 01 al outh Road / ONLY and IS NOT to be considered a property line survey. 1.VERTICAL DATUM:ASSUMED 2. MUNICIPAL WATER IS AVAILABLE. 5� C 3.SCHEDULE 40 PVC PIPE TO BE USED LOCUS 6at� m h 1S' THROUGHOUT SYSTEM UNLESS scot ;� w�te OTHERWISE NOTED. 4.ALL PRECAST UNITS TO CONFORM TO D 410z AASHTO: H-10&20 1 � 12 F0. " 5. PIPE PITCH-1/8" PER FOOT UNLESS a) Route 2 w 10`�'36 C°/rj 0- OTHERWISE NOTED. p 104 __� \ A3 S43 e/2t -d 6.ALL CONSTRUCTION DETAILS TO BE IN 1°2' co � N CONFORMANCE WITH MA ENVIR. CODE LOCUS MAP N.T.S. 1O' F (TITLE V)AND LOCAL REGULATIONS. ASSESSOR'S MAP: 122 7. CONTRACTOR TO VERIFY LOCATIONS PARCEL: 29 3,31 1°351 102<' '°a` ! ~ a OF ALL UTILITIES PRIOR TO REFERENCE: BK. 244 PG. 89 10 s�00/r \\\ a `F 5 CONSTRUCTION. FLOOD ZONE: C Town of Barnstable 102' '` enc PE 3`� F Roy g1' x �----- Too �� ) LEGEND #2500010015 C-(8/19/8 —_ f� 99 /�1 ; �--- gg �- PROPOSED CONTOUR 98 A9 -��/� ,� �i �! 99 PROPOSED SPOT GRADE NOTE: Failed leach pit to be 1 98 � 51' �� i — 40 EXISTING CONTOUR abandoned per Title V �c�,96`__._-�99 Too J Existing Tank 9 0��, �, c� 0 specifications. to remain 9-7 , ,�A,Og — 30.23 EXISTING SPOT GRADE X 99.78 2 B / ,' i S TEST PIT C 9 G/`,Q� X �� C�`Z 8g. ® EXISTING WATER SERVICE ,� a¢, 100'SETBACK TO WETLAND SO /SE o x WORK LIMIT LINE SAP K , ! i \\k OF Mqs �j g9,35 / OeC 3��/ ` i/ ,�/ �� �1'�P� AMY 59 HOFM,��9c BENCHMARK SET: 9`�° TH-1 �� ;A 9 3/ ; , �� L• m, TERRY yG� Right cor. cone. pad VOa1HOMEo ANN EL. = 94.91(Assumed) ,' 31 0 ,� a�0 9#1068� WARNER zap �93� '8 0 , ' 3 ZN s� .� � No•38721 qj 93 6 6g q,y�, - 1� ,Q 35, rags `c 3 �i — �c( � y 5 20' 1:. .:.. ' TH-2 Paved:; 19 CESARS WAY, OSTERVILLE, MA LOT 6 Sto ` .. 20,545± S.F. 25�. 0 9 ' � 0<�`'e . � VH ckkle ,S 44' rn 0.47± AC. . 31' F� \' S o7i 3,°5 ' 9?'�'� PREPARED FOR: Douglas Brown Ma 122 hce �3,5 \ � and p o Parcel 29 23' 13 / �� �1 a5 3 Peter Buckler Jennifer-Mitchell �— 164.18, J \ '� '�� �P/1�a°/1 19 Cesar's Way N 64°40,1011 W �2 39 Surveying in" Ostervi lle, MA 02655 TerryiL WanrerP.LS 22 Long Road Harwich, MA 02645 DATE REVISED SCALE SHEET NO. Scale: 1"=20' (508) 432-8309 01/17/07 1" = 20' 1 of 2