HomeMy WebLinkAbout0144 CRYSTAL LAKE ROAD - Health 144 CRYSTAL LAKE Ro
OSTERVILLE
A = 139 042
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�n
144 Crystal Lake Road �+
Property Address
Hugh MacColl r
Owner Owner's Name
information is Osterville Ma 02655 8-28-19
required for every
page. City/Town State Zip Code Date of Inspection CIL,
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:When filling out forms A. Inspector InformationJ�'/# y�9�
on the computer, Brett Hickey
use only the tab
key to move your Name of Inspector
cursor-do not B&B Excavation
use the return Company Name
key.
374 Route 130
r:s Company Address
Sandwich Ma 02563
to City/Town State Zip Code
r,sn (508)477-0653 S113747
Telephone Number License Number
B. Certification
I certify that: I 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 the property 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
Brett Hickey 8-28-19
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
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 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18
r
t
Commonwealth'of'Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1
144 Crystal Lake Road
Property Address
Hugh MacColl
Owner Owner's Name
information is Osterville Ma 02655 8-28-19
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: r
■❑ I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
The system was in working order at the time of inspection.
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," lease explain.
� p p
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
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
144 Crystal Lake'Road
V
Property Address
Hugh MacColl
Owner Owner's Name
information is Osterville Ma 02655 8-28-19
required for every
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:
l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
c Commonwealth of Massachusetts
�n s, ,jp Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
144 Crystal Lake Road
u
Property Address
Hugh MacColl
Owner Owner's Name
information is Osterville Ma 02655 8-28-19,
required for every
pag-3: 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:
4) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
❑ a 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
l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
144 Crystal Lake Road
Property Address
Hugh MacColl
Owner Owner's Name
information is Osterville Ma 02655 8-28-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
❑ El Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ 0 Liquid depth in cesspool is less than 6"below invert or available volume is less
than %day flow
❑ 0 Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ El Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ 0 Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ 0 Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
❑ El Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ El 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.]
❑ El The system is a cesspool serving a facility with a design flow of 2000 gpd-
10,000 gpd.
❑ 0 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 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 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18
c Commonwealth of Massachusetts
p� Title 5 Official Inspection Form
1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
r;
144 Crystal Lake Road
Property Address
Hugh MacColl
Owner Owner's Name
information is Osterville Ma 02655 8-28-19
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
❑ El Pumping information was provided by the owner, occupant, or Board of Health
❑ El Were any of the system components pumped out in the previous two weeks?
El ❑ Has the system received normal flows in the previous two week period?
❑ El Have large volumes of water been introduced to the system recently or as part of
this inspection?
O ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
❑ 0 Was the facility or dwelling inspected for signs of sewage back up?
E ❑ Was the site inspected for signs of break out?
El ❑ Were all system components, excluding the SAS, located on site?
El ❑ 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?
❑ 0 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:
0 ❑ Existing information. For example, a plan at the Board of Health.
❑ a 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)]
t5irsp.doc-rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
cam, Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
144 Crystal Lake Road
Property Address
Hugh MacColl
Owner Owner's Name
information is Osterville Ma 02655 8-28-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
6 Number of bedrooms(design): Number of bedrooms(actual): 6
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 660/GPD
Description:
Number of current residents: 2
Does residence have a garbage grinder? ❑ Yes Q No
Does residence have a water treatment unit? ❑ Yes Q No
If yes, discharges to:
Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes El No
information in this report.)
Laundry system inspected? ❑ Yes No
Seasonal use? ❑ Yes No
Water meter readings, if available(last 2 years usage(gpd)): See below
Detail:
***2018- 108,000gallons 2017- 175,000gallons***
Sump pump? ❑ Yes ❑■ No
Last date of occupancy: currentDate
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
144 Crystal Lake Road
Property Address
Hugh MacColl
Owner Owner's Name
information is Osterville Ma 02655 8-28-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
NA
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: Owner- date of last pump is unknown
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
PP—
Commonwealth of Massachusetts
Title 5 Official Inspection Form
J. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
r;
144 Crystal Lake Road
Property Address
Hugh MacColl
Owner Owner's Name
information is Osterville Ma 02655 8-28-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
El 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:
2000 per COC
Were sewage odors detected when arriving at the site? ❑ Yes X No
5. Building Sewer(locate on site plan):
2'
Depth below grade: feet
Material of construction:
❑cast iron ❑Q 40 PVC ❑other(explain):
Distance from private water supply well or suction line: Town waterfeet
Comments(on condition of joints, venting, evidence of leakage, etc.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18
c Commonwealth of Massachusetts
�d Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
144 Crystal Lake Road
Property Address
Hugh MacColl
Owner Owner's Name
information is Osterville Ma 02655 8-28-19
required for every
page.. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
1'
Depth below grade: 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
1
Dimensions: 500gallons
6"
Sludge depth:
3011
Distance from top of sludge to bottom of outlet tee or baffle
211
Scum thickness
611
Distance from top of scum to top of outlet tee or baffle
1511
Distance from bottom of scum to bottom of outlet tee or baffle
measured
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.):
The tank was in working order at the time of inspection. The tank is not in need of pumping
at this time but should be pumped every two years for maintenance.
t5irsp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18
•.s
Commonwealth of Massachusetts
e Title 5 Official Inspection Form
1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
I;
144 Crystal Lake Road
Property Address
Hugh MacColl .
Owner Owner's Name
information is Osterville Ma 02655 8-28-19
required for every
St
page. City/Town ate Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap(locate on site plan):
Depth below grade: fNA
eet
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):
NA
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
II— i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
l;
u
144 Crystal Lake Road
Property Address
Hugh MacColl
Owner Owner's Name
information is Osterville Ma 02655 8-28-19
requ red for every
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):
0"
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.):
The d-box was in working order at the time of inspection.
t5in5p.doc•rev.7/26/2018 Title 5 Official Inspection Form'Subsurface Sewage Disposal System•Page 12 of 18
I
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
144 Crystal Lake Road
v�
Property Address
Hugh MacColl
Owner Owner's Name
information is Osterville Ma 02655 8-28-19
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.):
NA
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:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
9 infiltrators 10'x61'x2'
El leaching fields number, dimensions:
El overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
144 Crystal Lake Road
u
Property Address
Hugh MacColl
Owner Owner's Name
information is Osterville Ma 02655 8-28-19
required for every
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.):
The SAS was in working order at the time of inspection. Leaching was dry when viewed.
12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
NA
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
Commonwealth of Massachusetts
Title 5 Official Inspection Form
ii Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
144 Crystal Lake Road
Property Address
Hugh MacColl
Owner Owner's Name
information is Osterville Ma 02655 8-28-19
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: NA
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
l5insp.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
Ilk- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
144 Crystal Lake Road
Property Address
Hugh MacColl
Owner Owner's Name
information is Osterville Ma 02655 8-28-19
required for every
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
Assessing As-Built Cards
TOWN OF HARidS'T'A.BiL E _
LocApolsi %/�lwrys '� P os1y' /['>� SEtYAGE:k
VILLAGE"AgF_/"e-0i/Ir ASSESSOWS MAP
INSTAI Lk3L'S NAME&:PHONE N;Ct:/Swa rfir5�r! u 7!ir vld
w-P nc'TANK CAPACITY
LE^cmNG FACilLITy:(type) �+l +G 33.r s. {size)
No OF EI7R001,45 L_
BX)1L DE O OWNER',
?v1PL2ANcz I>ATE:
Separation Distancc,Hetwezn then.
'N[axitnarit �tJju4tri3 C,rdjftd1wat Tatiic:t< €he Bpfttrm twf I::eat}trng Iacitity r?$ Feet
Private Water,Supply Well and Leaching Facility (Yf any-wells exist .
an site or,widun 200 feet of teachltrg facility) Feet
Edge of Wetland and Leaching Facrhty(Ii any wetlands exist
within 300 feet of teaching facility);
4 L 4D
I
W&'
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18
Commonwealth of Massachusetts
�m Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
` 144 Crystal Lake Road
Property Address
Hugh MacColl
Owner Owner's Name
information is Osterville Ma 02655 8-28-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
❑■ Check Slope
❑■ Surface water
R Check cellar
❑■ Shallow wells
No GW F below SAS
Estimated depth to high ground water: feet
Please indicate all methods used to determine the high ground water elevation:
El Obtained from system design plans on record
If checked, date of design plan reviewed: 12-16-1999Date
❑ 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:
A plan on file at the local Board of Health was used to determine high groundwater.
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
c Commonwealth of Massachusetts
�e Title 5 Official Inspection Form
col Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
144 Crystal Lake Road
Property Address
Hugh MacColl
Owner Owner's Name
information is Osterville Ma 02655 8-28-19
required for every
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
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Yes
J01pplication for ig ozat Stem Con.5truction Permit
Application for a Permit to Construct( ' epair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.mq Owner's Name,Address and Tel.N_q_
Assessor's Map/Parcel CFS M l i�t C P.U <6 o X '7 6
Installer's Name,Address,and Tel.Now /' } Designer's Name,Address and Tel.No.
14e
Type of Building:
Dwelling No.of Bedrooms Lot Size 1 �sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date / Z 6 p Number of sheets l Revision Date
Title S /0O S—c S f/S t-t-2TZ S//�1_�
Size of Septic Tank 1. -4- L:5) 0 Type of S.A.S.
• Description of Soil ..5"
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 d t ' Wd e
Signed Date
Application Approved by Date
Application Disapproved for the following re s ns
Permit No. Date Issued
V,,
!; Fees �
tK
Entered in computer:
THE COMMONWEALTH OF MASSACHUSETTS yes
!PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
Ipprication for Mi5poear *p5tem Comaruction VertMt -
Application for a Permit to Construct( air( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. / Owner's Name,Address and Tel No
1 Assessor's Map/Parcel 7'6
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
7-11,e ma's e G-,Q
Type of Building:
�r= s Dwelling No.of Bedrooms Lot Size l 9 �sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
ii Design Flow gallons per day. Calculated daily flow gallons.
Plan Date ! a / 6 - q Number of sheets / Revision Date
Title
i Size of Septic Tank of S.A.S. L
" .Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
I
Datp last inspected:
Agreement:j
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 d ly t ' o d Heal
Signed Date
Application Approved by 0 . / Date
Application Disapproved for the following runs
Permit No. Date Issued
: :
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of (tompliance
THIS IS TO CEPAIFY,that the On-site Sew a Disposal System Constructed(Y) Repaired( )Upgraded( )
Abandoned )b, le60 1 COe.
at C� r -? .�w 05 IK"ItIl /nas been constructed in accordance
with the provisions of Ti e 5 and the for Disposal System Construction Permit N dated
I Installer Designer
�l The issuance of this pet it's hall no e c-. slxued as a guarantee that th We will functii as�'esigned,�
Date Inspector �G1( !I" & i ifX'
r- rr
——— l
No. � '�D�,J -------------------------Feed r=-�------..-
THE COMMONWEALTH OF MASSACHUSETTS -
I PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
o° Migooal *p!tem Cougtruction Permit
Permission is hereby granted to Construct(� Repa' ( )Upgrade( ),bandon( )
r� f
+ System located at � a!
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:Constructio must be mpleeted within three years of the date of this
Date: Approved by
TOWN OF BARNSTABLE
LOCATION //y Cry;f/ 4,1L 9D SEWAGE #
i VII.LAGE �s/�ry�/�� ASSESSOR'S MAP & LOT +®
j INSTALLER'S NAME& PHONE NO. /,��+�ih�r .w�rd�/�on✓ y,� g�9�6
FPTIC TANK CAPACITY
.r
LEACHING FACIL=: (type) CyCAcG 33vi �U . (size) /d
j NO. OF BEDROOMS
BUILDER O OWNER /ems'
PERMITDATE: COMPLIANCE DATE: 490
Separation Distance Between the:
! Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility �f Feet
k Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility)
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) l Feet
Furnished by T
�h4
of � ,e.��l��if�
i
fl'�_ BSC
GROUP TRANSMITTAL
To: �,Z c c �lDo ay.�Q vt f -9 Date: 3 0 9 9
Proj. No: If
x1 ovl2�. En L3A-/L Project:
We are sending you:
❑Attached ❑Under Separate Cover
Via: 657 Main Street
❑Overnight Delivery ❑Taxi ❑Regular Mail Unit 6A, Route 28
❑Messenger ❑Direct from printer ❑Other: West Yarmouth, MA
02673
The following items:
❑Change Order ❑Drawings ❑Prints ❑Samples Tel: 508-778-8919
❑Copy of Letter ❑Photocopies ❑Reports ❑Specifications Fax: 508-778-8966
❑Digital Media ❑Plans ❑Other:
No. of Copies Drawings No. Date or Revision Description
This information is:
For Your Information ❑Approved as submitted ❑Resubmit _copies for approval
❑Unchecked ❑Approved as noted ❑Return _corrected prints
❑Preliminary ❑Disapproved ❑Submit _copies for
❑Revised Plans ❑Returned for corrections distribution
Final Plans ❑Sent for your review&comment
Remarks: A,p p r?? c N-,9� )-Fa u S cc f=6 a-rY.2 ow ter, ' C3� Axe✓> "
O aC3 t%•+ C Z ) P�.4ru s. i9-r.s n. u,a.+. %►,..1c c 2 mac? s t—
cc: Signed:
Note: If enclosures are
not as noted,please
contact us immediately.
, t
f�F tME 1p� DATE: /
» CE
FEE:
nARNSTAaLE, -
MASS. $ lREC. BY
wnof Barnstable
ABLESCHED. DATE. Board of Health,67�'Main Street, Hyannis MA 02601
Office: 508-790-6265 _ Susan G.Rask,R.S.
FAX: 508-790-6304 t `� _ Sumner Kaufman,M.S.P.H.
Ralph A.Murphy,M.D.
LOCATION
Property Address: /yy C&ti S 7-01c, v4-*E 2cr�,so, oSr�7w///cam�y,}
Assessor's Map and Parcel Number: /3`J `/2- Size of Lot: S•F'
Wetlands Within 300 Ft. Yes Subdivision Name:
No
Business Name:
APPLICANT CONTACT PERSON
Name: ,!¢ct 61y OF,- / i1-c Co// ?L Name: CieA�s A. dc;�A ,.Q 77f rASSG CoAa yP
CAY Spa 40,+,kE �.� !?o, 00M 7e. 6 67 Adm rw Z.B l 444j r G
Address: OSTEit✓i!/e, wo+ o2 G S»S" Address: t,-2 PD 2 s 7.?
Phone: 6'41 B — VZ 8 — JO/7 Phone: .SD if— 7 71? -- 8 9/ 9
FAX: FAX: 5,0 8 -. 7 aS-. 8 4'4 G
VARIANCE FROM REGULATION(List Reg.) 'REASON FOR VARIANCE(May attach if more space needed)
�O //sls�t r.4,�Jc 6S �gt4 a ES�n --
�a�S�6� /�S F'c mac. C•Y� �36?7/1Ce�s _
'eft-Ag2 -G'O a Jr 6 6 a GP D s'yS TCwi
I
Checklist(to be completed by office staff-person receiving variance request application)
Four(4)copies of plan submitted(including septic system plans and/or restaurant floor plans)
Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting
date at applicant's expense(for Title V and/or local sewage regulation variances only)
Full menu submitted(for grease trap variances only)
I
Variance request application fee collected(no fee for fireguard modification renewal,grease trap variance renewals[same ownerneasee only],outside
dining variance renewals[same owner/leasee only[,and variances to repair railed sewage disposal systems(only if no expansion to the building proposed))
Variance re uest gubmitted at least 15 days prior to meeting date
VARIANC :APPROVED Susan G. Rask, R.S., Chairman
NOT APPR Sumner Kaufman, M.S.P.H.
REASON FOR DISAPPROVAL Ralph A. Murphy, M.D.
Q:/WP/VARIREQ
t
'Town of Barnstable P# I
Department of Health,Safety,and Environmental Services
�Im Public Health Division Date
367 Main Street,Hyannis MA 02601
• BAMSTABLB,
MAM
i679.
Date Scheduled Time Fee Pd.
Soil Suitability Assessment for Sewage Disposal
Performed By: �C.OsT 1 VYZ>(UE�Z. Witnessed By:
OCATION & GENERAL INFORMATION
Location Address i / Owner's Name Vflr,�p��
®4 r
Addresstb6 L L�Q��
Assessor's Map/Parcel: 1%q —� Engineer's Name 1 F(Cr� n)SG (V`ftUp
NEW CONSTRUCTION _ REPAIR Iy Telephone#,nc�—% -
11 Land Used 5. 8(�'t-�q L Slopes(%) 0 Surface Stones VOl\)ks
Distances from: Open Water Body 1 Ob ft Possible Wet Area ft Drinking Water Well i 0%) ft
Drainage Way n 1 m ft Property Line ft Other ft
SKETCH: (Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
rP i
D
R y s �pc
LA �
Parent material(geologic) T1AS Depth to Bedrock N
Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face )n��
Estimated Seasonal High Groundwater ®�I
DETERMINATIOl�F'OR SEASOl�AL HIGH WATER TABLE
. : ._. ._.... .......... .: . .:. .... .
Method Used: ,
• Depth Observed standing in obs.hole: in. Depth to soil mottles: in.
Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft.
Index Well# ____. ...._ Reading Date: ___ Index Well level... Adi.factor_ Adj.Groundwater Level
PERCOLATIONTEST Date Time :O�aO
Observation
Hole# Time at 9"
�1
Depth of Perc Time at 6"
Start Pre-soak Time / >�� \@ Time(9"-6")
End Pre-soak �
Rate Min./Inch Z
L
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back j
Copy: Applicant
DEEP OBSERVATION HOLE LOG Hole:#
........ . .
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistency,° Gravel
u ,
G orvr
�.
E c:
DEEP OBSERVATION HOLE LOG ;Hole
1 Depth from Soil Horizon I Soil Texture i Soil Color Soil I Other
Surface(m.) (USDA) (Munsell) Mottling (Structure„S.oncs,Boulderes.
Consistency,°oGravel)
DEEP OBSERVATION HOLE LOG Hole#
•
Depth from Soil Horizon Soil Texture Soil Color Soil Other r .,.
Surface(m.) (USDA) (Munsell) Mottling (Structure,Stones,Boulder;s o"
Con istenc %Gravel
�r ti
a
DEEP OSERVATIONV HOLE LOG Hole#
Depth from Soil Horizon Soil TextjKe Soil Color Soil, Other
Surface(in.) (USDA)*,j �,+ (Munsell) Mottling (Structure,Stones,Boulderes.
3� Consistency,°oGravel)
t
f 1 �
Flood Insurance Rate Man: � --
Above 500 year flood boundary No Yes
Within 500 year boundary No V/ Yes
Within 100 year flood boundary NoV Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious 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 (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 training,expertis and experience described in 310 CMR 15.017.
Signature Date 2I A19
FORA 11 - SOIL EVALUATOR FORD'
Page 2 of 3
Location Address or Lot No. S Ur
On-site Review
nn
Deep Hole Number 0 ` _1... Date: �� "l��"1 Time: �(�'-`��l Weather 60t,. Su"h
Location (identify on site plan)
Land Use .4 A.ao h"�,.111 Slope M Ia Surface Stones. Pou
Vegetation
Landform
Position on landscape (sketch on the back)
Distances from: -
Open Water Body reet Urainage way?L00- -feet -�
Possible Wet Area 7 W-0 feet Property Line 10 feet
Drinking Water Well > IDI . feet Other
DEEP OBSERVATION HOLE LOG*
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface (Inches) (USDA) (Munsell) Mottling Structure, Stones, Boulders, Consistency, %
Gravel)
Q1
s
Lu
S ti�
c+ ( .
WbPUbALAREA
Parent Material(geologic) ` cir' � 5 _ DepttttoSedrock:
Death to Groundwater: Standing Water in the Hole: Weeping from Pit Face:
Estimated Seasonal High Ground Water:
DEP APPROVED FORM-12107/95
j�
TOWN OF`BARNSTABLE t -
LOCATION -6--*s1/ g, SEWAGE # 404
VILLAGE G�S/�/di��� ASSESSOR'S MAP & LOT13q
INSTALLER'S NAME&PHONE NO.,���s�i�� (� rvefoA✓ S�s'19��
'S-FP71C TANk"CAPAC= /'rV0 Go L
LEACHING FACILITY: (type) evGIee 33vs (2) (size) /d X: X�
NO. OF BEDROOMS
BTJILDER O OWNER U/tom �ow��•,
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility f Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) fi//Xl Feet
Edge of Wetland and Leaching Facility (If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by C'
Iq
. �J 6
l ,
• �. REVISIONS
SOIL TEST PIT DATA: P-9550 SEPTIC TANK DETAIL. 1 ,500 GALLON DISTRIBUTION BOX DETAIL. NOT TO SCALE LEACHING TRENCH DETAIL. NOT TO SCALE ENO. DATE DESCRIPTION
NOT TO SCALE NO. OF OUTLETS J 1
1.75 57.5 - 1.75'
TEST PIT 1- 5. INLET AND OUTLET TEES TO BE CAST IRON FINISHED GRADE
99.4' NOTES: 1, SEPTIC TANK SHALL BE STEEL SCHED. 40 PVC OR CAST-IN-PLACE CONCRETE, o 0 0 00 0 ° o 0 0 0 0 0 0 0 0 0 o o 0 0 0 0
GRD. EL. REINFORCED CONCRETE o
GW. EL. N A 2. SEPTIC TANK TO WITHSTAND H-10 LOADING TEES TO BE CENTERED UNDER MANHOLE COVER. C MO g� 2" WALLS NOTES: c o 0 0 0 0 0 0 0 0 0 0 0 0 0 ° o 0 0 0 0 000
0 LOAM SANDY 10YR 4 3 UNLESS UNDER PAVEMENT, DRIVES OR 6. RECOMMENDED MANUFACTURER-ROTONDO OR I ° PERFORATED PCV PIPE ° �„ ,
P EL 98.4 TRAVELED WAYS, WHEREIN H 20 LOADING APPROVED EQUAL. vr,v o a 1. DIST. BOX TO WITHSTAND H-10 LOADING 00 52 12
' SHALL APPLY. o:. .. ,y:. ....,:•4.:: T Pvc e
1 3. ALL PIPE CONNECTIONS AND CONCRETE TT UNLESS UNDER PAVEMENT, DRIVES OR 0 0
Bw TTRAVELED WAYS WHEREIN H-20 LOADING °o o
2' EL 97.1' LOAM SANDY 10YR 5/8 CONSTRUCTION SHALL BE WATERTIGHT. » SHALL APPLY. 0°00 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00
" I 15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3' 4, FILL ALL UNUSED KNOCKOUTS WITH 2-24 DIA C.I. (60# MIN. MANHOLE COVERS 11 GENERAL NOTES:
C " MORTAR. » '' ,. ! 8 2. PROVIDE INLET TEE OR BAFFLE WHERE 61' -' 1. THIS PLAN IS FOR DESIGN AND
42 BROUGHT TO FINISH GRA E 6 5,5 OUTLETS
TEE TO BE UNDER SLOPE OF PIPE EXCEEDS 0.08 FT./FT OR
4 M.H. OPENING 12 MIN. 3" e e ,�e T_ IN PUMPED SYSTEM. PLAN VIEW - LEACHING CHAMBERS CONSTRUCTION IT THE SEWAGE
• I- 2" 3. FIRST TWO FEET OF PIPE OUT OF DIST. DISPOSAL FACILITY ONLY.
2. ALL CONSTRUCTION METHODS AND
5 INDICATES RAISE M.H W�L.. 4 BOTTOM ON LEVEL BOX TO BE LAID LEVEL. MATERIALS SHALL CONFORM TO MASS.
10'-6" SEWER BRICK - a - STABLE BASE 6" MIN. 3/4" TO
PERC. �.- '• : • -:= -- 1 1/2 CRUSHED D.E.P TITLE 5 AND LOCAL BOARD
6 TEST 1o'-o" CROSS-SECTION 3 MAX. COMPACTED FILL 3 MAXIMUM& MORTAR 4. RECOMMENDED MANUFACTURER-ROTONDO
NORMAL WATER LEVEL 12 STONE BASE OF HEALTH REGULATIONS.
OR APPROVED EQUAL 0 0 0 0 o 0 3. ALL PIPES LOCATED UNDER PAVEMENT
• 0 0 0 0 0 0°0 0 0°0 o°o o°0 3" LAYER PEASTONE
7' •e 3" 5. ALL PIPE CONNECTIONS AND CONCRETE O T O O O O OR EQUAL
WAY SHALL BE SCHEDULE
PRECAST SEPTIC TANK a 10" 20" CONSTRUCTION SHALL BE WATERTIGHT. O O� O O
8 , INLET TEE 4'-9" 30 1/2" 6. FILL ALL UNUSED KNOCKOUTS WITH MORTAR. 30.5 24" O O O HIGH QO Q 00 O 4. THERE ARE NO KNOWN PRIVATE WELLS
SAND 2.5YR 7/6 EFFEC. O DENSITY O O LOCATED WITHIN 150 FT. OF THE
O ANY KNOWN WELLS PROPOSED WITHIN
9' _ _ 5'-2" 4'-6* a V-0" MIN. �o•�oio .� 5'_4" 15 1/2" DEPTH OO O O CUTEC 330E QQ O O PROPOSED LEACHING FACILITY NOR
10 EL 89.4 5_8 LIQUID DEPTH q�n�r O O
' ( �" O 150' OF ANY KNOWN LEACHING FACILITY.
PRECAST DIST.
11' N . 3 4" - 1 1 2" WASHED STOW
BOX / / 5. WITHIN LIMIT OF EXCAVATION REMOVE
1 34" 52" 34"
r -I. i � v:' •r.:•,.+.-. .. -.- ALL TOPSOIL, SUBSOIL AND OTHER
10' IMPERVIOUS MATERIAL
12 • BOTTOM ON LEVEL STABLE BASE e 3" �"• �, 6. REPLACE.WITH CLEAN WASHED SAND
DATE: PLAN VIEW 6" MIN. 3/4" TO � IlI 7 1/2 OR OTHER CLEAN GRANULAR SOILS
10/1/99 1 t/2" STONE CROSS-SECTION VIEW PLAN MEW CROSS-SECTION OF CHAMBER CONFORMING TO THE FOLLOWING
SIEVE ANALYSIS:
TEST BY:
THE BSC GROUP, INC.
107G MAX BY WT. SHALL
WITNESSED BY-
PASS ELEVATIONS: <10 x ONo. 50 44 S EVE SHALL
D. MIORANDI PASS No. 100
TOP OF FOUNDATION 101.7 <5 x OF No. 4 SIEVE SHALL
PERC. RATE: N F 4" INVERT AT BUILDING 900
9.3' UNIFORMITY PASS No. 2COEFFlgENT o No. 4
I �_MIN./INCH THEODORE & MARY ►► ' SIEVE </=6.0
SOIL EVALUATOR KLING 4 INVERT AT SEPTIC TANK (IN) 99.0
S. TURNER ASSESSORS MAP 139 4" INVERT AT SEPTIC TANK (OUT) 98.8' 7. EXISTING UTILITIES WHERE SHOWN
IN THE DRAWINGS ARE APPROXIMATE.
SOIL CLASS: N/F PARCEL 40 " ( ) THE CONTRACTOR SHALL BE RESPON-
1 4 INVERT AT DIST. BOX IN 98.4
FLORENCE E. FLYNN (OUT)
COOKSIBLE FOR PROPERLY LOCATING AND
4" INVERT AT DIST. BOX OUT 98.2' COORDINATING THE PROPOSED CON
L.T.A.R. �„ CERT. 121353 ANDUTHE APPLIC�ABB TY UTILIDTY-SAFE
ASSESSORS MAP 139 COMPANY AND MAINTAINING THE
0.74 G.P.D./SQ.FT. PARCEL 41 INVERTS AT LEACHING FACILITY: EXISTING UTILITY SYSTEM IN SERVICE.
►► THE STATE SOF MASSACHUSETTS
DATUM: HALL BE NOTIFIED PER
4 INVERT AT BEGINNINGSTATUTE CHAPTER
VERTICAL DATUM: ASSUMED OF LEACHING CHAMBER 96.5' AT TEL 1-800-32224844.THE 409
1/ ENGINEER DOES NOT GUARANTEE
BENCH MARK USED: NAIL SET IN DOUBLE OAKS AT REAR OF PROPERTY THEIR ACCURACY OR THAT ALL
UTILITIES' � �• ARE SHOWN. LOCATIONS SUBSURFACE STRUCTURES
ELEVATION 101.92 10 MIN `
-�' ELEVATION AT BOTTOM ELEVATIONS of UNDERGROUND UTILITIES
1 10' MIN LEGEND 94.5' TAKEN FROM RECORD PLANS. THE
c ,
OF LEACHING CHAMBER CONTRACTOR SHALL VERIFY SIZE,
PROFILE: NOT TO SCALE p�6$ LOCATION AND INVERTS OF UTILITIES
EL=1o1.T C.B. ® CATCH BASIN NO GROUNDWATER
50.9 X SPOT ELEVATION , AND STRUCTURES AS REQUIRED PRIOR
TOP FOUNDATION FIRST PIPE LENGTH $,9 OBSERVED 89•4 TO THE START OF CONSTRUCTION.
WITHIN71 TO BE SET LEVELS,
CONCRETE COVERS TO �, UTILITY POLE
EL-100.9' " -)30) 8. THIS SYSTEM IS NOT DESIGNED FOR
6 OF FINISHED GRADE FOR MIN. 2 FINISH GRADE $21*� G� / BENCHMARK NAIL -E- ELECTRIC LINE THE USE OF A GARBAGE GRINDER.
It
2 MIN. 4" PVC PERF � �y6A� � 0 3 '` O GMET GAS METER
9.6 A GARBAGE GRINDER IS NOT
( � P LOT 4.1 SET IN DOUBLE - _
" ';a OAKS. EL. 101.92 G GAS LINE DESIGN CRITERIA: RECOMMENDED DUE TO RECOGNIZED
ADVERSE IMPACTS TO THE LEACHING
SCH4 P 4" P LEACHING CHAMBER tL _,, �POE99.6 \�G j 9 TEST $" ` �✓ INTERIOR PROPERTY LINE Gv GAS GATE DESIGN FLOW: FACILITY.
� Q -- S,�pG 8V� RISER 10 'IT pAK �'' ��,� � _ _
.3' I- .8' =96.5' ;° \ • ' \5� 37 "*3
MIN fB 99.7 ,�, 10' MIN pQ WATER GATE 6 BEDROOMS AT 110 G.P.B./D 660 G.P.D.
6" 94.5' \ 100.4 EX 12 20 DOUBLE -W- WATER LINE
1=99.0' Z 100.0 \ 9.8 OAK MI / 12" SOAK' EXISTING 8' x 10' SHED ' TEST PIT
3 OUTLET I=98.2' N \ 99. EEC TO BE RELOCATED -
DIST. Box 5.1' a to ..�
1500 GALLON ' 99.9� 16� �,� 3 h
SEPTIC TANK I V \F �\ OUBLE �,,�� ''�.,, f� �" r REQUIRED SEPTIC TANK:
6" STONE BASE 1 NO OBSERVED GROUNDWATER J \�� 4,� S 12" OAK'S j� T 20 4 y � -
\ � a 660 X 200% - 1320 GAL.
89.4' BOTTOM OF TEST HOLE \c�` MIN a Lo 1500 GAL.
'0\ 12" '�e� / � cis The BSC Grou , Inc.
70,\ ti OAK"" \ /GAR. 12" �x *100.7 "D" BO �: SEPTIC TANK PROVIDED.7" OAK /'TO INE ^ 12 os APPROXIMATE LOCATION
00.6
�y '�� 100.5 ZE / PINE OF EXISTING SEPTIC
\�� o 100.7 WA 1,500 SYSTEM FROM INFORMATION SIZE OF LEACHING FACILITY REQUIRED:
X .GAL TANIC� X 100.7 PROVIDED BY THE BARNSTABIE �2 657 ROUTE. 28, (UNIT 6)
0' \\ �� / GRASS 100.5 GRAS 9 BOARD OF HEALTH. TO BE COLLAPSED DESIGN PERC. RATE: MIN./ INCH WEST YARMOUTH, MA 02673
17.7 G.P.D/S.F.
,w�/ \ 99.9\�^ / OHW �` 3S V M N - 4 'V AND BACKFILLED. LONG TERM APPL. RATE 0,74 (508) 778-8919
o \ \ OAK i ♦ ? o
/ PROP D 40• \ \ `. ,9/ rye• ^�, o \ N/F
cp
LAB \ \ /"� FK�ST flw�u.n�lle� ,��' , JOSEPH & ANDREA GUARNIERI
/ c,+ CERT. 148176 PROJECT TITLE:
CONCRETE TOP OF FOUNDATION os ASSESSORS MAP 139
•0• \ \ ; BOUND °,,,X 100.0 ELEVATION 101.7 59, PARCEL 43 SIZE OF LEACHING FACILITY PROVIDED:
... ...
�o t
9s.s x 0 \ - o SEWAGE DISPOSAL
/ . \ J'� GRASS 69 �`� �4..:, s _
t ^�o \ \ � ,• � .:;....sr ...... � ., 660GPD 0,74 SF/GPD - 892 S.F. M
�5�� o /� / \ \ o ,R.... ...::.:... SYSTEM DESIGN
m • .co � �h' 'os, �/ � °- 99.9 \ "�` � LOT AREA , tigNc :.,� ryti=;.- . � 100.3 � USE HI GALLEYS 0'X�X60'HYLENE
L Zo \ \ �Fti 17,6 83 S.F. GRASS _ ,+ _
\ \\ �F 12" 100.5 SID WLL-- 2C10X 61 ) x 2 = 284 144 CRYSTAL
BOTTOM10 61 610
PROPOSED ti"�/ry• \SIGN OAK / 894 S.F.
CD
C FOUco NDATION `""�-•_ LOT 17 / , LAKE ROAD
o �
100.E OSTERVILLE, MASS
/ <v 30.6'
3S� \ \ R. �49 91, �`'�.�,. GHT CONCRET- A
CURRENT OWNER: HUGH F. MacCOLL II \ 1 ,.,0
o � •,,,,� / �; BOUND/ cv ' �r P�MEN� D NO SCALE
o �- ,% 9 Q LOCUS PLAN.
POST OF o ! '
p DEED REFERENCE: CERT. 93816 \ GE �Z
LO
/o. ( •g5
_ PLAN REFERENCE: L. C. PLAN 7685 F \ �_- „^ ._ --- - ' L-'� .09 99.3 99.0 ,1N AIN S
c L. C. PLAN 7685 P 1 R ,NY �ME M
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3S?'criASSESSORS MAP: 139 ,� 99.7 EOGE�� PP
m 16� d` EXISTING _ CRYSTAL
�- OSTERVILLE
'SB' ti�O FULL PARCEL: 42 1 wy
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FOUNDATION RESIDENTIAL ZONE: "RF-1" PREPARED FOR:
• SETBACKS: FRONT 30' Q Mr & Mrs HUGH F. MacCOLL
0o SIDE 15'
o,• �►�`A"Rw -,� 144 CRYSTAL LAKE ROAD
o REAR 15 iHOFcy �d ��? 7rRPgs9� EAST P.O. BOX 76
MINIMUM LOT SIZE: 43,560 S.F. OCRAMA Q" .D,av►o�. ® O BAY OSTERVILLE, MA 02655
FIELD w c, CR10" IN . �
GROUNDWATER No.3=9 GI [L �� DATE' :'r 2f 199
0- OVERLAY DISTRICT: "AP"uj
�
`� PLAN VIEW �°°�� ' f`�sh'�,, �,.. L❑cus COMP. DESIGN: K. HEALY
rn LOT AREA: LOT 17 & LOT 41 \ / �t,_�, EyG
m 17,683t S.F. I- PLAN VIEW CHECK: D. CRISPIN
SCALE: 1' = 10 FEET NOTE: - 1�� CRYSTAL DRAWN: K. HEALY
c WATER LINE CONNECTS TO FRONT OF DWELLING SCALE: 1' = 20 FEET �� 9' '�
o EXACT LOCATION TO BE CONFIRMED BY CONTRACTOR W �� Iz LAKE ROAD FIELD: P.H. / A.D.
co 0 5 - 10 20 FT, PRIOR TO CONSTRUCTION. 0 4 FT 3� NANTUCKET FILE NO. 8109-SEP.DWG
10 20 0 . SOUND
DWG NO. 5167-02
JOB NO. 4-8109.00 SHEET 1 OF 1
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