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0073 EEL RIVER ROAD - Health
73`Eel River Road 116— 100 Osterville I I i I'l i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 27 Winfield Lane '3 Property Address Paul Kozloff Owner Owner's Name information is required for Osterville Ma. 02655 3/12/2010 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key 3 to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name r� P.O.Box 763 Company Address Centerville Ma. 02632 City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number t 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 ❑ Needs Further Evaluation by the Local Approving Authority Tea 3/12/2010 Insp tor'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 an co 'ies•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 t at;t'm This inspection does not address how the system will perform in the future under the sa a Nw, ent conditions of use. i vistave J0 14 1 V qi V /Ial "e t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Dispos Systm•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 27 Winfield Lane Property Address Paul Kozloff Owner Owner's Name information is required for Osterville Ma. 02655 3/12/2010 every page. City/Town 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: The septic system is irj proper working order at the present time. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 l f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 27 Winfield Lane Property Address Paul Kozloff Owner Owner's Name information is required for Osterville Ma. 02655 3/12/2010 every page. City/Town 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): i ❑ 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 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 27 Winfield Lane Property Address Paul Kozloff Owner Owner's Name information is required for Osterville Ma. 02655 3/12/2010 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 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 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. 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 overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 .f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 27 Winfield Lane Property Address Paul Kozloff Owner Owner's Name information is required for Osterville Ma. 02655 3/12/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. E] ® Any portion of a cesspool or privy is within 50 feet of aPriv t water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 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 Commonwealth of Massachusetts v Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 27 Winfield Lane Property Address Paul Kozloff Owner Owner's Name information is Osterville Ma. 02655 3/12/2010 required for every page. City/Town 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 by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? 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: ❑ ® 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 27 Winfield Lane Property Address Paul Kozloff Owner Owner's Name information is required for Osterville Ma. 02655 3/12/2010 every page. City/Town State Zip Code Date of Inspection D. System Information Description: The septic system consists of a 1500 gallon tank,D-Box and 6 flowdiffusors Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes M No Laundry system inspected? ® Yes ❑ No Seasonaluse? ® Yes ❑ No Water meter readings, if available last 2 ears usage d 2008:242,000 g ( y g (gpd)): 2009:202,000 Detail: 2008:663 gpd 2009:553 gpd Sump pump? ❑ Yes ® No Last date of occupancy: 3/12/2010 Date 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: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °wM 27 Winfield Lane Property Address Paul Kozloff Owner Owner's Name information is required for Osterville Ma. 02655 3/12/2010 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: 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): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 27 Winfield Lane Property Address Paul Kozloff Owner Owner's Name information is required for Osterville Ma. 02655 3/12/2010 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: 1994 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 20"feet Material of construction: III ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. 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 Dimensions: 1500 Sludge depth: 5" t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 27 Winfield Lane Property Address Paul Kozloff Owner Owner's Name information is Osterville Ma. 02655 3/12/2010 required for every page. City/Town 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 27" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 7" Distance from bottom of scum to bottom of outlet tee or baffle 13" 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.): Pump tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. 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 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 27 Winfield Lane Property Address Paul Kozloff Owner Owner's Name information is required for Cisterville Ma. 02655 3/12/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts w Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 27 Winfield Lane Property Address Paul Kozloff Owner Owner's Name information is required for Osterville Ma. 02655 3/12/2010 every page. City/Town 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 No 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.): Box is Ievel.Box has three outlet laterals.no evidence of solids carryover.No evidenceof leakage. 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: C 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 27 Winfield Lane Property Address Paul Kozloff Owner Owner's Name information is Osterville Ma. 02655 3/12/2010 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 5-Flowdiffusors ❑ 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.): Sandy dry soil.No signs of hydraulic failure.Flowdiffusors were dry at time of inspection.No visible stain lines. 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 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments <c^M 27 Winfield Lane Property Address Paul Kozloff Owner Owner's Name information is required for Osterville Ma. 02655 3/12/2010 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.): f t Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 © � e z �2x��la h' . a v5T al Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 27 Winfield Lane Property Address Paul Kozloff Owner Owner's Name information is Osterville Ma. 02655 3/12/2010 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of Leaching 5.2' 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: As-Built ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 e � Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 27 Winfield Lane Property Address Paul Kozloff Owner Owner's Name information is required for Osterville Ma. 02655 3/12/2010 every page. City/Town 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 r t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 f � l i M � i t C, K LOD No...... Fi$........t n..... THE COMMONWEALTH OF MASSACHUSETTS / BOAR® OF HEALTH .--......a.W 11..................OF........... 1 R-r�.S-r3t... V x 3 Appliration for Dig aii al Works Tonstrndinn Famit Application is hereby made for a Permit to Construct (✓f or Repair ( ) an Individual Sewage Disposal ,V i System at: O VI W-i wr-)tL�b LANE-,E:-f-�s�I�r►�� ,.Ma: o16-;3 scyso¢g MO 11 b p,��L_ 100 ---•------- 1.. f • ... ........- (� {� Location-Address or Lot No. U pnn ...Q...®.....� Q� ' �1..f.c. �115 .F.} , LT . �' �11N�+_ Lf1_.. 1 OSI ►161.E A/lh O'L65°5 r .................�......•--.... -•- ... Address Installer Address d Z Type of Building Size Lot__1-!.t.111-0--....Sq. feet Dwelling—No. of Bedrooms.......... a?R......................Expansion Attic (Nv) Garbage Grinder (pro) Aj A Other—Type of Building k!4kt................ No. of persons......-I A......______. Showers N , Cafeteria (,,IA Otherfixtures ......!.tom" ----------------------------------'-------------•---------------.....------------------------------------......-•---•---......---- W ( Design Flow.............! .........................gallons per person per day. Total daily flow------44o..........................._gallons. W \ Septic Tank—Liquid capacity.!5o�..gallons Length "..... Width__5'e."._._ Diameter______ _______ Depth..'s� ........ x y Disposal-r-eneh—No.......3.......... Width....A............ Total Length....54> ..•..... Total leaching area---- 48------sq. ft. Seepage Pit No...! ..... Diameter....a?JFk------- Depth below inlet....�1A........ Total leaching area....!41A.....sq. ft. Z Other Distribution box (✓� Dosing tank (N14) '~ Percolation Test Results Performed by.-__ A?�7 �.. .!�`�E_.r.. NL:.......................... Date...!�.:_0�'94....._.._....... aTest Pit No. I......4......minutes per inch Depth of Test Pit---- Depth to ground water.... ....... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ��'++ �. �'•-�--•IT G�---9-,-o---.-'-a--.-.-D---�---a-----3------ f-------�---•------�---�-------------------'•---•-----------------------------�--1•-'--a---"-----•-------p•-•i-d----V-t---.S---- D ------I-.-r-b----.--w--n----r-E-----�-----. O Description of Soil...... ---- .. . ..!.- _Mte eL- o'91y L.,y-mr.6%e sw1 Hv-,M A-t2e `fl ikco.6rz? A �---- --- • �-- _.U Nature of Repairs or Alterations--Answer when applicable._____�I-A................................................................................ ....................................................-•-•--•-----•------•--•••-•--•--•--•---....-•-----•---•-•-•••••••---••-•••-••••----••••---•----•-•-•••--••••••••-•-•••••--••-••--•.............••-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the.State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha_ n issued b d of health. Signed ... .... . .............. .. . . . .. .Dace ApplicationApproved By ----------------- --.. -- - -------------------------------- --------- --------------- ---- Application Disapproved for the fo lowing reasons- ...........................----------------------------------------------------------------------------------------------------------- ............ ------------------------------------------------------------------------------------------------- --- -- ---- ----- ----------------------------------- --- ...................... ..............---- • ./....Permit No. .......... ..' 72�.... -------------------- Issued ..............I �-1� =� L' Da,e .. Dace No......................... Fss.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 13 --_..I.a........_..................OF........... :RN S1?}..{.....L '7 Appliratiun for Uiupuual Worse Toniiirurtiun Permit aI)t Application is hereby made for a Permit to Construct (we) or Repair ( ) an Individual Sewage Disposal ,1 System at: lt.Ir-�E-L.f� �. �a� , �`2 iv►c.� , u'G455 t�SISt�P ...l.I �-.. A .......... •- ti .......................... ..... ..... l.... •- --.....---•--�...--------------•--- -- --------- -- ..... ti 4 Location-Address or Lot No. �'r;�r 1 . �E PAdaca.,,A , C•T ,tic. t�'�"1_V11w(� -��LP LA-J,�C . J�,_ I -� kAA Q-- --------•--- - - - -•-••- _........................... • - --- q Owner Address a + •-----•-----------------------------•--•----------------•--•-------•---................•.......... ..---•---------------•--••------------------...................................................... 1 1 Installer Address Z. Type of Building Size Lot.�"._. -p......Sq. feet Dwelling—No. of Bedrooms.______._Fc R'......................Expansion Attic (Pro) Garbage Grinder (arc) p-, ^?� Other—Type of Building ...ttl ................ No. of persons__.._.t!t 1 A______________ Showers (141A) — Cafeteria (w1A) 134 -+r� Other fixtures ----•-~- '` ` ...................................................... W Design Flow............ �?.........................gallons per person per day. Total daily flow......!`4..................................gallons. WSeptic Tank—Liquid capacity.15a0..gallons Length_t9 �:'.... Width..?.b__..___. Diameter__-___-........ Depth..17_7 x Dlsgesal-q-]= —No. _-__-_3......._.. Width....A.._.______.. Total Length--__`?4'......... Total leaching area___ 4 .______sq. ft. Seepage Pit No.__! :..... Diameter.....::Z: ._..... Depth below inlet.._t" A........ Total leaching area....j?.IA.....sq. ft. Z Other Distribution box (✓S Dosing tank (HIA) ~' Percolation Test Results Performed by-_--_E3Axr .=,_!"ram...._?."ts......................... Date...!1.4 J:_.`'�.`��..___._._.._... Test Pit No. I_...._4......minutes per.inch Depth of Test Pit.... Depth to ground water....!Qc>!"a'..._.. Test Pit No. 2................minutes per.inch Depth of Test Pit.................... Depth to ground water........................ a •-•-----•---------------•---•••------•-------•------...------••.....-•--------------•----•-•..-•-•••......................................................... O - t: ' L.G h nh 1 � ---a��i.�. --- ` -�` �•, M 4 plat e� `------.---- ----- v-r A•)--•--- Description of Soll-------''---•-•------=-------------------•---•-------......--•--...---I------------------------•-----------------------•----•----- -----.------------•---------------- ,- _ V d -_ I�f"�.... < ... ...............t.� ... C L I .., , ,..I cr... i`.^y5.........._..r..._�.sfl__......,. ......�.................---- -- W e. . ai .c14 VNature of Repairs or Alterations—Answer when applicable._____tLI.(!................................................................................ ---- --•----------•----•-----------•----••----------------------------------------•---•------------•----------------------------••----••---•-----•------•----•-•--------•--------------.......••-•----• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ------ ---------------- -------------------------- ---------- -- ---------------------------------- ........................................ Dare ApplicationApproved BY --------------...................................-------------------------------------------------------- ..................................--- ---------------------------------------- Dare Application Disapproved for the following reafon.r: ----------------------------------------------------------------------------------------------------------------- ............... -......................................................................................................................................................................... --------........ — ....---- -------- ,are PermitNo. --------. ---------------------------------------------- Issued .......... t.t.................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ------------ -CX.GA4--- ---------- OF ----- .. ... ... .. C�Erfifir to THIS S TO CERTIFY That the Individual Sewage Disposal System constructed ) or Repaired ( ) by '-/.. ` :` .................................................................................... :...... at ........ .{ A... — Tv........... --� Installer has been installed 't ccordance with the provisions"ot Tm Sof The State Environmental Code as described in the application for Disposal Works Construction Permit No. ------------......----- dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CnNST l7E[S AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE .1-7 �'' ..... Inspect .....- .. y I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................OF.. N ..�.:..��.. FEE-Io_�......... Disposal Workii Tunutra ion amit Permission is hereby granted------4 -4?f - 7,4 ------------------------------------------------------------------------ to Construe ) or Repair ( ) an Individual Sewage Disposal System I at No.•.�... ......... ... � re t as shown on the application for Disposal Works Construction Permit ' I _ ----- Dated._/-A-- f_ __Cf L.`---------- Board of Health DATE................................................................................ FORM 1255 :HOBBS & WARREN. INC.. PUBLISHERS \� f !'LiCA'i'IUN FUK 1 L 12CULAl IUN tJ S f AND UBSERVAT1UN CATION I'll W INf1i=Lp (.hnlE l�` LLAGE OS -- NO. --PLICANT DATE �g�2T � : QL�trs�yiA DRESS 17 — FEE dl DO --- 1—� � F_ U!>M-21+IL ELEPHONE R h N0. (Non-refundable 3INE} f3 � 7�-fZ -� �'�'E i�11G' TELEP NE TE SCHEDULED - 426• 't 13J `} Ap==can-t' ssignature) O O O o O o O 0 . C O o O O o e O O . . . O o O . O-O O . . . • • • 0 • • • 0 . . . . . . . . . SSESSOR'S MAP � LOT NO: ttco/ roc ti-se .st SOIL LOG 3-DIVISION. NAME k�fA I " oG - 9'_} 11 : 45; DATE TIME PANSION AREA: YES -," No _ =r3A"T><'¢' i"�'E �►.tc , ENGINEER qN WATER ✓ PRIVATE WELL A BOARD OF HEALTH EXCAVATOR . TCH : (Street name:, etc. , dimensions of lot, exact location o Percolation' tests , lo test holes andcate wetlands in proximity to test holes) 0 NOTES : A OP W to' s L • h "lam • ° � r FK , � �.\ SOD'`'• ,OJ'i q�s i �i I & .�' t4 �� /•j'/ :COLATION RATE: 4< M i�� :T HOLE NO: ELEVATION: TEST HOLE N0: 1 0 _ Z l-c7h oc.� ] ELEVATION 2 3 4 3 p 6 Sty rJ 0 $ '7 / 7 6 / 2 l� � l �/i � I ��s✓/\ is �..s f.I".R 9 8 10 10 11 11 12 13 12 iEs-r AIT rr-n O , E�-Rc-O -- 13 (�� 1" Tt�r p IT 00 +.a 2 /14 14 15 15 16 TABLE FOR SUB-SURFACE SEWAGE : LEACHINGIFIELD ✓LEACHING P LEACHING TRENCHES ITS UITABLE FOR SUB-SURFACE SEWAGE. REASONS: ►�-J E: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION GINAL: COMPLETED 'IN ENT RET P AND TURNED TO BOARD OF HEALTH Y: RETAINED BY APPLICANT � -°�� INSTALL RISERS AS REQUIRED TO e �'' :; pt ~�•• .; er WITHIN 12" OF FINISH GRADE USE (3) ROTONDO $" x 16' XFDL (OR EQUAL) " l �'/C;'• 0 :�'': ~ ,i• • m LEACHING CHAMBERS - H-20 LOADING C > •'• ,.,,• ALL STRUCTURES BURIED FOUR- .S .• : .�, �. '• •. �, � + I . p• ' ,. "iq :•+ FEET OR MORE OR IN DRIVEWAY �I" 0 ubi •; ,�� !n �, • •� ',•. TOP OF FOUNDATION EL = 12.6 f 2-FEET STONE ON SIDES "(' TRAFFIC AREA SHALL BE H-20 and SOIL TEST LOG - P-8329 .: .;°• \\ S „o: % "'• = 3-FEET STONE ON ENDS ' •'' EG 11 t PIPING TO BE SCHED 40 PVC I �.: I a :� •••\�• p NOT TO SCALE LIMESTONE •• �`` /j •.. , EG = 10.5' f EXISTING DRIVEWAY PAVED 12-06-94 0 11:45 AM STEPS n 13d Z Tar ker/ Neck 1 I,t 6� r PROPOSED NEW 25.0' Zt W Pottd�'k�� Jfps : es , 0- L - 0 2 L 23 ' WITH GRAVEL OVERLAY E - 1 R � 9.0' CONSTRUCTION 0 18.0' EG = 10' f LOG OF HAND-DUG TESJ HOLE 277' tO y. � -- Course:,. iatino••� u+ NOT TO SCALE LOAM ,& SUBSOIL PERGOLA `/ / 4 . \. ��w''• i �\ • rt�r:'�1°y `,'' "� H` 09-13-94 O 3PM 8.2' ,10 •.: + - `� ACME PRECAST H-20 2 EL = $.2' 0' EL = 4.3' c ,� $ 5, 1500-GALIg J=x EXISTING SINGLE STORY ESA• Cl �'^- '. . . . DB9 OR EQUAL / '. +�` < ..•� 8.25 SEPTIC TANK MEDIUM SAND :�? . +\�. .; " ••-,.,�`' do SUBSOIL WOOD FRAME DWELLING •�*' ,• H-20 8.0' 7.5' 7.25' LOAMz�E C • ; " " NO WATER ® TO BE DEMOLISHED do t1.5' tt.6 8.4' "., '► l la".Q". , ��. 7.0' _' EL' 6.0 2• EL = 2.3' 7.7' REMOVED FROM SITE r, 6" CRUSHED EL = 2.5' ZONE 8 / o / STONE N MEDIUM SAND /1'11/ `+ -. TERRACE vi TRACES OF GRAVEL '%j a0 LIMESTONE BLESTONE: ... SEA VIEW "• , � .:�• �. , 91 3.5' WATER ® EL = 0.8' �/k N s1,:Ps ACE 1.8' - 2.5 { 10' 10.5' 8' 9. c 8.3' 6.3' PERGOLA 10' MIN OFFSET 23' < �d 14.3' 9.T c LOCATION MAP �' R - 7.0' COTUIT QUADRANGLE 12' � w ti,�ay��°e. ,1.8' L - 32.6' PROPOSM BLUESTONE TERRACE SCALE: 1: 25,000 DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM pR, ���N� a REF: TOWN OF BARNSTABLE BOARD OF ?�,���y c s>p SS �, BMESTONE HEALTH ON SITE SEWAGE DISPOSAL r �N / �' LANDING NOT TO SCALE N CONSTRUCTION GENERAL REQUIREMENT 1.15 pF 11 js, x 10.510 F 11.4 s6. EXISTING/PROPOSED DIMENSIONAL DETAIL,. PERCOLATION TES 11.4 so+ »LE: 1 _ P-8329 e / ,�G x &a DIMENSIONS REFER TOPRO 30' POSED CONSTRUCTION 12-06-94 ® 11;45 AM EXISTING STRUCTURE TO BE DEMOLISHED BAXTER &. NYE, INC. (ENGINEER) EDWARD F BARRY AO 1 .1 ,�^�� x 10 �s9 /7 HAND EXCAVATION 10.4 S ��r 10.1�� D.B. N d• RECONFIGURE 8 B' EXIST DRIVE x 0.3 00 o `Z PERCOLATION RATE: 4 MINUTES PER INCH 44 G x0 0.0 11 GtiF .,o cb x .1 l 6 'S.9 5 4 x 7 u/G _ \ UTILITY x TBM ® CB/DH CB/DH FND G`5 CTRIC ` E 6.0 ro (DISTURBED) STU SB ) - _ P _ Lt� DESIGN DATA: 7 rk •e - - _ ` � DRAIN /' 6.0 ' a 9.0 PROPOSED 4-BEDROOM SINGLE FAMILY DWELLING 8.8 9 •1 - NO GARBAGE GRINDER - - x g.4 x 8' ' NOTE RE UTILITY LOCATION: DESIGN FLOW: 4 x 110 GPD = 440 GPD /6 9. 7 10. 6 LOCATION OF UTILITIES SHOWN PRGPOSED NEW x 5• ` ?O 8 Oc ON THIS PLAN ARE APPROXIMATE, SEPTIC TANK: 440 GPD x 150% 660 GPD �9h 1 ?' •.°' STON'R�ASEAL CONTRACTOR SHOULD VERIFY USE 1500=-GALLON SEPTIC TANK S CB/DH FND / � 9,yLp ` 1• 9 LOCATION WITH "DIG-SAFE" AND WATER DEPARTMENT PRIOR TO 9.0 CONSTRUCTION SEE TOWN OF BARNSTABLE BOARD OF HEALTH ON- �il//�, ` S x 9" W SITE SEWAGE DISPOSAL CONSTRUCTION GENERAL 5 � CESSPOOL i 0 REQUIREMENT 1.14 RE LEACHING FACILITY 250 FEET FaO�OP ` x 7.9 ,� 5 y^ No�Loc�TWED a• FROM WATERCOURSE ` �?.�� <v x D�cn N BOTTOM AREA REQUIRED: 440 GPD/0.75 G/SF/D = 587 SF J / hry <q�N 4'4 5�00.3 USE (3) :8'. x 16' LEACHING CHAMBERS J�.� !• �, �/,y� ,y'�`O �• 0 2 STONE ON SIDES - 3 STONE ON ENDS v P �4• l 10 c,°i� I m BOTTOM AREA: (55 SF x 13 SF)0.83 = 593 -GPD 4 A- h� 8. , z NO ALLOWANCE FOR SIDEWALL AREA ,3.7 10 J TOTAL DESIGN:, 593 GPD � v � o -7 � � - •0 9 x 1 .1 REQUIRED rPD: 587 / `� a� `Op,�o`' 3.3 3.5 CB/bH FND 7 8 x 8.7 �O 3.4 6 CONCRETE GARAGE FLOOR f NOTES •, • s •o , � ��, ;SQL p CELLAR F,1.00R (O AREAWAY) - � � 3.4 5 � Oi�4 /a`t' �'y� 1 .. EL = 5:49' 1. ELEVATIONS REFER TO NGVD LINE OF LOCAL/ 4 2. LINES OF COASTAL DUNE AND LOCAL FEDERAL WETLAND DELINEATED BY FUGRO-McCLELLAND EAST, INC , FLAGGING DATE: AUGUST 23, 1994, `�°oo. AL FEDERAL WETLAND # A- CB/DH FND a PROPOSED WORK LIMIT LINE \ FIELD LOCATION DATE BY BAXTER & NYE, INC. SEPTEMBER 13, 1994 � /0� 'y� INSTALL SILTATION FENCE 3. CURRENT ZONING DISTRICT: RF - 1 �� �� \ MINIMUM AREA 43,560 SFen- FRONTAGE: 20 �, �,.-•,� LOT WIDTH: 125' / I�^ P 1 %+> �► '� SETBACKS (FRONT/SIDE/REAR):30/15/15 pp,M / _ '�` APPROXIMATE UPLAND AREA: 38,390 SF NOTE: RESTRICTION REQUIRES 20' SIDELINE SETBACK 00'1 STORIES, WHICHEVER IS LESSER �o �0 �� 1" G MAX BLDG HEIGHT: 30 OR 2 1/2 y /2 AL APPROXIMATE WETLAND AREA: 32,330 SF f .���� 4. LOCUS FALLS WITHIN AQUIFER PROTECTION OVERLAY DISTRICT Q / �` °0 3 S I T E P L A N moo• TOTAL AREA (TO COMPUTATION LINE) ~ .J-� / -t o i 12 84D FND 70,720 SF f 5. LOCUS IS PARCEL 100 BARNSTABLE ASSESSORS MAP 116 ,50 E �n\ o. o, �,..,�8�go / AT •28 , rn 3.8 N 13 38, AIlc 6. LOCUS IS LOTS 3, 3A & Al AS DEFINED BY PLAN BOOK 225 PAGE 71 �'� $ 9' #27 WINFIELD LANE O O, i.�g 5 2.8 / N -73 OSTERVILLE MASS. AL FLOOD INSURANCE NOT AVAILABLE FOR NEW CONSTRUCTION OR ` g 65 A FOR SUBSTANTIALLY IMPROVED STRUCTURES ON AND AFTER NOVEMBER 16, 1990 IN DESIGNATED COASTAL BARRIERS. ` 1 3 �Q ROBERT• J. DePASQVA f• 1 COASTAL DUNE - SCALE: 1 = 30 OCTOBER 6, 1994 N q� 2.4 ��Lj' PLAN REVISIONS AT LEFT FLOOD ZONE LINES DIGITIZED FROM FIRM 1 2 / _ CB/DH FND BAXTER & NYE, INC. COMMUNITY PANEL No. 250001 0016D y 01 12/84 SURVEY MAP REVISED: JULY 2, 1992 USING FIELD 812 MAIN STREET 2.3 OSTERVILLE, MASS., 02655 LOCATIONS OF CENTERLINE WINFIELD LANE AND ° , 9�0 EXISTING GRAVEL DRIVE ON LOCUS ASORIENTATION > - $ �Z� - .c 1 2.4 CB/DH FND 1X OF 12/84 SURVEY 7 12-09-94 PERC 'TESTIS SYS JRE PETER ����µ u► 6 - - JRE 655 SULLIVAN 11 28 94 RECONFIGURE DRIVE/S-SYS R S � - r2.1 Mo•29733 FIELD TOPO/LOCATION DATES:5 11-16-94 DRIVE/S SYST/TERRACE JRE 74 SEPTEMBER 1'3 & 21, 1994T`' GRAPHIC SCALE 4 11-11-94 BUILDING DIMENSIONS JRE rt (1 ^ 30 0 1 b 30 60 120 OA t E ;. 3 10-27-94 DEMOL EXIST BLDG/BLDG DIMS JRE j REV DRI V/S SYS/WORK LIMIT 2 10-24-94 CHANGE:PROP ADDITION JRE ' � ( IN FEET ) 1 inch = 30 ft. 1 10-20=94 EL1M SSYST MAINFOLD JRE � 94116 (PPP02.DWG) NO. DATE REVISIONS BY • IjCo I�u jf -,� � ' ��_ TOWN OF BARNSTABLE LOCATION � fN�/��=7� 1 SEWAGE # l��i�-ZZe VILLAGE ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO49A4.1� SEPTIC TANK CAPACITY apt) 14 ')L o LEACHING FACILITY: (type/) to 9*$ Fit 11"i- (size) NO.,OF BEDROOMS BUILDER OR OWNERi9itiGST�ia�,y PERMITDATE: ��S°`�� COMPLIANCE DATE: l w - Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility ✓Z Feet Private Water Supply Well and Leaching Facility (If an wells exist PP Y g tY Y 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 t' �'tr ,, r W ., �' � - o'er � '� � � �'.� � _� .� <. :,;