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HomeMy WebLinkAbout0100 EEL RIVER ROAD - Health 100 EEL RIVER ROAD , 116-094 OSTERVILLE '` i f i w a i ' 1 . tf(r - 01`f cCommonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments tl Iv.P 100 Eel River Rd Front system tee; Property Address •` IQ Joanne Dibona r Owner Owner's Name �. information is Osterville Ma 02655 2/19/21 required for every {- page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: forms n A. Inspector Information filling out forms. on the computer, Michael DiBuono use only the tab key to move your Name of Inspector cursor-do not DiBuono Sewer And Drain use the return Company Name key. 35 Content Company Address Cotuit Ma 02635 City/Town State Zip Code 508-364-9587 S113522 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 16.340 of Title 5 (310 CMR 16.000); 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 2/22/21 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form M Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Eel River Rd Front system Property Address Joanne Dibona Owner Owner's Name information is Osterville Ma 02655 2/19/21 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary. - Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System contains a 1500 gallon H2O Septic tank as well as a concrete distribution box and three trenches with pipe in stone. System is functioning as designed 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and'over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y. ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Eel River Rd Front system Property Address Joanne Dibona Owner Owner's Name information is required for every Osterville Ma 02655 2/19/21 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts ` Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Eel River Rd Front system 90- ; m Property Address Joanne Dibona Owner Owner's Name information is required for everyOsterville Ma 02655 2/19/21 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public`Water Supplier, if any) determines_ that the system is functioning in a manner that protects the public health, safety and environment: ❑•The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system,has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal Y to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be'attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must Indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ • Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Forth: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 M 100 Eel River Rd Front system Property Address Joanne Dibona Owner Owner's Name N . information is required for every Osterville . Ma 02655 2/19/21 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ 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 El ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® 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.] ❑ 0 The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA._ Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a'tributary to a surface drinking water supply ❑ the system is located in a nitrogen sensitive area (interim Wellhead Protection Area—IWPA)or a mapped Zone I1.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 Commonwealth of Massachusetts Title 5 Official Inspection Form kv��V-01 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Eel River Rd Front system Property Address Joanne Dibona Owner Owner's Name information is required for every Osterville Ma 02655 2/19/21 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® 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)) t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 ` Commonwealth of Massachusetts Title 5 official Inspection- Form h�I Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Eel River Rd front system _ Property Address Joanne Dibona Owner Owner's Name information is required for every Osterville Ma 02655 2/19121 page. Cityrrown State Zip Code Date of Inspection D. System. Information 1. Residential Flow Conditions: Number of bedrooms(design): 5 Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203,(for example: 110 gpd x#of bedrooms):. 550 Description: Number.of current residents: Vacant Does residence have a garbage grinder? ❑ Yes ® No Does residence have.a water treatment unit? 1 ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readin s, if available last 2 ears usage d 429 GPD Est 9 ( Y 9 (9p )) Detail: Sump pump? ' A ❑ Yes ® No Last date of occupancy: Date r t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 c Commonwealth of Massachusetts Title 5 official Inspection Form c Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 100 Eel River Rd Front system Property Address Joanne Dibona Owner Owner's Name information is required for every Osterville Ma 02655 2/19/21 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Not provided Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped:. gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form I- i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 100 Eel River Rd Front system Property Address Joanne Dibona Owner Owner's Name information is required for every Osterville Ma 02655 2/19/21 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known)and source of information: Installed 9/10/04 Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ❑40 PVC ❑other(explain): Distance from private water supply well or suction line- feet Comments(on condition of joints, venting, evidence of leakage, etc.): System is vented at the roof line t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form F Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ti 100 Eel River Rd Front system Property Address Joanne Dibona Owner Owner's Name. information is required for every Osterville Ma 02655 2/19/21 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ®concrete ❑ metal ❑'fiberglass ❑ polyethylene ❑ other(explain) 1500 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: 3 Distance from top of sludge to bottom of outlet tee or baffle 24" ` 3" Scum thickness 411 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 30" How were dimensions determined? Tape Measure/Data On File Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tee's are in place no signs of leakage t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 100 Eel River Rd Front system Property Address Joanne Dibona Owner Owner's Name information is required for every Osterville Ma 02655 2/19/21 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: El concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 r Commonwealth of Massachusetts F Title 5 Official Inspection Form pi Subsurface Sewage Disposal System Form-Not for Voluntary_ Assessments 100 Eel River Rd Front system w Property Address Joanne Dibona Owner Owners Name information is Osterville Ma` 02655 2/19/21 required 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): . Depth of liquid level above outlet invert Level and at normal level 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.): t5insp.doc•rev.7126=8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts ? Tale 5 official Inspection Form M1 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M ct 100 Eel River Rd Front system Property Address Joanne Dibona Owner Owner's Name information is required for every Osterville Ma 02655 2/19/21 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or 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: 3 42' ❑ leaching fields number, dimensions: ❑ 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Eel River Rd Front system Property Address Joanne Dibona Owner Owners Name information is required for every Osterville Ma 02655 2/19/21 page. Cityfrown 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.): No ponding no break out 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y 100 Eel River Rd Front system Property Address Joanne Dibona Owner Owner's Name information is required for every Osterville Ma 02655 2/19/21 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth&Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Eel River Rd Front system Property Address Joanne Dibona Owner Owner's Name information is required for every Osterville Ma 02655 2/19/21 �;j- 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 8/2V2019 Assessing As-Built Cards TOWN OF BARNS I'ABLL • LOCATION 1 tp CE L h0e-V SEWAGE 0 a009 U t S r U%k\JE. ASSESSOR'S MAP&LOT! INSTALLER'S NAME&PHONE N0, R4 A r SEPTIC TANK CAPACITY " ' Inc size LEACFIDJO FACILITY:(type) 7 r! we (size) *Y0 NO.OF BEDROOMS �_ BUMDER OR OWNER �n ' CO PERMPPDATE:�''ab'^O`� COMPLIANCE DATE: /o Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 14 P°Y_ 46, t, 0 https://townofbamstable.us/Departments/Assessing/Property_Values/HMdisplay.asp?mappar=116094&seq=2 1/2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 90 100 Eel River Rd Front system11 - Property Address Joanne Dibona Owner Owner's Name information is required for every Osterville Ma 02655 2/19/21 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 6.5 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 4 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Test hole data on plan 1 . Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments yya M ,v 100 Eel River Rd Front system Property Address Joanne Dibona Owner Owner's Name information is required for every Cisterville Ma 02655. 2/19/21 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 c Commonwealth of Massachusetts `j 0 5 q . Z Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments c 100 Eel River Rd Rear System' Property Address ; Joanne Dibona s c Owner Owner's Name A information is required for every Osterville Ma 02655 2/19/21 page. Citylrown 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:When filling out forms A. Inspector Information Slip $i5q on the computer, Michael DiBuono use only the tab key to move your. Name of Inspector cursor-do not DiBuono Sewer And Drain use the return Company Name key. , h 35 Content Ln ' IL�I Company Address Cotuit Ma 02635 City/Town State Zip Code 508-364-9587 S113522 Telephone Number License Number B. Certification 1 certify that: 1 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 2/22/21 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 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ° r`K . , 100 Eel River Rd Rear System Property Address Joanne Dibona. Owner Owner's Name information is required for every Osterville Ma 02655 2/19/21 - page. Citylrown State Zip Code Date of Inspection C. Inspection Summary , `Inspection Summary: Complete 1, 2, 3, or 5 and all of and 6. 1) 4System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System contains a 1500 gallon Septic tank as well as a concrete distribution box and two trenches with pipe in stone. System is functioning as designed 2).? System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of .Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance.indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts ro Title 5 Official Inspection form A Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Eel River Rd Rear System , Property Address Joanne Dibona Owner Owner's Name information is required for every Osterville Ma 02655 2/19/21 page. Cityfrown 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 ppumps/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 pumpingmore 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): El obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and,the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 c Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Eel River Rd Rear System Property Address Joanne Dibona Owner Owner's Name information is required for every Osterville Ma 02655 2/19/21 page. Cityrrown 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 ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form .i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,. 100 Eel River Rd Rear System Property Address Joanne Dibona Owner Owners Name information is required for every Osterville Ma 02655 2/19/21 page. CitylTown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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/z day flow ❑ .® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain,of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® 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 11 ❑ _ 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 Commonwealth of Massachusetts Title 5 Official Inspection Form F i Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 100 Eel River Rd Rear System Property Address Joanne Dibona Owner Owner's Name information is required for every Osterville Ma 02655 2/19/21 page. CitylTown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the conditlon 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments y� ,. 100 Eel River Rd Rear System Property Address Joanne Dibona Owner Owner's Name information is required for every Osterville Ma 02655 2/19/21 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: Number of current residents: Vacant Does residence have a garbage grinder'? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): 429 GPD Est Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Date 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 100 Eel River Rd Rear System Property Address Joanne Dibona Owner Owner's Name information is required for every Osterville Ma 02655 2/19/21 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203)- Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Not provided Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Eel River Rd Rear System Property Address , Joanne Dibona Owner Owners Name information is required for every Osterville Ma 02655 2/19/21 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed(if known)and source of information: Approximate install date Unknown, appears to be original to home before new construction Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. Building Sewer(locate on site plan): 2 Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): System is vented at the roof line t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 - CommoSnwealth of Massachusetts R -. (P Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Eel River Rd Rear System Property Address Joanne Dibona Owner Owner's Name information is Osterville. Ma 02655 2/19/21 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cony) 6. ,Septic Tank.(locate on site plan): Depth below grade: x 1 feet Material of construction: ®,concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1500 If tank is metal, list age: ° years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No . . 1500 Dimensions: Sludge depth: 3 2411 Distance from top of sludge to bottom of outlet tee or baffle 311 Scum thickness 4" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 30" How were dimensions determined? Tape Measure/Data On File Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tee's are in place no signs of leakage t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form yy�] Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M ,• 100 Eel River Rd Rear System Property Address Joanne Dibona Owner Owner's Name information is required for every Osterville Ma 02655 2/19/21 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form M1 Subsurface'Sewage Disposal System Form-Not for Voluntary Assessments 100 Eel River Rd Rear System Property Address Joanne Dibona ` Owner Owner's Name information is required for every. Osterville Ma '02655 2/19/21 page. Cityrrown 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 Sox(if present must be opened) (locate on site plan): , Depth of liquid level above outlet invert Level and at normal level 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.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts x Title 5 Official Inspection form M Subsurface Sewage Disposal System Form- Not for Voluntary Assessments s M - 100 Eel River Rd Rear System Property Address Joanne Dibona Owner Owner's Name information is required for every Osterville Ma 02655 2/19/21 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10, Pump,Chamber(locate on site plan): Pumps in working order:' ❑ Yes ❑ No" Alarms in working order: ❑ Yes . ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or 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: 2 38 ❑ `leaching fields number, dimensions: ❑ -overflow cesspool number: ❑ innovative/alternative system Type/name of technology. t5insp.doc•rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 c Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments .�� 100 Eel River Rd Rear System Property Address Joanne Dibona Owner Owner's Name information is required for every Osterville Ma 02655 2/19/21 page. Cityrrown 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.): No ponding no break out 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert t 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 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Eel River Rd Rear System Property Address Joanne Dibona Owner Owner's Name information is required for every Osterville Ma 02655 2/19/21 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13: 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 1S Commonwealth of Massachusetts Title 5 official Inspection Form c Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,. 100 Eel River Rd Rear System Property Address Joanne Dibona Owner Owner's Name information is required for every Osterville Ma 02655 2/19/21 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 r t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 -T-S3 •�i 15,3 It https:/ltownofbamstable.us/Departments/Assessing/Propetty Values/HMdlsplay.asp?mappar-116084&seq=1 1/2 r . 4 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Eel River Rd Rear System Property Address Joanne Dibona Owner Owner's Name information is required for every Osterville Ma 02655 2/19/21 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 6.5 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: 4/27/04 Date ❑ Observed site(abutting propertylobservation 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:. Test hole data on plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts �M1 Z Title 5 official Inspection Form iSubsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Eel River Rd Rear System Property Address Joanne Dibona Owner Owner's Name information is required for every Osterville Ma 02655 2/19/21 page. Cityrrown 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 checked El 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:Sut=rface Sewage Disposal System•Page 18 of 18 W,Town of BaAnstable OpfME Tp y Regulatory Services ' ., . .. ... F Thomas F.Geiler,Director ► 1AMSTABLE, 9 MASS. Public Health Division .t63.9. `0m FEDa Thomas McKean,Director 200 Main Street,Hyannis,MA 02601.' Office:.508-8624644 Fax: 508-790-6304 Installer & Desiener Certification Form Date: 6 OS' Designer: A5c 6-,,Qoy19 Installer: Address: 65-7 6'Y/4sn/ $;%� r, U1VC7-6 Address: L✓ �i�6z�'►oo�H , eq On was issued a permit to install a (date) (installer) septic system at JDo Eg( ✓Lr✓ram 12o.40, SY57,cM`;5 based on a design drawn by (address) - f7SC 'GROvIo dated7� (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 any vertical relocation of any component of the septic system)but in accordance with State & Local Regulations. Plan revision or certified as-built by desi er to follow. i stalle Signature). CwsF4N CML No.32112 /ONALEN� . esigner'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 7 I No. Fee THE COMMONWEALTH OF MASSACHUSETTSi Entered in computer: _- VY PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,, MASSACHUSETTS 01pprication for Migozar *pgtem Construction Permit S)S yLfn Q--> Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) complete System ❑Individual Components Location Address or Lot No. ` )V e r— O E Owner's Name,Address and Tel.No. (� Assessor's Map/Parcel I ) �(� �1 �r , Lc x W r e-.n Cam. l� c)�_ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. v ,jr C. 5,n S7L>1eSOS : C C)YDIX-P Type of Building: Z 331 Dwelling No.of Bedrooms Lot Size�sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers(Tj ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned es to ensure the constructi a' cc o e afore described on-site sewage disposal system in accordance with e,provisions of Title 5 of the al Co e a not to place the system in operation until e ' t- cate of Complianc ee oard f �' l Sig Date v Application Approved by Date :Application Disapproved for the following reas Permit No. Date Issued (� { G•... �. (� sty/^�y/j�f `iL � �✓'{ Y / ,a. Vc- Fee Entered in computer: 4' TlE COMMONWEALTH OPWNScSA IUSE: S Y PUBLICtHEALTH DIVISION -I-TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for Mf6potaf *p.5tem Construction Permit pplication for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) complete System ❑Individual Components A Location Address or Lot No. I t>D 4 2 1 V e Y— ��` s ^O.,wner's Name,Address and Tel.No. Assessor's Map/Parcel 1 ) n oC1 L) u f L cx l u► v n C-e Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 2 °a 1� C.L S? rv�c� 1�-c� SL, SUCI 0)7-3 `�C C-,YUL\. p ' Type of Building: `s i 331 Dwelling No.of Bedrooms S Lot Size 9sq.ft. Garbage Grinder( ) �i Other Type of Building No. of Persons Showers( Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil ,.r Nature of Repairs or Alterations(Answer when applicable) Date last inspected: # Agreement: f The undersigned.agrees to ensure the constructi a rin�a'- ce of e afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the ...I,'n C •e a not to place<th ystem in operation until e •ifi- cate of Compliance ash ee ems. _ y-th`is Board f Signe Date r Application Approved by ti��° 9.- v. 1 Date Application Disapproved for the following reasons 1 4 Jr--- Permit No. Date Issued U V t 'THE COMMONWEALTH OF MASSACHUSETTS s -5 c I 10/r, BARNSTABLE, MASSACHUSETTS Certificate of Complia 're " THIS IS TO C T Y, that t e Oti-site Sewage Disposal System Constructed.(, *)Repaired ( )Upgraded( ) Abandoned( )by /�1 at 6L) 1 1,�r Rd r. j Nr , S an � r� f �`h s been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ( dated r Installer Designer The issuance of this ermXsl� fesystef not be construed as a guarantee that �cti as desi ned.g Date ��� Inspec NO. Fee vvv THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migogal *pgtem Construction Permit Permission is hereby granted to Construct repair( )Upgrade( )Abandon( ) System located at � � i`✓�8.y' _ and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following.local provisions or special conditions. Provided:Construction - ust be completed within three years of the d Cteef this p 't. Date:_. �� Approve TOWN ORBARNSTABLE L'OG4TION c j f^� (=. C, SEWAGE #A004 J I 4VIL AGE t�S=�z v \� ASSESSOR'S MAP & LOT11 INSTALLER'S NAME&PHONE NO. B414 (fC,1 1.54,oC CV'C Q. . SEPTIC TANK CAPACITY 5 SSG LEACHING FACILITY: (type) l 2v%c—La.2 5 (size) q'YO NO. OF BEDROOMS BUILDER OR OWNERi PERMITDATE: �' Jp-O COMPLIANCE DATE: �� v 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 it •(0 1 ' (t0, fog' _�T_v 13 Co f to B5 •- 6 , 87 _ r19 ' k. TOWN OF BARNSTABLE LOCAyTTON IJQ EEL lr/e✓ R4 SEWAGE # `VILLAGE 13SL-rij,Ile ASSESSOR'S MAP & LOT 0 INSTALLER'S NAME&PHONE NO. R 5d2-5:yJ a-ROW SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 7rem aAe.S (size) ?f?Q �. ^ NO. OF BEDROOMS o� BUILDER OR OWNER / PERMIT DATE: y 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 a.s. F Fee— --------------- No. - BOARD OF HEALTH TOWN OF BARNSTABLE Apptication,forVerf Congtruction3permit Application is hereby made for a permit to Construct O4), Alter ( ), or Repair ( )an individual Well at: i a Location — Address Assessors Map and Parcel 4 i {^ c r Vd ��Q- `tc1nGl Owner JAddress v Qlr Installer -riller Address — — Type of Building Dwelling -— ------ -- - ----------- Other - Type of Building —--------- No. of Persons-------------------------- I i -F Type of Well— — G-1C�-`��— ---- Capacity — Purpose of Well-----1�1�i -------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until Certific to.. Compliance has been issued by the Board of Health. ------- -- _ i 70�— Sig — date Application Approved By -- -------——— _--{ date Application Disapproved for the following reasons:-------------- —--- - --------- ----------- --- ---------------------------- -- date Permit No. —t�J-` -t�� _ -- Issued---;-°�►��.�-�� -------- date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate Of Compliance THIS O CERTIFY, That the Individual ell Constructed Altered ( ), or Repaired ( ) y------ -- -- -- - ------------------ Install r has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. --------------------Dated-------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--------------------- -— —-- Inspector------------------------ ----- ----— - J ..+.` `c'iy7' ih' ti ry1 Fqie-e----------- BOARD OF HEALTH TOWN OF BARNSTABLE zipplicat ion for Veil construction3pertnit Application is hereby made for a permit to Construct ( ,), Alter ( ) or Repair ( )an individual Well at: b a F 2n\_ rs Ma and Parcel ---- )I • Location - Address p Tic [.raw M"u, ��1 or a —_ I 6!aJ'Asr S �` Q-kyi.s_ikA o? i Owner 1jAddress DkSmohc�wt�� �ti� - yy\ YY\ana lQ O�Z�g3 QC��A A o2653 Installer --Driller Address Type of Building Dwelling -- -- Other - Type of Building— ------------ - No. of Persons--------------------- o+ C�Pm Type of Well—y—SC\�L1 O P v C- _ Capacity---- _—--——---- — Purpose of Well Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until d Certificate.of Compliance has been issued by the Board of Health. --------------- •r 7-10 s Signed — --- date Approved Application By -- ------ --'--11-- -L �/ date n Application Disapproved for the following reasons:-------- - --- - -- -- ---- w l — ----- t ' date Permit No. Issued--------�----�-�- �-------------- date _ r --r_: -,-, �,,..-ac•,,:.R=�'---_��._.,�:f-...•-era- ��,�,� .�.-._�-,-...�� BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f (Compliance THIS IS-,,TO CERTIFY, That the Individual-Well Constructed ( Altered ( ), or Repaired ( ) y Installer • 1 at has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection r i;��; Regulation as described in the application for Well Construction Permit No. ---------------Dated----- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL- SYSTEM WILL FUNCTION SATISFACTORY. DATE----- --- ---- - -- Inspector------- - ---- —------ BOARD OF HEALTH TOWN OF BARNSTABLE Ivell con5truct ion 3permit No.----- Wi t(— f 4 Fee=" — � i� GL- GGt rmi ion is hereby ranted �®�'� ��' � �-- &= --- 4�-=---------- Pe ss y g j' to Construct (✓), Alter ( ) or Repair ( ) a Individual Well at: e�6 Street as shown on the application for a Well Construction Permit ____i_ __%_°_`�� No.----- -- ---_—_—_ Dated----- _----------------------------- _ =!` -------------------------------- C Board of Health DATE—! — f a 1.4B0RATORIES IVO Ei�%IR07 EC11 11L4 OERT.NO.:Al-AL4 00 ,hAP f cp 8 j an Sebasd.w Dr- Unfr#12 Sandwich tII (I25(3 To PARCEL O sob(888-64ran) 1-ettf�339-fi 61J s, ' t3.:p��` `E fobs (508)888-64 CLIENT. Desmond Well Drilling LOCATION: "tl``s5�p 01 O'EeI-River Rd ADDRESS: (DiBona) Osterville MA COLLECTED BY: -Desmond Well Drilling SAMPLE DATE: 10/2/2004 SAMPLE TIME: 12:00 WATER SAMPLE TYPE: New Well DATE RECEIVED: 10/4/2004 LAB I.D. #: 0410030 WELL SPECS.: 4" SCH 40 PVC Irrigation 40'/18' RESULTS OFANALYSIS: Parameters Units Recommended Results Method Date Analyzed Limits Coliform bacteria / 100ml 0 0 9222 B 10/4/2004 pH pH units 6.5-8.5 5.79 4500 H+ 10/4/2004 Conductance umhos/cm 500 254 120.1 10/4/2004 Nitrate-N mg/L 10.0 3.99 300.0 10/4/2004 Nitrite-N mg/L 1.00 <0.004 300.0 10/4/2004 Sodium mg/L 20.0 32.9 200.7 10/5/2004 lion mg/L 0.3 < 0.1 200.7 10/5/2004 Manganese mg/L 0.05 0.022 200.7 10/5/2004 COMMENTS: Low pH indicates high corrosive characteristics. Sodium level is not a health hazard. WATER MEETS EPA STANDARDS AND IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. <=less than Date��• l Z�C� >=greater than --- TNTC=too numerous to count nald J. Saari Laboratory Dir for Massachusetts Department of Environmental Management 1 i Office of Water Resources 1 34 y 6 6 TYPE OR PRINT ONLY i Well Completion Report 1.WELL LOCATION GPS (OPTIONAL) LATITUDE LONGITUDE P . Address at Well Location:/00 ``"��� Rt Property Owner. - l--• t ��Y`�. Subdivision Name: Mailing Address: «Ock vqo S n ml__,- 4, City/Town: 0�P.rq'WL- City/Town: \t 1R`1 � o -q$l „ Assessors Map Assessors Lot#: NOTE: Assessors Map and Lot# mandatory if no treet,addrTry av ila le ElA, .Is Board of Health permit obtained: Yes �. Not Required Permit Number Z00q'Oyu DDates ed b 2. WORK PERFORMED = 3.'PROPOSED'USE 4. DAILLINOVETHOD C] New Well ❑ Abandon ❑ Domestic PQ Irrigation ❑ Cable ©;Auger ❑ Deepen ❑ Recondition ❑ Monitoring ❑ Municipal ❑ Air Hammer'❑ Direct Push ❑ Replace ❑ Other ❑ Industrial ❑ Other ❑ Mud`Rota `:0 w❑ Other 5.WELL LOG - i= Unconsolidated Consolidated 6:-SITE SKETCH(use permanent landmarks with distances)v - W Permeability Q � From (ft) To (ft) 3� v High Low C7 m Other Rock Type S r 11 eo o -14 X x 'X L I 4+.s fi -I NA 7.WELL CONSTRUCTION 8.-CASING 3 Total Depth.Drilled 410 From (ft), To (ft). Casing Type and Material Size O.-D..(in) Well Seal-Type - Date Drilling Complete A W' ~3(, tit�►, PVC `'� alZ 0 k B.-SCREEN. = 2 From (ft) To (ft) Slot Size Screen.Type and Material Screen Diameter L '' 10 FILTER PACK tGROUT/-ABANDONMENT MATERIAL 11.ADDITIONAL WELL INFORMATION g Developed? N Yes El No From.(ft) To (ft) Material Description Purpose Fracture _ `., Enhancement? ❑ Yes `'[g No , A Method d Disinfected? [9 Yes ❑ No 12.WELL EST DATA(PRODUCTION'`WELLS} �p 13. STATlC-WATER-LEVEL(ALL WELLS) x Yield Timped Drawdown to Time Recovery to Depth Below Date Method (GPM} (lirsme.Pu& min) (Ft. BGS) (hrs & min) (Ft. BGS) Date Measured Ground Surface (FT) P W4 14.=PERMANENT PUMP(1F`AVAiLABLE) . `._ .=� 15 g, :`NAMFIADDRESS OF PUMP INSTALLATION COMPANY Pump Description oul 25 GS(� Horsepower , 'S yy_fz1 Q�' 1Iin t 1�_ Pump Intake Depth , ` (ft) Nominal Pump Capacity 2� (gpm) 5 . (J(-UAVRvk,0Z653 16.COMMENTS 17.WELC ORILLEA'S STATEMENT',_-,-' This well was drilled and/or abandoned under-my supervision, according to applicable rules and regulations, and this report4, complete and'corre t to the best of my knowledge. ol Driller: ervising Driller Signature: " Registration #: Firm: Date: Rig Permit#: NOTE. Well Completion Reports must be filed by the registered well driller within 30 days of well completion. BOARD,OF HEALTH COPY r t fi C(J f mu m LL �T ep a S p, m C i � l s1 U T D c m 'J 1 N I II f-- _.- � i 3 ................._ .r c TV N . . ►�� N F MASS e o`y�FS� lCt ELE TU OR s o. 4774 cn RU TURAL — r ♦� MICHELE C. TUDOR, E. p ��������(( - -- Consultinq Structural Engineer Poz-� 1� 123 Cottonwood Lone, Centerville, uo3aochu3ct 02632 D i DWG ��i pe�c� Drown By: TACT Dote: 30 ..Q. -___�r aW1I1 oo r%rL �N�+z- g Scale: AS NOTED Rev, o - File Nome: Project No.: �- l �� --KoioVo ' � s ....�.� .'��...._..... �V I�--- S.1No�1 �12 AT AU- . ►1 N=5 i � � a M � I Mgss9� M I H LE yG X f C. N VILA (�11 YJ.> N T D R 74 11 ST UMURAL ST PlAFl. : MICHELE C. TUDOR, P.E �� — Consulting Structural Engineer 3 r�x PO S e Po(z. 123 Cottonwood Lane, Centerville, M=ochusetts 02632 PjNA Drawn By: 1ACT Date: ?0 tot..-- DraWln Scale: AS NOTED Rev. n �LE , T��; - �K--2 of File Name: Project No.: I DiBONA RESIDENCE SK-3 of 3 100 EEL RIVER RD., OSTERVILLE, MA PROPOSED PORT.E COCHERE CONSTRUCTION GENERAL NOTES AND MATERIAL SPECIFICATIONS: FOUNDATIONS 1.All workmanship to conform to the requirements of the Massachusetts State Building Code,latest edition. 2. For site location and grading inforniation,see Site Plan,by others. Work this plan with architectural plans by others. .3. Assumed net allowable soil bearing capacity,q=4000 psf,for a compacted medium sand/gravel composition. Other soils encountered,contact the Engineer of Record. Compact backfill soils around perimeter with a vibratory compactor. Add sand/gravel mix,as required during compaction to provide final grade. 4. Concrete: Minimum 28 day strength,fc=3000 psi,3/4"aggregate,designed per American Concrete Institute Code,latest issue maximum slumh =4". a.) Steel reinforcing bars: new billet steel,ASTM A-615,Grade 60. Provide 2#5 perimeter ring at top of wall,max.2"clear. b.) Anchor bolts ASTM A307 galvanized,5/8"diameter, 12"long,w/2"hook,spaced at 4'-0"o/c max.,max. F-0"from jogs unless otherwise noted. c.) Welded Wire Fabric:(optional)ASTM A1.85;furnish flat sheets. install in top V of slabs-on-grade for temperature/shrinkage crack control. FRAMING 1.All workmanship to conform to the requirements of the Massachusetts State Building Code,latest edition. 2.Structural Design Loads: Dead Loads:Actual Weight ol'Building Componcnts Live Loads:Snow Load=25 psf plies drill 2N1)Floor=30 psf IST Floor = 40 psf Wind Load=21 psf 3. Structural Steel: (as required) a. ASTM A572 Grade 50;shop paint with rust inhibitive paint.Th u-Bolts: ASTM A307, 1/2"diameter;punched holes in plates:9/16"diameter. b. Welds: Shop weld cap and base plates to columns;shop weld bearing plates to beams;use E70xx electrodes. Alternatively,field weld by certified welders. C. Deflection Criteria: L/360 total load deflection. 4.Timber Framing: a.All new timber framing:Spruce-Pine-Fir No.2 with Fb=I000psi,E=1,300,000 psi,or better. b.Pressure treated timber(P.T.):Southern Pine with Fb=1300 psi,E=1,600,000 psi,or better. c.Laminated Veneer Lumber:All L.V.L.shall be MICRO--LAM L.V.L.(M.L.)with Fb=2925 psi, E=1,900 ksi,Fv=285 psi,Fc_per=750 psi,Fc_iar=3035 psi. Parallam(PSL):All PSL shall be 1.9E ES with Fb=2900 psi,E=2,000 ksi,Fv=290 psi,Fc_per=750 psi,Fc_par=29(N)psi. Note that MicroLam and Parallam may be used interchangeably. 1. Deflection Criteria: L/480 Live Load,L/360 Total Load 2. Optional: Provide shop drawing submittal of engineered lumber systems for approval prior to materials purchasing. 3.Metal.Connectors: As manufactured by Simpson Strong-Tie Co.shall be handled and installed per manufacturer requirements,with all nail holes tilled,with the size nail as specified herein. 4.Bolts: Bolts in wood framing shall be standard machine bolts unless noted otherwise.Bolt holes in wood shall be 1/32"larger than bolt diameter.Bolt heads and mats shall bear on standard malleable iron washers,or square plate washers.All nuts shall be retightened at completion of job. 5.Blocking: a.Blocking shall be solid blocking,2x minimum,and full depth of member. b.Stud Walls:provide blocking at 8'-0"o/c,maximum height. c.Nailing Schedule: Solid Blocking to Bearing 2-8d toenails ea.side ,;NOF MgssgC Blocking Between Studs 2-10d toenails ea.end,or 2-10d end-nails ea.end �y> MtCHELE yGJ, 6.Nailing Schedule: All nailing shall be in accordance with Appendix C,unless noted herein specifically. TUDOR Multiple Studs 16d @ 12"staggered o No 34774 a.All nails shall be common wire nails. � TRUC-TURPAL b.Sub-bore where;nails tend to split wood. 7. Headers less than T-0",use 3-2x6;all others per MA State Building Code Table 3606.2.6. gFGISTEP��` �IONAUL r r 8�3v�D COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTEC IOrRECEIVED n F to F. d10, SEP 10 2002 C TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 11L OFFICIAL INSPECTIONFORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM 7' PART A CERTIFICATION Property Address: 100 EEL RIVER RD OSTERVILLE,MA 02655 Owner's Name: LARRY DIBONA, Owner's Address: DUNHILL CO. 776 AMIN ST OSTERVILLE MA 02655 Date of Inspection: 8/19/02 r , Name of Inspector:(please print) JOHN GRACI Company Name: "` SEPTIC INSPECTIONS Mailing Address: ?- Pi.0. BOX 2119 TEATICKET,MA.01536 cop Uff t Telephone Number: 508-564-6813 FAX 568-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected t_he 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: X Pagses Conditionally P ses Needs Furtile aluation by the Local Approving Authority Fails t Date: 8/19/02 Inspector's Signature: f The system inspector shall submit a opy of this inspection report to the Approving Authority(Board of Health or DEP)within of 10 000 d or greater,the 30 days of completing this inspection. If the system.is a shared system or has a design flowgp g Y inspector and the system owner shall-ksubi_lit 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 SYSTEM PASSED TITLE V INSPECTION. RECOMMEND PUMPING,NOW AND THEN EVERY TWO YEARS TO PROLONG THE SYSTEM'S.U$EFUL,LIF�E, report only descrj-�es conditions at the time of inspection and under (lie conditions of use al lhul Mule.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Incnertinn Fnrm 6/1 S,q,- no,-,i' t r � Page 2.of 11 r. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) �k k � Property Address: 100 EEL:R'IVER RD OSTERVILLE, MA 02655 Owner: LARRY DIBONA Date of Inspection: 8/19/02 Inspection Summary: Check A,B,,C,D or E/ALWAYS complete all of Section D A. System Passes: t 10 X I have not found any information+which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure,criteria not evaluated are indicated below. Comments: SYSTEM PASSED TITLE V INSPECTION. RECOMMEND PUMPING NOW AND THEN EVERY TWO YEARS TO PROLONG THE SYSTEMS USEFUL LIFE. 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. Answer yes,no or not determined(Y;N,ND) in the for the following statements. If"not determined"please explain. n/a 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; ank 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 oldis.available. ND explain: n/a n/a Observation of sewage backup or'-break o6t or high static water level in the dirt ibution 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, ND explain: n/a n/a The system required pumpink 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 i t NU explain: n/a t { 7 Page 3 of,I I ". OFFICIAL INSPECTION FORM - NOT FOR VOLL`1"+ 'ARY ASSESSMENTS SUBSURFACE SE' AGE DISPOSAL SYSTEM i.*+��PECTION FORM. PART A CERTIFICATION(continued) Property Address: 100 EEL RIVER RD OSTERVILLE,MA 02655 Owner: LARRY DIBONA s Date of Inspection: 8/19/02 C. Further Evaluation is Required;b, tiie:Board of Health: _ Conditions exist which requir6further evaluation by the Board of Health in ord--i-t-a determine if the system is failing to protect public health,safety or the enviroum:nt. 1. System will pass unless Board of,Health determines in accordance with 310 CMR 15.303(1)(b)that the sysiem is not functioning in a manner,which will protect public health,safety acid the environment: _ Cesspool or privy is wit hin50,'fee of=a,surface water _ Cesspool or privy is within,50 feei.of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board J Health(and Public Water Supplier; if any)determines that the system is functioning in a .anner 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. .F _ 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 are SAS and the SAS is less than 100 feet Lut 50 feet or more from a private water supply well**. Method used to determine distance n/a **This system passes if.the well,water analysis,performed at a DEP certified iaboratory, for coliform bacteria and volatile organic compounds indicaes that the well is free from pollution frorr.that facility and the presence of arnmonia nitrogen and nitrate nitrogen is eGua1 to or less than 5 ppm, provided that rio tither failure criteria are triggered. A copy of the analysis must be attached.to t' %s`form. s 3. Other: n/a fG 14.E .cp z F, 5, d Page 4 of I i y , OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 100 EEL.RIVER RD.OSTERVILLE, MA 02655 Owner: LARRY DIBONA ;. Date of Inspection: 8/19/02 I�g D. System Failure Criteria applicable ra all systems: You must indicate"yes"or"no"to each of the following for alLinspections: Yes No 1 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 distnoution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than''/z 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 NO PIJMPIN( INFORMATION. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspoo'I,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. IThis system passes if the well water analysis, performed at a DEP certified laboratory, foe,coliform bacteria and volatile organic compounds indicates that the well is free from pollution from`that And the presence of ammonia n'.t�ogen and nitrate nitrogen is equai to or less than 5 ppm,provided thvif no other failure criteria are triggered.A copy of the analysis must be attached to this form:1 (Yes/No)The system fails.'1 hdie determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the sysfem'fai s". Fe' system owner should contact the Boa-id 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 desig�:l 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 Iorge systems in addition to the criteria above) yes no X the system is within 4010,feet of a surface drinking water supply X the system is within 200 feet of a't,ibutary to a surface drinking water supply X the system is located in a nitrogen Sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water'suppi,y Nell If you have answered"yes"sto eny question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large syste r nos failed.The owner or operator of any large system considered a significant threat under Section E or Failed under Sec%ioii DshaWupgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional of ice of the Department. a Page 5 of_I 1 OFFICIAL INSPECTION,FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B as CHECKLIST Property Address: 100 EEL RIVER.RD.OSTERVILLE,MA 02655 Owner: LARRY DIBONA Date of Inspection: 8/19/02 Check if the following have.been`done.'�Ypu must indicate "yes" or"no" as to each of the following: ;t Yes No " X, _ Pumping information:was,provided liy 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 o`f 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'? X _ 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 occtipants.,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.tbo 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 15.30,(TM] t. {I Page 6 of 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART C SYSTEM INFORMATION Property Address: 100 EEL RIVER RD OSTERVILLE, MA 02655 Owner: LARRY DIBONA Date of Inspection: 8/19/02 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 5 Number cf bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (fo example: 110 gpd x#of bedrooms): 550 Number of current residents: 2 Does residence have a garbage grinder(yes or 7o): NO Is laundry on a separate sewage system(yes or no): NO (if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): n/a Sump pump(yes or no): NO Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203).n/agpd Basis of design flow(seats/persons/sgft,etc.):n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no):-,, Non-sanitary waste discharged to the Title 5 system(yes or no): NO . Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: NO PUMPING INFORMATION Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons-- How was quantity pumped determined? n/a Reason for pumping: n/a 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. At:acr 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): n/a Approximate age of all componefits,date installed(if known)and source of information: 1993 PER ASBUILT Were sewage odors detected when arriving at the site(yes or no): NO • Page 7 of 11. A .A OFFICIAL INSPEC'1 IONYORM—NOT FOR VOLUNTARY ASSESSMENTS ACE,SEt'�AGE DISPOSAL SYSTEM INSPECTION FORM SUBSURF PART C SYSTEM INFORMATION(continued) Property Address: 100 EEL RIVER RD OSTERVILLE,MA 02655 Owner: LARRY DIBONA Date of Inspection: 8/19/02 g BUILDING SEWER(locate oh,site plan) ' Depth below grade: 66" Materials of construction: cast iron X40'PVC_other(explain): n/a ; Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 60" Material of construction: Xconcrete metal .fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is''age*con irtned',6y a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 2000G L 12' H 6' W 6' 6"". Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 7" , Distance from top of scum to top of outlet tee,or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 11" 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.): - SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING NOW AND THEN EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. t.y GREASE TRAP:—(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,°etc.;,: n/a ul Page 8 of 1 I' „ OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM :INSPECTION FORM' PART C SYSTEM INFORMATION(continued) Property Address: I00 EELUIVER RD OSTERVILLE, MA 02655 Owner: LARRY DIBONA Date of Inspection: 8/19/02 jo TIGHT or HOLDING TANK: (tank.must be pumped at time of inspection)(lorate on site plan) Depth below grade: n/a i Material of construction:_concrete rnetal fiberglass_polyethylene_other(explair)`. n/a. Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working2or:er(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and flow s,,rvitches,etc.): n/a DISTRIBUTION BOX:.X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE Comments(note if box is level and dist-rib."Llon to outlets equal, any evidence of solids carryover,any evidence of leakage into or out of box,etc.): D-BOX WAS VIDEO INSPECTED'AINIIYIS STRUCTURALLY SOUND. j PUMP CHAMBER: _(locate on"site,plan)'< 3 Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,'•condition of pumps and appurtenances,etc.): n/a { Y.l t ,rL .. 's � 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: 100 EEL RIVER RD OSTERVILLE,MA 02655 Owner: LARRY DIBONA Date of Inspection: 8/19/02 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type n/a leaching pits, number: n/a n/a leaching chambers, number: n/a GALLIES leaching galleries, number: 4 n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): GALLIES ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.SYSTEM SHOWS NO SIGNS OF FAILURE.BOTTOM IS AT 10 FT.THE GALLIES APPEAR TO HAVE Y OF STONE AROUND THEM. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no):NO Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a 4 Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(cont;nuted) Property Address: 100 EEL RIVER RD OSTERVILLE,MA 02655 Owner: LARRY DIBONA Date of Inspection: 8/19/02 :4 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. c. AA IV AF t: AC. W to , �n Page 11 of l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 100 EEL RIVER RD OSTERVILLE, MA 02655 Owner: LARRY DIBONA Date of Inspection: 8/19/02 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to do-termine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain::.n/a You must describe how you established the 1.,Agh ground water elevation: HAND AUGER- 12+ FT: { { t r APPMED Fxs......../t1.�.... THE COMMONWEALTH OF MASSACHUSETTS �.. AR® OF HEALTH Signed ate TOWN OF BARNSTABLE Appliratiou fur Diripniia1 World, Towitrnrtinn Prrmit Application is hereby made for a Permit.to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst at: 0 l�� ...................... --- ...............-- ocaLon-Address - or Lot No. 0 or 1 d v .L(.----/�r_v.etc.--....1�............................... -- ------ �` dOwner dress �^ W ✓ / )/r"bI� �J S ...r Installer Address Type of Building Size Lot............................Sq. feet ,.., Dwelling—No. of Bedrooms..... ------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ..........:......._--.--___ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ...._---------------------------------------------------------------------------------- W Design Flow......................................------gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacityI1_a�LgalIons Length---------------- Width................ Diameter................ Depth................ x Disposal Trench--No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No.___--._.-_------.- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by------------------------ ................................................. Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit-_-__-__.-.__-_--_-_ Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 1:4 ODescription of Soil..............--...---•-------•----------------------------•-------------!-------------------------------------- -----•----•---------------........................... x U •••-•----•-------------------------•--•-••--•--••••••••--•-•---•-------•---•-••-•-•---------------........•----•-----•------•--•--•-----•--•----•-•.................................................... W •-•-••-••-•---- -------------•...•••----------•-..........----------•-......._.......-----•...---•••-----•.....•. ° 7 . U Nature of Repairs or Alterations—Answer when applicable._.__._...___N_.__ 1 ....._.....:2 ...Q r.___..S_�R ac -• :------ -•--•--------•---•----••. -----------------•-••--•--•---- T /C :.. !!.P.......0.0-n4�r._...:je----•-....L...• .... 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 issue, eby the board of health. Q d'L� Signed -........- ^''...................... ... .t.'... ..-.. : Dare Application Approved BY `� �-------------------------------------------------------------------------- ...... �.s,Z.3..-..��.3 Dare Application Disapproved for the following reasons: ............ .................... . .. .......... .. ....... . ............................................... . ...................................... ...q... -- .................. .................................... ....................... ...---............... .. ................ ........................................ D. Permit No. ......f....- -- ---------------------- Issued Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' TOWN OF BARNSTABLE (fertifira e of (gomyliance THIS JS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by------------------- s 'L.........5- t, -.. -........... _ ms....... ....................... at .--------.r�r°D.. ...... .... .....�f.... - - .+�C ......le _....... has been installed in accordance with the provisions of TITI.E f The State Environmental Code as described in the application for Disposal Works Construction Permit No. ... 3_---- 5 ..... dated ................._..... . THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. q � DATE.---.. ........ ------- .............. 3..__.............---............. Inspector ---- �.r �-y _..........._................................ THE COMMONWEALTH OF MASSACHUSETTS <No - BOARD OF HEALTH TOWN OF BARNSTABLE .------- FEE.---�().&.)...... i n �t1 nrkii Tuntrution Prrntit Permissionis hereby granted---------.-�. :........ - ---------------------------------------•---------------------.------------- to Construct ( ) or Repair ( ) an Indi idual Sewage Disp osal System -- -------f.at No.. 7 « ' Street as shown on the application for Disposal Works Construction Permit No..�3 J`�. Dated....... �..'.�_..3_'.��. r�c ......................................................... 3 Board of Health DATE---------------- ---------------�------------.-...----•------------- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS No........................ Fic$....... �J. .... THE COMMONWEALTH OF MASSACHUSETTS 5� BOAR® OF HEALTH TOWN OF BARNSTABLE App iration fur Di►ipwial Wi nrk.5 Tnntrurtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at 1 � J L �/ P.%Z h Location-Address or Lot No. "._w.. .P e �• �,�•.�i o-•-•------------------------•--. ��'.. - .._. .L_ /Z',_v�,r r�� ----- ------ .............. Owner Address _ a t°� N 5^ .� t G' _ A _E'a, s rRd( t'. ............................. Installer y Address of TypeDW BunlgdingNo of Bedrooms-----�...................................Expansion Attic ( ) Size Lot_-G rbage Grinder (feet) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures . ------------------------ --•-•'---•---'-••-. W Design Flow...........................................gallons per person-per day. Total daily flow............................................ W -Septic Tank—Liquid capacitvli!�iU--gal Ions Length................ Width................ Diameter------_. --_--- Depth.....,.......... x Disposal Trench--No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter--------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank aPercolation Test Results Performed by-------- -----•---.....-----•-•----••-••-••--•-------......---•-'-•----'-- Date....................................... Test Pit No. I-_-- -.-._-_minutes per inch Depth of Test Pit.................... Depth to ground water........................ Lz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth td ground water........................ 04 '-•--•..........................'-'•--------•-'--'-------•••'-------------------•-----------------•-......................................................... 0 Description of Soil................................................................... --------------------.....-'----------...--------------------------•'---'•---•---•--•......._--•••--- x W ..........................................................'--......-••---•-----------------......................•----• ............................._. UNature of Repairs or Alterations—Answer when applicable.__.___.. -1. -�--.-.-----.-2--d-o _/�- -•---- - r�• !�•.1���< 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 ComplianJcee has been issued by the board of health. Signed .... ��r`' �"`."-.." .................................................. ....!c .... �.-..�1..:. Date Application Approved By ........... .t.......��. .... . ................................ ................... ...... �. ..-..`r...3 JDice Application Disapproved for the following reasons: ............ ......... ....... ...................---............ .... ......................................... ................................................................................................................................................................................................................ ........................................ PermitNo. -----./..13..-.....• 6 ................. Issued .....-- -- ................. . .....-- ............. Date No.---------- --- ----- Fee------------------- BOARD OF HEALTH TOWN 'OF BARNSTABLE v ApplicationArVell Congtruct ion Permit Application is hereby made for a permit to Construct (k<Alter ( ), or Repair ( )an individual Well at: Location — Address Assessors Map and Parcel Owner Address -®.t`zc4 i S "ell d�� s� - - ---- _. Installer — Driller .Address Type of Building Dwelling------------------------------------------------------------------- Other - Type of Building------------------------------------ No. of Persons----------------------------------—--------------- Type of Well �� - -('�-��------ ---- Capacit ,�_ - Purposeof Well-- ------------- ------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a ertificate .of Qompliance has been issued by the Board of Health. Signed date - —_— Application Approved By— t3 - --- —- Application Disapproved for the following reasons: - - --- - - -- --- -- —- ----- ------------------------------------ - - - ----------------------------------------- date ��' Permit No. -- — - Issued-------------- =_ - - -- --- -------- - --- date BOARD OF HEALTH TOWN OF BARNSTABLE (Certif irate ®f (Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) bY----------------- --- - - - - Installer at- --- — -------- --- ----------------------------------------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Boar o Heal rivate Well Protection Regulation as described in the application for Well Construction Permit No. C�' Dated--- - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE---------------------------------------- --------- Inspector------------------------------------------------------------------------- f, BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of ComPriance THIS IS TO CERTIFY;.That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by--------— --- ------------------------------------------------------------------------------------------------------------------------------------------- —- Installer at----------------------— ----- -------- - ---------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Boar of Heal rivate Well Protection Regulation as described in the application for Well Construction Permit No. (�'�-- -Dated------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE- --- ------- —-- ----- Inspector--------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE 1peCr Con$truct ion Permit No. ------ -- ---- ee---d ------------ ffi 0 Permission is hereby granted- _s - - - VD to Constru t ) Alter 'Lrepa' ) al vi0 dual ell a . go tt as shown n t e plication for a 11 Construction Permit No.-------- - -- -- — —---------—------------- Date -------- 1-5 ------------- ----- -------- ------ --- - ---- A------ - Board o H alth DATE---- - — — - ♦ J No.---------- --- -^ Fee------------ --- - BOARD OF HEALTH TOWN OF BARNSTABLE (((fff Aup[icat ion ArVeil cootruct ion Permit Application is hereby made for a permit to Construct (Alter ( ), or Repair ( )an individual Well at: Location — Address Assessors Map and Parcel 'Zoo _ ,l q uec---,v ee. chi, C,,..= -- /�Y_ Owner Address 1 i IP�/7E �'f/ -��r'iGC�Ci�_- ,�iC ��y�7,P& 0,Pl��9 --------------------------------------------------------------------- Installer — Driller Address Type of Building Dwelling-------------------------------------------------------------- Other - Type of Building ------------------- No. of Persons------------------------------------------------------ TYPe of Well �qle- --------------------- Capacity -------------- Purpose of Well ------- - ------ /J Agreement: U The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate.of ompliance has been issued by the Board of Health. � r Signed p _�/.� - - -- - --- --------------- ----------- - date Application Approved By — — ---— — — �� -G — date Application Disapproved for the following reasons: - ---—-------------------------------—-------- -- - ---— -- -- ------------------------------------------- ------------------ ---- --------------- -` ---------------date UPermit No. -� _ -___- — -= Issued -=-= =- = � �, - - - - date TOWN OF BARNSTABLE Iy!S�CATION SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME PHONE NO. I<&,x4� SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) Lf x y NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No L/ 0 A wn 'b A . 41 3 ,_61_�-s S� o r �fl` . 3� �!�'�t c..t�_,t,{�t�2 G�c.e�:�� P.v L �'i�-'� Nt_rt-i•) l= 1� PYc- Ptec -w"o e0c, ._-- t�T Paz' UGIM P 1-0 -Was= alto. 4 . 2-0 Pvc Ptee'7-tp PLay Nb.11A `►z ' 2V l Ll try tl�t i - -Y4" TO Vo t.,tmi: o2b�s� )Et-�- urc� fwc isd- ra��t rs 4fl W QC`1 �p 1 — 5 i-cCzOT. 2 , i a i s f Room r 3 Q i o�`"Era,, Town of Barnstable ti Regulatory Services Barnstable sBLE`g Richard V. Scali, Director . AN-tn► �ATEv �A�� Public Health Division Thomas McKean, Director 2007 200 Main Street Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 March 30, 2015 CANZANO, GAIL A 36 COMMERCE WAY WOBURN, MA 01801 RE:, Underground Storage Tank 483 EEL RIVER ROAD Osterville Map/Parcel: 114018 Tank Number: 1 Tag Number: 00713 Board of Health records indicate that an underground fuel (or chemical) storage tank at the above location exceeds thirty(30)years in age and has not yet been removed as required by the Town of Barnstable Code Chapter 326, Section 3, Fuel and Chemical Storage Tanks. You are directed to remove this tank within sixty(60)days from the date of this Notice. Upon completion of the tank removal and within ninety(90)days of receipt of this Notice, please submit to this office a copy of the permit for storage tank removal issued by your local Fire Department. This permit is required to be obtained prior to the tank removal. This copy of the removal permit serves as documentation that the underground storage tank was properly removed and disposed of. Should you be unaware of the existence of the above mentioned tank or'its possible previous removal, an independent third party (i.e. oil company,tank removal company, or environmental services company) may be able to assist you in physically locating and/or verifying the current existence of the tank. Should this be the case, a written document from the independent third party is required within ninety (90)days of receipt of this notice as verification that the tank had been previously removed and/or does not exist. You may request a hearing before the Board provided that a written petition requesting same is received by the Board of Health within ten (10)days after this order is served. Failure to comply with an order of the Board of Health will result in automatic scheduling of a hearing before the Board at the July 14, 2015 public meeting. The meeting will begin at 3:00 PM and will be located at Barnstable Town Hall, 367 Main Street, Hyannis, MA 02601. Thomas A. McKean,RS, CHO Public Health Division, Director Q:\Hazmat\Underground Tanks\2015\1etters\30 yr old UST 483 Eel River Rd OST.doc FEMA FLOOD C, DATE 7/2/1992 REVISIONS: ZONE DISTRICT: PANEL #250001 0016 D NO. DATE DESC. FZOpD BOTTOM OF SLOPE / VEGETA�VE WETLANDS Fop 20�yE N Op F 41 / ' 20N 1,�L£E WIANNO GOLF I CERTIFY TO THE BEST OF MY C Vq n0/� 11 CLUB AND PROFESSIONAL A THAT OWTHE GSEPT C INFORMATION SYSTEM, ASSESSORS MAP 116 AS-BUILT, SUBSTANTIALLY CONFORMS WITH ti PARCEL L-22 THE PLAN APPROVED BY THE BARNSTABLE N F � BOARD OF HEALTH.r� XTM� TODD H./WETZEL �� v 90 EEL RIVER ROAD WOOD FRAMED 1 DAVID J. P v OPEN STRUCTURE CBDH CRISPIN u, ASSESSORS MAP 116 Q CIVIL PARCEL 93 y 50, BUFFER TO WETLANDS FOUND CBDHFOUND , _ No.32112 N 66'1 T 50"E 346.53' - PROFE SIONAL ENGINEER DATE 2/12/1954 - - - PROPANE - - TANKS 41.2' AS - BUILT POOL HOUSE SEPTIC RASS \ 100' ,BUFFER TO WETLANDS 1 -- PLAN TOC.=21.4 » » SYSTEM B A #100 EXISTING CBDH [ ]FOUND CONC. PAD POOL D ELL RIVER ROAD 26 OSTERVILLE, GRASS 28 M ASSACH U SETTS TOC.=21.4 » »P REAR SEPTIC DECK 2514� � o 0 179 C 26.5, 23 27 " s " EXISTING 20 5' O O22 4 PVC N 1500 GAL DWELLING 21 D SEP. TANK BOX AUGUST 30, 2004 H-20 1500 GAL SYSTEM "A" SEP. TANK H-10 SYSTEM "B" D GRASS �y DRIVE UNDER GARAGE ` PREPARED FOR: DUNHILL COMPANIES, LTD. m 776 MAIN STREET OSTERVILLE, MA 02655 (508) 420-9222 N .u CBDH FOUND 657 Main Street, Unit 6 S66'17'50'W 341.50' W. Yarmouth Massachusetts 02673 508 778 8919 BLDG 11ES DESC INVERT C D ELEVATIONS 20. OUT FOUNDATION 19.91 �_C) 2004 The BSC Group-Norwell, Inc. o N/F 21. 15.0' 32.0', IN TANK 19.60 SCALE: 1" = 20 FEET M FRANK A. & GERALDINE SULLIVAN 22. 22.0' 37.5' OUT TANK 19.27 120 EEL RIVER ROAD 23. 50.5' 63.5' IN "D" BOX 18.78 m ASSESSORS MAP 116 " " 0 10 20 40 FT. Z PARCEL 95-1 24. OUT D BOX 18.55 25. 53.0' 69.0' 4" PVC 17.82 PROD. MGR.: C. FIELD 26. 74.5' 93.0' 4" PERF. PVC END 17.64 W 27. 57.0' 70.5' 4" PVC 17.84 FIELD: D. GAZZOLO / J. McCARTIN 28. 79.0' 95.0' 4" PERF. PVC END 17.62 CALC./DESIGN: P. HAGIST m DRAWN: P. HAGIST 4 CHECK: C. FIELD > FILE: 8459-AB.DWG DWG. NO: 5396-03 SHEET 1 OF 1 co .Q JOB. NO: 48459.00 a I SEPTIC TANK DETAIL: 1 ,500 GALLON DISTRIBUTION BOX DETAIL: NOT TO SCALE LEACHING TRENCH DETAIL: NOT TO SCALE REVISIONS SOIL TEST PIT DATA: P #1 0,34o O ATE DESCRIPTION NOT TO SCALE NO. OF OUTLETS = 5 TEST PIT #L TEST PIT #2- NOTES: 1. SEPTIC TANK SHALL BE STEEL 5. INLET AND OUTLET TEES TO BE CAST IRON, FINISHED GRADE 36" MAX .COVER - GIRD. EL. 12.64 GIRD. 40 PVC OR CAST-IN-PLACE CONCRETE.D. EL. 11.26 REINFORCED CONCRETE. TEES TO BE CENTERED UNDER MANHOLE COVER. FINISHED GRADE REMOVABLE 2" WALLS LOAM do SEED DISTURBED AREAS EST. HIGH GW. 6.5 EST. HIGH Gw. 6.5 2 SEPTIC TANK TO WITHSTAND H-10 LOADING COVER NOTES: UNLESS UNDER PAVEMENT, DRIVES OR A A TRAVELED WAYS, WHEREIN H-20 LOADING �;,a„+a;,a„+a;.� �;.�,;, r 1. DIST. BOX TO WITHSTAND H-10 LOADING LOAMY 5YR SAND „ LOAMY SANDSHALL APPLY. P`c SA� UNLESS UNDER PAVEMENT, DRIVES OR CAP ENDS 9 7.5YR 2.5 1 11■ 3. ALL PIPE CONNECTIONS AND CONCRETE 2-24" DIA CONCRETE MANHOLES T TRAVELED WAYS WHEREIN H-20 LOADING 4" PVC •+ • •+ e„ • e o e o e .+ e e+ e o o • ` B B CONSTRUCTION SHALL BE WATERTIGHT. W METAL HANDLES BROUGHTSHALL APPLY. LOAMY S ND LOAMY S ND 4. FILL ALL UNUSED KNOCKOUTS WITH TO 6" OF FINISH GRADE 4)_ �. •+ . e e+ • e e+ fie e r r !' 8 2. PROVIDE INLET TEE OR BAFFLE WHERE GENERAL NOTES: 10YR 5 4 24„ lOYR 5,4 249 . MORTAR. 6 1. THIS PLAN IS FOR DESIGN AND EL = 10.64 EL - 9.26 TEE TO BE UNDER 12" IN. 5.5 OUTLETS a SLOPE OF PIPE EXCEEDS 0.08 FT. T OR LEVEL BOTTOM / M.H. OPENING r • •� •� T IN PUMPED SYSTEM. 42' CONSTRUCTION OF THE SEWAGE MEDIUM SAND MEDIUMI SAND 3 �- 2" 3. FIRST T1M0 FEET OF PIPE OUT OF DIST. DISPOSAL FACILITY ONLY. HIGH GROUNDWATER COMPUTATION PROFILE 2. ALL CONSTRUCTION METHODS AND RAISE M.H W� _ BOX TO BE LAID LEVEL. BOTTOM ON LEVEL 1OYR 6/6 „ 10YR 6/6 BASED ON TP 2 10'-6" - _ STABLE BASE 6" MIN. 3/4" TO MATERIALS SHALL CONFORM TO MASS. 1 1/2 CRUSHED D.E.P TITLE 5 AND LOCAL BOARD 42 SEWER BRICK .:. 'e.e_': .::e - • r 50 10'-0" do MORTAR t2r •` CROSS-SECTION STONE BASE 4. ALL PIPE CONNECTIONS AND CONCRETE 36" MAX. - 12" MIN. COVER DEPTH TO WATER 9.0 NORMAL WA R VEL CONSTRUCTION SHALL BE WATERTIGHT. OF HEALTH REGULATIONS. INDEX WELL MIW- 9 �e 3" 5. FILL ALL UNUSED KNOCKOUTS WITH MORTAR. 2% MIN. FINISH GRADE � 4" MIN. LOAM & SEED 3. ALL PIPES LOCATED UNDER PAVEMENT 84'9 WATER LEVEL RANGE ZONE B PRECAST SEPTIC TANK 10" 14" OR TRAVELED WAY SHALL BE SCHEDULE 40 OR EQUAL. EL = 6.5 _ 57" CURRENT DEPTHUNDEX WELL(9/02) 9.9 INLET TEE =S 5'-1" 30 1/2" 4. THERE ARE NO KNOWN PRIVATE WELLS WATER LEVEL ADJUSTMENT 4.2 _ - _ -13. _ LOCATED WITHIN 150 FT. OF THE C2 C2 DEPTH TO ADJUSTED HIGH WATER 4.8 5'-2" 4'-6" 4'-0" MIN. W SM � � 5'-8r 15 1/2- DATUM: �� " PROPOSED LEACHING FACILITY NOR FINE MED �AND FINE MED AND - - - " Z == LIQUID DEPTH • 2 MIN. OF 1/8 TO ANY KNOWN WELLS PROPOSED WITHIN 2.5Y 1 2.5Y '1�4 5'-B' �/4 00N PRECAST DIST. VERTICAL DATUM: MSLt 24' 24' 24' 1/2" WASHED STONE 150' OF ANY KNOWN LEACHING FACILITY. " „ it :} a BOX �/ �� 5. WITHIN LIMIT OF EXCAVATION REMOVE EL = 2.14 - 126 EL = 2.26 = 108 _ e _ BENCH MARK USED: TOWN OF BARNSTABLE 3/4" TO 1-1/2" DOUBLE ALL TOPSOIL, SUBSOIL AND OTHER „ „ %e.::. •e.�.-:.• -: . .�: =:i 2 6 2 6 WASHED STONE (NO FINES) IMPERVIOUS MATERIAL. EL = 0.64� 144 EL = 0.269 132 'a BOTTOM ON LEVEL STABLE BASE '+ 3• h- GIS DATA I�rE- TYP I PLAN vlEw 7 1/ BENCH MARK SET: HYDRANT 20 TAG s. REPLACE WITH CLEAN WASHED SAND DATE: DATE: INDICATES 6" MIN. 3/4" To # CROSS-SECTION OR OTHER CLEAN GRANULAR SOILS 9/26/02 9/26/02 y ESTIMATED 1 1/2" STONE CROSS-SECTION VIEW PLAN VIEW BOLT. ELEVATION 24.0 CONFORMING TO THE FOLLOWING = SEASONAL HIGH SIEVE ANALYSIS: TEST BY: TEST BY: GROUND WATER (MAX) THE BSC GROUP, INC. THE BSC GROUP, INC. �y♦� ��� F SLOPE / VEGETATIVE W�IETLANDS " " 10PASSANo.e50 S VE ALL WITNESSED BY: WITNESSED BY: INDICATES �► OFw�, � � 'OF �_ t000 SOTTOm OF YSTEM A <10 % OF No. 4 SIEVE SHALL DAVE STANTON DAVE STANTON GROUND WATER '`�� i CRAIGA. F`000 20N£ N/F _ PASS No. 100 PERC. RATE: PERC. RATE: ' DAVID I IN i t FIELD i; 20NE C, �� �Vq T <5 x OF No. 4 SIEVE SHALL f WIANNO GOL- PASS No. 200 t CIVIL ] No.3B039 SON CLUB ESI GN CRITERIA. UNIFORMITY COEFFICIENT O No. 4 �-MIN./INCH N/A MIN./INCH INDICATES No.32112 A N F ] ► ASSESSORS MAP 116 SIEVE </-6.0 SOIL EVALUATOR SOIL EVALUATOR PERC. ♦ �.,� ♦ / ♦ �•� DESIGN FLOW: TEST • TODD H. WETZEL • ti PARCEL L-22 7. EXISTING UTILITIES WHERE SHOWN CRAIG FIELD CRAIG FIELD 90 EEL RIVER ROAD a 4 BEDROOMS AT 110 G.P.B./D 440 G.P.D IN THE DRAWINGS ARE APPROXIMATE. THE CONTRACTOR ALL BE REON- SOIL CLASS: SOIL CLASS: INDICATES i�I TE: ASSESSORS MAP 116 BLE FOR PROPERLY LOCH NGSPA D F�1 1 UNSUITABLE PARCEL 93 sl QY �'� WOOD FRAMED COORDINATING THE PROPOSED CON- MATERIAL y TOPOGRAPHY UPDATED A(f Z REQUIRED SEPTIC TANK: STRUCTION ACTIVITY WITH DIG-SAFE L.T.A.R. L.T.A.R. SINCE 2002 PLAN Q OPEN STRUCTURE CBDH AND THE APPLICABLE UTILITY 0.74 G.P.D./SQ.FT. 0.74 G.P.D./SQ.FT. WETLANDS _ _ THIS PLAN REPRESENT A �'� 50 BUFFER TO � FOUND FOUND 440 X 200% 880 GAL. COMPANY AND MAINTAINING THE EXISTING UTILITY SYSTEM IN SERVICE. INVERT ELEVATIONS: SYSTEM "A" SUBMITTED PLAN OF ORIGINALLY2002 ;, SEPTIC TANK PROVIDED: = 1500 GAL. DIG-SAFE SHALL BE NOTIFIED PER REVISION TO THE N66'17'S0"E 346.53 THE STATE OF MASSACHUSETTS STATUTE CHAPTER 82, SECTION 409 _ _ SIZE OF LEACHING FACILITY REQUIRED: AT TEL. 1-888-344-7233. THE TOP OF FOUNDATION 23.04 A ENGINEER DOES NOT GUARANTEE " 19.30 B REPLUMB FROM REAR CBDH �� DESIGN PERC. RATE: <2 MIN. INCH THEIR ACCURACY OR THAT ALL 4 INVERT AT BUILDING I FOUND - / FORMER 10 WIDE RIGHT OF WAY 12 1 g54 - - - \ UTILITIES AND SUBSURFACE STRUCTURES 19.05 C �^ FICATE #2495, DATED 2/ � - - PROP AN LONG TERM APPL. RATE 0.74 G.P.D/S.F. ARE SHOWN. LOCATIONS AND 4„ INVERT AT SEPTIC TANK (IN) I EXTINGUISHED IN CERTI - - . - - -_ - _ _ __ TANKS '�f ELEVATIONS OF UNDERGROUND UTILITIES 4 INVERT AT SEPTIC TANK OUT 18.80 D rn I _ _ - . - . - • - • -_ __ - - - - - - - - - I _ TAKEN FROM RECORD PLANS. THE _ _ _ \ \ 440 GPD + 0,74 GPD/SF 596 S.F. CONTRACTOR SHALL VERIFY SIZE, (OUT) _ _-_ 41.21 ` /� \ �'_ LOCATION AND INVERTS OF UTILITIES 4 INVERT AT DIST. BOX (IN) 18.73 E -� I,I _ . - - - �--- J \ 4" INVERT AT DIST. BOX (OUT) 18.56 F v I . __ _ - - - - _ _ I AND STRUCTURES AS REQUIRED PRIOR EXISTING DRIVEWAY POOL \ To THE START of CONSTRUCTION. ---- SIZE OF LEACHING FACILITY PROVIDED: HOUSE _ PINE g FER TO WETLA DS L- 8 THIS SYSTEM IS NOT DEIGNED FOR INVERTS AT LEACHING FACILITY: Z _ _ _ - - PINE Q -- - RASS 1 3-2 WIDE, ? DEEP, THE USE OF A GARBAGE GRINDER. 4" INVERT AT BEGINNING "' N F _ OAK I - - - �, 42' L❑NC TI\,- A GARBAGE GRINDER IS NOT OF LEACHING TRENCH 18.50 G BREAKOUT ELEV. 19.0 11� LAWERENCE DIBUNA PINE OAK I\ i '`_ ��� _ - RECOMMENDED DUE TO RECOGNIZED r ADVERSE IMPACTS TO THE LEACHING 100 EEL RIVER ROAD * PINE ELE. TO BE �1~(' 3x(2'+?'�-2')x42' F , FACILITY. _ 4" INVERT AT END o I ASSESSORS MAP 116 I ML REMOVED OF LEACHING 1 OF LEACHING TRENCH 18.29 H Ic, I PARCEL 94 - 756 x 0.74 GPD / SI 559 GPD THE CONTRACTOR PRIOR TO CONSTRUCTION 9. EXITING INVERTS ARE TO BE CHECKED BY I o I-1 z 82,331t S.F. GRASS ELE # TOC.-21.4 '1/ PR❑VIDED THE ENGINEER IS TO BE NOTIFIED OF ELEVATION AT BOTTOM f c,, 1.89t ACRES MET. -r� � _� ANY FIELD CHANGES THAT MAY BE OF LEACHING TRENCH 16.29 J I I s - REQUIRED. SIZED TO ACC❑MADATE 5 BEDROOMS ESTIMATED HIGH I o OAK GROUNDWATER ELEVATION 6.5 K W vs f K v DH LOCUS INFORMATION PROFILE: NOT TO SCALE - FRONT SYSTEM C'' OAK OAK a FOUND I I x I I CONC. PAD I ANDO ED � TAK \ CURRENT OWNER: LAWERENCE & JANET BSC G&OUP TOP FOUNDATION FIRST PIPE LENGTH i K UTILITY P E CONCRETE COVERS TO WITHIN TO BE SET LEVEL `�`'�STE A SH. 1 Nw DIBONA \ 657 Main Street, (RT. 28) Unit 6 s" OF FINISHED GRADE. FOR MIN. 2' TITLE REFERENCE: CERT. 90204 W. Yarmouth Massachusetts EL.=22.2 OAK --� EL.=21.4-22.o i I / : :• „ �� S ~B� 2 N•� 02673 4" PVC I ! = \ D PV GRASS cn PLAN REFERENCE: L.C. 3145-1 I / _ ! - 'BO M1N TOC.=21.4 �� ,}{, 5 M No 508 778 8919 4" Pv " I I I I _ 10 �''f{' N 5^ Ui ASSESSORS MAP: 116 r I I OAK ,/ p. \ PARCEL: 94 PROJECT TITLE: I- I ®�� 1500 GAL /- E 500 GAL 50� �- . o I CB i S P. TANK SEP. TANK �.: m ZONING DISTRICT: RF-1 JI I=E I=G o' 1=H I I CB FO N OAK � �, SETBACKS: FRONT 30' SEWAGE DISPOSAL 5 OUTLET I=F a Z I I `- '�i : / EXISTING \�- SIDE 15' •e: DIST. BOX BOTTOM EL_ I , :j� DWELLING P _- - U, REAR 15' SYSTEM DESIGN SEPTIC TANK I I I \ . OAK / UNDER CONSTRUCTION 10 0 i OAK EST HIGH WATER EL.- K C GRASS OAK • 1g LIMITS OF EXCAVAZQN MINIMUM LOT SIZE. 87120 S.F. » I I � / -- '��'� �`- SE1F-NOTE I / �/ & 6 I EXIST. TOTAL LOT AREA: 82,331t S.F. SYSTEM A L_\L\tMITS OF EAVATION / 'L 22 NOTES`5 & 6 / SEE NOTES / --..� n��. OVERLAY DISTRICT: AP PINE I / \/ --�� ' � NITROGEN SENSITIVE #100 ZONE: NOT A ZONE II ELL RIVER ROAD FEMA FLOOD N I I I PINE ZONE DISTRICT: C, DATE 7/2/1992 OST RVI g I DRIVE UNDER E LLE I �•' '� GARAGE 14 ISTIN SYSTEM COM NEWTS BE PANEL250001 0016 D I 0 ► I OAK \ *PINE o � ����' P PED ND RE VED FROM SI IN M ASSACH U SETTS a I I ACC DANC WITH TITLE VARIANCES REQUESTED. �, " D I PINE OAK ` 9 • NO SCALECL FRONT SEPTIC % * o LOCUS PLAN. 0 T 1---I NCHMARK x INE m I I YDRANT TP1 '� OAK \ �j I m I � �TAG BOLT �20 � � / OAK NONE I ELEV. 24.0' IN , 12 t N PREPARED FOR: s \ Y I I C PINE DUNHILL COMPANIES LTD. I I MAIN STREET 776 MAIN STREET � I � RED MAPLE 79•3 OSTERVILLE, MA N I J I I 3 P 02655 I � DRIVEWAY PINE \ , , ' $P� (508) 420-9222 � PINE \ ` CBDH DATE: APRIL 27, 2004 I I I Z OAK \ \ FOUN OAK tn� v COMP. DESIGN: K. HEALY I I OAK /^� PINE I < �� v S66'17'50"W 34 0' PLAN VIEW L❑CUS �� CHECK: D. CRISPIN l I II OAK ��L DRAWN: K. HEALY N/F GAZZOLO D LO FIELD: D. J. MCCARTIN I PINE OAK OAK FRANK A. & GERALDINE SULLIVAN SCALE: 1' = 20 FEET � Dyd / 120 EEL RIVER ROAD FILE NO. 8459-EXC.DWG S I ASSESSORS P1 116 PARCELLO 95 0 0 10 20 40 FT, y DWG NO. 5396-01 co SHEET 1 OF 2 JOB NO. 4-8459.00 • SEPTIC TANK DETAIL: 1 ,500 GALLON DISTRIBUTION BOX DETAIL: NOT TO SCALE LEACHING TRENCH DETAIL: NOT TO SCALE REVISIONS SOIL TEST PIT DATA. P #10,340 No. DATE DESCRIPTION NOT TO SCALE NO. OF OUTLETS 5 TEST PIT -.#1_ TEST PIT _92- NOTES: 1. SEPTIC TANK SHALL BE STEEL 5. INLET AND OUTLET TEES TO BE CAST IRON, FINISHED GRADE 36" MAX .COVER GRD. EL. 12.64 GRD. EL. 11.26 REINFORCED CONCRETE. TEESSCHE T 40 PVC TE CAST UNDER CONCRETE. FINISHED GRADE TEES TO BE CENTERED UNDER MANHOLE COVER. REMOVABLE I-�- 2 WALLS EST. HIGH GW. 6.5 EST. HIGH GW. 6.5 2 SEPTIC TANK TO WITHSTAND H-10 LOADING COVER NOTES: LOAM do SEED DISTURBED AREAS ` UNLESS UNDER PAVEMENT, DRIVES OR �.,, ' �, ., " c Moot 1. DIST. BOX TO WITHSTAND H-10 LOADING A' A TRAVELED WAYS, WHEREIN H-20 LOADING �. •v.. o.•�....,:•v.:•' CAP ENDS A LOAMY SAND LOAMY $AN SHALL APPLY. UNLESS UNDER PAVEMENT, DRIVES OR 4" PVC•'' • •� • �• •�-+4'�F MW 40MC- 01152' • ,,-• 7.5YR 2.5 1 9" 7.5YR 2.5 1 11» 3. ALL PIPE CONNECTIONS AND CONCRETE 2-24" DIA CONCRETE MANHOLES T TRAVELED WAYS WHEREIN H-20 LOADING • • • • • • • 8 'B CONSTRUCTION SHALL BE WATERTIGHT. W/ METAL HANDLES BROUGHT 1 L-F 15• SHALL APPLY. • • •• • 4 • • 0.4 �. ,a,,,LOAMY S ND LOAMY S ND 4. FILL ALL UNUSED KNOCKOUTS WITH TO 6" OF FINISH GRADE • • • • •I 2• PROVIDE INLET TEE OR BAFFLE MERE GENERAL NOTES: 1 OYR' S 4 1 OYR 5 4 MORTAR. 6" 5 5" OUTLETS L SLOPE OF PIPE EXCEEDS 0.08 FT. OR 1. THIS PLAN IS FOR DESIGN AND EL = 10.64 24" EL = 9.26 24" TEE TO BE UNDER 12» IN LEVEL BOTTOM M.H. OPENING 3• • � -T- IN PUMPED SYSTEM. 25' CONSTRUCTION OF THE SEWAGE lFoiaMEDIUM SAND MEDIUM SAND 2. ALL CONSTRUCTION METHODS AND C1 C1 HIGH GROUNDWATER COMPUTATION RAISE M.H w� 4 BOTTOM ON ��• » L 2" » 3 Box TO BE LAID ��FIRST TWO FEET OF E OUT OF DIST. PROFILE DISPOSAL FACILITY ONLY. 1OYR 6/6 1OYR 6/6 » - 6 MIN. 3/4 To MATERIALS SHALL CONFORM TO MASS. 42" BASED ON TP#2 10-6 SEWER BRICK :: .::a :•: STABLE BASE 1 1 2" CRUSHED 50" 10'-0" do MORTAR "t CROSS-SECnON S BA 4. ALL PIPE CONNECTIONS AND CONCRETE 36" MAX. - 12" MIN. COVER OF H TITLE 5 AND LOCAL BOARD DEPTH TO WATER 9.0 N WATER 12 CONSTRUCTION SHALL BE WATERTIGHT. OF HEALTH REGULATIONS. S LOCATED UNDER PAVEMENT INDEX WELL MIW- !e » 3" 5. FILL ALL UNUSED KNOCKOUTS WITH MORTAR. /2X MIN. FINISH GRADE 4" MIN. LOAM & SEED 3. OR TRAVELED WAY SHALL BE SCHEDULE 84" WATER LEVEL RANGE ZONE B PRECAST SEPTIC TANK t 10 14 _ 40 OR EQUAL EL = 6.5 57" CURRENT DEPTHOINDEX WIELL(9/02) 9.9 - - INLET TEE 5'-1" 30 1/2" 3i IMXIIN�1 4. THERE ARE NO KNOWN PRIVATE WELLS __ LOCATED WITHIN 150 FT. OF THE WATER LEVEL ADJUSTMENT 4.8 = _ � » � = � r• " DATUM: � �" "� i I » PROPOSED LEACHING FACILITY NOR RESERVE2 MIN. OF 1/8 TO ANY KNOWN WELLS PROPOSED WITHIN C2 C2 DEPTH TO ADJUSTED HIGH WATER 4.8 5-2 4-6 � 4'-0" MIN. �o" a+ '� 5-8 15 1/2 FINE .5YD'/�AND FIN 2.5YD_,_ 5 ND - 5,-8" x At. LIQUID DEPTH ii►s aoMwa�,) PRECAST DIST. 24' 24� •+ 1/2" WASHED STONE 150' OF ANY KNOWN LEACHING FACILITY. :. VERTICAL DATUM: MSL± a 'r BOX �� �� 5. WITHIN LIMIT OF EXCAVATION REMOVE EL = 2.14 126" EL = 2.26 108" BENCH MARK USED: TOWN OF BARNSTABLE 3/4" To 1-1/2" DOUBLE ALL TOPSOIL, SUBSOIL AND OTHER 144" 132" v a yam:: :e#�.:::4: :. r•.--��.: -�+ » GIS DATA 2 121rP 2' ASHED STONE (NO FINES) IMPERVIOUS MATERIAL EL = 0.64 EL = 0.26 a BOTTOM ON LEVEL STABLE BASE 7 1/ PLAN VIEW 3 BENCH MARK SET: HYDRANT 20 TAG s. REPLACE WITH CLEAN WASHED SAND DATE: DATE: INDICATES 6" MIN. 3/4" TO CROSS-SECTION VIEWS PLAN v1Ew # , CROSS-SECTION OR OTHER CLEAN GRANULAR SOILS 9/26/02 9/26/02 �_ ESTIMATED 1 1/2" STONE BOLT. ELEVATION 24.0 CONFORMING TO THE FOLLOWING TEST BY: TEST BY: - SEASONAL HIGH SIEVE ANALYSIS: THE BSC GROUP, INC. THE BSC GROUP, INC. GROUND WATER F F SLOPE / VEGETATIVE y�TLANDS 10X (MAX) BY WT. SHALL �O 0 >►f " <10AX OF No. 4 SIEVE SHALL WITNESSED BY: WITNESSED BY: SS No. 50 SIEVE INDICATES OBSERVEDr,►� of 00 IO BOTTOM SYSTEM B PASS No. 100 DAVE STANTON DAVE STANTON GROUND WATER F��OD 2p N£ A>>�f N/F <5 X OF No. 4 SIEVE SHALL PERC. RATE: PERC. RATE: .� �� a��A. N NE C �VqT� MANNO GOLF CLUB ESIGN CRITERIA: PASS No. 200 2 MIN./INCH Na MIN./INCH INDICATES �� No•�� ► O� �� ASSESSORS MAP 116 UNIFORMITYCOEFFICIENT o No. 4 DAV1D J. t• N/F SOIL EVALUATOR SOIL EVALUATOR SST• CRISPIN v► � PARCEL L-22 DESIGN FLOW. 7. EXISTING UTILITIES WHERE SHOWN TODD H. WETZEL ��t�' CRAIG FIELD CRAIG FIELD N CIVIL All 90 EEL RIVER ROAD" a 1 BEDROOMS AT 110 G.P.B./D 110 G.P. IN THE DRAWINGS ARE APPROXIMATE. SOIL CLASS: SOIL CLASS: INDICATES ' .sue NOTE: ASSESSORS MAP 116 � g THE CONTRACTOR SHALL BE RESPON- 1 1 UNSUITABLE W PARCEL 93 /jam �aOR PROPERLY LOCATING AND MATERIAL TOPOGRAPHY UPDATED (,( WOOD FRAMED L.T.A.R. L.T.A.R. SINCE 2002 PLAN �� OPEN STRUCTURE CBDH REQUIRED SEPTIC TANK: AND THE APPLICABLE PLICA L WITH Inc-SAFE y Zjl Q WETLANDS CBDH FOUND 110 X 00% = COMPANY ANDLIMAINTAINI G THE 0.74 G.P.D./SQ.FT. 0,74 G.P.D./SQ.FT. ,'}. V _ THIS PLAN REPRESENT A yr 50' BUFFER TO FOUND 2 220 GAL. REVISION TO THE ORIGINALLY SEPTIC TANK PROVIDED: = 1500 GAL. EXISTING UTILITY SYSTEM IN SERVICE. DIG-SAFE SHALL BE NOTIFIED PER INVERT ELEVATIONS: SYSTEM "B" SUBMITTED PLAN of 2002 THE STATE OF MASSACHUSETTS » STATUTE CHAPTER 82, h66'17 50 E 346.53 sEcnoN 409 TOP OF FOUNDATION 21.00 A _ _ SIZE OF LEACHING FACILITY REQUIRED: AT TEL 1-888-344-7233. THE CBDH ,--� .�- - ENGINEER DOES NOT GUARANTEE 4" INVERT AT BUILDING 18.00 B FOUND THEIR ACCURACY OR THAT ALL - ' DESIGN PERC. RATE: <2 MIN./INCH FORMER 10' WIDE RIGHT OF DATED 2/12/1954 _ LIRE SHOWN. AND SUBSURFACE STRUCTURES " �" CATE #2495, D 4 INVERT AT SEPTIC TANK IN 17.70 C o i IN CERTIFI .___ . _. - - - - ' __ PROPAN LONG TERM APPL. RATE 0,74 G.P.D/S.F. ARE SHOWM. LOCATIONS AND ( ) EXTINGUISHED - __ ____-_ \ - �� - ELEVATIONS OF UNDERGROUND UTILITIES 4" INVERT AT SEPTIC TANK OUT 17.4 D 1 - . ._.- • ___--- � TANKS \ - TAKEN FROM RECORD PLANS. THE 110 GPD 0.74 GPD/SF 149 S,F. CONTRACTOR SHALL VERIFY SIZE. " ( 17.3 E O - - - __ _ ----- --- 41.` `-' LOCATION AND INVERTS OF UTILITIES 4„ INVERT A T DIST. BOX X (I N) -Q \� ____ -.�__- --� 1 \ AND STRUCTURES AS REQUIRED PRIOR 4 INVERT AT DIST. BOX (OUT) = F 1 - EXISTING DRIVEWAY _ __ POOL \ To THE START OF CONSTRUCTION. -'_ HOUSE ADS SIZE OF LEACHING FACILITY PROVIDED: ' _Z___ PINE B FER TO WETL � � 8. THIS SYSTEM IS NOT DESIGNED FOR INVERTS AT LEACHING `FACIL'ITY: z1 . _ _-- PINE \ -- RASS 1 8-2 w IDE, 2 DEEP, THE USE OF A GARBAGE GRINDER. ,� '{ i ' _ OAK \ _ \ 25' LONG TRENCH A GARBAGE GRINDER AS NOT 4 INVERT AT BEGINNING N/F OAK I '� RECOMMENDED DUE TO RECOGNIZED .OF LEACHING TRENCH 17.00 G BREAKOUT ELEV. 17.5 �\ LAWERENCE DIBONA PINE \\ I ��-- '�' ADVERSE IMPACTS TO THE LEACHING 100 EFL RIVER ROAD PINE ELE. TO BE 2x<2'+2'+2')x25' _� 300 S.F. FACILITY. �� \ OF LE'fiACH NG AREA 4 INVERT AT END a III ASSESSORS rMAP 116 \ _ ML REMOVED - 9. EXITING INVERTS ARE TO BE CHECKED BY OF LEACHING TRENCH 16.87 H PARCEL 94 �}{, 300 x 0.74 GP.D / SF = �222 GPD THE CONTRACTOR PRIOR TO CONSTRUCTION Ir^ I= 82,331t S.F. # / PROVIDED THE ENGINEER IS TO BE NOTIFIED OF 10 1� Z GRASS � ELE TOC.=21.4 �ti'\ ELEVATION AT BOTTOM �, * CA 1.89•t ACRES - MET. / ANY FIELD CHANGES THAT MAY BE OF LEACHING TRENCH 14.87 J I I I s O - - -/ REQUIRED. 1 � I ' 0 OAK ERGR C� • SIZED T❑ ACC❑MADATE 2 BEDROOMS ESTIMATED HIGH r�W 1 0. VNO10C]• / - GROUNDWATER ELEVATION 6.5 K W E�C�SCR I K W EXISTING C DH LOCUS INFORM ATI ON PROFILE: NOT TO SCALE - REAR SYSTEM I X OAK OAK CONC. PAD POOL FOUND I I AN 0 ED TAK ` CURRENT OWNER: LAWERENCE & JANET BSC GROUP EL.=A FIRST PIPE LENGTH I V- K UTILITY P E TOP FOUNDATION CONCRETE COVERS TO WITHIN TO BE SET LEVEL N DIBONA � 657 Main Street, (RT. 28) Unit 6 EL=22.2 6" OF FINISHED GRADE. FOR MIN. 2 I / OAK a3" STE A SH. TITLE REFERENCE: CERT. 90204 W.Yarmouth Massachusetts .5' I I ' ! ? s "B" 2 01, 02673 4" PVC I I / !� D " PV TOC.=21.4 GRASS N PLAN REFERENCE: L.C. 3145-1 I I �, ••' ° 1 MI �i S S No 508 778 8919 4" P " I PVC SCHI \ ::. R •n N �; ASSESSORS MAP: 116 . (- -� PARCEL: 94 PROJECT TITLE. IPA _U I I OAK -./ �- 1500 GAL �''-r 'T 500 GALS P ��= '\ 0 _ = I I CB ��•••.�`� �' P. TANK E SEP. TANK �• l:' r*i ZONING DISTRICT: RF-1 I-E 1=G > I-H I I , _ i •� OAK �� -� i \ �, SETBACKS: FRONT 30' SEWAGE DISPOSAL JI SOUTLET I-F a z ( I FO N� \.-:•G �-- -. EXISTING " P �'�� SIDE 15' DIST. BOX = I , / _ ' .„-�- SYSTEM DESIGN SEPTIC TANK �, BOTTOM EL- OAK DWELLING 10 ° - . �: '-: N I •ice- UNDER CONSTRUCTION REAR 15' Go OAK EST HIGH WATER EL- K I I GRASS OAK -- LIMITS OF EX AVAZ1QN MINIMUM LOT SIZE. 87,120 S.F. " » I I S�1�OTE & 6 ' EXIST. TOTAL LOT AREA: 82,331 t S.F. SYSTEM B ti / L LIMITS OF E AVATI0N rn I ,2 2 I I 2 PINE SEE NOTES 5 & 6/ --� A OVERLAY DISTRICT. AP #100 NITROGEN SENSITIVE I I . �c ZONE: NOT A ZONE II ELL RIVER ROAD FEMA FLOOD N I I I PINE l DRIVE UNDER ZONE DISTRICT: C, DATE 7/2/1992 OSTER V 1 LLE �°3 14 v ISTIN SYSTEM COM ENTS BE PANEL #250001 0016 D GARAGE I I OAK *PINE 0 \��� P PEP ND RE�VED FROM SI IN M ASSACH U SETTS I O I \ ACC DANC WITH TkTLE :N. " » N VARIANCES REQUESTED: .--- � I D I PINE OAK ` 9 NO SCALE REAR SEPTIC I I \ �Ec l o LOCUS PLAN. E U �•-I NCHMARK PINE TP�1 '�� OAK I I YDRANT I TAG BOLT #20 / OAK I I - ELEV. 24.0' I 12-----. ` N PREPARED FOR: Y NONE I I C PINE DUNHILL COMPANIES LTD. I I ` MAIN STREET 776 MAIN STREET I M RED MAPLE 79•3 OSTERVILLE, MA CN N I \ 02655 I I o DRIVEWAY PINERpP (508) 420-9222 co I � \ s� O DATE: APRIL 27, 2004 F I PINE CBDH n I I I z OAK OAK \ \ FOUN �� y COMP. DESIGN: K. HEALY OAK �� PINE < � Y I S66'17'50"W 34 0' (� /� ^ I /I \ / L❑CUS ��� CHECK: D. CRISPIN PLAN I V VIEW V DRAWN: K. HEALY I L OAK OAK OAK N/F �Q FIELD: D. GAZZOLO / J. McCARTIN FRANK A. & GERALDINE SULLIVAN SCALE: 1' = 20 FEET I PINE 120 EEL RIVER ROAD 9d FILE NO. 8459-EXC.DWG I I ASSESSORS MAP 116 p 10 20 40 FT, 9 DWG NO. 5396-01 I i I PARCEL 95-1 ,d SHEET 2 OF 2 I JOB NO. 4-8459.00 a L L Town of Barnstable � tNe Two Regulatory Services Thomas F.Geiler,Director w BARNSThBLE. s 9 Public Health Division rED A Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: h q o Designer: g$L Gaoap Installer: Address t S 7 14f}x,V 5rkc�gr ONXT-,� Address: On was issued a permit to install a (date) (installer) septic system at_ 10c, g,4r& 4Wg Qvw 0, 5 -/5T07M �A based on a design drawn by (address) 956 "wP dated (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 any vertical relocation of any component of the septic system)but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. , OF OAY0 A S CRisPIN « (Insta is Signature) CN& Na�2t1! 'Arre� SsroNAL •oT esigner'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 FEMA FLOOD C, DATE 7/2/1992 REVISIONS: ZONE DISTRICT: PANEL #250001 0016 D NO. DATE DESC. BLDQ TIES DES DESC INVERT _ A B ELEVATIONS 1. OUT FOUNDATION 19.41 - 2. 45.5' 45.9' IN TANK 19.22 - 3. 1 57.0' 39.6' OUT TANK 18.93 _ 4. 86.3' 70.7' 1 IN "D" BOX 18.09 5. OUT "D" BOX 17.86 6. OUT "D" BOX 17.86 Ftp - 7. OUT "D" BOX 17.86 Ftp 2pNE q' 8. 84.4' 77.0' 4" PVC 17.82 2pNe 411, 9. 126.4' 111.3' 4" PERF. PVC END 17.60 C 10. 4" PERF. PVC END 17.64 N/F 11. 90.9' 66.6' 4" PVC 17.84 TODD H. WETZEL 12. 130.8' 104.3' 4" PERF. PVC ENDI 17.62 90 EEL RIVER ROAD h 1 CERTIFY TO THE BEST OF MY ASSESSORS MAP 116 PROFESSIONAL KNOWLEDGE, INFORMATION PARCEL 93 AND BELIEF THAT THE SEPTIC N� AS-BUILT, SYSTEM, SUBSTANTIALLY CONFORMS WITH THE PLAN APPROVED BY THE BARNSTABLE BOARD OF HEALTH. N66-17'50"E 346.53 J. CRisaIM CBDH FOUND cyF�'kr,,I I FORMER 10' WIDE RIGHT OF WAY 2 12/1954 1 EXTINGUISHED IN CERTIFICATE #2495, DATED / _ _ _ --- PROPANE , 1 r"1 --- _ _ _-- - --- - - -- TANKS `'. -h5 41.2' P OFE SIONAL ENGINEER DATE EXISTING DRIVEWAY --_- - -- POOL HOUSE AS - BUILT 1 I \ I GRASS \ RASS SEPTIC \ I) N/F FRpPOsEo I n 1 I I LAWERENCE DIBONA D RIVEWAy PLAN 0 1-n 100 EEL RIVER ROAD TOC. 1 1 v ASSESSORS MAP 116 1 PARCEL 94 A 82,331t S.F. I z I ® 1.89tW�4CRES I i W w EXI SYSTEM "A" q P i I o CONC. PAD I o #100 I I � ELL RIVER ROAD -- - OSTER VI LLE, _ _ 1 __ _ I 0 24"PVC BOX ,3.8 M ASSACH U SETTS I CBDH sQ 10' DECK I i FOUND �S�M 8 4"PVC 35.5 3 0 " 5 4 9� SCH $° 1 EXISTING FRONT SEPTIC" 6 7 SEP�TANK _GAL DWELLING I C SOS rn 23 11 � H-20 I1 9 I � I STONE 2' 10 °`�� -� SEPTEMBER 14, 2004 I I WIDE TYP. �01 GRASS i T I 12 �oQ DRIVE UNDER I O I GARAGE I D I Q BENCHMARK HDRANT •, I TAG BOLT #20 I I ELEV. 24.0' I ( PREPARED FOR: DUNHILL COMPANIES, LTD. I I 776 MAIN STREET OSTERVILLE, MA 3 02655 (508) 420-9222 8 ► i m I I S66-17'50"W 341.50' y a i to `�'" O U W. Yarmouth Massachusetts I ©2673 a 5®8 778 89�19 N/F FRANK A. & GERALDINE SULLIVAN 120 EEL RIVER ROAD (0 2004 The BSC Group-Norwell, Inc. M ASSESSORS MAP 116 CD PARCEL 95-1 0 SCALE: 1" = 20 FEET N 1�1 0 10 20 40 FT. 0 m Q a PROD. MGR.: C. FIELD ui FIELD: D. GAZZOLO / J. McCARTIN m CALC./DESIGN: P. HAGIST 2 DRAWN: P. HAGIST > CHECK: C. FIELD N FILE: 8459-AB.DWG c DWG. NO: 5396-04 a SHEET 1 OF 1 JOB. NO: 48459.00 SEPTIC TANK DETAIL: 1 ,500 GALLON DISTRIBUTION BOX DETAIL: NOT TO SCALE LEACHING TRENCH DETAIL: NOT TO SCALE REVISIONS SOIL TEST PIT DATA: P #� 0,340 N0. DATE DESCRIPTION NOT TO SCALE NO. OF OUTLETS : 5 36' MAX .COVER ES i PIT _ i TEST PIT - 2 NOTES: 1. SEPTIC TANK SHALL BE STEEL 5. INLET AND OUTLET TEES -I BE CAST IRON, FINISHED GRADE SCHED. 40 PVC OR CAST-IN-PLACE CONCRETE. � FINISHED GRADE I ORD. EL. 12.64 GRD. EL. 11.26 REINFORCED CONCRETE. F TEES TO BE CENTERED UNDER MANHOLE COVER. REMOVABLE I 2" WALLS LOAM do SEED DISTURBED AREAS I ;. HIGH GW. 6.5 EST. HIGH GW. 6.5 2. SEPTIC TANK TO WITHSTAND H-10 LOADING COVER NOTES: UNLESS UNDER PAVEMENT, DRIVES OR LOAMY SAND LOAMY SAND TRAVELED WAYS, WHEREIN H-20 LOADING �;.q„+a;.q„+ �;;� �;.�,;. 20 �A 1. DIST. BOX TO WITHSTAND H-10 LOADING SHALL APPLY. T UNLESS UNDER PAVEMENT, DRIVES OR CAP ENDS 7.5YR 2.5 1 " 3. ALL PIPE CONNECTIONS AND CONCRETE » T TRAVELED WAYS WHEREIN H-20 LOADING 4' PVC'' ' '-=-L ' u-' '-i-t4'�F 4�VL" .0�' .�. 7.5YR 2.5 1 9" 11 2-24 DIA CONCRETE MANHOLES � •+ o o or a or a or e e I CONSTRUCTION SHALL BE WATERTIGHT. 0 4 e o e e a o o o r e B B W/ METAL HANDLES BROUGHT 4 -•�- 15- SHALL APPLY. , ° ° • ' LOAMY S ND LOAMY S ND 4. FILL ALL UNUSED KNOCKOUTS WITH TO 6" OF FINISH GRADE I e+ . o 1OYR 5/4 " 1OYR 5,4 " MORTAR. 6' 5,5' OUTLETS < 8 1 2• PROVIDE INLET TEE OR BAFFLE WHERE e e GENERAL NOTES: 24 24 TEE TO BE UNDER 12" IN 1 SLOPE OF PIPE EXCEEDS 0.08 FT. T OR LEVEL BOTTOM EL = 10.64 EL = 9.26 Cl Cl M.H. OPENING 3. e�� o L " IN PUMPED SYSTEM. - 27� 1 CONSTRUCTION FOF THE OR I SEWAGE MEDIUM SAND MEDIUM SAND HIGH GROUNDWATER COMPUTATION � 3. FIRST TWO FEET OF PIPE OUT OF DIST. Al."_ DISPOSAL FACILITY ONLY. RAISE M.H W�L 4 BOTTOM ON LEVEL BOX TO BE LAID LEVEL. PROFILE 2. ALL CONSTRUCTION METHODS AND 1OYR 6/6 1OYR 6/6 �- ' I 6 MIN. 3/4 TO " BASED ON TP 2 10'-6 STABLE BASE 1 1/2 CRUSHED MATERIALS SHALL CONFORM TO MASS. SEWER BRICK d-. •d. •.: .:.. ' 42 50" do MORTAR 4. ALL PIPE CONNECTIONS AND CONCRETE D.E.P TITLE 5 AND LOCAL BOARD 10-0 - :` CROSS-SECTION STONE BASE 36 MAX. - 12 MIN. COVER OF HEALTH REGULATIONS. 1 DEPTH TO WATER 9.0� 1 :_ NORM AL WATER 12 CONSTRUCTION SHALL BE WATERTIGHT. INDEX WELL MI:'�-29 �d 3" 5. FILL ALL UNUSED KNOCKOUTS WITH MORTAR. 2% MIN. FINISH GRADE 4- MIN. LOAM do SEED 3. ALL PIPES LOCATED UNDER PAVEMENT 84" WATER LEVEL RANGE ZONE B _ 10 14" OR TRAVELED WAY SHALL BE SCHEDULE PRECAST SEPTIC TANK d 40 OR EQUAL. EL = 6.5 �_ - 57" CURRENT DEPTHONDEX WELL(9/02) _ :� INLET TEE =S 5'-1" 30 1/2' 3i �c� 4. THERE ARE NO KNOWN PRIVATE WELLS WATER LEVEL ADJUSTMENT -;1 _ _ - C LOCATED WITHIN 150 FT. OF THE C2 C2 DEPTH TO ADJUSTED HIGH WATER ti.8 5-2 4'-6- � » " d 4'-0" MIN. 90'am ON _� 5�-8» 15 1/Z" DATUM: �t'MIN •y � - " PROPOSED LEACHING FACILITY NOR FINE IVIED SAND FINE MED AND - - z == LIQUID DEPTH aoww�aa d ESERV 2 MIN. OF 1/8 TO ANY KNOWN WELLS PROPOSED WITHIN L 2.5Y �/4 2.5Y 7/4 5_8 PRECASTBOX DIST. VERTICAL DATUM: MSL± 24 e e 24 e / 1/2' WASHED STONE 150' OF ANY KNOWN LEACHING FACILITY. EL = 2.14 - 126" - - 108" � •' e " - 5. WITHIN LIMIT OF EXCAVATION REMOVE - EL - 2.26 _ 41 BENCH MARK USED: TOWN OF BARNSTABLE �`�_ 3/4 TO 1-1/2 DOUBLE ALL TOPSOIL, SUBSOIL AND OTHER GIS DATA I f l ��I 6. REPLACE WITH CLEAN WASHED SAND R:L 0.b4' 144 EL = 0.26' 132 1 BOTTOM ON LEVEL STABLE BASE 3' � S" 2 - - B WASHED STONE (NO FINES) IMPERVIOUS MATERIAL. PLAN VIEW " " ,,,IRy� ,r,�� 7 1/ BENCH MARK SET: HYDRANT #20 TAG CROSS-SECTION OR OTHER CLEAN GRANULAR SOILS !�A-E' DATE: INDICATES 1 6 MIN. - S To CROSS-SECTION VIEW PLAN VIEW 9/26/02 1 1/2" STONE BOLT. ELEVATION 24.0 CONFORMING TO THE FOLLOWING r �_ ESTIMATED _ � SIEVE ANALYSIS: "EST BY TEST BY: - SEASONAL HIGH "� PASS No. 50 SIEVE THE BSC GROUP, INC. THE BSC GROUP, INC. GROUND WATER OF SLOPEGETATIVE y,�TIANDS 107G (MAX) BY WT. SHALL °Ni?"NESSED BY: WITNESSED BY: INDICATES ,✓ �. � Op0 BOTTOM » » <10 X OF No. 4 SIEVE SHALL •_('�ry,VE STANTON DIVE STANTON � OBSERVED , ,� ,� F�Opo 20/yf q' N/F SYSTEM B PASS No. 100 GROUND WATER � �� � j CRAIG A. 2p1\l l�f� WIANNO GOLF <5 X OF No. 4 SIEVE SHALL PERC. RATE: PERC. RATE: ,✓ OF E C £Vq TIpN CLUB ESI GN CRITERIA: UNIFORMITY COEFFICIENT O No. 4 _.. PASS No. 200 �-MIN./INCH ��MIN./INCH INDICATES �/: � � No.3I3039 FIELD (A j 1 ASSESSORS MAP 116 SIEVE </=6.0 SOIL EVALUATOR SOIL EVALUATOR PERC. j �N N/F ti PARCEL L-22 DESIGN FLOW: CRAIG FIELD CRAIG FIELD TEST CIVIL . TODD H. WETRO � '�BI0 7. EXISTING UTILITIES WHERE SHOWN IN THE DRAWINGS ARE APPROXIMATE. ► 90 EEL RIVER ROAD , �p 1 BEDROOMS AT 110 G.P.B./D 110 G.P. THE CONTRACTOR SHALL BE RESPON- No.32112 THESIBL FOR PROPERLY LOCATING AND SOIL CLASS: SOIL CLASS: INDICATES i � OIE: ASSESSORS MAP 116 ►►�� g UNSUITABLE x� PARCEL 93 , �1 . O� COORDINATING THE PROPOSED CON- MATERIAL ►► uTOPOGRAPHY UPDATED 340 WOOD FRAMED STRUCTION ACTIVITY WITH DIG-SAFE �.T^A.R. L.T.A.R. �01 SINCE 2002 PLAN �I q OPEN STRUCTURE WETLANDS CBDH REQUIRED SEPTIC TANK: - AND THE APPLICABLE UTILITY J. 14 G.P.D./5Q.FT. 0.74 G.P.D./SQ.FT. �xj CBDH FOUND 220 (`,AL COMPANY AND MAINTAINING THE 50' BUFFER TO 110 X 200% THIS PLAN REPRESENT A yr FOUND EXISTING UTILITY SYSTEM IN SERVICE. » » REVISION TO THE ORIGINALLY 1� SEPTIC TANK PROVIDED: _ -1500 AL. DIG-SAFE SHALL BE NOTIFIED PER INVERT ELEVATIONS: SYSTEM B SUBMITTED PLAN OF 2002 " THE STATE OF MASSACHUSETTS N66"17 50 E 346.53 STATUTE CHAPTER 82, SECTION 409 AT TEL. 1-888-344-7233. THE TOP OF FOUNDATION 21.1 A CBDH --� - SIZE OF LEACHING FACILITY REQUIRED: - � - - % ENGINEER DOES NOT GUARANTEE 4" INVERT AT BUILDING 19.91 B 1 FOUND DESIGN PERC. RATE: <2 MIN./INCH THEIR ACCURACY OR THAT ALL CHfCk n FORMER 10' WIDE RIGHT5 F DD 2�12�1954 \ / UTILITIES AND SUBSURFACE STRUCTURES 4 INVERT AT SEPTIC TANK (IN) 19.60 C r 2 - PROPANE\ LONG TERM APPL. RATE 0.74 G.P.O/S.F. ARE SHOWN. LOCATIONS AND EXTINGUISHED IN CERTIFICATE #1 _ - - - ____ - _ f- TANKS `� ELEVATIONS OF UNDERGROUND UTILITIES 1 TAKEN FROM RECORD PLANS. THE 4 INVERT AT SEPTIC TANK (OUT) 19.27 D �^1 - _ _ _ - - -_ _ _ _ - - - - - - - 41 2' �'' 110 GPD + 0,74 GPD/SF = 149 S.F. CONTRACTOR SHALL VERIFY SIZE, 4" INVERT AT DIST. BOX (IN) 18.78 E -onI' - _ _ ---- LOCATION AND INVERTS OF UTILITIES ) -0 I� - -�y- - \, I AND STRUCTURES AS REQUIRED PRIOR 4 INVERT AT DIST. BOX (OUT) 18.55 F \ _- --_ EXISTING DRIVEWAY _ \ ----- POOL HOUSE !� SIZE OF LEACHING FACILITY PROVIDED: TO THE START OF CONSTRUCTION. �I I - /- � E \ � g FER TO WE DS / - rn 1 - ,�[--- 1'DQ' 2 2' WIDE 21 �1FEP, 8- THIS SYSTEM IS NOT DESIGNED FOR INVERTS AT LEACHING FACILITY: PINE //w \ - _ --- RASS \ I f THE I ',E�OF A�G JAGE GRINDER. 4 INVERT AT BE - OAK \ "�� 27 L❑RG TRr_ N_ I-I Ar GEF IDS CBOT �cr II OF LEACHING TRENCH 18.45 G BREAKOUT ELEV. 19.0 \� OAK R )_ ` . __ cM4._ PINE + - \1f ELE. ,}{, 11I !1 1 2xCP' 4" INVERT �I END PINE \ '}(' 1 I C OF :AU ., e _ �- M L TO BE �' w -_ L I I 18.02 H o I \ _ REMOVED 9. EXHINV w4VEk Nr._. f0 BE CHECKLED BY , OF LEACHING TRENCH IC I N F --- - 324 x 0,74 GPD_ „r = 240 GPD THE CONTRACTOR PRIOR f0 CONSTRUCTION to !� LAWERENCE DIBONA �'� ELE # TOC.=21.4 �/ _ PROVIDED THE ENGINEER IS TO BE NOTIFIED OF ELEVATION AT BOTTOM .,, 100 EEL RIVER ROAD ANY FIELD CHANGES 'THAT L!,�Y BE OF LEACHING TRENCH 16.02 J I 1 , ASSESSORS MAP 116 O- � - --- MET. I U U i SIZED TO ACC❑MADATE' 2 BEDROOMS REQUIRED. I➢ I ' PARCEL 94 OAK ESTIMATED HIGH I 82,331 t S.F. uN Ft\G� GROUNDWATER ELEVATION 6.5 K i z I 1.89±WACRE Ir C �R K IN O- EXISTING C DH LOCUS INFORMATION PROFILE: NOT TO SCALE - REAR SYSTEM 1 0 Ar OAK CONC. PAD POOL FOUN 1 I AN 0 ED TAK CURRENT OWNER: LAWERENCE & JANET UROUP EL.= A FIRST PIPE LENGTH 1 K UTILITY P E ry DIBONA TOP FOUNDATION 1 � / OAK k,� W 657 Main Street, (RT. 28) Unit 6 CONCRETE COVERS G WITHIN TO BE SET LEVEL TITLE REFERENCE: CERT. 90204 W. Yarmouth Massachusetts EL.=20.3 _ 6" OF FINISHED GRADE. FOR MIN. 2' I I ' E _ - 5' 1 1 ' I rn / OAK , �, 6' " GRASS �� Nj 02673 4 PVC I M 4 pV 3j ,`�& ` PLAN REFERENCE: L.C. 3145-1 I 1 / SYVE� A OSH• 1 TOC.=21.4 �. Q ` No\ 508 778 8919 S' PCH 4 - I I .-� #c PVC1 OAK / / 0� M ASSESSOPARCEL: 94 PROJECT TITLE: 1 I \ D ;,,r f / �(500 GAL ��, YSTEM o =B 1= I I BOX4"r ; E SEP. TANK 5� rn ZONING DISTRICT: RF-1 I=c I=E I=G o I=H I I o N ! ��� �> SEWAGE DISPOSAL ry SETBACKS: FRONT 30 •e: DIST. BOX TLETI=F a I I ` _ � 0 150 AL DWELLING NG " P BOX \, \�`` U SIDE 15, SYSTEM AS- BUILT SEPTIC TANK in BOTTOM EL- I I / / / 1 / i K OAK H-�gONK UNDER CONSTRUCTION , �� N REAR 15 EST HIGH WATER EL.- K I I ` .• G '� �� OAK -,__� /' i �� �► MINIMUM LOT SIZE. 87,120 S.F. \ / _ ✓ �-- I I �! -- •- �: \ � �-` -�`� EXIST. TOTAL LOT AREA: 82,331t S.F. SYSTEM "B» � GRASS �-_LIMIT JOVERLAY DISTRICT: AP OF EXCAVATIO \ �``e OA `� SEE NO 5 & 6 - - - NITROGEN SENSITIVE I 7 i z 6,, �'` I ZONE: NOT A ZONE II #100 PINE r1�� \� FEMA FLOOD : I i 1 PINE ���j DRIVE UNDER - 14 ZONE DISTRICT C DATE PANEL E2 7 000119 2 D ELL RIVER ROAD I I _ GARAGE �'`�\ \�V I I OAK '�` PINE OSTER VI LLE VARIANCES REQUESTED. I _ it ,- > ► PINE OAK \ YNDCRHAMNTA , \ , y LOCUS PLAN: NO SCALE M ASSACH U SETT S pw RK INE TP# N oA x * I 1 REAR SEPTIC TAG BOLT #20 OAK I I ELEV. 24.0' \ A ___ .12 N PREPARED FOR: NONE I S � \ DUNHILL COMPANIES LTD. C PINE �.;4 t \ 1 I _ _ RELY MAP Pflt;};0 ED C;F�'(.V�=�tt�AY O- �9.3' MAIN STREET 776 MAIN STREET I ^ O- d- OSTERVILLE, MA OW 02655 I 3 PINE ~`---- ' BPS R� (508) 420-9222 PINE ' CBDH DATE: AUGUST 30, 2004 I OAK �. FOUN I Z OAK / OAK PINE 17- COMP. DESIGN: K. HEALY I I f S66'17'50W 341 01 < LOCUS �� CHECK: D. CRISPIN PLAN VIEW I �. OAK � ` �,rL �° DRAWN: K. HEALY I I OAK N/F _ t^ FIELD: D. GAZZOLO / J. McCARTIN I I PINE OAK FRANK A. & GERALDINE SULLIVAN SCALE: 1 - 20 FEET I I I 120 EEL RIVER ROAD d FILE NO. 8459STK1.DWG I I ASSESSORS MAP 116 10 20 40 FT 9 DWG NO. 5396-03 0 . I I I PARCEL 95-1 SHEET 1 OF 1 I JOB N0. 4-8459.00 L