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0109 EEL RIVER ROAD - Health
Road., - Osterville A- 1150010. � • r t n n •`,i a r THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEA TH _. .----- ...........OF.......... . .... .. ........ . � ����irtt�iutty���r ������tt� larks Cnlatt�#�ixr��l�tt ; p�tlti� Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst.-- t ___ .. .................................................... ------------------------------------------------------•-----------------------------------•------ W /�•�A� cati ddr; . - ......... .........................................." �L .._.__.._...----�..... .......... ....��........ ---•---- Owner Address Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms------------------______--____-__--..-_-_-_Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Pa Other fixtures ------------------------------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity---__---__-gallons 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 ( ) Percolation Test Results Performed by.......................................................................... Date------------------------------•-------- a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-.._:-----_-----__----_ ' �14 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground= water------------------------ �--;--•------ --- ------------------------------------------------••--------------------•----•-------------...__...-------------- 0 Description of Soil-------x W ------------------------------------------------------------------------------------------------------------ - ----------- ----- -- U Nature of Repairs or Alterations—Answer when applicable.-.. ._...______ _________/ ------------------------------------------------------------------------------------------------------------------------------ ------------- ......_.......... ......--- . . ------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is ed by the board of health Signe ...I.Y-.e-- ----- -----•-------------- --=` ----. ............�S Date Application Approved By.... ... . j .=::. .'-... �. ...._..Da......---•- Application Disapproved for the following reasons__________________________________________ _ _____________ ____ __._ it .........--•--........--••--•.............•-•-------••-------------------•----•-•-•---••---------------- �/ f, Date PermitNo--------------------------------------------------------- Issued...................... ................................. Date Fss .................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF........20F HEALTH .. .... .....!i. ...�_-. ....................... _ Appliration for Dhipviiat Works Tomitrurtion Vrrmft Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal Syst t __;1 ........................ ........ --------------------.......................cati ............................................or-'r.....v................................................ A-Ac!4�s o ............ ..................... .................................................................................................. -------------------Owner-' Address ..... .................. ........................................................................... �vInstaller Address < Type of Building Size Lot------_--------------------Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder Other—Type of,Building ............................ No. of persons-_-___-_--_________------.-- Showers Cafeteria P4Other fixtures ---------------------------------------------------- -----_---------------.......... Design Flow............................................gallons per person per day. Total daily flow---------------------- ....................-gallons. P4 Septic Tank—Liquid capacity------------gallons Length---------------- Width..._....--.-.-.- Diameter__-__....._.-_.. Depth..-.-_._.-_---- Disposal Trench—No---------------------- Width-_----------------- Total Length_-_--------.._-__--- Total leaching-area--------------------sq. f t. Seepage Pit No------_-_---------- Diameter................._.. Depth below inlet_............._._._. Total leaching area-----_----------Sq. f t. Z Other Distribution box ( ) Dosing tank ( ) ,..-I Percolation Test Results Performed by-------------------------------------------------------------------------- Date-----------------------------------..... Test Pit No. 1................minutes per inch Depth of Test Pit__._............._.. Depth to ground water---------------- (Lq Test Pit No. 2................minutes per inch Depth of Test Pit.-_--___________--_- Depth to ground water_-_-__--__-_-__-_---.. ------I.........------------------------------------------------------------------------------------------------**--------------------------------------------------- 0 Description of Soil-.------- - 1;� ...... -------------------------------------------------------------------------------------------------------------------------------------- U -------------------- -------------------------------------- ....................................................................... ------------------------------------------------------------ ---------------I--------------- ------- -------------------------------------------------------------------------- ----( I....A--------/....................... ------------------------ Nature of Repairs or Alterations—Answer when applicable.-_Z� `rn U ---- --- ........ ---------- --------------------------------------------------------------------------------------------------------------------------------/ ------- --------------------------------------- ............ ------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a.Certificate of Compliance has been issued by the board of healtl-L 1W............................................. ..... Igne _�� -.1, S* --- --------------------------- Date Application Approved By..--' _.;�i ..................... Date Application Disapproved for the following reasons:................................................................................................................ .............................................................................................................................................................................. ------------------------- Date PermitNo........................................................ Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD 0 HEALTH .........OF........... . ........ . ....... ..I.... ......................................... (IT U'r -f iratr of Tompti-aurr THIS IS Ta CE IT. RIF Y aatthikedividual Sewage Disposal System constructed or Repaired by- .. .. ........... ...... Z-7. ..... . ................ ... ........ ....... . .............. ...... . ----Installer 7, t li a .. ...... . -------CZV-----A,(_,�_ ...... .......... • ....... ...... t .................... ...... visions zticle has been stalled in accordance with the pro IR r)" �l of The State Sanitary Code as described in the /7— � 4/— 7_) — application for Disposal Works Construction Permit kN ',/------------------------------------ dated.... .......................................... ol 2 f I- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. . DATE................................................................................ Inspector................................................. .................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH (7 ................ ........... ......... . ......... .......0 F No......................... FEE. .................... kp Permission is hereby granted......... --- ----------------------------------------------------------------- ---------------------- to Const(u-ct or R--,aLilr arAndividual Sewa e &itspo'sAl yet m .............. ...................I... ......le.......!------- ....... at No. I AA Street as shown on the application for Disposal Works Construction Pe ON mi, No.__ ----r-----) ed.. .................. .....— �4 -0 ...... .....4�� -------------- 7 f Health DATE..... .................................................. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 5EW Q_ E - ER MIT 1.1 O. - - -VILLAGE-* Ihl_STQ L�RS_f`1 ME_�_ADDRESS l3U1_LD_.E . 5_1J.Q►�llE ._AD,_QRE_SS _�DlaT.E_P_ER1�1T ISSUED_•—.���-7�__ —_— D AT_E_COMPLI WACE- ISSUED: ��[ // � .: ��' {� �- � __ � �3 � �� . `� �'`� •� r YU � \ 4T' �n�' `C./ i� � `���,(„N�� TONVn'Of Barnstable Regulatory;Sen ices e: Thomas F. Geiler,Director 9.H"R g Public Heal th Division 16s� t .. Thomas McKean,Director , ' 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification.Form Date: (Q 30 0 .a Designer: 50\VIva % I" • Installer: ©/� �"�/ ce*z�� Address: ;. �.0 , Address: On / ,�©� 1� j -�/�°�/ was issued a permit.t6 install a (date) (installer) septic system at I oq ' A �� �o�� -- based on a design drawn by —� address S ��U�✓1 11 unties dated cep►sedgy JhI>10 (designer) 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 chancesi.e.o 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., (Ins 's Signature) o (Designer's Signature) (Affix D s�r s Stamp 'PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COl�1PLLA1 CE WILL NOT BE ISSUED UNTIL BOTH THIS FORM A1�FD AS- BUILT CARD ARE RECEIVED BY THE B_ARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certincation Form . ley. Barnstable Town of Barnstable ��� anxrrsTne�. � 1 KASS. g Board of Health A'Fa �s 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi September 14, 2007 Peter Sullivan, P.E. Sullivan Engineering Box 659 Osterville, MA RE: 109'Eel River Road,-6sterville", A:= 11.5=009 Dear Mr. Sullivan, V You are granted permission on behalf of your clients, W. Frederick and Diane Uchleir,to construct an onsite sewage disposal system designed to be connected to eight bedrooms at 109 Eel River Road, Osterville with the following conditions:. • The engineering plans shall be revised to show a double compartment septic tank. • The septic system shall be constructed in accordance with the revised plans. Sin ly your , Wayn filler, M.D. Chai6fian BOARD OF HEALTH TOWN OF BARNSTABLE Q:\WPFILES\EightBedroomsSullivanUchleir2OO7new.doc DATE:a9/.2.2, O FEE: RARNS ESE +� MASS. 6N3 I9. `� REC. BY Town of Barnstable St:HED. DATE: Board of Health 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,RS. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Wayne A.Miller,M.D. VARIANCE REQUEST FORMLATIN , PPopertyAddress: / 9 ��� /Ei'ver RDa-W_ 0,sk4 jYlc, _ a Assessor's Map and Parcel Number: Size of Lot: boy OUES ` ._ AMeel laa� Wetlands Within 300 Ft. Yes .� Business Na e: No Subdivision Name: APPLICANT'S NAME: W• /" /re ��' U/ 41er'Fhone� Did the owner of the property authorize you to represent him or her? Yes No PROPERTY OW/NEWS NAME CONTACT PERSON Name: y- Name: A Address: /tD / e/ /'CIwr �ek I Address: 0/ 100"rxA ,- I2ax O s k.-V v /7i da�53 p d ,6 cac 65Y Phone: Phone: O's Yev0 j t-1 m VARIANCE FROM REGULATION(List Reg) REASON FOR VARIANCE(May attach if more space needed) ry -7-O7NL &OOM 7 Aeirns^ I NATURE 01F.WORK House Add•tion ❑ ????? House Renovation ❑ Repair of Failed Septic System 0 Checklist (to be completed by office staff-person receiving variance request application) > , Please submit copies in 4 separate completed sets,_ _' Four(4)copies of the completed variance request form , Four(4)copies of engineered plan submitted(e.g.septic system,plans), ✓ Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) C�/l r Signed letter stating that the property owner authorized you to represent him/her for this request )V J� Applicant understands that the abutters must be notified by certified mail at least ten days prior to meet' date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) C:\Documents and Settings\decollik\Local Settings\Temporary Internet Fi1es\0LK3\VARIREQ.D0C i z August 21,2007 Town of Barnstable Board of Health 200 Main Street Hyannis,MA 02601 RE: 109 Eel River Road, Osterville Dear Board of Health, As owner of the above referenced property, _please be advised that Sullivan Engineering,Inc. _ has my permission to represent me before your Board in all matters pertaining to the proposed septic system at my property. Sincerely, l Diana Uehlein w Town of Barnstable P# 116, 13 Department of Regulatory Services g Public Health DivisionARAM Hate +aly 200 Main Street,Hyannis MA 02601 Date Scheduled � 4 / Time Fee Pd. i ©0 , v ' S it Suitabil' ss ment for Sewage Disposal Paforrud By: LOCATION&GENERAL INFORMATION London Address Owner's Name J;� X4-eme l ��,��L��[,.•/l/% l7 Address � /Off' �i' �i✓f/1 Np,`)� Assessor's�,( Z4 � A r 1k�' En nMeerr'� aATme" ` NEW CONSTRU N _ k REPAIR Telephone# Land Use Slopes(yb).. 2g Surface Stones "L Distances from: Open Water Body 'o'-140. ft Possible Wet Area QQft Drinking Water Well ?SM ft Drainage Way j44 ft Property Line ' �-� R Other ft SKETCH:(Street name,dimensions of lat,exact locations of test bola tit Pere tests,locate wetlands In proximity to holes) N vc S, - e v� 1 a..- -1 1 ' I . .. .1•f 9F2 �. � �. � _� 1 r { m m Parent material(geologic) Depth to Bedrock * •3Q� Depth to Groundwater. Standing Water in Hole: /1'df°L. C. Weeping fmm Pit Face / Estimated Seasonal High Groundwater ' DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: In. Depth to soil mottles: ' In Depth to weeping from aide of obs.hole: In, Groundwater Adjustment fc. Index Well# Reading Date: Index Well level,,..�._ Adj.fActur Adj.Oroundwater level,,, PERCOLATION TEST Date&QL-7 Thn.e 29Leeon Observation Hole# 71me at V, ��JD PF,pL i✓aT , Depth of Pere � � � �p,?��� Time at&' Start Pre-soak Time C O t7Jf tsme(9"-6") _..__. End Pre-soak �ji.�/ �'lL�P/ C L Rate MinJlnch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) t . Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100,of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q.%SEPTICIPERCFORM.DOC r DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;BouWers. a- 1 n 6 /45 Yle DEEP'OBSERVATION HOLE LOG Hole# Depth from . Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stoma,Boulders. ly f� q Y e— leg DEEP OBSERVATION HOLE LOG Hole#.� : Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (MunselQ . ' Mottling (Structure,Stones,Boulders. "q 4 I f DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. oyl /O r Y � C� � �%�� •Q 7 �g Flood Insurance Rate Man: W, Above 500 year flood boundary NO— Yes --- .—:1 t: Within 500 year boundary No= Yes Within 100 year flood boundary No_ Yes -- Death of Naturally Occurring Pervious Material Does at least four feet of naturally occtnring pervi us material exist in all areas observed thro ghout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring rvious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Envi nmental Protection and that the above analysis was performed by me consistent with . the required trai ' xpertise Zana 'ence described in 310 CMR 15.017. Signal Date Q:\SEPTICIPERCFORM.DOC hT COMMOf�IVEALT H F MA S HUSETYS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for ]h5pogal *potem Cou0tructiou Permit Application for a Permit to Construct(.4�'Repair O Upgrade O Abandon O .Complete System ❑Individual Components Location Address or Lot No. 109 Eel 'leer- f,&A Owner's Name,Address,and Tel.No. loq Eel K:vec'Rprc� Assessor'sMap/Parcel I IS—00ci 0 �� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �Arc Type of Building: Q Dwelling No.of Bedrooms 17 loom S Lot Size I.•b�j sq.fr. Garbage Grinder (A/0) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) PF® gpd Design flow provided I I k gpd Plan Dates Zl.ZeO� Number of sheets Z-k-5 of 3 Revision Date of `1'3ta:7 Title lc,(� ro qSe• s�ei Size of Septic Tank '7300'%\_ � - Z C6 Type of S.A.S. Q-";6o ("A' Zs x35 c Iaa� Description of Soil l7il�y�1 � 'CN 3 �P�.� La►�w� ��ZtCi '1� C�`lc 1Qvl� rc�'c 1.d0�r�-� SA�,g `Z(.-Lee, C.\ LA s:K lk k1'6 n\eo--F0NL qt-U" CAmoL 5.wy Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this B of %oe / /eq Signed Date !�( / Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. d 0®7 — 't i t Date Issued —13-0 "7 j No. r / 3: d j l '1 Fee S6 entered in computer: T E COMM., 4WEALTYH 6F MASSACHUSE S r , 1 BA a.� � PUBLIC HEALTH DIVISI�`N TOWN OF RNS TABLE, MASSACHUSETTS Yes , 4, Application for .XDi!9pogar *pgtem COYCOtruction Permit f. Application for a Permit to Coristiuct(_4-�Repair O .Upgrade O Abandon O ©Complete System ❑Individual Components 4' Location Address or Lot No. we,, f,o,,A Owner's Name,Address,and Tel.No. Derv\1Q,,mR- �dCCNLV_", \ p,w VCMe_%n Io9 G Qr Rrsu1 Assessor's Map/Parcel 15•0 0 9 p�K� I Installer's Name,Address,and Tel.No, Designer's Name,Address and Tel.No. 771-9... 9 3 ��a� N sae- Za-33ti Type of Building: Dwelling No.of Bedrooms 1-7 KoolY\S Lot Size 14V ACees sq.ft. Garbage Grinder (/10) _ 4 ry Other Type of Building No.of Persons Showers( ) Cafeteria( ) i r Other Fixtures Design Flow(min.required) R8o gpd Design flow providedlit gpd Plan Date Aj vA Zl}Z00:_ Number of sheets Z A'b S 3 Revision Date 9 h314 7 - title , u a Size of Septic Tank OOa - o Type of S.A.S. B-qo0 (oa\. (ham)D-ec S r� a ZS x3�i j=t L !i Description of Soil l7#-IIiW 1 LOA" . -6 LA� 10\1$ .hi LoA+n-r SA+O JYS r -Y-tPC- Tb—IZO" \C SS` I Me, N Nature of Repairs_or Alterations(Answer when applicable) P„ Date last inspected: Agreement: ;. = The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage di po§al system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance,has been issued by thisP d of e h. ""'���..Signed Date /,o f/�Z/ � i 1 Application Approved by : Date Application Disapproved by: 1 Date for the following reasons Permit No. 00 1 �. ' Date Issued '9 -/ 3-0 -7 i ————————————-—————— —— ————————=————————-- ,',,,A Q_THE,COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS 71 Certificate of Compliance nce THIS IS TO CERTI Y,that the On-site Sewage Disposal System Constructed (vr Repaired ( ) Upgraded ( ) Abandoned( )byC� at 0 KkQ-Cr kz,,A has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer I Designer ,A Va #bedrooms /'� � , � Approved design flow gpd The issuance of this permit shall of be cgnstrued as a guarantee that the system ill fu cf rra''designed. Date �, �� Inspector t �✓" " —————————————————————————— No. Gp -. L� Fee �� V THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS 1=i5po5a1 *pgtem Construction Permit Permission is hereby granted to Construct /) Repa' ( ) Upgrade ( ) Abandon ( ) z System located at 161 e few eC C k and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: C)nstruction must be completed within three years of the date of this p� it. Date y J Approved by __ TOWN OF BAR�N`STABLE LOCATION CL� 12 0 V 0Z— SEWAGE# )C,0:7. 44—P VILLAGE 6,Sf+g;'V /I LLr7 ASSESSOR'S MAP&PARCEL U BD INSTALLERS NAME&PHONE NO. C o > T SEPTIC TANK CAPACITY , LEACHING FACILITY:(type) `r1 LZ> (size) NO.OF BEDROOMS _ OWNER C b —L01 PERMIT.DATE: COMPLIANCE DATE: 3�C 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 within200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 41 ► .�, 4-7 ► 4LItIL .k I �, a � TOWN OF BARNSTABLE LOCATION d l '&l (%VL/ R�- SEWAGE # i VII;LAGE pST�rv' ¢' ASSESSOR'S MAP & LOT 11 S 001 INSTALLER'S NAME'&PHONE NO. J CS {fT Ord ZNS O SEPTIC TANK CAPACITY CA Lsp co LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: 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 leachi facility) �—� Feet Furnished by Tit ST&fi""D'1 �1 • F4� { J,A A a 3q 30 a a a8 Sy Town of BarnstabIc r# Of 1F1! , o Department of Regulatory Services i aaruvatiaw 3 P1JJx'blic Health Division Date NAG& �' : - 1110 Main Street,Hyannis MA 02601 - ttijy. Date Scheduled Z07)- Time U D Ice Pd. c3v i; Soil Stuital�ilit, Assessintent for Sewage Disposal � �. n t o V - Performed By -''�11dtn �Vk.ir�P�t^tr Witnessed _ � !�' ! 1 LOCATIOl`!t& GENERAL INFORMATION Owner's Name 1 r fedt-r�,-X Location Address (0�"£t� �N ,���,�� I e9 CtC R•vcr 4�d�:Nei.�,nt� R Address I OJ Cep I�lrcr P�ac�i� Engineer's Name 5v�\�Jai1 Assessor's Map/Parcel:-�15-QU 9 •�j NEW CONSTRUCTION ✓ REPAIR j C_. Telephone N 50%-L�Z�-s34 Land Use I Slopes(%) -ZOO/6- "Surface Stones AU A1& Distances fmnn: Open Water Body 210 I R, Possible Wet Area j&LL::�tt Drinking Water Well It Drainage Way � I ft Property Line R Other A/l tt SKETCH:(Street name;dimenshnis of lot, act locations of test holes&pert tests,Iociie wetlands in proximity to holes) ZZi i • ❑ . ;� �, �•� cal � /Y/ T)7 MA :I 6 Parent material(geologic)-00 R r1 , Depth to Bedrock 5 rz, Depth to Groundwater: Standing Water in Hole: NQ Weeping from Pit Pace Ac!N # Estimated Seasonal High Groundwater ?O -- t~ Z,S �� T•i13���0`' _ DETE NATIO TOR SEASONAL HIGH WATER TABLE: Method Used: 'ALAS 41ca MA6 in. Depth Observe standing In obs.iio e: in. Depth to soli mottles: Ill. Groundwater Adjustment �-' n. Depth to weeping Rom side of obs.hole: Ad.factor Adj.Groundwater LeGel I -� Index Well N Reading Date: Index Well level j n PERCOLATION TEST Date Time I Observation Time at 9" Hole# T Depthof Pere Time at 6" iD 1 Start Pre-soak Time Q 6`+`0L _ Time End Pre-soak Srnin 8•,,�+-tS��c. • Rate MinAnchin Site Suitability Assessment: Site Passed ✓, Site Pained: Additional Toting Nceded(YIN) original: Public.Healiti Division Observation Hole Data To Be Completed on Back------ ***If percolation test is to be conducted within 100, of tivetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:I I EALTI U W P/P ERCf ORM DEEP OBSERVATION HOLE LOG Hole It Depth fium Soil Iloiizon Soil Tcxlure Soil Color Soil Other Surtltea(in.) (USDA) (Munscll) . Mottling (Slructure,Slopes,Ilu.uldeis. ('nnalatenay %GraVCI) - - -- � C+oda��( toy (o-1 i`r t•,, Atr sn� lo`ti2e 5/Z Z7-51 Z3 ! ! DEEP OBSERV T11ON MOLE LOG. Ilole If Depth from Soil Horizon •Soi exture Soil Color Soil Other D^) (Munsell) Mottling (Structure,stones,Boulders. Surface(in.) Conlistom%Gravel).___._. rt i 0— lOP-,r 5 > [Dyk q b Z'SNI 7 6 li! DEL,P OBSERVA ,ION HOLE LOG IIolc# _ from Soil}forizon Soi exlure Soil Color`- Soil Other Depth Depth a(in.) (U�DA) (Munscll) Moltlbtg (Structure,Stones,Boulders. SurraConsistcncv,° 'iPycl) - t U-S LoNAk Up—4b q�©t\ C �i DEEP'OBSERVA`,!ION HOLE LOG Hole It Depth horn Soil f lorizoo Soil,Texlure Soil Color Soil Other Surface(ln.) (USDA) (Munscll) Mottling (Structure,5toites,Boulders. Cun4is1clicy %Gravel) b art lbtP>� — N 2I Flood Insurance Rate MnO-: Above 5oo year flood boundary No Yes Within 500 year boundary No Yes LA)�-\ l0 ICU CMtl!'� Ndk_ lC)C._ If Pr�r� Within too year flood boundory No::L Yes U Deuth of Natursilly Occurrin Pei`vious Material Does at least four feet of taturally occurring pervious material exist ul all areas observed throughout the rarea proposed for tilts soil absorption systcsii7 pilot,what is the depth of naturally occurring pervious material? j C11•ti[ication t a )roved b the I certify that ou 0 (date)I lsave passed the soil evaluator examination . pl Y Department of Envirotunental Protection and that the above analysis was performed uy me consistent with the required training,ex so and experience described in 310 CMR 1.5.017. DA1C411 lkyz signature Q:1113A.LTI-IMPIPERUORM SECTIONSENDER: COMPLETE THIS SECTION COMPLETE THIS .ELIVERY ■ Complete items 1,2,and 3.Also complete A.•S• natur item 4,if Restricted Delivery is desired.. gent ■ Print your name and address on the:reverse- X *��, ddressee so that we can return the card to yo'u. ■ Attach this card to the back of the mailpiece, B eceived •y ri4t�ci„lya ) C. ID or on the front if space permits. D. Is deli ery address different from item 1? El as 1. Article Addressed to: If YES,enter delivery address below: ❑ No I F rmonver Road 3. Service Type MA 02655. ❑Certified Mail ❑ Express Mail I ❑ Registered ❑ Return Receipt for Merchandise j ❑ Insured Mail ❑C.O.D. I 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 'I (Transfer from service label) �I PS Form 3811,August 2001 Domestic Return Receipt 102595-02-M-1540 f UNITED STATES POSTAL SFR First=Class Mail 40 Postage&Fees Paid USPS Permit No.G-10 • Sender: Please p �Qyoty name, address, aid Z1P+4 in this-box.', I a >� PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE 200 MAIN STREET HYANNIS, MASSACHUSETTS 02.601 � ll'Lli►1L5 - C3 OFFICIAL SE p Postage $ E Ln Certified Fee ,! Q CO U = Postm Return et )fTlRequired) (Endorsement R Re wirered 3 Restricted Delivery Fee C3 0 (Endorsement Required) Y p Total Postage&Fees $ i USpS r— ,,,p f0 J1--- ---------------------------------- Street,A t.No.;gr P Box Ner o ---:----------- - ------ -------- C3 Ciry, late, P+4 � S _L-.0 Certified Mail Provides: o A mailing receipt o A unique identifier for your mailpiece o A signature upon delivery • A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First=Class Mail or Priority Mail. o Certified Mail is not available for any class of international mail. o NO INSURANCE'COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail o For an additional fee,a Return Receipt may be requested to provide proof Of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form-3811)to the article and add applicable postage to cover the fee.Endorse mailpiece `Return Receipt Requested".To receive a fee waiver for a duplicate return receipt, a USPS postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail, receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this'receipt•and present it when making an inquiry. PS Form 3800,May 2000(Reverse) 102595-99-M-2087 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM c PART A CERTIFICATION Property Address: 109 Eel River Road a S o� Osterville. MA 02655 _ Owner's Name: Jav Larmon Owner's Address: ® �'- crs a Date of Inspection: July 29, 2005 r— c1 a rn Name of Inspector: (Please Print) James M. Ford Company Name: James M.Ford Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: _(508)862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the-time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section S o 15.340 of Title 5 310 CMR 15.000 . The system: PP Y P P ( ) Y Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority ✓ Fails Inspector's Signature: iffymeDate: August 2. 2005 The system inspector shall sub 't a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 1.0;000 gpd or greater,the inspector and the.system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****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. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 109 Eel River Road Osterville, MA Owner: Jay Larmon Date of Inspection: July 29, 2005 Inspection Summary: Check A,B,C,D>or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated'are indicated below. ' Comments: a x 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. 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. � r ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to,a broken,'settled or uneven distribution box. System.will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: ` The system required pumping more than 4`.times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 109 Eel River Road Osterville, M4 Owner: Jay Larmon Date of Inspection: July 29, 2005 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment:. Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. A The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 109 Eel River Road Osterville, MA Owner: Jay Larnion Date of Inspection: July 29, 2005 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than'/zY da flow q P P✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. _ ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.]. Yes (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply _ . the system is within 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 11 of a public water supply well E If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 109 Eel River Road Osterville, MA Owner: Jay Larmon Date of Inspection: July 29, 2005 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ _ Was the site inspected for signs of break out? ✓ _ Were all system components,excluding the SAS,located on site? ✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition. of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ _ Was the facility owner(and occupants if different from:owner)provided with information on the proper maintenance of subsurface sewage disposal systems The size and location of the Soil Absorptiono System SAS on the site has been determined(SAS) based on: Yes No ✓ _ 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(3)(b)]. r I 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property AddresJ 109 Eel River Road Osterville. MA Owner: Jay Larmon Date of Inspection: July 29, 2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n/a Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 2 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): n/a [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)): Unavailable Sump Pump(yes o no): No Last date of occupalncy: Currently occupied I COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe I: GENERAL INFORMATION Pumping Records Source of infonnation: Pumped approximately 3 years ago-per owner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank, distribution box, soil absorption system Single cesspool ✓ Overflow'cesspool Privy Shared sy i tern(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval , Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed on Julv 28, 1975-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 I Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 109 Eel River Road Osterville, MA Owner: Jay Larmon Date of Inspection: July 29, 2005 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron 40 PVC =other(explain): Distance from private water supply well or suction line- Comments(on condition of joints,venting,evidence of leakage,etc.):' SEPTIC TANK: ✓ (locate on site plan) Cesspool acting as a septic tank Depth below grade: 2 0"to cover fl Material of construction: _concrete _metal _fiberglass _polyethylene ✓ other(explain) Cesspool brick If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 5'W x 5'T x 7'bottom to grade Sludge depth: 10" Distance from top of sludge to bottom of outlet tee or baffle: -- 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: How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): No outlet tee was present. GREASE TRAP: None (locateon site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Continents(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM,INSPECTION FORM PART C ` SYSTEM INFORMATION (continued) Property Address: 109 Eel River Road Osterville- MA Owner: Jay Larmon Date of Inspection: July 29, 2005 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: None (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 109 Eel River Road Osterville. MA Owner: Jay Larmon Date of Inspection: July 29, 2005 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: leaching fields,number,dimensions: ✓ overflow cesspool,number: I Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): The overflow cesspool was 5'W x 6'T x 10'bottom to grade and had Y of 1Lquid on the bottom. The scum line was up to the bottom of the Vie. The cover was 10"below garade. There were signs ofgast failure-no reserve left. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): PRIVY: None (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.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 109 Eel River Road Osterville, MA Owner: Jay Larmon Date of Inspection: July 29, 2005 I 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. Ggra L . A Q 39 30 a. a �g Sy 10 I' o• Page I 1 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 109 Eel River Road Osterville, MA Owner: Jay Larmon Date of Inspection: July 29, 2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 20+/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contour maps the maps were showing approzintately 20'+/ to ground water at this site The system is within 300'o a tidal bay and no hijh ground water adiusttnent needs to be taken. This report has been prepared and the system inspected and failed as'of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied,relating to the system, the inspection and/or this report. 11 j Vent-Fad Lomim to be Dd®oed - - a75meo[Ioaasao..abe . oabwayrienouac Poabb Finish(lade F.F.ffi-23.0 M-aw , F.F.EL 28.51(iomt8o®) �..�. rcrr+�Sr+fSL -r�. Illk lYf 4 F.G.F. EL a(D-OW se<Nde4 Bra) ll s i73 {�v. FA EL.26.0(naednooaa) F.ri 81-23.0 3'Mmc. !1 3i _A{L!�-=� "� 1111 ri 9"Mm -CompattedFll - Fiha EE NOTE 7(TYP.) A. 1B'-tir . 2" _ Peastme jy arc.ar..2233(rmanenm) 3' .. '�' bauble Washed 2000 Galion Teo a Zaoo y LEACHING StmO CHAMBER Septic Tardy D Bmc H-20 H-20 „ergs Flow Egmliaers AS PL19.00 _ Leashing e J ' 19 00 �H-20 �---4'.10" Bed&M rs,8L Baffels IV as Per Tide 5 xP11-it"nceenteved arrow a: Y of !/a AOIItwmbb Bolawde6Taf ._ - _ -CROSS _ _ - ._._ _ _ _ - _ _ �: lard°.-sub (See Notes neod::eam�odbes� --`.__-. � -- -_ CROSS-SECTION OF - _ 20 - NOT TO SCALE . DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM aL M NOT TO SCALE - !� P.T.oA�dwd.MR • -. Ir r SEPTIC NOTES DESIGN DATA 1.Location of Utilities Shown on This Plan Are Approx At Least 72 Hours Single Family-17 Rooms PERC TEST: 11,613 Prior to Any Excavation For This Project the Contractor Shall Make With NO Garbage Grinds the Required Notification to Dig Safe(1-888-344-7233} Daily Flow=110 x 8=880 GPD PERFORMED BY:STETSON R.HALL,R.S.lk EDWARD E.KELLY,R.P.L.S. 2.The Contractor is Required to Secure Appropriate Permits Form Town Septic Tank:880 GPD x 200%=1760 Gallons WITNESSED BY:DONALD DESMARIS,R.S.-TOWN OF BARNSTABLE Agencies For Construction Defined by This Plaa Use 2000 Gallon Septic Tank FEBRUARY 25,2007 3.The Water Line Shall be Constructed in Coordination With COMM Water;and shall be in Accordance with 248 CMR 1.00-7.00 LEACHING AREA TEST HOLE-I EL.�.5 TEST HOLE-2 EI.2�.5 TEST HOLE-3 27.5 TEST HOLE-4 EL.z6.a &310 CUR 15.00.The Water Line Shall be Sleeved Where Required 880 GPD/094=1189 SF Required O LAYER O LAYER A/O LAYER l OYR 3/3 A/O LAYER 1 OYR 3/3 4.htstall Risers to Finished Grade(7 Require4 Side SANDY LOAM SANDY LOAM DARK BROWN DARK BROWN Bottom Area=Z(25'+'x 39=256 SF 5.All Strucdrrrs Buried Three Feet or More or Subject ' 26.3 SANDY LOAM 16' 26.3 61 SANDY LOAM 27.0 6" 26.3 to Vehicular Traffic to be II 20 Loading.It is the Engineers Bottom 1231 SF Total l P(25 rov rev xidedd =975 SF 16 B LAYER 10YR 618 B LAYER IOYR 6/8 E LAYER E LAYER Recommendation that H-20 Always be Used BROWNISH YELLOW BROWNISH YELLOW 6.Septic System to be hustalled in Accordance With 310 CMR 15.00& 42 -LOAMY SAND 24.0 42 LOAMY SAND 24.0 7' hD-SAND 26.9 7" hD•SAND 26.2 248 CUR 1.00-7.00 Latest Revision and the Town of Bamstable LEACHING CHAMBER DESIGN C LAYER IOYRY 75 C LAYER 1 OYRY 7/3 ` B LAYER 1 OYR 618 B LAYER 1 OYR 6(8 Board of Health Regulations. All Pipes to be Schedule 40.Use VERY PALE BROWN VERY PALE BROWN BROWNISH YELLOW BROWNISH YELLOW 7.All Piping to be Sch.40 PVC,and Shall be Marked with Magnetic 8-500 Gal.Leaching Chambers in a M®SAND UED SAND 4(r , LOAMY SAND - 24.2 40" LOAMY SAND 23.5 Marking Tape or a Comparable Mwns in Order to Locate thorn 25'x 39'Washed Stone Fields as Shawn a" PERC TEST 21.8 68' PERC TEST 21.8 C LAYER lOYRY 7/3 C LAYER lOYRY 7/3 <2 MINA . 15.5 144' <2 MNAN. 15.5 VERY PALE BROWN VERY PALE BROWN Once Buried 144' S.Imes Tees Shall Extend a Minimum of 10' NO GROUNDWATER ENCOUNTERED NO GROUNDWATERENCOUNTERED 120' MED.SAND 17.s 120° M®.SAND 16.8 - NO GROUNDWATER ENCOUNTERED NO GROUNDWATER ENCOUNTERID Below the Flow Line 9.An Outlet Tee Shall Extend IV Below the Flow Line, and Shall be Equiped With a Gas Bale ETER SUPLLIVAN j NO.29733 � WE 0 Sheet # Title: Site Plan Prepared By. Prepared For. Scale: Noted Proposed Improvements Sullivan Engineering, Inc. `''apeS��ry Frederick & Dianna Uehlein 3 PO Box 659 7 Parker Road 1Q9 Eel River Road Date: 3 At Osterville, MA 02655 Osterville MA 02655 21�AUG�O7 Osterville, MA 02655 109 Eel River Road (5p8)428-3344 (508)428-3115 fox (506)420-3994 (508)420-3995 fox SO Project: Barnstable (Osterville) Mass ; capesurvacapecodnet ADW Fe ,.d iff V. 1 •y.t II 6.�• :I. I ,•I : i -Ttt�''f,1ti4 r tL � h Wus < .__ 91. .a , ... (FT,, il` - ^ sue + ' . Ij•I� ,�. ' YI �' Ftl, i ;lei t : II11M § 4 T T I I I Tr�r rl�Tll rr�Ill� 1 ewrae I Till I I IIiII�' , I '1 Ft1 � I � r _ 'I I. . IN71G �I I _��� W II I tll l .L. : I •b - -- -- - - iwlli�Ili IIII + wl ,�-vr i mwmue _ fl �1 �I� Q4 ITT 11}t�!I�'ri e 4 e Ii III 'Il Illlllll� IIIIIIIII�i�I r�I I `+ TLT' ITIIII�Irr�llr it -:I I" � , _ I J.a�R LL IIII I. :Ili O IIIgGN I L. I \ 1 I 1-{-: � „' , II 111 I I I III I I aGI illllal I % " -�� • , I•i�ram. �I�I• I �,. ..,:. 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IZW n t - , L m m ININ6 RDO KITCHEN •p -------------- ir n , O - --- --- i f_ it O IVIN6 l l --- ---- i� U + --- ---- m Fo^ri=R 4'-4 1/4" 'i'-b" W-O 3/4" 8'-0 3/4" T-5 1/2" 4'-4 1/4" 3Q'-Q 1/2" , � I � 5T �FLOOiZ P�L �11N ter w.t s a \J W .i 0 Legend•� p FLOOD ZONE: 0 0 S y. W / P.• • ° Zone V17(EL14) & C Holly Tree -•0 Guy a i • Community Panel No. °�•' .x • r+ 11a "M ) 250001 0016 D -0- Utility Pole July 2, 1992 � Wetland Flog ® Water Gate (round) �" / �' E°o` ,-- F d j .'u.• A,y� ns'� y �, r „ ' .. `3 Deciduous Tree © Gas Gate (round) x 5 f t ZONE: OHW— Overhead Wires O z' / .23' 65 O TOM a$2-.3'NGw R -1 Coniferous Tree 25- "- Elevation Contour 64• E R- / Tianerm"W Top of ce/bff s, K+ f� F :b �` Area (min. 87120 SF � •••••••• S •••••••• Underground Utility Line / Frontagge (min) 20' Width (m in) 125' -v- Sign ' / * / / 2& kk / �.. ,. 4, .161 e Setbac s: Light Post CID / 6//Front 30 Side 15 Location Map: Rear 15' O Misc Manhole p - Catch Basin L 1"--Z 000f' ® F cry&Tot FEMA Zone Line Hydrant ' 1.46 As Per FIRM Panel # to ASSESSORS REF.: 250001 0016 D O Iron Pipe N/F TrUet / / , Map 115, Parcel 009 El CB/DH LliZobet ctfg8 -ZZ- �(3 27800 OVERLAY DISTRICT: K N AP Aquifer Protection Districtlnreplom N 64;B2 Lawn t c . a Lawn R-2r.r t ` l Lawn / Lawn � ` ® �pakb9� N ry/ J. fill WON Luawb/,,.. -zzJ 09 sty wit t 22x4 Lowre pwellIng I I I� III 1 f<' / / � \ � ! ` 1 � � � � ! � _, __..L—•••' I I I I I I 1 I L. 1 i ( i I ` _�L ► __ — tTtiw I I ! ! 11111jN p Of (Coastal Bon ce/bl♦ ! 1 I 1 by Sate Deh` itton Fad 1 1 ( _ _ - ) F 1 , .Ellev 14, ( I , t / .... slate Path eft Wk Slots wok _ _ '55 E 1 I ( I I I 1 N / o.s2' 1 , I _ — Lam^ N 64'S2 :. . �2� 1 I ( III / "' i i _—•�' ! i -.� --'" 0 726 273.87' n t I once Tarr St Ng Mdly U. T Robert J. i47270 y 1 1 1 ,t Fen• DIRECTIONS: From Hyannis - Take Route 28 into Osterville. At the fights by White Hen Pantry, take a left onto Osterville- Top Of Coastal West Barnstable Road and follow to the end; Take *bad Qmh by TOB Definitio a left onto Main Street; Take a right onto Porker Road; 9().29733 At the stop sogn take a right onto West Bay Road; CIVIL Take a left onto Eel River Road, and property is on the right, #109. Is 71 TLE. Site Plan PREPARED BY- PREPARED FOR: NOTES ExistiOnConditions . CapeSury Sullivan Engineering, IncFrederick & Dianna Uehlein 1.) The property line information shown was compiled from PO Box 659 7 Parker Road available record information. m Osterville, MA 02655 Osterville MA 02655 1 09 Eel River Road -� 2.) The topographic information was obtained from on on the (508)428-3344 (508)428-3115 fax (508) 420-3994 (508) 420-3995 fox Osterville MA 02655 ground survey performed on or between 041AUG107 and 061AUGIOZ 109 Eel River Road copesurv@capecod•net m 3.) The datum used is NGVD 29, a fixed mean sea level•datum.Bastable (Osterville) Mass Bench Marks used: RM36 & RM33 as designated by FEMA Draft: JOD Field: WHK/DWB 20 0 10 20 40 80 DATE: August 21, 2007 SCALE. 1 „_20, Review: PS Comp.: RRL Project #° 27018 Drawing # C637_1 G1 1 f, * •k'�� � wide d Legend FLOOD ZONE: � . w Zone V17(EL14) & C Holly Tree Guy Gu -- -• � V� Community Panel No, V -O- Utility Pole #250001 0016 D Re y - t. Jul 2, 1992 L Wetland Flog Water Gate (round) ?' 210/ Ta�A i zsr Fnd Deciduous Tree c O Gas Gate (round) r" ZONE: OHW— Overhead Wires 65O ' TeM E1-243'Ncw RF-1 - 25- - Elevation Contour / N 64•52' 5 E Tronerar"W Top Of CS/W Coniferous Tree ....S.......... g y _ 7° -24/ Underground Utility line / 'f4 Area (min. 87,120 SF Fron'age min) 20' /p�. j '_ a t, • lydth (min) 125 -°- Slgn / / s. SeFront 30' Light Post Side 15' Q Misc Manhole Location Ma ,p. Rear 15' Catch Basin L / !°; 1"=2,000f' ® ' FrS� CTV&W / to / O FEMA Zone Line {o} Hydrant / I,/ As Per FIRM Panel # / �i �a / ASSESSORS REF: 250001 0016 D O iron Pipe / - OSED N O CB DH N Ladd Trust _ — _ / i PROP AY Map 115, Parcel 009 / 81�zabet�tf#144g98 PROP E� i�' / DRI�W q 278°00 T OVERLAY DISTRICT: SED r�� Z AP - Aquifer Protection Districtl \ r / l 1 > � / I N CAROI BASIN / 2 N 64�2 55" � �,. I i I � / __ - / I I ++ l I I N / O Ii II IIi /\\II (II(II(�'t,' /// /.. /-^ -'/ / / // `1f \/,/''" -` .• ----t / %' -/�'\/ ( f OPO I / / _ %PROVIDE ED ODRYWS p-BO TH_4 ` c.� FOR F � POSED / DRIVEWAY2+x NOUT/ TYP•) LE RUNOFF O TH-O / POSED PROO 25 Law TAN SEPT PROPOSED I I J I' I c�i Wiz? / ( / Zo DRIVEWAY 171 / �„+► i Laen 0 � I I I ca/rcn LIMIT OF - __..22-' N I I I I tw c c� j PROP ISTING I TERbtrACE I , EX WELLINGpSED D P GARAGE t y TH-1'�" !i I m 1 1 h I I I {II OJ / ' \ lawn PROPOSED G ' DWELL I ___•�- I i III lit I o, I`c Z , ce/br► I I di l I I I Fnd TO BE REMOVED rn &UENLARGE i (ry PROPOSED- POSE ti° ! i ( / 1 i PR RA EE , _ TERRACE PROP 2s,n• R GARDEN I / G LANDiNi3 FRO _ / `7 a� ! N g4'52'55" E I i 5 S To i To 6�i0 1 00 I - N I I REBUILD - STEPS _1__� _� 1._ Lawn 726t I T 0 p I r I I I II 73-870 PROP S -�C \ 2 IIII t � 7_.� I ocko Fence I I I �e � N&Molly �• Tarr I III t- 1 PLANVNGS ` ca Robert J.o'{1472Ta Fen DIRECTIONS: ( + ] I I From Hyannis - Take Route 28 into Osterville. At the lights by White Hen Pantry, take a left onto Osterville- m Q y West Barnstable Road and follow to the end; Take I `<�° � �� a left onto Main Street; Take a right onto Parker Road; lio At the stop sogn take a right onto West Bay Road; �° o ' �L6 � Take a left onto Eel River Road, and property is on � n p '(o o CIVIL the right, #109. P P Y j a 1 3 TITLE: Site Plan PREPARED BY- PREPARED FOR: NOTES: Proposed Improvements Sullivan ineerinEn Inc. CapeSury g gT Frederick & Dianna Uehlein 1.) The property line information shown was compiled from At PO Box 659 7 Parker Road available record information. Cb Osterville, MA 02655 Osterville MA 02655 109 Eel River Road �- _ 2.) The topographic information was obtained from an on the 109 Eel River Road (508)428-3344 (508)428-3115 fox (508) 420-3994 (508) 420-3995 fax Osterville MA 02655 ground survey performed on or between 041AUG107 and 061AUG107. capesurv®copecod.nest 3.) The datum used is NGVD '29, o fixed mean sea level datum. Bamstable Cost@rVlllG'� MaSS Bench ,Marks used: RM36 & RM33 as designated by FEMA � Draft: JOD Field. WHKIDWB 20 0 10 20 40 80 DATE: august 21, 2��7 SCALE: 1 „-20, Review: PS Comp.: RRL Project ° 27018 Drawing # C637_1G1