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HomeMy WebLinkAbout0194 EEL RIVER ROAD - Health 194 Eel River Road Osterville A= 115-011 -7 � II i Commonwealth of Massachusetts 1� Title 5 Official Inspection Form �ry Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 194 Eel River Road Property Address Tim Breene Owner Owner's Name information is OSterville required for every MA 02655 8/25/2019 " page. Cityrrown State Zip Code Date of Inspection F-� 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 S /y�b� filling out forms A. Inspector Information on the computer, use only the tab James Ford key to move your Name of Inspector cursor-do not Ford Septic Services, LLC use the return key. Company Name P.O. Box 49 Company Address Osterville MA 02655 City/Town State Zip Code r 508-862-9400 S 12482 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. 0 Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further aluation by the Local Approving Authority . 4. ❑ Fails 9/3/2019 Inspect 's Signature Date The s . m 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. l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form ( Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 194 Eel River Road Property Address Tim Breene Owner Owner's Name information isequired fr every Osterville MA 02655 8/25/2019 page. Cityrrown 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: ® 1 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: 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): I 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 194 Eel River Road Property Address Tim Breene Owner Owner's Name required fo is every Osterville 4 required for eve MA 02655 8/25/2019 page. Citylrown 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 p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;�. 194 Eel River Road Property Address Tim Breene Owner Owner's Name information is required for every Osterville MA 02655 8/25/2019 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 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 p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 194 Eel River Road Property Address Tim Breene Owner Owner's Name information is required for every Osterville MA 02655 8/25/2019 page. Cityrrown 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 '/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 ❑ ® 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 p Title 5 Official Inspection Form (- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 194 Eel River Road Property Address Tim Breene Owner Owner's Name information is OSterville required for every MA 02655 8/25/2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C:5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ® ❑ 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 S Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 194 Eel River Road Property Address Tim Breene Owner Owner's Name information is required for every OSterville MA 02655 8/25/2019 page. CitylTown 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: 2 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 information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: unknown Sump pump? ❑ Yes ® No Last date of occupancy: currently 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 194 Eel River Road Property Address Tim Breene Owner Owner's Name information is OSterVllle required for every MA 02655 8/25/2019 page. Cityrrown 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: Unknown Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Reason for pumping: maintenance 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 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 194 Eel River Road Property Address Tim Breene Owner Owner's Name information is required for every Osterville MA 02655 8/25/2019 page. Citylrown 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: 12/15/2009- per as built Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts r= (P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 194 Eel River Road Property Address Tim Breene Owner Owner's Name information is Osterville required for every MA 02655 8/25/2019 page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 51 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gal. H-20 Sludge depth: 2 Distance from top of sludge to bottom of outlet tee or baffle 23 Scum thickness 3 Distance from top of scum to top of outlet tee or baffle 5 Distance from bottom of scum to bottom of outlet tee or baffle 13 How were dimensions determined? measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tees were present. There was no sign of leakage. The steel covers were 12" below grade. The tank was pumped after inspection t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 AL Commonwealth of Massachusetts rn F Title 5 Official Inspection Form X Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 194 Eel River Road Property Address Tim Breene Owner Owner's Name information is required for every Osterville MA 02655 8/25/2019 page. City/Town 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 El other(explain): N/a 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 'El other(explain):. N/a 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 X Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �v 194 Eel River Road Property Address Tim Breene Owner Owners Name information is required for every Osterville MA 02655 8/25/2019 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.): N/a "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 even Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The D-box was normal. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 194 Eel River Road Property Address Tim Breene Owner Owner's Name information is required for every Osterville `MA 02655 8/25/2019 page. Cltyrrown State Zip Code Date of Inspection D. System Info rmation ormatlon (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.): 1000gal. H-20 chamber was 70" below. Pumps and alarm were working. Steel cover was 3" below * 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: 47500 gal. chambers ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system M Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 f i , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 194 Eel River Road Property Address Tim Breene Owner Owner's Name information is required for every Osterville MA 02655 8/25/2019 page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The chambers were dry and clean and there was no sign of failure A camera was used 12. 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 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.): I 15insp.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 194 Eel River Road Property Address Tim Breene Owner Owner's Name information is required for every Osterville MA 02655 8/25/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: N/a Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I A t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 194 Eel River Road L Property Address Tim Breene Owner Owner's Name information is required for every Osterville MA 02655 8/25/2019 page. Cityffown 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 f � DrlZ(v ew%J 'Fe'lc e 414.1 -a- 30` - 47t -3- 35 61 -9- 66 3 arch go' -b- 89 6 13 I'Lnyo . t5insp.doc•rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;V 194 Eel River Road Property Address Tim Breene Owner Owner's Name information is required for every Osterville MA 02655 8/25/2019 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: 25'+/- feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Topo and water contours map. ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: The SAS is high in elevation above pond in back yard 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 0 Title 5 Official Inspection Form XSubsurface Sewage Disposal System Form -Not for Voluntary Assessments 194 Eel River Road Property Address Tim Breene Owner Owner's Name information is required for every Osteryille MA 02655 8/25/2019 page. Clty/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 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 off. Commonwealth of Massachusetts u Title 5 Official Inspection Form aX Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M a •'' 194 Eel River Road C: Property Address Edith Hornor Owner Owner's Name t+ information is required for every Osterville page. Citylrown MA 02655 7/11/2016 i'$+ State Zip Code Date of Inspection .. .Ca 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 A. General Information filling out forms on the computer, J l W use only the tab 1. Inspector: key to move your cursor-do not James Ford use the return key. Name of Inspector Ford Septic Services, LLC rab Company Name P.O. Box 49 Company Address Osterville MA 02655. CitylTown State 508-862-9400 Zip Code Telephone Number S12482 License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 7/13/16 Inspect 's Signature Date The sy em inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for VoluntaryAssessments ssessments `�M® •'r 194 Eel River Road Property Address Owner Edith Hornor Owner's Name information is required for every Osterville MA 02655 page. CitylTown 7/11/2016 State Zip Code Date of Inspection B. Certification (Cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal,and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for VoluntaryAssessments sessments 194 Eel River Road Property Address Edith Hornor Owner Owner's Name information is required for every Osterville MA 02655 page. City/I own 7/11/2016 State Zip Code Date of Inspection B. Certification (Cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if Pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ , broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. I. 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 l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •` 194 Eel River Road Property Address Edith Hornor Owner Owner's Name information is required for every Osterville MA 02655 page. Citylrown 7/11/2016 State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet supply well. of a private water ❑ 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. 3: Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 194 Eel River Road Property Address Edith Hornor Owner Owner's Name information is required for every Osterville MA 02655 page. 7/11/2016 City/Town State ZipCode Date of Inspection B. Certification (Cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® 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 provided that no other failure criteria are triggered. A co pp and chain of custody must be attached to this form.] copy of the analysis ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the-system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat., or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v,•°•y 194 Eel River Road Property Address Edith Hornor Owner Owner's Name information is required for every Osterville MA 02655 7/11/2016 page. City/Town C. Checklist State ZipCode Date of Inspection Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (if they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Com monwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 194 Eel River Road Property Address Edith Hornor Owner Owner's Name information is required for every Osterville MA 02655 7/11/2016 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: unavailable Sump pump? ❑ Yes ® No Last date of occupancy: currently Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: 15ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts t Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 194 Eel River Road Property Address Edith Hornor Owner Owner's Name information is required for every Osterville MA 02655 7/11/2016 page. CityfTown D. S State Zi p Co de Date of inspection P System Informatio n on cont. Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: unknown Was system pumped as part of the inspection? Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool f ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 194 Eel River Road Property Address Edith Hornor Owner Owner's Name information is required for every Osterville MA 02655 page. Cityrrown State 7/11/2016 Zip Code Date of Ins ection D. System Information (cont.) p Approximate age of all components, date installed (if known)and source of information: system installed on 12/15/09-per as built Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 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.): Septic Tank (locate on site plan): Depth below grade: 4 feet Material.of construction: ® concrete [❑ metal ❑ fiberglass 9 El polyethylene El other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: gal.al. H-20 _ Sludge depth: 2 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 194 Eel River Road Property Address Edith Hornor Owner Owner's Name information is required for every Osterville MA 02655 page. Cityrrown 7/11/2016 State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 27 Scum thickness 2 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 14 How were dimensions determined? measure 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.): The tees were present and there was no sign of leakage. Inlet steel cover was 6" below grade. Grease Trap (locate on site plan): Depth below grade: n/a feet Material of construction: ❑ concrete ❑ metal ❑fiberglass 9 ❑ polyethylene El other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 194 Eel River Road Property Address Edith Hornor Owner Owner's Name information is required for every Osterville MA 02655 page. City/Town 7/11/2016 State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition str liquid levels as related to outlet invert, evidence of leakage, etc.): uctural integrity, 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 9 ❑ polyethylene El other(explain): N/a Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,A-a 194 Eel River Road Property Address Edith Hornor Owner Owner's Name information is required for every Osterville MA 02655 page. Cityfrown 7/11/2016 State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert even Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The D-box was normal 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.): cycled the pump and alarm, both worked fine steel cover was to rade ` If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Vo luntary Assessments „a 194 Eel River Road Property Address Owner Edith Hornor Owner's Name information is required for every Osterville MA 02655 page. Cityrrown State 7/11/2016 Zip Code Date of Inspection D System D. y m Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 4-500 gal. chambers ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): A camera was used to inspect the SAS. It was dry and in new condition. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration n/a 1 Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Subsurface Sewage Disposal System Form - Not foro F®rluntary Assessments 194 Eel River Road Property Address Edith Hornor Owner ' information is Owners Name required for every Osterville MA 02655 page. City/I own 7/11/2016 State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): N/a S 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 194 Eel River Road Property Address Edith Hornor Owner Owner's Name information is required for every Osterville MA 02655 7/11/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 O y 4, y ' A 13 3 O O a 30 3 491 3r ----------------- 61 I5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 15 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 194 Eel River Road M Property Address Edith Hornor Owner Owner's Name information is required for every Osterville MA 02655 page. City/Town 7/11/2016 State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 18'+/- feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: Topo and water contours map. ❑ Checked with local excavators, installers -(attach documentation) ❑- Accessed USGS database -explain: You must describe how you established the high ground water elevation: see above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 194 Eel River Road Property Address Edith Hornor Owner Owner's Name information is required for every Osterville MA 0 7/11/2016 page. CitylTown State Zi p Code Date of Inspection E. Report Completeness Check list klist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information-Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 KI TCHEN DEN LI VI-NG BA TH SCREENED. BREEZE WA Y BATH CL. BEDROOM BEDROOM BEDROOM BEDROOM BATH FIRST FLOOR SKETCH SECOND FLOOR SKETCH Town of Barnstable OFtHE roy, Regulatory Services Thomas F. Geiler, Director # Y ' Bn MASS.NSTA LE, Public Health Division ArEo039.�A Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 ' Date >oZ�� Sewage Permit# 4601--37Z. Assessor's Map/Parcel If S-a l Installer & Designer Certification Form Designer: SU Ijgn�E , cs Installer: ��uct Address: P.0 .-60( (Q51 Address: '�06 IN Of bego 0�k On /3 -G9 �\ rvee �,eQ� e was issued a permit to install a (date) (installer) septic system at qy � �� ,. °`�"` based on a design drawn by (address) �Jy r1 e es dated .&;. (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.' .Stripout (if required) was inspected and the soils were found satisfactory. 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 je pc_ation of any component of the septic system) but in accordance with State & LoJ�I�R�Egu� ts. Plan revision or certified as-built by designer to follow. Stripout (if re q iE )-was"�r�'spc d and the soils were found satisfa tory. �� JOHN C. yG� o ODEA c, CIVIL �; No.48168 , v (Installer's Signature) 9o,��FGIM?;� SS/ONAL�N6 (Designers 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. gAoffice forrrrsWesignercertification form.doc No. t. �° � . Fee /o v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for �Bigpogal 6pgtem Conotruction Permit Application for a Permit to Construct( ) Repair�pgrade( ) Abandon( ) ZComplete System ❑Individual Components Location Address or Lot No. y C 4"-,ok Owner' Name,Address,and Tel.No. Assessor's Map/Parcelivy I o Iz' Installer's N e,Addres ,and Tel No.� Designer's Name,Address and Tel.No. cwcc AcalC.s tcs) Ste" I{J e 8 �.,l4�va� Cnj h —_ � how �. P.a.t3 ctsn �az..(lr l �g�v� aZ�Ss 504s'�1Zi?-334 Type of Building: Dwelling No.of Bedrooms Lot Size 1 3 sq.ft. Garbage Grinder (N Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 5SO gpd Design flow provided 5 Q gpd Plan Date Ov,tvyx er 9`Z,QtCj Number of sheets Revision Date Title Si Ve �1� 1��(iQ � 5KA(_ Sy,sk: n Size of Septic Tank 1.506 G%�td:C Type of S.A.S. y-S6Z tGy�lah (1Akwt�` Description of Soil r 1'Z_'7: 0 S" Is- Zw � 1 ti Lo c t3 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 d not to place the system in operation until a Certificate of Compliance has been issued by this Board Health. Signed Date /a r 7 ' �QO Application Approved by Date 12C, Application Disapproved by: Date for the following reasons Permit No. 2 Q 0 q— Date Issued �/ /3 2oa e THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) M A� C DATA No. 2 60 1` ( 2 °' .E i s Fee /0 U �- i, „ THE COMMONWEALTH OF�VIASSACHUSETT$ Entered in comp iuter: (YCl/ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS � ,'%p1icdtion for Mi!gp,ogat iip�t m Con5truction permit Application for a Permit to Construct O Repair(t Upgrade ')"Abandon( ) 10completeSystemEl Individual Components Location Address or Lot No sy t'et l k Owner; N Hee,Address,and Tel.No. os Assessor's MaplParcel (I S—O 1ZZC �� enu Installer's Name,Addres Land Tel.No.-� Deg; ner's Name,Address and Tel.No. t� c tCal II,s c� `i � 5v art ^yheerrn�, l�nL Type of Building: gwelling No.of Bedrooms 5 Lot Size IT.3 b sq. ft. Garbage Grinder (A) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 5150 gpd Design flow provided 570 d gP Plan Date kitmher cj Z0739 Number of sheets � Revision Date _ Title si�*— 5n �CuQ�,�'el 5 yVt- SyS�Y� Size of Septic Tank 1504 Type of S.A.S. `-i'Seo tn5�Jdr\ (, ryjbL s , Description of Soil R,-(" - 54nN--1 C(y,rj 10ye, 3/3 5 IoNg - 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 )d not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health Signed t > Date. at'G f .Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. Z 0 / 3 -! 2 Date Issued - - - ;i"r t.T4 ON OR4.!++ATut�l THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( Upgraded ( �) Abandoned( )by i f at (cl�� i5f 1 Q W 2r �i►G^��, has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 200 ?) Z dated 1111?h o oal Installer CC h C`CC`11, S Designer S c C.t �V-,tj S:N4 #bedrooms Approved de i rn,flow�� S SrU! gpd The issuance of th''s permild� shall not be construed as a guarantee that the system will-function A designed. ^ � Date I �S Inspector G/ Vt✓,� r�c:��`=ct"::'a..c;1�h+a�5rsrda-§=�a-�..—H crr�.`�ira�� �w.wraRM�srl�!�*1��wi#:+nwarlr�wae?a�+?ir.C+o w�s:iabs:.a,i:a�rs; No. 2 0041 ` 3 T Z Fee /0 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS lwi.gponl *pztem C, ng ruction Permit Permission is hereby granted to Construct ( ) Repair ( Upgrade ( ) Abandon ( ) System located at (��f C=c( ��er 05A �,k -- and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply Provided: Construction must be completed within three years of.the,date of this p7, , u Date �/�3/ 2 U y Approved by s, �- 'PI OF BBARNSTABLE LOCATION / T�r�/�/yF2 VV/• SEWAGE# VILLAGE age—l- IVe ASSESSOR'S MAP&PARCEL//S�-'O// INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY // / /00C/ �3. 617'4 ,_ LEACHING FACILITY: (type) Jg O*/r y�( 4 (size) NO.OF BEDROOMS 5 OWNER I72s'- 3Pw:7 Ueh/cl PERMIT DATE: /` 13'0 4 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 1nS�Q�w�CAS -- iFG.,c e W4 30 r .r J3 _�— 663 �i ch 61 ; Town of Barnstable P# 3 ; •.°� epartment of Regulatory Services i Dates ublic Healtl>t Division 200 Main Street,Hyannis MA 02601 Time Date Scheduled 11`1 Fee Pd. � U� r • Soil Suitavilt Assessment for Sewage Ds,�vsal Wits essed By: t✓h V 1 GI d✓ J.7r n7)ry /C performed Or t"N j LOCATION c4c GtNEKAL INTOA, ION Location Address (�t( Cc-L�64 Owner's Name «Address.. Assessor's MaplPtircel: ).Eitgincer's Name cd1k NQW CONSTRUCTION ✓ itPA1R ' Telephone NOlb l 7 e t and Use Slo cs % Surface Sloiies &Q l l7C�N\�`�C p O Distances froin: Open Water Dedy I '0 R Possible Wet Area L— Drinking Wnler Well a y n Drainage Way i. . R Pivperty Lille Other Nk' STCIXy tStnr�name,dlmonsioi u,of foy exact locntiot>s of test lttiles do here tests,loeitla welltiiids in proximity to holes)_ I AZ ik 1 : i• . r _ s a I Depl�t io de Pock . Pa�snt melerlal(geolvglc� w. 1 ]l j( F Weeping from Pit-ace VC ; Ueptlt to Qroundwatcr 5lattding Wata In Hol :, i M r yy Csliinated Seasonal H1gfClroundwat�r r s>�As+oNX . zcx1 WA El TABUo DET I Melitod Used: N I 1 in iDeplit to soil mottles:�n Depth Obse; ed tending'Iin o s:�t e i : ii,, GroltndWaler Adjustment R Dcptit to Wee i►ig m tide o bs ole Ad Otoundwatcra.cvcl Dttl p:A id @x Well,levcl Adj factot"____. j lndex Well iI ' r Milt ST I Observation 2�' Time at 9" t: r Depdi of Perc. a Tinte(9"G") — t Start Pre soa6 Time Q f = vct�••�t' End Pre conk N+ Rate MWInch ` I {{r ' i AddUionnl Testing Needed(YIN). tl Site-abed-- Site Suttabluty Assesstii�nw Site Passed s I Ort inel Public Nenitti bl+rl ion OUser�ation Hale Data To Be Cotnpleted on Back---~---~ g I I� ***If licrcollltiol{t t is tti U (co due c wtlittr 100� of wetland,you must first notify tt►c F. B><t n$taUle Co><t rW tion i�i � �`l: st ona(1) celf prior# lsi tile wgnning IIEALTIUWP/PERC 0 I + I I ' fl } I VEEP OBSERVATION HOLE LOG J:I010 It � Dcpth fium Soil Ilorizon Soil Texture Soil Color Soil Other 9urlkaa(in.) (USDA) (Munsall) . Mottling (Squcltnoi Stuncs,Uuuldem , Couslstonay�°la arn�ai)___—_ i 5 DEW OBSRVATXON WOLF LOG Hole! 2-" Depth from Soil}Iorizon Soil Texture Soil Color Soil Other Surface(in.) ". t15DA) (MUIISCII) .: Mottling (Struclure,Stones,DotllJers. to a cl W*" DEEP OBSERVATION HOLE LOG Mole 9 � Depth from Soli Horizon I `'StJil'Tezturd L . : Soil Color I Soil Olhcr Surfncc(in.) (USDA) (Munsell) Mottli g (Slrucliire;5toiies;Itotildero. ConsistcncY.° mycl) - I I i I DCLP OBSEItV 'TION HOLE LOG. Depth Prorn Soil Ilorizon Soi Tcxturc Soil Color. Soii Other SDA (Munsell) Mottling. .(SIMcture,Sloius,Uuiililcrs. Surface(in.) ( l ), Consia'cncv "/o Oravcll `. .. r I I ? l zo qq i 1 �kk . blood�nsurnnc b , µ . AboYe Sb0 year tl od riot ilea _ I 1 Witl in 500 c ontlety y Within 100 e r p bd bounila `Tlo e e lh of Ngturnli': urri f P, ri►i lis. a �t'irl x , Does at lestst four ft: t 6 natti Ili ew; r�i19 ip sous Do Unit exis ut all are so oliservetl tltrouglrout the I are pro flit Ali so i ao ti n's strf I '' Jfnot, ht is the do th !trial ral, frill ervtous matetta17 trCl titiCallU.tt I �; I I I , I i 1 certifyttlrat on ,. date l Im a�assed the soil eva luator examinat on.approvcd.liy tlic i popertmw±nt of Pnv mt eiital Pro:�ctl n iri f tat the above oven s was.performed by tno corts'Istent wit i the tequtred tra nitig ttise;an d�cxp rrcn o described ill 310.CMR Signaturo , i llate I I . r I ij ° Q: ICALTLOpt%RC'�'1 FL J r - .24'.0" 21•-2.. vkovc A t G CENTER GAS.FIREPLACE IN THIS SPACE 12 r �.v �' z' `•`�— I e NEW WALL CONST. • - � 2.1/2"PLYWOOD SHEATHING ' • •' BUILT-IN GAS BUILT-IN N 3.WSQSHIXTERNGLE SIDING UNFINISHED CABINET FIRE LACE , CABINET 4.BATTTYPA I EXTERIOR VAPOR BARRIER^ _ 2'-2' � - .5.BATE INSUALTION(R20) STORAGE EXISTING BEAM IBOVE __ NEW I - - 2K•2J ANDERSEN TOP OF PLATE 2 x 12's @ 16"o.c. ADH2648 �.. EXISTING MULTI •. - _ WINDOW HUNG - LVL HEADER �C n rtl VERIFY ALL CABINET_ WINDOW - � r * - �=-`./� Q_►(,,r DETAILS IN IN THE FIELD W/OWNERS 2J .. O - TOP OF PLATE (Uy Yill..�VJ NEW GAMEROOM U.C. ANDERSEN v• q€ r REF. APWa838 m PICTURE .„• _ * 2 U WINDOW _ NEW 3-2x8 .o - { - " GAMEROOM HEADERS FOR a NEW 3l4"P.T.PLYWOOD - v - N - GLUED&NAILED , 2J � NEW WINDOW � .. - • z ROUGH OPENINGS TOP OF FOUND. TOP OF FOUND. X x - - NEW P.T.2x 4 JOISTS ON - .. FILL IN EXIST.O.H.DOOR r— OPENINGS W/NEW CONC. THE EXISTING CONCRETE . Q ACCESS _ BLOCK WALL W/NEW 2 z 6 SLAB AT 16"o.c.W/RIGID ` THATCH -I _ - WALL ABOVE.FILL CORES OR SPRAYfOAM INSULATION _ (ABOVE I &INSTALL 5/8"ANCHOR - , (R30)BETWEEN JOISTS TS,FASTE J _ • BOLTS @24"o.a. SEAL ALL TO IOORJW NPL ADHESIVIN E - NEW 2z4 WALLS � � � � � - � A - A SECTION @ GAMEROCOG AT MIDSPAN ELECTRIOAL c .. -G 1 - •PANEL 3'0"x 6.8" ANDERSEN ANDERSEN - .` • a - `�%t" ADH21048 ADH21048 > r FIRST FLOOR PLAN ) LEGEND: ' 10 EXISTING WALLS CONSTRUCTION TO BE REMOVED TOP OF PLATE - - . NEW CONSTRUCTION NOTES: 1.) CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS. SIDING OMATCH 2.) CONTRACTOR TO VERIFY ALL INTERIOR&EXTERIOR MATERIALS, EXISTING C . DETAILS,&FINISHES IN THE FIELD WITH OWNER NEW AZEKORKOMA 3.) ROUGH OPENING HEAD HEIGHT OF WINDOWS AT ,xaTRIMw/z°SILL a 8 FIRST FLOOR TO BE 6'-10"ABOVE SUBFLOOR 4.) ALL CONSTRUCTION TO CONFORM TO 780 CMR MASSACHUSETTS TOP OF SLAB STATE BUILDING CODE 8TH EDITION AMENDMENTS&IRC2009 5.) 110 MPH EXPOSURE B WIND ZONE, 1.00 ASPECT RATIO 6.) ALL SHEETS OF PLYWOOD WALL SHEATHING TO BE INSTALLED VERTICALLY OR HORIZONTALLY W/BLOCKING AT EDGES,3"EDGE/ FRONT E L E'VAT I O N o 12"FIELD NAILING 7.) FOLLOW ALL MANUFACTURER'S SPECIFICATIONS FOR INSTALLATION RIGHT E L E VAT I O N OF ALL SIMPSON COMPONENTS P 8.) VERIFY ALL PLUMBING&ELECTRICAL DETAILS ON SITE DURING FRAMING CONSTRUCTION THE��/J ERRORSIGNER SHALL BE OR OMISSIONS ARE FOUND OFIED IF N"T SCALE : DRAWING NO.: B� ( COTUIT BAY DESIGN, LLc NEW REMODELING FOR• THESEDRAWINGSPRIOITO START OF • y h\ 43 BREWSTER ROAD WLL BE RESPONSIBLE IBLEF FOR CONTENTDR 1/4"WILL DE RESPONSIBLE FOR THE CONTENT IN THESE DRAWINGS IF CONSTRUCTION CON ES MASHPEE MA. 02649 THESE AWINGHOUT SOTIFYING LELYFOR HE THE B R E E N E RESIDENCE DESIGNER OF OWNER NOTED. ARE ERRORS OTHER OMISSIONS DATE PH. (508)274-1166 THESE DRAWINGS REQUIR STEWRITT USE FAX(508) 539-9402 194 EEL RIVER ROAD OSTERVILLE, MA ARTHE DWURAL COED.ANYPROTECTION THESE DRAWINGS REQUIRES UNDER 9/15/2016 CONSENT OF THE DESIGNER UNDER THE ARCHITECTURAL COPYRIGHT PROTECTION ACT OF iS90. 1 . 1 4'-I1/4" 9.91/4--�_y,-/,�„^,�,8-31/4""�.,,,�„•�„_,- 411/4-,_�I � 6.31/4 „--- I 1 CONSTRUCTION IYKEY NEW CONS ' _ T. <I I .. h I12 _ t ! aster Bath t - I / cI M 109 r seater Bedroom _ K ' - 2 11/2" 14 43/4 _____-15-f i/2',' - '5'-3" N CLOSET � � � t9 0 •ply -' I ' aI `— d E1m�Hall � D 1-N' I I I� 7a2 E)I TWG 2%6 E%TE9109 CONSTRUCTION. 3 I vER11 COIJDMON OF SHINGLES, a _ 5� UCTN RE AND IN5ULATION REPLACE 6 i I I I I r. t 9' NEW CONSTRUCTION W1 CONSTRUCTION I -I F J 5LUE30ARD 5?A5T O' AND 2 COAtS PLASTER b w � I I ,02A -- k \ . I 2:91/4"_,I4'.212 t1 � NEW2X6EMEMORCON5TRUCTION WHITE I Laundry � 1 CEDAR MAIOEL NANTULKET'5HINGLES OVER 76 I Hall� HOMESUCKER OVER 30 La.FELT OL'ILOING a I WRAF OVER.5/0"LOX PLYWOOD SHEATHING W/ I I 1 6-B I �1251 e OPEN CELL 5PRAY INSULATION(MATCH -\------------ ---------I -- - I. a �,,,- A] EXISTING SHINGLE EXP05URE LENGTH) Kitchen ®12C1 - - Bea TPorch I I 31 N�� - - - a MI _ � 3 a m EXISTING 5TONE STEPS O Catalano Architects Inc. EXISTING 2%41NTERIORCON5TRUCTION, IG - VERIFYCONDITION OFFIN15HE5 AND I fining Koom - REPAIR TO MATCH NEW FIN15HE5 31"_i 2_,Di/2�, Hornor Residence +� 5_,1"'/2_--� 194 Eel River Road,Osterville,MA,02655, 5 A].c D First Floor Plan SCALE: 1/4" = 1'-0" DATE:10/25/13 • �I Catalano Architects Inc. 1 1 115 Broad Street Boston,Massachusetts 02110 telephone617-338-7447 i -- i--- � ---?Tj°"------ ----I facsimile617-338-6639 I 1 1 IJL 1 , I V I i I 11-5 V2, , 2'ta'. _2'lo",may,.•, 1'.5 " �A A .,__-_ _ --_-_. --- \ - _ _ _ 'V --- -- -- - -NRY 2X6EXTERIORLONSTETCDHINOLES N ;;..__ _ .--___•-------�,..-- ._ _ _LEDAR MAIBEG"NANTUCKCT"SHINGLDI OVER --- - ------------ _.HOMESLILKER OVER 30 LB.FELT BUILDING -- - -- - --•WRAP OVER 5/6"COX PLYWOOD SHEATHING IY SHINGLE __ .• ._- _._.__-_•__- _-__--------- _ __ ______ _ OPEN CELL SPRAY INSULATION MATCH EXPOSURE LENGTH) .. _. .__-___.. I _ I 2 ------------`---------------- -`-----._ .-----'-'---'-'- --------'-----'-- -- ---'- - -- " � I I _ - -- - - ------------ -' -- - ------------------------ -- - -- -- --------- - ---- --- - L a - - - --- ----- - -- - -- -- _ --_ 16, - - ----- - - --- -- — .. _: _ -' - _ - __ _ - - __._ ___ _____ ___ - I_ . � I 206A ._ _. -------_ _ _____ ..4 1_--.- I i9 b I i n N 5 - N', Bedmomt __LL05ET__ m Bedroom2 ---- Iz�6. _ 6 \ IN 202E 203A 61/. LLNG.HT LI EN �' — W I CLOSET A - CLOSET 1 1 I �CTI�7 (Bathroom A N Shared 4 rt aNG.HT . 41NTERIOR I \6-8" —WALL CONSTRUCTION I W/5/8"BLUEBOARD 1 I AND 2LOAT5 PLASTER I t - � s i to E1P r I i Bed 3I NI EXISTING 2X.6 EXTERIOR CONSTRUCTION, CLOSET F. 6, ,;--.\- 9 2'6" STORAGE _7_7777 __ 3 VERIFYCONDITIONOF5HINGLES ELOPED a \6•-8�� SLOPE ED STRUCTURE,ANDIN5ULATION(REPLACE —CEILING—�I NI , C O CEILING ®Catalano Architects Inc. OR REPAIR WHERE NECESSARY) --------------- lP ( IP -.�. t t - Hornor Residence W z G - 0 ,; z- — _, 194 Eel River Road,Osternlle,MA,02655, -- - } -__ - - -- - - ------------- -- - =-------- ---- - -= - -=-===1== --- - - a --= ---=-=------------ ---=-=--- __%==-=====_=-===---- --------_-_=_ Second Floor Plan ------ ------- -. ----- -----=------------- ----------------- ---- --------------- - -- SCALE: 1/4' = 1'0" - - _-------__ - - -_-- - - - ------------------------------------ DATE: 10/25/13 - - ---- ----------- - ----------i I Catalano Architects Inc. i I! 115 Broad Street J Boston,Massachusetts 02110 telephone 617-338.7447 facsimile 617-338-6639 I A 1.2 DIRECTIONS: OVERLAY DISTRICT:From Hyannis - Take Route 28 towards Osterville; AP - Aquifer Protection District ; �+ ' Take a left onto Osterville West Barnstable Road, and Estuarine Watershed Overlay follow to the end; Take a left onto Main Street, and s then bear right onto Parker Road; At the stop sign take a right onto West Bay Road, and then take a FLOOD ZONE: r 1 left onto Eel River Road; House is on the left, #194, Zone B Community Panel No. #250001 0016 D °' .•0 0 ,.July 2, 1992 •Cz a ,. p ZONE. . t<"s v ,�`�• sue;. RF-1 (RPOD) "'v ?"�` a Area (min.) 87,120 SF Fronts ae (min) 20' Width min) 125' Setbacks: Front 30' xr� Nw •, M ` t{ Side 15' Rear 15' LOCATION MAP: ASSESSORS-2 000 REF. Map 115, Parcel 011 CB/DH L 7 Fnd i t CB/DH Fn d / C 061 2 DESIGN DATA Allowed: 9 Bedroom(91,230 SF/10,000 SF) Per Estuaries Proposed rr�� Sec Single Femay GGt° • i -5 Bedroom @ I I O GPD �J No Gubage Grinder Total Daily Flowo550GPD Ot\�OJ Use a 1500 Gal Septic Tank i 20-' A(ti 1 /� I �/ l l' LEACHING AREA o 550 GPD/0.74(LTAR)m 743 SF RequrW Jo / ��(� lib i Sidewau ea-30SF SF r / Bouom Area 540 SF Co �J 'CS /� / / / LEACHING CHAMBER DESIGN M / / / Fnd // / / / All Pipes to be Schedule 40.Use / / / / / 4500 Gal.Leaching Chambers m a i.::�� / j'••. / /�/ / / Washed stone Fieldmshown �Q '� / / / �' / �' '•/ // /, . 1 VARIANCES SEPTIC NOTES �,�•� / �� rQ.- / / -�i,230E S / / / 1)3 10 CMR 15221(7)GenenlConaWction Requirement For All System Components 1.Location of U W hies Shown on This Plan Am Appox.At Leval 72 Ham / Priorto Any Excavation For This Project the Contractor Shall Make / 2.09 �c �/ / / •.� / No More Than 36"}saloon Grade Required the Contractor Notification b o S Safe Appropriate Petunia Septic Tank&Pump Chamber To Be No Mom Than 7Y Below Grede Provided ,�^ wl / 2.The Confnetor is Acquired b Seeaae Apprupiale Panrita From Town CB/DH /y /��/ / - - ' (To 1jlg,' �jFcl-��.H) �� 2)Coda OFThe To"Of Hamatablo Chapter 360-1 Location OfCompomnta W"ilh Respect To Water Bodies Agexies For Construction Defined by This Pfea. / IW Required / / / Both Fn +B d / / /.•t ' / /� / j // Septic &Pump Chamber 75'Pwvided 3.Wherovm Sewer Line Must Crow Water Supply Lines Water to Be Constructed of Clean 150}kmsum Pipe and Shag be We1er Tmcd b Assure Watertightrteas.In General,Watu Lma9m1(be ComUL<- rim !Y �'/ / // / / / , Coordination With CotuiI Water,and Shall be in Accordance With 249 CM 1.00-7.00&310 CMR 15.00. 4.A Minimum of 9"of Cover is Required for All Compatmta // / 5.All Structures Buried Thme Fat or Mae or Subject to Vehicular Traffic to be H-20 Laedio&It is the Ecgineefs Recommendation that H-20 Always be Used 6.lmnll Wateni i Access sen Ri and Covets to within 6"ofFmiahed / ast Grade Over SepticTenk Inlet and Ouilet Pump CJamlxa trial D Box and One Lesching Chamber. Install Acsme ltim and Coverto Grade over Pump Cbamber Omld / I / !►' :; i / 1 1 // / F /pH.....- / 7.248 StiCSystem 1.00 107 ao�Latest xe�is,A oa> e�rlo Leo& nd ,f Board of Health Regulations. ��� Wood Bulkhead S.All Piping to be Sch.40 PVC. (see SE3-1986) 9.D-Box Shall Have a Minimum Inside Dimcnsion of 12",anda Mimimw TBM E1=19.72' NGVD '29 gyN l/ ( Slone mil TnpEI-s.o' sump nf6-. top of Mag Nail d D k A all 10.The separation Distance Between the Septic and Tank lalets and 7 o•11 Outlets Shall be No Less than the L Inlet Tees Shell Extend t� 11 a Minimum of 10"Below the Flow Loa OuQet Tees Shall Exleed 14' ! � Below the Flow Line,and Shall be Equiped With a Cm Baffle for the Septic / -la !i rick B.M. = SLAB EL 6.6 ` Tank,and a Department Approved Effluent Filter fur The Talc qil Parker Pond Ryi .0. , , o ) la 1 # 194 IR= 'a 2 Sty W/F m4 (EI.=3.4' NGVD '29 on 02/SEP/09) is of 9 \ Dwelling q m1 q ll 00t j co \ 1 3'0 -10 \ \\\ I 3 \\ 14"/C.a C- � >� p EXISTING ..�\ \ a 14BANEM TO OR o \ row°"°rq w REMOVED \ \ 4.1 40 PVC R14% Cover I \ \a Lawn.•• 4+qh Mbtr.uamr ro 9. L000ew ..err o r SEP1je�N \ ? { K�RRO \ \ PERC TEST: 12,734 ! P '^C'�'• 1 ��� \\ \ ` \` PERFORMED BY:JOHN O'DEA,PE-SULLIVAN ENGINEERING St." T'0"-ear Yas- lfln.2 Conr SOIL EVALUATOR NO.2911 uscury naat CB/D WITNESSED BY:DAVID STANTON,R3.-TOWN OFBARNSTABLB _ Fnd ; i \ I tX �� °i { ' , OCfOBER 14,2009 Lead Pm O+at.aco CONO A� 4j \ ' I 1 Off a sa. at r : o� a' TEST HOLE-t EL•zli TEST HOLE-2 EL.22A vttorn of � U1� 0 i7'. tiI ' /' ` I ( 1 " ( i n ,�� 000 / r = - I _ 209 9o"em Fl 2,! I I2 fl;'t' ? ;'Lawn e�D% it ,72 2� _1 .7 1000 GALLON H-20 TH4C LAYER 2_5Y 66 0 / / LIGHT YELLOWISH BROWN OLIVE YELLOW _j / I , j / I MED.SAND 112 MED.SAND 21 8 "' NO GROUNDWATER ENCOUNTERED 36" PERC TEST 19.1 PUMP CHAMBER SECTION DETAIL °7� 25 GALLONS IN<15 MIN. PD BOX '•i I I I t i I I / I PERCRAUNDWAT RENCOAREED 21 NOT TO SCALE NO GROUNDWATER F21(:O11N77AFD // I I I �� y /• TEST HOLE-3 EL.229 TEST HOLE-4 EL.231 Fa Hoot 21.6 2IS err k O Wth r r&a.3Soa To Slap.Q 04.Codas Z. / / / ' o / C LAYER 23Y&6 C LAYER 2.5Y&6 f N F i rKj ! ( / ' / / / OLIVBYELLOw OLIVE YELLOW / 1 /// / MED.SAND 1 MED.SAND oNi.Oda 10 P / Michael A. & Maureen 0. Champs I I ~' ` 'f• ! / /` / / 39" PERC TEST t .7 NOGROUT1DwATEREtXJDUNTFTim tr-r ctf#135911 I / / zs GALLONS m<ISMB+. /// / / R Edge ofesource Ire PERC PATE<2MiN/IN(LTAR-0.74) 12.9 NO GROUNDWATER ENCOUNTERED h Pond High Water/ I 1000 GALLON H-20 - Top Of inland Bank SITE PASSED l / EI=4.4' (NGVD'29) PUMP CHAMBER PLAN VIEW DETAIL Per Survey NOT TO SCALE 2t2ra 3 Il // ;% / / / / Vent - Fit T e f Installation to be io / Determined of Time of Instollation so //// // f/ as to be as inconspicuous as Possible cs /, /l I ll ! F.G EL 13.00E F.G. EL. 22.50t REGRADE AS REQUIRED See Note 6 (fyp.) fns action / It1 (� C SEE NOTE 8 (TYP.) ort EL 10.00 T2p EL 20.5 EL 6.88 0 Installer To 1000 Gallon EL D-Box Confirm Prior E H-20 \ ` ` 1500 Gallon / To Any Work Pump Chamber ® ' r ?� �j I , ` \ H-20 lut.p,00re�.,w., EL Leaching Septic Tank "/Tun(z)CeoN d A,P•e+d 5sda,e Chamber Flow E uillzers e/no(2)coots or AV,--d saa,r As Required J ,•\ i� I I .�1 I I ' t 1' \ \ If Encountered Remove & Replace got, EL 17.5 \\ \ \ b All Unsuitable Soils within 5' of \ Bedding,"Ts, do Baffels The Outer Perimeter of The System ' X 10' as Per Title 5_ Min.\ \ \ x \ \ \ \ \ \ \ 10' Min. - SlobEL. 11.20 / 2ry \\ \ \ \ \ \ \ \ \ \ \ \ \ 20 Min. - Foundation No Groundwater \ \ \ \ \\ \ \ \ \ See Test Hole 1 DEVELOPED PROFILE OF SYSTEM NOT TO SCALE FEMA Flood Zone Line as per FIRM ��P ' / / y` ,� \ \ \\ ( ' I I I 1 / l I 4'0 Perforated PVC #250001 00160D I / / \ \ \ �0 \ I f 1 I I l J1 / Inspection Port W/Screw \ Cap Placed Vertically Down rev July 2, 1992 f \ \ \ j \ If If 1 J ( 1 Into Stone To Soft Below Accessible To Within 3" of Finshed Grade Finish Grade - 1✓/ " Max.Min 9 Compacted Fill Filter Fabric And/or avw �4y I 1 I I I , / r ( 1 I / / l r �I 'os ^ 1/8" - 1/2" OPoo Stone 3/4' - 1 1/2" 14.2 LEACHING Double Washed \ �,, / / ` / / / / / CHAMBER Stone Legend: F CB Tl� 7 C N• ACCESS i 4' - 10' l � `� COVER - 12' Deciduous Tree / g o LCb Fnc CROSS SECTION OF CHAMBER Coniferous Tree / C,J Ware Fence 24.3' *MINOR FIELD AO,R/STMENTS TO GEOMETRY NOT TO SCALE post TO AVOID 5lGNIFlCANT TREES MAY BE „ ALLOWED iN CONSULTA77ON WITH ENGINEER -�- Sign ( �o Ng�'03 25 E Viale nd Trust, Inc' WSPECTION Light Post gornstabctf#135911 PORT VENT Q Misc Manhole ® Catch Basin N/F :� ,9*� , S.A.S. PLAN VIEW DETAIL Harry L Carr Jr SCALE: 1"=10' Hydrant ctf# 132672 El cB/DH i PLAN VIEW -0 Guy ' Q Utility Pole �� SCALE: 1"=30' © Water Gate (round) c -OHW- Overhead Wires " -25- -- Elevation Contour �SSIONAL ECG\ TITLE: Site Plan PREPARED BY. TREPARED FOR: NOTES: CapeSurv ' 1.) The property line information shown was compiled from = Proposed Septic System Sullivan Engineering, Inc. Dewitt Hornor � At PO Box 659 7 Parker Road available record information. I"n Osterville MA 02655 ~ Osterville, MA 02655 1220 ark venue 2.) The topographic information was obtained from an on the 194 Eel RhVIer Road (508)428-3344 (508)428-3115 fox (508) 420-3994 (508) 420-3995 fax New York NY 10128 ground survey performed on or between 06/JUN/06 and 03/SEP/09.capesurve�capecod.net `i3.) The datum used is NGVD '29, a fixed mean sea level datum. Bench Marks used. RM36 & RM33 as designated by FEMA O Bamstable (Osterville) Mass Draft: JOD Field: RRL/MML 30 0 15 30 60 120 D`arE. November 9, 2009 SCALE: 1 „_30, Review: PS Comp.: RRL Project: 29018 Project: C659