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0414 EEL RIVER ROAD - Health
414 Eel. River. Osterville A = 114 •624 �i r I u f No. 4210 1/3 BGR ESSELTE 10% (l O 0 0 0 3� 2-° 12- A,d. 3 fiz f f .2- 5-z) -7 S Commonwealth of Massachusetts Title 5 Official Inspection Form <a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments t hJ 414 Eel River Rd t1 Property Address Robert P Coyne Revocable Trust Owner _t Owner's Name/ e information is Cisterville �/ MA 02655 02/14/2020 required for every page. City/Town State Zip Code Date of Inspection i•4 Inspection results must be submitted on this form. Inspection forms may not be altered in any } .• way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information s/� a ;�� '• on the computer, use only the tab Michael T Bisienere keyto'move your Name of Inspector cursor-do not 'Cape Septic Inspections use the return ke Company Name y. 52 Rivers End Road " I Company Address Teaticket Ma. 02536 City(rown State Zip Code 508-280-3356 S13938 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 t (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address } listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function " and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined ` that the system: 1. ® Passes ` 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 02/15/2020 I Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board F 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 t 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. a , •. _ 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. I n k 1 ' ' 1 t5msp doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 y i 1 Commonwealth of Massachusetts I: Title 5 Official Inspection Form < Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 414 Eel River Rd . V Property Address Robert P Coyne Revocable Trust Owner Owner's Name information is required for every Osterville MA 02655 02/14/2020 1 ?; page. City/Town State Zip Code Date of Inspection C. Inspection Summary y Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. f 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: This 12 bedroom has 3 septic systems. Each septic system is rated for 4 bedrooms. At the time of the inspection all of the leaching systems were dry and no visible failure criteria was found. ' le 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. tr< The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally t# 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. i ❑ Y ❑ N ❑ ND (Explain below): t t. + t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 ; e Commonwealth of Massachusetts t - Title 5 Official Inspection Form <� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 414 Eel River Rd a Property Address i i+ Robert P Coyne Revocable Trust Owner Owner's Name information is OSteryille required for every MA . 02655 02/44/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) k t 2) System Conditionally.Passes (cont.): t ❑ 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 t " 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): P r i • ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): 1. , `�, ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The P F' system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): � I < } ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): { 4 f , 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 ` + 9 the system is failing to protect public health, safety or the environment. y a. System will pass unless Board of Health determines in accordance with 310 CMR E 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t . f ` t5insp.doc•rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 t t ' Commonwealth of Massachusetts { : ? Title 5 Official Inspection Form lI p Subsurface Sewage Disposal System Form Not for Voluntary Assessments + + 414 Eel River Rd I Property Address ° . Robert P Coyne Revocable Trust Owner Owner's'Name information is required for every Osterville MA 02655 02/14/2020 P page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) s ❑ 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, i safety and environment: I ( i ❑ 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. o + y ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water + supply. P P + ,) z ❑ 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: � g 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 I be attached to this form. .8 c. Other: f , 4) System Failure Criteria Applicable to All Systems: tA t You must indicate "Yes" or"No" to each of the following for all inspections: • P Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool I ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters f`E due to an overloaded or clogged SAS or cesspool F,t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 T Commonwealth of Massachusetts Title 5 Official Inspection Form IIll Subsurface Sewage Disposal System Form -.Not for Vol u ntary.Assessments, .,, 414 Eel River Rd Property Address ' Robert P Coyne Revocable Trust Owner Owner's Name information is required for every Osterville MA . 02655 02/14/2020 ' page. Citylrown State Zip Code Date of Inspection s C. Inspection Summary (cont. 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No r Static'liquid level in the distribution box above outlet invert due to an overloaded I fr ❑ ® or clogged SAS or cesspool s El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow i € El ® Required pumping more than 4 times in the last year NOT due to clogged or x' obstructed pipe(s). Number of times pumped` r ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. w 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 i 0 ® well ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. t ❑ ® 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 3 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- El 10,000 gpd. l • ` ® The system fails: l 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 I r + design flow of 16,000 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. 4 i Yes No - r ❑ ❑ 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 LL' El El Area 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 Lei,. -- t Commonwealth of Massachusetts ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments } 414 Eel River Rd 3, Property Address ' Robert P Coyne Revocable Trust Owner Owner's Name y information is Osteryille MA 02655 02/14/2020 required for every " page., Cityrrown 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 r " 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 [ r should contact the appropriate regional office of the Department. 4 6. You must indicate "yes" or"no",for each of the following for all inspections: , + l ,i Yes No fib ® ❑ 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? ` E ❑ ® 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? i Were as built plans of the system obtained and examined? (If they were not. f ' ® El 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? [R: E, ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank F : t inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ElWas 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 3 t 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 ® El 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 L_ a.; 71 Commonwealth of Massachusetts - P .Title 5 Official Inspection Form x ; p <� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 414 Eel River Rd f ul Property Address 3 Robert P Coyne Revocable Trust +,•,Owner Owner's Name `$information is required for every• Osterville MA 02655 02/1.4/2020 £. page, Cityrrown State Zip Code Date of Inspection ; w D. System Information ' 1. Residential Flow Conditions: t q, Number of bedrooms (design): 12 Number of bedrooms (actual). 12 I " DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 1320 plusGPD ►' Description: I Number of current residents: - Does residence have a garbage grinder? El Yes ® No Does residence have a water treatment unit? ❑ Yes ® No I If yes, discharges to: • ' Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No t � Laundry system:inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available (last 2 years usage(gpd)): ? Detail: In 2019-7,000 gallons were used and in 2018-28,000 gallons were used s ., ` Sump pump? ❑ Yes ® No Fall 2019 • Last date of occupancy: � � Date 9,c Ry it it f. !� �t5inspAoc•rev.7/26.!2018 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 - Commonwealth of Massachusetts k _ - Title 5 Official Inspection Form M1l0 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments / .�u 414 Eel River Rd ` Property Address Robert P Coyne Revocable Trust # Owner. � . Owner's Name information is Osterville MA 02655 02/14/2020 r. d required for every page. City/Town State Zip Code Date of Inspection 4.T ' D. System Information (cont.) + •y y ., 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? El ,Yes ❑ No Water treatment unit present? ❑ Yes ❑ No } If yes, discharges to: j . Industrial waste holding tank present? El Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes El No Water meter readings, if available: i . f 1, t Last date of occupancy/use: ' Date t{„ Other(describe below): . f , i ' ♦ t 3.' Pumping Records: . Source of information: f k Was stem pumped as art of the inspection?Y p P p p ❑ Yes N No a If yes, volume pumped: =r3 gallons #' How was quantity pumped determined> Reason for pumping: r/ P t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 t }' Commonwealth of Massachusetts t Tithe 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments k' \ � 414 Eel River Rd . Property Address Robert P Coyne Revocable Trust s r Owner Owner's Name i _ A information is Osterville MA 02655 02/14/2020 I t required for every page. Cityrrown State Zip Code Date of Inspection d D. System Information (cont.) '. 4. Type of System: ® Septic tank, distribution box, soil absorption system j . ❑ Single cesspool i n \ f ElOverflow cesspool ❑ Privy rr i I ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and • s ; ; ' maintenance contract(to be obtained from system owner) and a copy of latest ' inspection of the I/A system by system operator under contract r k ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): {' Approximate age of all components, date installed If known and source of information: 1992, 2001, 2002 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): # r t,af,4 Depth below grade: eetox 19" , . Material of construction: f ❑ cast iron ®40 PVC ❑ other(explain): f town water. p Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence,of leakage, etc.): - .y it , ytty t5insr.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 z s Commonwealth of Massachusetts B .. Title 5 Official Inspection Form h Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u- 414 Eel River Rd f Property Address Robert P Coyne Revocable Trust Owner Owner's Name .' information is Osterville MA 02655 02/14/2020 . required for every �1 page. City/Town State Zip Code Date of Inspection ` D. System Information (cont.) 6. Septic Tank(locate on site plan): . 12" on average Depth below grade: feet } ' . Material of construction: r . ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) a , i R If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: all 3 tanks 1500 gallons each t 9 Y Sludge depth: av 3" Distance from top of sludge to bottom of outlet tee or baffle avg 33" t Scum thickness avg 1" ` Distance from top of scum to top of outlet tee or baffle avg 5" avg 13" Distance from bottom of scum to bottom of outlet tee or baffle f , r sludge judge t " t How were dimensions determined? r Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): . I recommend the new owner put the septic tanks on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the liquid level was at working level and the tee's were in place on all three tanks. NOTE: System#3 has an H-20 septic tank in the # r„ driveway. s' v 4, 4j. - ' ' ' t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 ° Commonwealth of Massachusetts ' - Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments " v 414 Eel Riiver Rd Property Address Robert P Coyne Revocable Trust Owner Owner's Name fi $1 information is required for every Osterville MA 02655 02/14/2020 ! s page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): # Depth below grade: feet r f.t Material of construction: t El concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑,other(explain): t Dimensions: l j°r Scum thickness � r 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, t 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: l � tt • r!' Material of construction: E a El ❑metal [Ifiberglass ❑ polyethylene ❑ other(explain): r ! Dimensions: Capacity: .°f gallons Design Flow: gallons per day {t t5insp'doc"rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System"Page 11 of 18 11 f Commonwealth of Massachusetts _ • Title 5 Official Inspection Form yyyy ,' Subsurface Sewage Disposal System Form - Not for Voluntary.Assessments ie. J € u� 414 Eel River Rd r Property Address •'. Robert P Coyne Revocable Trust ' Owner Owner's Name information is r required for every Osterville MA 02655 02/14/2020 t -page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding,Tank (cont.) t F , Alarm present: El Yes El i t 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 )tf 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0. j f 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.): t At the time of the inspection the liquid level was at working level and there were no visible signs of, t leakage or solids carryover in all three D-Boxes. i t } t , y . t5msp.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 18 t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1. 414 Eel River Rd . Property Address t Robert P Coyne Revocable Trust Owner Owner's Name information is required for every Osterville MA 02655 02/14/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): I`- �ln • Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ElYes ❑ No* t '+ Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): i t { _ * 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): f ' a If SAS not located,explain why: t. Type. t a , F' ® leaching pits number: System 1-Two 3 each on leaching chambers number: System 2 and 3 r ❑ leaching galleries number: t ❑ leaching trenches number, length: 4 + ❑ leaching fields. number, dimensions: t _ ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: '� i t5insp.doc rev.7/26/2018 " Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 414 Eel River Rd l Property Address Robert P Coyne Revocable Trust # owner Owner's Name information is required for every Osterville MA 02655 02/14/2020 F page. Citylrown - State Zip Code Date of Inspection s D. System Information (cont.) i 11. Soil Absorption System (SAS) (cont.) P � Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of ,f vegetation, etc.): At the time of the inspection no visible failure criteria was found in all three systems. 4 a � 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): � I t l 1_ Q , Number and configuration +i[' °.j 3 Depth—top of liquid to inlet invert Depth of solids layer "t( , Depth of scum layer. < ; Dimensions of cesspool ' Materials of construction Indication of groundwater inflow ❑ Yes ❑ No ;ra Comments (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.): yF. x f.� , S t i f , ... t5insp'doc re'.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments F I 414 Eel River Rd . ` Property Address ` - Robert P Coyne Revocable Trust Owner Owner's Name t'. information is required for every Osterville MA 02655 02/14/2020 page. CityTrown State Zip Code Date of Inspection D. System Information (cont.) r1. ' 13. Privy(locate on site plan): Materials of construction: k� t l Dimensions _' ti• 3 i Depth of solids a4�, Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): S t I • 1 ,^, i + t r� t .t t�f5insp 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 I _ =I 414 Eel River Rd j, a, a.. Property Address ° Robert P Coyne Revocable Trust � t ' Owner Owner's Name infom,ation is Osterville MA 02655 02/14/2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference. landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters. ¢' the building. Check one of the boxes below: t- 3' ❑ hand-sketch in the area below ® drawing attached separately r. 4 f Y i• { I _ s� ,f31Jt5insp.doc•rev.7/26/2018 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 4� !! I I I ` LEGEND: # Light Post Gas Gate ® Catch Basin O CB/DH Concrete Bound w/drill hole [] BRB Barnstable Road Bound / � Guy •�/ i Utility Pole -�^ Overhead Utility Wires ®e i i i E i Wlf ,A9N. - l 45 \• ! � tJ ,0 °, •- \ / —20— -� i.o• •• ,gyp ena �\ rra L m J2.62' K `2 m \� 0 o 1 s LA �g i°a 0 3(1 _000 �� "� ` sue * a N � �� .•-�1 � 9 N� �.T�`N\,_si�, rye f;oo■. j \ M PRQ Po _ Lot\60 38.27.11Esr ........... 44.34 W n,d �d taw[ ° i \ ......` \ �01 5 9 / a46 Stone s' j1.39'59� '\ 1 - _ 5 L01 Est Crawl 14�_ �i ,pi OFA!p e reue-t4.te rose rT eAOe/Wt 16000ailon R1CWRD rA! 3 a Septic Tank. L wkux N.i \ 0�V PLAN VIEW _ N•xo �9oFessNo�P ��(� DScz(e'I°=30 D4 WErLAND FU,6E0 BY ENSR. DELVELOPED PROFILE t l Not losca!e P>, PREPARED BY: PREPARED FOR: USE ADDITION o IVER ROAD Sullivan Engineering, Inc. Cap�Z)UN ROBI ' PO Box 659 7 Parker Road j.LE,MASS, Ostervifle, MA 02655 Osterville MA 02655 (� (508)428-3344(508)428-J115 fox (508)420-3994(508)420-•3995 fox I — 30 n IS to :QO •�' ION 1,62 p4D0 REss' � gm, IL Sh Azov �N pv PO 1 _ 4 A1 Eon IT d 1� � L• stogy -� -•- . LOT _ ! fi e c 2CP` O a AD aa , a .. a�-3 3s El Q.� 3 c J Mgt n h�OuSc A I = as v 3 r 5�5�CYYN A 3 oa � A I = ►"� � 0 O A► 3 = y ? � 33 - 56 N-ao OSri S}onc L7r�VG E�� �:vec ion d { . - Commonwealth of Massachusetts Title 5 official Inspection Form ti Subsurface Sewage Disposal System Form Not for Voluntary Assessments r; 414 Eel River Rd u Property Address f .,r Robert P Coyne Revocable Trust - I I• 1 , Owner Owner's Name information is Osterville MA 02655 02/14/2020 required for every page.' City/Town State Zip Code Date of Inspection t D. System Information (cont.) 15. Site Exam: 4' ® Check Slope Surface water Check cellar ' ➢r,4 - ® Shallow wells } Estimated depth to high ground water: f etplus feet tF" ; Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record f 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: y.: ElChecked with local excavators, installers-(attach documentation) i, ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: F " g . I augered a hole at a lower elevation and I shot it with transit to show 4 plus feet of seperation Before.filing this Inspection Report, please see Report Completeness Checklist on next page. t' t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts ' p Title 5 Official, Inspection Fora ��I� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 p Y ry , 414 Eel River Rd p: F Property Address Robert P Coyne Revocable Trust Owner Owner's Name F information is required for every Osterville MA 02655 02/14/2020 page. Cityrrown State Zip Code Date of Inspection t Y E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: i, • } ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked i ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate i.f§ 4 (Failure Criteria)and 6 (Checklist) completed i ® 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 , 1 If " 1.i Y i F t xa S 1r:t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 ast /a`. Fee o THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes ��� PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ft plication for aig pozal Opotem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) Complete System O Individual Components Location Address or Lot No.41 y EEL R IYE pt. 1ZOAD Owner's Name,Address and Tel.No. OSTEKVIL(LE, /l4 R05eRT+5U5hN COYNE Assessor'sMap/Parcel I'y,OZy to4t�LIFTON IKOAD Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 'I �hc ��o.J 5UILLWAN ENb1NEE1ttWD 7 PAgKER Rd. PO-BM&-59 OSTE V1 LL1G(AA, 5b%-4 Z B-3344 Type of Building: t Dwelling No.of Bedrooms q Lot Size sq.ft. Garbage Grinder(N0) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow q 55 gallons per day. Calculated daily flow yqo gallons. Plan Date AARc.H 29,ZOOZ Number of sheets I Revision Date — 1 Title PKr3?051M NOUSC APD t•CIO V Size of Septic Tank 15010 6AL. Type of S.A.S. IZ-10 x33-V FIELD Lai 3•SM 0J , / C1tltMtBEKS Description of Soil ry " s,n' ca tam e r Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss by this Board—of Health. Signed Date q Z,1 a Application Approved by Date !/ Application Disapproved for the following reasons Permit No. 2(o 2 / Date Issued 43 0 Z� -�.'° Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN"OF BARNSTAB E., MASSACHUSETTS Yes ZIPPrication for �Bigpoga[ 6' gtem Comaruction Vermit Application for a Permit to Construct( 'Repair( )Upgrade( )Abandon(4 ) C omplete System El Individual Components Location Address or Lot No.414 Ee L R IVE Z IROAD Owner's Name,Address and Tel.No. 05TERVIL�-E, 9013ERT -,5u5hN COYNE °. \Assessor'sMap/Parcel (Oy CLIFTON �oAp Ily- OZy- MIL"TON MVA Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Ct-0y��Sv-veIa 5U tVA4 EN&INEERING 7 PAKKF-R R,.1• -Pb-B X ta59 t3 �•� f Y-a` 05TERV►LLE MA 50S-4 Z 6-"3344 Type of Building: t a Z - r Garbage e Grinder f Bedrooms Lot Size �B U s .ft. G b NO Dwelling No.o � � q S ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow t{S 5 gallons per day.cCalculated daily flow W gallons. Plan Date (LIAR CH 21, ZOdZ. Number of sheets I e "Z -01 Revision Date ^ ! �1 Title i?R0 0SE -) HOV SC- ADD IT ID Size of Septic Tank 60'0 6At_ Type of S.A.S.BIZ=I6 x A-r ' FIEU7 wl 3.500 6A , ` �� Description of Soil; J. A w 2 �/s n,, r u. hb� l u n,vaa n e M ! [ wAe r n r 10 11 Nature of Repairs or Alterations(Answer when applicable) c 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 placelthe system in operation until a Certifi- cate of Compliance has been iss a by this Bo f Health. , Signed '. Date q ?_ Z1 Application Approved by Date=o Application Disapproved for the following reasons Permit No. Gu a Date Issued y r c' THE COMMONWEALTH OF MASSACHUSETTS ` LY BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO C RTIFY,that the On-site Sewage Disposal System Constructed( ✓) repaired ( )Upgraded( ) Abandoned( )by k�� deg e>ru at 41/q e'E V 5 r , 0S&/✓1'JJ 4- has been constru/qed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. `// dated Installer Designer The issuance of thisf permit shall not be construed as a guarantee that the systeltw�ill,function as de igned� Date �I l a/(J Inspector �lJ• y t J — a V a c/� 'r---------------------------Fee / V(J THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Xigpoga1 *pgtem Congtruction Vermit Permission is hereby granted/to Construct( vRepair( )U grade )Abandon `' ( ) System located at / �e/ } / r Rq e o � "✓�Z/, 4(11ON s fifi,, r_ i7rij � I and as clescribed in the above Application4or Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. w Provided:Constr ction must be completed within three years of the date of th7,9L- % t. Date:— V J `'_ Approved by TOWN OF BARN TABLE �. i.OL,�'::ON` CC-el SEWAGE # o�0oa_ 7y� VILLAGE a4 ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ISDD LEACHING FACILITY: (type) 3— — (size) NO. OF BEDROOMS 171 — BUILDER OR OWNER PERMI DATE:_ O �' _ OMPLIANCE DATE: Z h Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leachinb Facility Feet Private Water Supply Well and.Leaching Facility (If any wells exist on site or within 2Q0 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (if any wetlands exist within 300 feet of leaching facility) Feet Furnished by j GvS� i 3° 0 O TOWN OF BARN TABLE �. LOCATION 7''l� C' v' ��.y.� � '�!' SEWAGE # VILLAGE L4 ASSESSOR'S MAP & LOT —U �?tj INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY lSol� LEACHING FACILITY: (type) 3— (size)(size) /2/v 9'3� X NO. OF BEDROOMS BUILDER OR OWNER PERMIT DATE: OMPLIANCE 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 2Q0 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by No. FCC41tes ' go THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2ppYication for Mizpaal *raem Conwurtion Vermit Application for a Permit to Construct( Repair( )Upgrade( )Abandon( ) LComplete System ❑Individual Components Location Address or Lot No.41`I EEL RWEtZ Roles Owner's Name,Address and Tel.No. oSCtsRvlu.�,IYIR ?k4atA r Souv% lLall 1e Assessor's Map/Parcel ay Cti�J�on Rogcl I►y OZy YW%Wor\.AMA Installer's NWORY No. ,, Designer's Name,Address and Tel.No. 7P4rE 0%Ck,"r,n �Y,(fir/ 10 l�l/ 7�.c�.er Rood,Yp.�3oo� 1059 ' 5 8 34N a sec \e,,t`l1A OZloS So8-4Z 3 Type of Building: JOV Dwelling No.of Bedroom ` Lot Size •Blo kes +q-ft. Garbage Grinder(N0) Other Type of Building 1NjjjjkQ= No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 4 yy gallons per day. Calculated daily flow 0' 9'0 gallons. Plan Date 5Q� Ii3, Zoo t Number of sheets 1 Revision Date — Title -pto Qoseol Ho-s e W;dj o r, Size of Septic Tank 1500 ate,\, Type of S.A.S. i \ 4( Description of Soil, C lec►n &my\ c�r r a\ Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been i ued this Board o He Signe Date ! ® ' Application Approved by Date Application Disapproved forthe following reaso Permit No. Date Issued e. �' ,( ' <• -� � � 'Fee' / 4Yes %' g . Entered in computer:THE COMMONWEALTH OF MASS CH' SETTS re .� PUBLIC HEALTH DIVISION _TOWN OF BARNSTABL'ES MASSACHUSETTS F Yi�ation fob Miopooal bpgtem Cone4ruction Permit Application+fora Permit to Construct( Repair( )Upgrade( )Abandon( ) ©'Complete System ❑Individual Components Location Address or Lot No.Ll14•EEL ?S\V C Owner's Name,Address and Te1..No.; y 1 ��el:YZvILLL'.i1}a 94N:) A »sc^ C.Olmt 'Assessor'sMap/Parcel (,,ACl���on 1�0����: I�ynzy r���\cn MA Installer's N Address, /d' a No. J Designer s Name;Address and Tel.No ••w-•+µ � V i/I!D ���,v�, , Eny;nte�,nr'�-A I C� o �, tt o Aec ,Ile, fyjA LIZB ''3-a`iLt Type of Building: Dwelling No.of Bedroom W10V Size Pilo 4a-s sq--ft. Garbage Grinder(No) Other Type of Building No.of Persons Showers( ) Cafeteria( ) �Other Fixtures Design Flow ao gallons pet day,.Calculated daily flow " gallons. Plan Date Sr pi. 16. c�o 01 Number of sheets Revision Date Title�P foPoSed ",j, kar-A,on L� Size of Septic Tank 1500 ` Type of S.A.S./ < Description of Soil C'.IPnn` isrtin ��� ,5 Natureof'Rep rs or Alterations(Answer when applicable) r i r max± r Date last inspected: Agreeyment: The,-undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system y in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation,until a Certifi- r cate of C'ompq; ce,has be n i ued b, this Board o HOPI Signe _ Date t 0 Application Approved by Date Application Disapproved for the following reaso s d i Permit No. ..�- Date Issued t THE COMMONWEALTH OF MASSACHUSETTS j,BARNSTABLE, MASSACHUSETTS Certificate of Compliance € 1i . viitl THIS IS TO CERTIFY,th t the On-site Sewage Dis osal'System Constructed( )Repaired( )Upgraded( ) Abandoned( )by „'�/ ��-- C <- at `' h constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit N dated �� S Installer Designer The issuance�°f this pennit shall not be construed as a guarantee that the syst •y will function d�esAy ned. DateT���U 1 Inspector •,� �""�" - - - -- - ----- ----- -- r No. VA �� Fee J(2!51__7 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migogar bpotem Construction Permit Permission is hereby granted to Construc�j( )Repair( )Upgrade( Abandon.( ) System located at 7 y Cam- y`Cti. C f(G�G�_ and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. 4 Date: Approved by f TOWN OF BARNS ABLE LOCATION t SEWAGE # ��— VILLAGE , ASSESSOR'S MAP & L'OT_LtJQ INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) '� Grp size) Al 49 X -577 NO. OF BEDROOMS . BUILDER OR OWNER ry PERMIT DATE: / �` OMPLIANCE DATE: WU 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 I 1 NZ yr+ T01AF4"1�=OF$ARNSTABLE " LOCATION SEWAGE VILLAGE '� ;�.�/ ASSESSOR'S MAP & LOT 0 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 'LEACHING FACILITY: (type) (size) ii O.OF BEDROOMS BUILDER OR OWNER > F� va PERMITDATE: OMPLIANCE DATE: Z L01 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) Y Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) 'Feet Furnished by b � dIP fl b . ti , ,3 ASSESSORS MAP N0: PARCEL NO: 36) No. -• ---.. Fps............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Applira#iou for Dispniial Works Towitrurti Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at• _ D ,—bocation Aoress or Lot No. c ----- --•......................................... ..............`-'.....•-•-•-•--•........................-----•........................... /�/Zer(� Owner Address •--...... / ................................ ......... ....... -- ------------------------------------------- Installer Address Type of Building Size Lot............................Sq. feet v Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 0 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........................................ W Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (� Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ ---------------------------------------------------•-----•-•------------.............----.................-•--•---•--------------•--••--•...........--•.•-•-- ODescription of Soil........................................................................................................................................................................ V --•------------•----------------------•--•----•------•---------------------------------•------------------------------------------------ ------- W s .............................................. r t — _ .. _'U Nature of Re airs o ....._. �o..-=---- E ---•-•--•---•---•-•••---•-•--------------•--.----••-----.•---...--•--•----•-... ---•-•. . •-•-- . ....___••--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compli ce h s been ' sued b alth. Sig -------- -- - ---- .......---- Date ApplicationApproved By .... . . ...... ........... . . .. ...... .......................................... -------------- .....I..------------.... Date Application Disapproved for the following reasons: ........ .. .................................................................. ..... ....................... ............... ----------- ------------------- --------------- ---------- ---------------------- -- ---------- ----------------------- ----- ------ Dare PermitNo. ................ Issued ................................................................... Date No.9 . FIZZ 3...........:..``...... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE A p liration for Bid oM Works Tomitr.-a,--ij� prht# Application is hereby made for a Permit to Construct,.( ) or Repair ( ) an Individual Sewage Disposal System at: �' 6sTL z 6,-1 �f ------------------ --••-•••--•... ��� / ,-Location �ress � � or Lot No. ............... — ..- ..... ................................................. .......-•-•`•..=�....._......-----..........__....... ......------ Owner Address a -•---•-••.................••••••-••••--•---...•••-•••-•-••••----•-----............••............._ .......•-------....-••----•-•-•......•.......................'.....__.._.......................... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. ofl Bedrooms___________________________________________Expansion Attic ( ) Garbage Grinder ( ) �a Other—Type T e of Building ___..______ No. of ersons____________________________ Showers YP g ----------------- P ( ) — Cafeteria ( ) Otherfixtures -------------------------------------------------------------•••••............---- .................................. ' Design Flow............................................gallons per person per day. Total daily flow___ew........................_............gallons. W- Septic 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........................................ Test'Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ----------------------------- ------------------------------ _.......... •--------- •---____-•--•--.._--------- •------•---_-______---------- •-------- 0 Description of Soil-----•-----------------------------------------------------------••----••-------------------------------------------•-----------------------------------................ x (� ------- •-•------------------------- •----------- ------------------------- ------------------------ •-•------------------ •---------------------------- •------------------------ •••-----------••-- W U Nature of Repair's or Alt ations—Answer when applicable.....OY O_o• ,S T------- . L f/C� 6- CD ......................!�G�-. --••----------•----------•------•------•----._...-•----------------•--._...-----•--•--------•-••--•............ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE-5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate•of Compliaacehhhas beet ' sued b�thl- af- alth. fJ Dare Application Approved BY ----- -----..%............ �....,.. ./. iw ............................. ....... f /li v: ....... ............... -.. ........ .... ..........Date....... ........ Application Disapproved for the following reasons- ...................................................----------- -------------------------------------------------- ------------ .............---------------------------------q.. _ re..........................Dare...... Permit No. -- -- -�-......................------ ----.. Issued \ Dare THE COMMONWEALTH OF MASSACHUSETTS I BOARD OF HEALTH TOWN OF BARNSTABLE CErttft. ate of CII1r pliaYi.CE THIS ISTg CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired by ... y------------------------------------------------------------------------- ------- --------------------------- -- ---------------------------------------------------------------- — IL Installer at ..... .......�C/..� c..Ur..�-..... ....................... 5--.. .., ------------------------------------------_---------------------------------_--------_ has been installed in accordance with the provisions of TITLE of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ..... ... .....� .......---....... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE S A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...................... -`.. :f...n .. Inspector .............. _:...... ... .... THE COMMONWEALTH OF MASSACHUSETTS D BOARD OF HEALTH TOWN OF BARNSTABLE No..................... FEE. ......... .. `�rkg Tonotrnrtion rrmii Permission is hereby granted_ . / G ff ------------•----------------•------.....-------------•---------------•-------•---•---------------._....------.....•---..._............_.. to Construct ( )`o/r Re air . an Indiv'duah.Sewage Dii po System at No.................. •-7--1�--------���-----�.c v - - ` treet as shown on the application for Disposal Works Constructio er- ``N ted:____________________do._____._......_. o DATE.......................l.C._;-,� ----!-�------•------------ Boar f ealth FORM 36508 HOBBS 6 WARREN,INC.,PUBLISHERS , - r { (a ... - �.� p -... .'.......... ..:. - .Y. •.sad.". `;•r.¢: :te'.57: °�'�� f 't� - .'�, ._.fir s.... :f., ,.,,..>..:• ,_ a .,,-,. .. . . 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Y •S' Hfw vV�' N tNl"+ F A ' [ b t�p artwt 6f 4+ [59 , 6 6la C�1 rYnt7P�a �,f 2b� �t4yT$"�! + �dar Is i e&fir: tt. rat yi�t K a d"� el af f' d'rfp^f j Ykp!`} t 'J t!}`� t1 t't �d 5'?•{y, yy+',. y3; fi' Qr. IF1,1 � �f 1, -Taxy$iL�;.i�y���L[A A Will sa' 16 P faYY'' h4 1 ,, 1 ,}s� !t Fmk;`3ta tt� Yet IV MI, -0' 3.Yf; 1 .,"9! +_ ;$'y • "n t,'tl�y t•7Kr , ,<' 'rre#'g ,t ................ ;: �' + • Oz.. 'ez. I :�• � '� �'� ��� :.off! - �� f� "':'�'.,p.. •an ofii �< •: 3 LEGEND: ZONE: rke, Neck '•• :c, Pond 6 "a # Light Post RF-1 / s �, ,cn . .�", Resource Protection Overlay District Se Ia © Gas Gate CL / Area (min.) 87,120 SF 1 , o • �tio Catch Basin (min) ` lo�\ ® Fronts a min 20 .} El CB/DH Concrete Bound w/drill hole ) Width mrn 125 1 LOCUS , a ElBRB Barnstable Road Bound Setbac s: E Front 30' 2 Guy Side 15' -O- Utility Pole Rear 15' 4 t e l w1�`'' y a+w Overhead Utility Wires RID 0✓r ;;y ,1. ERLA Y DISTRICT. AP - Aquifer Protection District /20 ��H As Shown on Plan Entitled ? i ''Revised Groundwater Protection 1.11•ht Overlay Districts" — April, 1993 -- Location Map 1"=2000'1 ASSESSORS REF.: y2 Map 114 , Parcel 24 It i —20— 1.01 �p • ao Ii e o pa�°R'j Nov,` REFERENCES.g Land Court Case # 2664-72 0 �oQogor* 41s�': Cert. # 151198 r = Q oo'� / r� o j Fhd � .'Q � nd 421 \ 1 � U1 to I IZ.16 ..M, Q \ = 20,>ZG� _ p w o NOTES DESIGN DATA L = 32.162 N o 0 o House Addition-4 Bedrooms \ c O + %s c L Water Supply ForThis Lot is Municipal Water o Dal Flow a 440 GPD -A 2 Location of Utilities Shown on This Plan Are Approx. Septic Tank:440 GPD x 200%a 860 GPD os cT At Least 72 Hours Prior to An Excavation For This �: SPTIG ,3 a y TANK Z `� 1° Use 1500 Gallon Septic Tank •� N �c's. Project The ContractaShall Make The Required y o +g3 Notification to Dig Safe(I-888-344-7233) y O O O ; �b y1\ N o Leachina Area I C / EXI s Sh ' 3'The Contractor is Required to Secure Appropriate 440 GPDr0.74=595 SF Required' �„` Permits D-Box I �e, ` t0007 Sy$* sCp� Defined From ThisPlan Agencies For Construction - Sldewalla=2(1�r-10"+33g' s185SF sC' ` •`e _ Softcm rem 1 1. x0, . 4-"SIM Install Risers as Required to Within 12"ot 615 SF Total Provided Finished Grade. G ' k S.All Structures Busied Four Feet or More All Pipes to be Schedule 40.Use e or Leaching Chamber Deslan � °t• � � � � to Vehicular Traffic to be H-20 Loading. r e, & Septic System to be Installed in Accordance With 3-500 Gat.Leaching Chambers In a \ _ 1240"x 374"Washed Stone Field as Shown 310 CMR 15.00 Latest Revision And The Town of \ �Q F9 Barnstable Board of Health Regulations 1, T. AI I Piping to be Sch.40 PVC. f1N10r� NOTE: Soil tobeVerifiedin The Field Lot •60 C By The Engineer 81 Board of Health N \ 38'27,1;isF . FIIMr .. Agent at Time of Installation. �' ` �• Fe" 0,n9•eh�fill _ 1'� Ile-Ile /to \ \ ` /bH M erase �� e Z _ - � � \ \` - - � \ �q,3� M Fnd A ►�,���► '''� Cn Iy 0° 78 ` L•OeAln! 3/4--11/1"' N w Q O d Sh q°`�Z N e6e nMr DwMe WO*W IN, i s-lo . I SION J -O ••• = ` �.• �6 �s� CROSS SECTION OFCHAMBER __ 7d--4 16°. ,cA" \ .,:NOT 70 KALE Stone Drive -- $ 707 °T _ d yn►Ile N 53 85 r c raa I F.G. 19.0 F.G. 18.0 CBIDH 14 _ '\ ctt pri n n Fd � 16.5 15.5 TBM a-14.1s(NGVD'29) 1500Gallon r Top El. 16.5 / Top of CB/DH 16.3 Septic Tank 16.1 y Bol.El. 13.5 PLAN VIEW �.-�..<:.,_: 15.9 15.7 8.5'3 Beddirig as "_ Scales I - 30' Per Title 5 Than 5.0 PerTO.8 Ground water Map. DELVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Not to Scale Revision Revised Septic System to Accommodate 4 Bedrooms Date:03/22/Ol 1 Title: PREPARED BY- PREPARED FOR: Notes/Revision: The property line information shown was compiled PROPOSED HOUSE ADDITION �c p~nm �'�( ROBERT 8► SUSAN COY from available record information and does not (b Sullivan Engineering, nc p represent on on the ground survey. CD 414 EEL RIVER ROAD PO Box 659 7 Parker Road 64 CLI FTON ROAD OSTERVILLE,MASS. Osterville, MA 02655 Osterville MA 02655 MILTON MASS. The topography and detail shown was obtained (508)428-3344 (508)428-3115 fox (508)420-3994 (508)420-3995 fax by conventional survey-methods in July/01. V 0 The datum used Is NGVD '29, Based on FEMA benchmark data. V 30 0 15 30 60 12° Field: WHK/MHD Draft: RRL Date: Scale: Comp.: MHD/RRL- — ----— Review: September 1-8, 2001 As Shown Proj # Drawing # C493g1 - a i •a •r tl r end 0+ " •: J �'+ K �N •.•• LEGEND: ZONE: _ •' r Neck 6• # Light Post RF-1nm Resource Protection Overlay District 4 pRSSe�, / iati © Gas Gate ® Catch Basin Area (min. 87,120 SF o o eo • 1° Fronto a (min) 20' I S In CB/DH Concrete Bound w/drill hole g ) - width (min 125 , ;LOCU ElBRB Barnstable Road Bound Setbacks: Fron t 30' Guy Side 15' ' '"" a° " ",ai -O Utility Pole Rear 15' F 1 a►+»' Overhead Utility Wires O` ® n• + OVERLAY DISTRICT: .SE • Y : •.o ' :: �� _ / / AP - Aquifer Protection District \ aTlo� /20 cetl As Shown on Plan Entitled5'k 1 Fh "Revised Groundwater Protection Rala' �10 A Overlay Districts" � April, 1993 Location Map �19 1"a2000'f i 6 5 200 ASSESSORS REF.: Map 114 , Parcel 24 _20- 01 paw _ -1..••' � • REFERENCES: '7 Land Court Case # 2664-72 Cert. # 151198 Fnd 1 Ln tD M A20100_ At)b a \ NOTES DESIGN DATA L 3Z'62' I.�p`PFCOVRESS -o o Z7 o o Water Supply ForThia Lot is Municipal Water House Addltlon-4 Bedroom s IN e + � �� �. 2 Location of Utilities Shown on This Plan Are Dall Approx. SepticFlow■440 CPO Tank:440 GPO x 200%■ee0 GPD �t At Least 72 Hours Prior to Any Excavation For This Use 1600 Gallon Septic Tank IS- Project The ContractorShail Make The Required N ► Notification to Dig Safe(I-888-344-7233) Leachinuires O O O y� CO, FX1 r sr- Sh 3 TChe,Cdniro t 5r Is Requiredto Secure Appropriate r "0 GPD10.74■696 SF Required 4 Nx y Permits From Town Agencies For Construction slrtwrre0.7(1r.1lr.rx r r 1re�eF C s So M Fen 4, Install Risers as Required to Within 12rrof IHS Bottom F Totol Provided x 33'�6`'=430 SF Finished Grade. s f 5.All Structures Buried Four Feet or Mare or Subject' Leschlrtu Chamber Deslan et• �\ = to Vehicular Traffic lobe H-20 Loading. All Pipes to be Schedule 40.Use \ / w — i & Septfe System to be Installed in Accordance With 3-500 Gal.Leaching Chambers In a �P 310 CMR 15.00 Latest Revision And The Town of 14•-10"x 33'-6"Washed Stone Field as shown 83.1' \ , �Q� \�— 1�9 Barnstable Board of Health Regulations \ y 7. At I Piping to be Sch.40 PVC. \ _ _ \ + \ op, OV0 \ i '� "\ f'� iJ r NOTE- Soil to beVerifiedin The Field oN \` `�f '�� C \ _ By The Engineer 8i Board of Health • '— � SF ry 8,2 \ n1r" o � Installation. �^ "brl" ple onq.u.+nn Agent at Time o / z \ ��.3� , W Fnd NOTE: If Encountered Remove&Replace All to o-' 2 \ ` \ Unsuitable Soil Within S of the Outer N o o d �,raa \ \ '0 •°0 78 \ ` N `"°"�"" oeya.ebr+a Perimeter of the System. O 1 5 s "C. '12 • cb...b". 31-11Ve.. U O - 1 SrsTc \ \ $ H-20 slow / '' ' 6 \ CROSS SECTION OF CHAMBER / 0 rS 160'k 9° W rror TOacre / Stone D �" -- -' $ J1.31'5 51 LOT e /. -o 0/fLe00ta Crawl FG. la5 FG:,IS CSIDH� Ott f 785 Space t1OF Fd 14 � � � � � 2, yS�OFA� 1 ��� 79M a-14.1s'(n►cw'29) 1500Gallon Top El.14 of ce/bH 3• Septic Tank 13.6 If No.297M .'i �� RICR.- n, , 3 H-20 BoI.EI. CWIL Lei R. N PLAN-VIE W� i3.4 I f #34312 1 ,r , 1>4 Bedding as Groundwater .Of Los Per Title 5 Than 5.0 Per�T0.18 Ground 9o�Fss`o. >?le I = 30 water Map. s / WErLANO FL.AGEc BY ENSR. DELVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Not to Scale / Revision Revised to Show Wetlands on Adjacent Lot I?1 &Relocated Septic Sydem Outside of 100'Bier Date:04/1&12 Ttle: PREPARED BY PREPARED FOR: Notes/Revision: The property line information shown was compiled s PROPOSED HOUSE ADDITION ���iv�� �� ��tCtCY'1� ���, Vim 0�;�Jl(� ROBERT a SUSAN COYNE from available record Information and does not Cb g, represent an on the ground survey. 414 EEL RIVER ROAD PO Box 659 7 Parker Road 64 CLI FTON ROAD Osterville, MA 02655 Osterville MA 02655 The topography and detail shown was obtained OSTERVILLE,MASS. MILTON , MASS. b conventional curve methods in Jul 01. 11 (508)428-3344 (508)428-3115 fax (508)420-3994 (508)420--3995 fax y y y� The datum used /s NGVD '29, Based on FEMA -+, benchmark data. / The Location of the ADDITION IN PROGRESS V 30 0 15 30 60 120_ Field: WHK MHO Draft: 50D Date: Scale: COMP.: MHO/RRL Review:�S- --- and Associated Septic System is Based on the Approved - March 29, 2002 -- - - J # Orawin Plan of Record Dated September 18,2001 Revised March 22,2001. As Shown Pro: g # C493g1