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0058 EVANS STREET - Health
;.; 58 EVANS STREET, OSTERVILLE u ° N r, i • i y _t z O B SxA .E 3o- LOCp' TON �� ✓G•�.5 . �_,._.W_SEWAGE Vl[t.LRGE STe�U t �LS'�-.--- -�.55�5"amR'S 1►iiA1''&�t)'t' -- IT35Tl?�LLL1�'S�tA11���1`IQIdE CIO sc �Ar cA l IODU G �.. .�.�. -� 3 1C1 I�Qli3 G I Sepraiat�on�3isturaes;Bstvieeaae10 root Maxiittucu Al)ustEd Gapu�acfweter'Caatile to the i3uttom aisGhtn Nuiihty Piivt�. glt�tcr Su ! Vic!!a��ci 1�eaa4�t�g l�aoaliryt ►y vr;19s exist �: boos oh sate ac:evlthio Q0 feet of�le�cliuttg f�c iaty') �?si � caii�►ltHancl add Leac6un�t�acali�y( u�y wEtland exist _.� w: „-W=� ee 1+1Dtiz�n UQ c et p 1c:acbung�uoiliry) � c urnl3he��y - v � oa li o 37� Q�3 "36 0 3- 37' ll- Ogg Commonwealth of Massachusetts rr Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Title 5 Official Inspection Form 58 Evans Street '" Property Address David &Shannon Roddy 0 Owner Owners Name ..V information is :X; required for every Osterville MA 02655 9-14 18 page. City/Town State Zip Code Date of Inspection y.ts Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Plcasc scc completeness checklist at the end of the form. ���uuuuriu�,� Important:WhenA. Inspector Information �.• filling out forms on the computer, pa:' LnS. use only the tab James D.Sears = ;' 'JAMES key to move your Name of Inspector EARS cursor-do not Capewide Enterprises =*; `ca use the return 's r key_ Company Name ..RTIF O 153 Commercial Street i�voryF S IN SIP _0 Company Address n Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification 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: T. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 9-15-18 pector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please nose: This NoOrt only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.W26/201a Tdle 5 Oticial Inspection Form!Subsurface Sewage Disposal System•Page I of 18 bZ a5ed xez! dH 6t,10 81,0Z 86 daS Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 58 Evans Street Property Address David &Shannon Roddy Owner Owners Name information is required for every OStervllle MA 02655 9-14 18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary:Complete 1, 2, 3,or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system is a 1000 Gal. Tank D Box and two 500 Gal dry well chambers. 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upuii c;urflpletlon of the replacement or repair,as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N. ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev,7/26/2018 Title S Official Inspection Form:Subsurface Sewage Disposal System•Page 2 0l 18 gZ abed xeJ dH 0910 ME 86 daS Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 58 Evans Street Property Address David &Shannon Roddy Owner Owner's Name information is required for every Osterville MA 02655 9-14 18 page. City/Town 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 pipes) 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 dotormino 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.712612018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 3 of 10 9Z abed xed dH l•g:Lo 8602 el. d@S f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Evans Street Property Address David &Shannon Roddy Owner Owners Name information is required for every Osterville MA 02655 9-14 18 page. Gty/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cocopool 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 t51nsp.doc-rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 LZ abed F xeJ dH l,gLO 960Z 96 daS Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 58 Evans Street Property Address David &Shannon Roddy Owner Owner's Name information is required for every Osterville MA 02655 9-14 18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in is less than 6"below invert or available volume is less than Y2 day flow ERC14"U6 ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed plpe(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— IW PA)or a mapped Zone II of a public water supply well t5insp.doc•rev.nmzo1 s Title 5 Ofrxial Inspection Form:Subsurface Sewage Disposal System•Page 5 of t8 gZ abed xe:1 dH 25L0 860E Si, daS Commonwealth of Massachusetts Title 5 Official Inspection Form i' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Evans Street Property Address David &Shannon Roddy Owner Owner's Name Information is required for every Osterville MA 02655 9-14 18 page, City(Tom 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 CM 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 no*e as NIA) ® ❑ 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)] 15insp.doc rev.U2812018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 62 a5ed xe� dH 25L0 8 1,0E 9 6 daS Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 58 Evans Street Property Address David &Shannon Roddy Owner Owner's Name information is required for every Ostervllle MA 02655 9-14 18 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage 2016-39,000Gals g { y g (gpd))' 2017-25,000GaIs Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NA Date t5insp.doc•rev.7l261201 B Title 5 Official fespaction Form:Subsurface Sewage Disposal System•Page 7 of 18 06 a5ed xeJ dH £5:L0 860E 86 d8S Commonwealth of Massachusetts Title 5 Official Inspection Form N Subsurface Sewage Disposal System Form • Not for Voluntary Assessments �.' 58 Evans Street Property Address David &Shannon Roddy Owner Owners Name information is required for every Osterville MA 02655 9-14 18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available, Last date of occupancy/use: Date Y Other(describe below): 3. Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp•doc•rev.7/28/2018 Title 5 Official Inspection Farm:Subsurface Sewage DiWsal System•Page 8 of 18 6E abed xed dH t,510 91,02 el, daS Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Evans Street Property Address David &Shannon Roddy Owner Owner's Name information is required for every Osterville MA 02655 9-1418 page. City/Town' State Zip Code Date of Inspection D. System Information (cunt.) 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 IJA 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: Tank NA D Box Chamber's 2017 Permit # 2017 - 118 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5, Building Sewer(locate on site plan): Depth below gr2de; 32"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.): Pipeing is 4" PVC SCH - 40. t5tnsp.doc•rev.7!2612018 Tille 5 XHidal Inapecdon Form:Subsurface Sewage Disposal System•Page of 18 Z£ a6ed xed dH b5:L0 860Z 86 daS f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Fie58 Evans Street Property Address David &Shannon Roddy Owner Owners Name information is required for every Osterville MA 02655 9-14 18 page. Cityffown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 22~ 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: 1000 Gal. Precast H-10 Sludge depth: 1" rr Distance from top of sludge to bottom of outlet tee or baffle 299 Scum thickness Orr 91, Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 18 How were dimensions determined? Asbuilt- Plan-Tape Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Tank at working level. Tank and inlet cover at 22"below grade w/outlet cover at 15". In and outlet Tee's. No sign of over loading. t5insp.doc•rev.712612018 Tltle 5.official Inspection Form:Subsurface Sewage Disposal System•Pep to of 18 ££ a6ed xed dH t,5L0 8 602 9 6 daS Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Evans Street Property Address David &Shannon Roddy Owner Owner's Name information is required for every Osterville MA 02655 9-14 18 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 ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection)(locate on.site plan): Depth below grade: Material of construction, concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day G5insp.doc rev.7126/2018 Tile 5 official inspection Forth:Subsurface Sewage Disposal System-Page 11 of 18 t£ a5ed xe:1 dH 55L0 81,0Z 81. daS Commonwealth of Massachusetts Title 5 Official Inspection Form , a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �.� 58 Evans Street Property Address David &Shannon Roddy Owner Owner's Name information is required for every Osterville MA 02655 9-1418 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cost,) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): 'Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9, Distribution Box (if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 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, eta): D Box is H-20 16"x16-54" below grade w/cover at 2D". Box is new-2017. D Box is clean and solid wltwo line's out. No sign of over loading or solid carry over. t5insp.doc-rev.7!26120iS Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 13 gE a5ed xezl did 99:LO 860Z 86 d@S Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �.' 58 Evans Street Property Address David & Shannon Roddy Owner Owner's Name information is required for every Ostervllle MA 02655 9-14 1 B page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No' Alarms in working order: ❑ Yes ❑ No" Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): " If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS)(locate on site plan, excavation not required):. If SAS not located, explain why; Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: t5insp.doc•rev.7!2612018 Title 5 Offidal Inspection Farm:Subsurface Sewage Disposal system•Page 13 or 18 g£ abed xed dH 95L0 860Z 86 daS Commonwealth of Massachusetts VTitle 5 official Inspection Form ,,P,�i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Evans Street Property Address David &Shannon Roddy Owner Owners Name information is required for every Osterville MA 02655 9-1418 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) 1cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,etc.): Leaching is two 500 Gal. Dry well chamber's w14"stone. Chamber's at 58 below grade w/cover at 1'.Chamber's are clean and dry. Chamber wall's andibottom look like new. 12. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow . ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.dac rev.7[2612018 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 14 of 18 L£ 96ed xed dH 9910 8 2 86 CI@S Commonwealth of Massachusetts Title 5 official Inspection Form r � p 4 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments k 58 Evans Street Property Address David &Shannon Roddy Owner Owners Name information is required for every Osterville MA 02655 9-1418 page. City/Town State Zip Code Date of inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7!2612018 Tice 5 Official Inspection Form:Subsurface Sewage Disposal Syslem-Pace 15 o11d g£ a6ed xed dH LS:LO 860E 86 daS Commonwealth of Massachusetts i Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 58 Evans Street Property Address David & Shannon Roddy Owner Owner's Name information is required for every Osterville MA . 02655 9-14 18 page. City/Town State Zip Code . Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately t5insp.doc•rev.7126/2018 Title 5 Official Inspectan Form:Subsurface Sewage Olspmel System-Page 16 of 18 6E a6ed xed dH LS:LO 810Z 86 daS TOWN OF BARNSTABLE. LOCATION ��(/�� j 6 - SEWAGE#r! �2 0 f 1 — fig VILLAGE t✓S — � ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO.CAParGa;tQ€ TTMVA(S8g SEPTIC TANK CAPACITY ( 00C LEACHING FACILITY:(type)( jea GA& Cl ANi3 5 (size) �� r IVO. OF BEDROOMS OWNER j PERMIT DATE: COMPLIANCE DATE; Separation Distance Between the: Maximum Adjusted Groundwater Table to tite Bottom of Leaching Facility N ,q Feet .Private Water Supply Well and Leaching Facility(If any wells exist;on site or within 200 feet of leaching facility) fU A Edg g Facility Of wetlands exist within e of Wetland and Leaching Facili Feet 300 feet of leaching facility) N Q FURNISHED BY !Coc- iza6 Feet,¢� A Qy A 8 - B -3 - 3o ` o 9-4 = 323 ' a 5 0� abed xed dH L5L0 860E 86 C18S r i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .v 58 Evans Street Property Address David &Shannon Roddy Owner Owner's Name information is required for every Osterville MA 02655 9-1418 page. Cityrrown State Zip Code Date of Insp ection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to**ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on repord 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: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: Yuu must desuribe I luw yuu tastdUlisl iud the I liyl l yluuuU wdtel dluvdtlui i. Auger T.H. 14'no G.W.. Bottom of chambers at T-4" below grade. Bottom of chambers at 6"-8" above T. H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.70612018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 6b abed xed dH 9910 ME 9l, daS Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Evans Street Property Address David &Shannon Roddy Owner Owner's Name information is required for every Osterville MA 02655 9-14 18 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3„ or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached Fir 14- Skatrh of$e.-agA Disposal System drawn on pg, 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7!28!2018 Tme 5 0fteI Inspection Form!Subsurface Sewage Disposal System•Page 18 of 18 Zb abed xeJ dH 85L0 86 8l, d@S �,ttE Town of Barnstable P 0 IL6 3�` Departiment of Regulatory Services i Public Health Division Date rE1 ^� 200 Main Street,Hyannis MA 02601 / / j Date Scheduled z`f"! `1 /1 Time_ Fee Pd. t Soil Suitability Assessment,fog- Sewage .disposal Performed By:As ae' f'lrnem4e1,C_&6, , l T Witnessed By: LOCATION&GENERAL INFORMATION Location Address Owner's Name � �(� 52 c-vA"z a5 i o s-rc -v I u kcDt,% Address 94"P 1AJ S{ V o uQkAs, Assessor's.Map/Parcel: `t (� CAASC,JirX5 ENT er Engineer'sName � NEW CONSTRUCTION((�� REPA[R _ Telephone# S02�- 147'Y � -Q 37 9 Land Use: ralYl4J2 ;4YV;A duzl* Slopes(%)_ -0 Surface Stones Distances from: Open Water Body ft Possible Wet.Area : ft Drinking Water Well ft Drainage Way ft Property Line ft Other - ft r SKETCH:(Street name,dimensions of lot,exact locations of test holes&Pere tests,locate wetlands in proximity to holes) See ct acked. plcm• Parent material(geologic)Q 44W a$fl Depth to Betlrgek a" Depth to Groundwater. Standing Water in Hole: ? I 1 - .i k S ' Weeping from Pit Face 7 3 bT p. Estimated Seasonal High Groundwater 7 13 a b tt r DETERMINATION FOR SEASONAL HIGH WATER TABLE. Method Used: D1(t C4 rA0WVA410y1 Depth Observed standing in obs.hole:. 7 t 3 a In. Depth to 5411 mottles: Depth to weeping from side of obs.hole: \3 Z In, Groundwater Adjustment f. Index Well# Reading Date: - Index Well level ____ Adj,hctbr,,Y, Adj.Groundwater Level, PERCOLATION TEST bate y/11 '11ne p_ M Observation Hole# 1 Time at 9" Depth of Pere 20-18* Time at 6" Start Pre-soak Time @ 10:06 A M Time(9"41) End Pre-soak la.;a o AM Rate Min./Inch Site Suitability Assessment: Site Passed _ Site Failed: Additional Testing Needed(Y/N)A Original: Public Health Division Observation Hole Data To Be Completed on Back---------- ***If percolation test is to be conducted within 100" of wetland,you must first notify the. Barnstable Conservation Division at least one(1) week prior to beginning, � Q:\SEPTIC\PERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# ! $ Q_ Depth from Soil Horizon Soil Texture .Soil Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders, i ten(::Y.%'Gravel) 0-161' Fill 16-ao" A 1E i- 5 - o-4a C 2.5' Y 611 - - DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) Munsell Mottling (Structure, (Munsell) g ( tru cure,Stones,Boulders. Co si en %Grave DEEP OBSERVATION . NATION HOLE LOG Bole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Co i to c O e DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soll Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones',Boulders. Cositn Flood Insurance Rate Map: Above 500 year flood boundary No— Yes—/_ Within 500 year boundary No_1L_ Yes Within 100 year flood boundary No.—V— Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? vpe If not,what is the depth of naturally occurring pervious material"? Certification I certify that on 101141qg_(date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,experti!9 anZvm_ rience described in�10 CMR 15.017. Signature _ Date 17� Q:1S.EPTiC\PERCPORM.DOC No. u� v Fee Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppCication for Mi!5poga[ 6p6tem Cou6tructiou Permit Application for a Permit to Construct( ) Repair(x Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 52 EUO�k/C ST O Owner's Name,Address,and Tel.No. DAv ro P,oQ'by Assessor's Map/Parcel /q 71 Aje �1I bou(:�LPS K ^ Installer's Name,Address,and Tel.No. ` Designer's Name,Address and Tel.No.S-02 9-7 3—03-77 04QeW t D a 215T Z C. F.1\JFtNEEWAJ, T 1:53 c S7_ ! IPam' IoIS64 CA4080W 64WV c. ZA A-A Type of Building: Dwelling No.of Bedrooms 3 Lot Size 19'7( sq. ft. Garbage Grinder ( ) Other Type of Building (Z92S I DE&JGlAL, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3*,�fj gpd Design flow provided 34C'l' gpd Plan Date `T—a(4—t'7 Number of sheets Revision Date Title 52 6—VA NC 518, 7T *_';76kK/CUE__ Size of Septic Tank 11 o0c> cz"I/ Type of S.A.S.�07� wD 66�� Description of Soil �&A'I SA"Z) <,�_Q) Q�r Z.5'6�- PL-4 Nature of Repairs or Alterations(Answer when applicable.) t.�Sj� 6X(:5-T l a..& (1 000 �U bkj .5(SPrLC zA{62v- WD V-C=k) 0-,10 D-86x sov t4n9c) c OJC� C-"emu Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health.Signed Date 14— 4 Application Approved by Date 17 Application Disapproved by: Date for the following reasons Permit No. Date Issued iL 1L i No. _ � � �.: ,y Fee c J THE C®MM'ONWEALTH OF MASSACHUSETTS Entered in computer: } > PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTSVves j { Z(pprication`for Di.5' aft*p tcnt fort truCtioil Permit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon O Complete System,0 Individual Components Location Address or Lot No. 52.EVA N 5; \1 fig Owner's Name,Address,and Tel.No. x IDAU10 ROT>`b4 Assessor's Map/Parcel v 9q ?,I,&)E �5 DOU Exc-AS,` nA Sots-471 -7S8-r1 So$-97 3-0377 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. „C►41pewiDc 6J7E1°�,6�415 �G EIJ�In i r2/1ut�-�n1�. l S3 <014m car sr- I�'h4Se�I Prr a Type of Building: Dwelling No.of Bedrooms 3 Lot Size VA 1127(0 sq.ft. Garbage Grinder ( ) " Other T e of Buildin Yp g No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 32)o gpd Design flow provided 3�� gpd Plan Date Number of sheets l Revision Date Title Size of Septic Tank 11040 Type of S.A.S.(a) S'Qb Description of Soil 4.O014 AY S7�4,va 5ZR d0 t 56-g: PLAN i I Nature of Repairs or Alterations(Answer when applicable) 1. SE EXt ST t&JEa 1 i 000 C-Au-&j 6(--V i c Wt7"t-F Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by'this Board of Health. Signed .- Date ��o " 4-0 1-7 Application Approved by c Date �l Application Disapproved by: Date _ - for the following reasons Permit No. : `'Date Issued THE COMMONWEALTH OF MASSACHUSETTS r• BARNSTABLE MASSACHUSETTS . r Certificate of Compliance a .., THIS IS TO CERTIFY, w that the On-site SewageDisposal System Constructed ( ) Repaired (k) Upgraded ( �) Abandoned( )by CAPG (b5 �/ }! &-RrXjS ale $ ��!¢ 1,�� S"T QE1-T d 57IJlL 1v has been"Constructed in accordance / / with the provisions of Title 5 and the for Disposal System Construction Permit No. / -/f dated �•`� Installer (ApF;Wa* EMMQf IZI Designer —Tc EW3d1jEG0jmG 3: Jc / #bedrooms ,7j Approved design flow _ 3�d gpd Il The issuance of this permit shall none corAtrued as a guarantee that the syste�m`:vv'i'117 nc an as signed. Date' Inspecto`r.. • s No 1 Et: k t Fee . ,r -THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS i$ OgaY patent -Construction Permit Permission is hereby granted to Construct ( ) Repair ( Upgrade ( ) Abandon ( ) 1. System located at x _ and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special-conditions. Provided: Construction must be completed within three years of the date of this permit. i Date t (t.� APProved by 06/05/2017 09:22 5082730387 #5504 P. 001/001 it • Torn of Barnstable o� ` Regulatory Services i i Richard V. Seali,Interim Director WLQW- Public Health Division Thomas McKean,Director M Main Street,Hyannis,MA 02601 Office: 508-862.4644 Fax: 508-790-6304 Installer& Designer Certification ]Form Date: Sewage Permit# J 0 i 1' 1 l 9 Assessor's Map\Pareel Designer:, _SC !✓n t� eerms �' ,nG. Installer: Cae?.wiJe. E-witrerise_s Address,, 20`I Cfan'v4rr4, �i y� w Ty address: 1-5 3 Comm erc i o l s4(pe,+ bask warr,4�unn HA o253$ }-iask��e., }-t(ac e.Z (�y 9 Qn '01(o—o?Ql Cnawide.,_ EM?4eaw was issued a permit to install a (date) (installer) septic system at 8 �u4a�� Spree. based on a design drawn by (address) TC �o5ine.e.rCA :roc,. dated Aerii ZY 20 ( 7 (des g en r) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found s4tisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic gystem) but in accordance with State & Local Regulations. plan revision or certified as-built by designer to follow, Strip out(if required) was inspected and the soils were found s4'tisfactory. I certify that the system referenced above was construe ncc with the terms oche I\A ap}�roval letters(if applicable) JOHN v CNuR II.�JR. �+ (I stallq'4 Signat e) IL A9 N .41 7 s signer's Signa Affix igne s S mp Here) PL AS)E TiETV TO BA STABL-P PURL HE H D YIS N. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL .BOTJI TMS FORM AND AS. BUILT CARD-A E RECE WED BY THE BARNSTABLE PU C HEALTH DIVISION. Ti�A1vI{Y®U, Q:\Soptic\AGsiSner Certification Form R.ev 8.14-13.doe S ��--^^ TOWN OF BARNSTABLE (_. LOCATION VAOS S-tka'r SEWAGE# l al r VILLAGE CST vlLLC ASSESSOR'S MAP&PARCEL l ( gg INSTALLER'S NAME&PHONE NO.CAPawtoG E1TeekwuseS SEPTIC TANK CAPACITY l iw® cD4C.LOt i t i LEACHING FACILITY:(type)() .500 GAL cwAM3eks(size) la's NO.OF BEDROOMS OWNER IDAV( PERMIT DATE: 4~A4-' P.0 1-7 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility A Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) NIA Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) X A Feet FURNISHEDBY C7v OQ d0 lT.i 3 W P Barnstable Town of Barnstable Regulatory Services Department 1edcac#y BARN5PABLE, Public Health Division m MAC A 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO. CERTIFIED MAIL# 7012 1010 0000 2847 8629 Y . April 4, 2017 _ v RODDY, DAVID C 94 PINE STREET DOUGLAS, MA 01516 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 58 Evans Street, Osterville, MA.was inspected on 03/17/2017 by Shawn Mcelroy, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching pit or cesspool with high liquid level, -512" below inlet(per Town Code 360-9.1). You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the,septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH T mas McKean, R.S:, CHO w Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\58 Evans Street Osterville.doc I IKE r, Town of Barnstable XAM Regulatory Services Department Public Health Division 200 Main Street,Hyannis MA'02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIA FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15,000) An"x"marked in the o is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑Discharge or ponding of effluent to the surface of the ground w . ❑Pum m- more than 4 times during the last year not duet c p g g y o logged or obstructed Pipe = ❑Backup of sewage into the house due to an'overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution:box above outlet invert due to an overloaded or clogged SAS or cesspool - ❑Any portion of the SAS; cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA q Single Cesspool ❑Any"conditionally passed°systems"(broken cover,relocation of a'pipe, relocation of a driveway due to H-10 components, etc) each ng pit or cesspool with high liquid level, <12"below inlet(per Town Code 360=9.1) ❑Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: WSEPTIMDEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts f Title 5 Official Inspection Form. .. I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments- t !„ 58 Evans St Property Address Shannon Roddy 4:4h Owner Owner's Name information is `� r required for every Osterville MA 02655 3-17-17 page. City/Town State Zip Code Date of Inspection A Inspection results must be submitted on this form. Inspection forms may'not be altered in a way. Please see completeness checklist at the end of the form. A. General Information Rol 1. Inspector: Shawn Mcelroy $ Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number 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 , 3-17-17 In ctor's Sighature Date ' The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional`office of the DEP. The original should be sent to the system owner 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 �� VS Commonwealth of Massachusetts r Title 5 Official Inspection Form 21 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Evans St Property Address Shannon Roddy Owner Owner's Name information is y- required for every Osterville MA 02655 3-17-17 page. City/Town State Zip Code Date of Inspection ` B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ 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: 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 i Commonwealth of Massachusetts :a=1 Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary.Assessments ,_�_�;!✓ 58 Evans St s . Property Address Shannon Roddy Owner Owner's Name information is Osterville MA 02655 3-17-17 _ required for every - page, City/Town 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.' 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in' a manner which will protect public health, safety and the environment.: "r ` ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts ^+ (# Title 5 Official Inspection Form I-I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Evans St t J" Property Address Shannon Roddy Owner Owner's Name information is required for every Osterville MA 02655 3-17-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 I i Commonwealth of Massachusetts r : I �� Title 5 Official..lhs�pection Form , [ Subsurface Sewage Disposal System Form Not for Voluntary Assessments • a/ 58 Evans St t ,. Property Address Shannon Roddy Owner Owner's Name information is Osterville ., MA 02655 3-17-17 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No r? ❑ ® 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. ❑, ® r Any portion of cesspool or privy is within 100 feet of a surface water,supply or tributary to a surface water supply. " 4❑ ®, 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 t. 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 adesign flow of 2000gpd- 10,000gpd. The system fails. I have determined tfiat one or more of the above failure ® E.] criteria exist as described in 310 CMR 15.303,therefore the system fails. The system ownershould contact the Board of Health to determine what will be 3 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 16,000 gpd. •. For large systems, you must indicate either"yes" or,ino"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 El ❑ 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 El ❑ Area=IWPA) or a mapped Zone'll of a public watersupply well If you"have answered"yes"to'any question in Section E tfie system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of,17 l Commonwealth of Massachusetts :a=1 Title 5 Official Inspection Form ' 'i�- Subsurface Sewage Disposal System Form Not for Voluntary Assessments 58 Evans St Property Address Shannon Roddy Owner Owner's Name information is required for every Osterville MA 02655 3-17-17 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts :a=1 Title 5 Official Inspection Form 1�-I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Evans St Property Address Shannon Roddy Owner Owner's Name N: information is , required for every Osterville - n MA 02655 3-17-17- page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? . ;_ , ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump?,, ❑ Yes ® No Last date of occupancy: 3-2017 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR'15.203): a Gallons per day(gpd) Basis of design flow(seats/persons/sqft., etc.): r Grease trap present? �t 1 El Yes ❑ No Industrial waste holding tank present? t. ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts f� Title 5 Official Inspection Form ,-IN Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Evans St Property Address Shannon Roddy Owner Owner's Name information is required for every Osterville MA 02655 3-17-17 page: City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner--pumped within last 2yrs Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): thins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form �1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Evans St Property Address Shannon Roddy Owner Owner's Name ,. information is Osterville MA 02655 3-17-17 required for every ' page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1980's with new pit added in 1994 Were sewage odors detected when arriving at the site? . `t R � Yes No 9 g ❑ Building Sewer(locate on site plan): Depth below grade: 24" • y ` feet Material of construction: , ® cast iron ® 40'PVC ❑ other(explain)': ' `r Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): . Depth below grade: 18„ "feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ 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: 1000 gal Sludge depth: 12" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Evans St Property Address Shannon Roddy Owner Owner's Name information is required for every Osterville MA 02655 3-17-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 4" Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 12" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts :a=1 f� Title 5 Official Inspection Fora I, , Subsurface Sewage Disposal System Form -Not for Voluntary Assessments `�•4\, �;!% 58 Evans St Property Address Shannon Roddy Owner Owner's Name G information is required for every Cisterville MA 02655 3-17-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.):' Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: , ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons, Design Flow: i ° 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts f Title 5 Official Inspection Form N Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Evans St Property Address Shannon Roddy Owner Owner's Name information is required for every Osterville MA 02655 3-17-17 page, City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 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.): Good condition with water at working level and stain lines above inlet invert. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Pq -I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments i_;s!✓ 58 Evans St �_ _ Property Address Shannon Roddy Owner Owner's Name information is required for every Osterville - MA 02655 3-17-17 page, CitylTown State Zip Code Date of Inspection D. System Information (cont.) - Type: ® 1-1000 gal leaching pits number: 1-600 gal ❑ leaching chambers number: ❑ 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.): Leach pit 4 was filled to outlet invert. Water level in pit 5 at 12" below inlet invert with stain lines above inlet invert and into riser. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth-top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts :aa Title 5 Official Inspection Form eN Subsurface Sewage Disposal System Form -Not for Voluntary Assessments -�;!✓ 58 Evans St Property Address Shannon Roddy Owner Owner's Name information is required for every Osterville MA 02655 3-17-17 page: City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions - Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 I Commonwealth of Massachusetts , E;• ` Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a' 58 Evans St I y Property Address Shannon Roddy Owner Owner's Name information is Osterville MA 02655 3-17-17 required for every 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 • C) . E IP _ .. - :37' -3e 0-3 . ram- 3. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17. Commonwealth of Massachusetts :aal Title 5 Official Inspection Form f ' ,.��l Subsurface Sewage Disposal System Form Not for.Voluntary Assessments z, 58 Evans St Property Address Shannon Roddy Owner Owner's Name information is required for every Osterville MA 02655 3-17-17 page, City/Town 4 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: 20 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: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database - explain: You must describe how 9 you established the high round water elevation: y 9 USGS and town maps show groundwater at 20'. I, Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•W13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts f Title 5 Official InspectionFrm s► � I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments -s,!a 58 Evans St Property Address Shannon Roddy Owner Owner's Name information is Osterville 'MA 02655 3-17-17 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file 6 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 T _ Date: j J1 1 i 4� 000`3- TOXIC AND HAZARDOUS MATERIALS REGIS TION FORM NAMEOFBUSINESS: 5 1041 *1 L 4 cn Men+ BUSINESS LOCATION: 034cC v11 Q MAILINGADDRESS: PO gov a,356 ITastpote /n Y / Mail To: Board of Health TELEPHONE NUMBER: Town of Barnstable CONTACT PERSON: i7Av,0 Rgaay P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: Sd g -73^) 3ti9b Hyannis, MA 02601 TYPEOFBUSINESS: Ar Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES NO b . This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) -Hydraulic fluid (including_brake fluid) _ Refrigerants - -- Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ' NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar �o�Z�� Fertilizers Paints, varnishes, stains, dyes �'� ' PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels — Paint brush cleaners (including chloroform, formaldehyde, Floor & furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers / WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS i 911"3 04 -;: I'Z,741,--o .. Fxs .3.. ...0.......... APPROVED THE COMMONWEALTH OF MASSACHUSETTS rnst a 9mrvation o ZqtOWN BOARD OF HEALTH OF BARNSTABLE i ne>i Oration for Di-aipm3al Wurku Tunutrnrttun rrruttt Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: 58 Evans St Osterville .............•---•---••------•------------•-------------------------:..._..-------------------•••• •-•--•-------------------------...------------.....----------------------------...--------....---- Mr. Barton Location-Add...s 76 Main St Sf3dt borough MA ......................_.......................................................................... ------------------------------•--•----.....•---------•••-------------............--------•-----•-- Owner. Address W. E. Robinson Septic Service - P-.-O.---Box---1•089Centery 1.1le MA I1istaller Address Type of Building Size Lot______________ __________Sq. feet Dwelling—No. of Bedrooms.............3--_-_---. -._-._--..-_--.Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures --------------------------------------------------------------------------------------- ------------------------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capadtv------------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........................ fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x ----------- ------------------------•------•-------------------------------•-----------_......._.....-------------_...--------=------............_----- 0 Description of Soil------------sand----••-----------•----•-------------------------------••--------------------------------••-------------------------------- . V -•-•-----------------------------------------------------------------------------•------.....---------------------------------------...------------..-----------------•------------•------------_------ W __ _______________________ _ __________ _ ___ _ IT: Install additional Overflow U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ------•-•-----------------------------------•-•---------•--------•--...------------------••-........----••----•-----------------------•--------------------- -------------......._..__..._...---__------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the b errd ealth. -7?!V Signed ---- .. ---- .....C.7c.�.F Dare ............... Application Approved ByOthe ..... ...... ........ ... .. .--------- - - ---- --. ............----- ...............'Dare-................ Application Disapproved ffollowing re nr: - .................... ......................................�----------------------- .................................. .................... Permit No. - - ---�.�...--�................ Issued - ------ -� ��..... Dare 7 00 No.. Fz�$..$.30............................ THE COMMONWEALTH OF MASSACHUSETTS /` BOARD OF HEALTH 'TOWN OF BARNSTABLE J�ppliratiun for Ui.1j-Vu!3tt1 Wurk,6 Towitrnr#iun Frrutit Application is hereby made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal System at: 58 Evans St Osterville -----------•--••-•-------------------------•----------------•----------•---•---------...---------- -----•-----------------...---------•--...----------------------------------------•----...----•-... Mr. Barton Location-Address 76 Main St SeSftl °�'orough MA ......................-.......................................................................... •-----•----------•-••--•-•--------•-..........---•---=------•-••--•----•--•-------..............-- Owner Address a W. E. Robinson Septic Service P.O. Box 108�9__-Centerville__MA............... a Installer Address Type of Building Size Lot............................Sq. feet ., Dwelling—No. of Bedrooms-------------- _________________________._Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building g ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) 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........................................ Test Pit No. 'I________________minutes per inch Depth of Test Pit-------- ........... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P ------------........................................................................................--•---•--............................................... O Description of Soil..........:.....................................sand V •--•--•••-----•---•------••-------------------------------•---•------------------••--------------••-----••---••--...-------•-----------•-----••-----••--••---------------------......-----••-----..•--•- -----------------------------------------------------------•----------......---------- ------------- •s •- ----•-- x Tns��al......acTc�itiOna.... .®verblow U Nature of Repairs or Alterations—:Answer when applicable.............................................................•......_...__..____.___.__._._..... -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------••- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the b rd o ealth. J� Signed ? ......._... ...=fj. G ._.. ......y...... _.... ate.......... f ,rt Y J �j Application Approved By fr t .dt ......:.v t <?Z✓�s/�/�< . ------- ---------------------------------------- AJ% � .J�' ✓ v ..:;•. �.,.. ............... . Date ' pplication Disapproved for the following.reas, ns- --------------------------------------------------------------------------------------------------------------------------------- ---------------------------- ------------------------------------------------------- Permit No. " ' '� 5191 = _ Issued - - - -- - : ;�`"/ tr Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Clertifi atc of C�nmpliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( x ) W. E. Rob&nson Se tic -- - - - -- bY ..... - ---------------------------- m,ta-iet at ----------------58...Evans St Osterville..:....- - - - - - - .......... ------------------------------------ - has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as describedin the application for Disposal Works Construction Permit No. ' :..... � - dated ... ^_.. ..� `.. ~r`� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.... r Inspecto - . ` ---------------------------------------------------------------------------- THE . COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -� TOWN OF BARNSTABLE . No... :�'...�.. FEE.s0... 00.................... Uwpaoal Workii �unu r r#uan anti W E. Robinson Septic Service Permission is hereby granted - ••-••.•. --------. -- -----. to Constr ( or Repair (x ) an Individual Sewage Disposal System � Evans St Osterville . -_- _ - , at No.............................................................. Street A. as shown on the application for Disposal Works Construction PermNo" 'r'. -Dated, �� ... - Board of Health DATE - .....-----•---••---•----_... FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS 4L� TOWN OF BARNSTABLE L(3CATIr%4 ,S' L U L -x / SEWAGE # � / S�J VILLAGE ASSESSOR'S MAP & LOT •-� " INSTALLER'S NAME & PHONE NO. 11 d`b j .t, 6�- `� 7 SEPTIC TANK CAPACITY U d LEACHING FACILITY:(type)-,l-- i f -s (size) NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER B��R OR OWNER 6,4,04 16 DATE'PERMIT ISSUED: —9 Z) DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 1-- � ~ �' 1 ,,�� � -- �-� �,� �� ��� ��� � 1 i �. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Application is hereby made for a Permit to Construct X or Repair an Individual Sewage Disposal System at: le- Installer ddress U ................Expansion Attic Garbage Grinder 04 Septic Tank—Liquid capacit LbV---gallons L_ ........... Z Other Distribution box Dosing tank ( ) - Performed by ,Y ..i.e. - 4L. Tt Date....jkl Agreement: cordance with I The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in ac the provisions of TI I TI 1E 5 of the State San'itary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Date Date � Application Disapproved" for the /"~"=nx reasons:................................................................................................................. _ � Date ^ PermitIssued' Date ^ Fmc A..e�................ No.---------- ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............................'.'�-'..OF..................................... ............................................... Appliration for Dhqpviial Works Tomitrurtion ranfit Application is hereby made for a Permit to Construct or Repair -an Individual Sewage Disposal System at: ------------------------------------------------------ ........... . ...........I.............................Location-Address----------------.......... -------------------I-------"......*..... or Lot No. ................................................................................................. .................................................................................................. Owner Address .........................................I......................................................... .................................................................................................. Installer Address PQ Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder ( ) Other—Type of Building ............................ No. of persons.._.__.._..._........__:____ Showers,.( Cafeteria ( ) Otherfixtures ..............----_---------;......................I................................................................................................ Design Flow................55.................. --gallons per person pVr day. Total daily flow_____..._.......9.aa_--------------gallons. 1:4 Septic Tank—Liquid capacitylbl;o-.gallons Length...S.'n4o'.. Width..4 .... .. Diameter---------------- Depth-..W Disposal Trench—No..................... Width.................... Total Length__..._.......!..... Total leaching area....................sq. ft. �4 Seepage Pit No............1.... Diameter.........G'...... Depth below inlet.......J6........ Total leaching area...Z.O.0..sq. f t. Z Other Distribution box Dosing tank '_4 LA 9 Percolation Test Results Performed by_*5iT'AWt_t T V .......A !J.....0095..Ka'Date.... ----------- �-4 Test Pit No. 1....2..__.__minutes per inch Depth of Test Pit......(Ir------. Depth to ground water......!!!t............. Test Pit No. 2......2*....minutes per -inch Depth of Test Pit.......tZ ...... Depth to ground water.. ............ ....................................... ........ .................................................... 0 Description of Soil? -C-�.............. -----------� --------------------------- ......SAW>..........4.... ..... .............................................. .... .................L................................ -------------------------------------------------------***-------------------------------*..............-----------------------*----------------............... ........................................................................................................... ........................................................................... U Nature of Repairs or Alterations—Answer when applicable..........................................z..................................................... ............................:�..................... ..............I............................. .................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal.System in accordance with the provisions of LIT IL 5 of the State Sanitary Code— The undersigned further agmes.'not to place the system in operaii-16n until a Certificate of Compliance has been issued by the board of health. Signe . ..................... ........................... Date —,2 ..... .... --- ... .. Application Approved By........ . .... . ..... ... . Date Application Disapproved for the following reasons:.............................................................................L I................................. .....................................................................................................................................................................I.................................... Date PermitNo--------------------------------------------------------- Issued..................................................I...... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL..eTH ................. 7; ......... . ;......... ....... OF:.: T IS TO CERTIFK, Individual Sew age'Disposal System constructed or Repaired by__ '9-0.... ................... ........ ....................................... U41-----4 ....... ------------ ---Installer ............... ............ .....................7................. 'de as described in,the. has been instilled in accordance with the provisions of I of The State Sanitary Code 1�--------------- application for Disposal Works Construction Permit 1'� . ........... ............... dated - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE'CONSTRUED AS A GUARANTEE THAT THE SYSTEM wiLL-FUNCTION SATISFACTORY. DATE............................................................................... Inspector...................................................................................... THE COMMONWEALTH OF MASSACHUSETTS A BOARD O/F HEALTH ....... ....... . ...... ........................ ......7onr�- OR_ FEE... No....... 41, 0" T110tr wit VarAft granted ._'o Permission is hereby 41 ............................................................................. to Constr t or,kepair ( t/aindividug Sewage "��po ys, n "AAA ................................................................. ............... r ............ Zt- a 'V. t. .'41---------- ..._. . Nreet as shown on the application for Disposal Works Construction er it 0 ......A....... Dated.4�. '� ................ .......... ....................................... ...... Board of kep ............................i DATE .......... ........... FORM 1255 HOBBS & WARREN.'INC., PUBLISHERS D��lG►�l rj�S,TA. rx,t t-�l t`Low :. i I b �• 3 = 3�o G,p.p. trEP1-IG T�tC = .3�o,�.ISC °ro = •��? G.P.D. �' USA- l�Ob 4S.4,L.. r L PIT usE' l eoc�o Gal SO sue. TOTAL T lasl6.t .42S G•?.D. ToTA t_ -c>A-t L�4 'F'Lr,Sw = 33p 6FT). r-4 VEtZGDI.QTtO t.] tZ/�T'E �'`II.1 �.�rt I tJ OiZ I.�SS• 10 f 3-7 Z. r' f fv fAFtD VIA f Y A Tor Pwx> =roo.o T�sT ,. ;Z4 Z 4'Pp vIST -Box Se-sync 1© e 5. rrn ioaa 95.4 t,NV. rWV. > GAL. " Wiru •} f 1 a�4.�rf2 C[.ell rJ r wAS► ED nt aro, sroN�. �,g PR..pT='1LE� LbGhZ'Id� a`ir�4/Il..l..•L- . Peopcws Q il.%,, 2 rc� �4C- c_1t►z't t t=Y 'r N Ar T t-!� "pv�st.,[.I►4 Le 5 uo��►.y �. t-!�,t?[ fit.a Gc>Nl�'t_YS V�/ t TE-L 't't-li: S 1 D l_l►-ate �oT -�o w►,.? cam'" �,'����� �E3t..� �IJQ �ov�.Z' (��� /v� �►�• ? CJta�r Iwo 2 }Z B A.XTC•Z tZEGISEZii=D 't�F,lp >Ue�iE.Yvl=� Tt41� C�t_Ati_I tank A`.l os t�.l C '�r U�rGi'� Tc> i�1�1-Gt�Mt►!E I CiY' l_t4Ei_= E� -_ 5jp.?tA '>Vk--.iVA -J .... k . V --- -- J #. tu -..... — ----- bA R. ' -----------—---------—---'----- { �r ---------------- - --- -----— -- IJ C9 ..r r — - n 1010) } Ve -EER o 1 - _—_ _--------__— s ., —_._ i _ 4 1 r t � U— Front Elevation SCALE: 1/4" 52 EVANS-11x17-10.10.2018.pin A-3 M QBl ¢ Q U O °v d -- — r----- ------- — — -- - - _ — --- C. 0 I I I I WET BAR BATH Robrn p I �400 `. STORAGE 2668 26606 8 I I 7' kn V { I I I * I I \2668 I I O I GYM I I Z ° I i ,, I CO PLAY ROOM I 15 I I UP ^ 15 I I I I Z I I I o ——— ——— ———————————————— 36' c�i) . 0 2' 4' 8' Cu Qv m ® Foundation / Footings kn F SCALE: 1/4" = 1'-0" 52 EVANS-11x17-10.10.2018.pin UP 74. w: i ,•fir -C C Gp .., p kn Y G� Do E-+ C) ------- Existing Girt-(3)2x10 GIRT-(3)2x10 - .. _. .-: .. _. —------ __-._____—._-.____—___.______ .-________— •�I Q J �— — — --- --- -- -- -- -- --- — — -- --- --- --- -- -- -- --- --- --- -- -- —J ,_ ..-.... .--- - __ L_ -- --- -- -- -- --- — -- -- ` 2x10 @ 16"oc OFFICE ------------- _— --- - - `__ _ 5 O w 12'-3 3'-Y 20'-6" ---' - ... _.. -'_ `-....__ -... ............ ...... ......_..- .-' _._....-____.-. _. ........._.._ ... .. - ------_--_...._..... ._._._.... --- ... ....___. ........._- cu ..... ..... ... ... . . ... .. -. ...._. ...... ... ...._.. ... .. . . . .. ... ... .. _ _ .. . .. ._... ._..__.... ..__._..__ __._ ...._ .. __ .. - - _._-_._.__.. __._ . _ ._ .. ... -- .. LLL �� L -' -_ LL _._. - --- __.. PORCH---:»- _ _.._. _.._ . _. _-- ---- Q - _ ---.--____.-______-_____ - ._ _,__.______--- _. cfl . —``-- _ INC. ____.______._.__.______. ____._ _:® First Floor Framing F SCALE: 1/4" = 1'-0" 52 EVANS-11x17-10.10.2018.p1n A-3 M 9, UP 2442 v ° U 4 o o _ ai DNV ow cd 4 0 ® - - z j .� bI) b El I , DECK 'p DINING _ v� 3' W KITCHEN El - x d .. i ---- -- --- ---- - --- r�r y 00 LAUNDRY iF 00 o _ N (O M LINEN C0 - -- 2668 2668 i ___, MUDROOM._ 2668 Q ,S; 00 CLOSET .o S --.----. 6068 ----- CLOSET 40. N o O M [..� i 5 KING Qi 60 5 `' -15 a o DE�I�' 04 V M co co COATSCN � L - __—___. _ __ I I. s - O . 6 2 1/2 1t 9 112 = 11 91/2 W 6 2 1/2 ..I _:_:... .......... .......: ..._... ...._.._ :. _ _..__._.._ .... .-. ._ ._.:- _ .. _...__.. _._.:� ....._ _........... ._.. _.._._.. _..... ..._.i:.._.I_ fn �. t...__._..., _ -._..- _---.-....._..... ........__.. ...._..__.. _.....__.._......_ ........_.____ .......__...._.... ___..._..._.. _.__ _ ._._._..._.._—....__....................__ .. �. . .. _.. . __..... _...._. .--_-._ I. .I. -.. .__ -.__. .._._---'—' __ .._..._..... __.. _._..___.._.._. ___ — —'--'-'--.._ -....--'--.....__ __..._.._ _ . .....__....�_ ... _. ... .. - --._._..--.___ .__ _..__....._..._._.—.—__— ..__.._...--_. I I_.—.�._. ____—....—_ ._. _.___ _...___..._.___.__._...._._---.__—.__._ — ____—.._. ... _____ --.__..__.__..._..`—__ _.....__—_______._____..__ __ __ .....____. -.._._..__. __._._. .._.... __..-...._._.. .. ........_.- _.........-... _....__......_..__. .-_._ .........._..__ ....---.—.......-.— _ _....__.........__..._...._. .__ ._....... .. __...._..__. ..___... .__.._.__ ._......._. .-.....__.._.I___.L. ,:._-- ------__..:.-------- - --_-... _.--- . _- 0-- ._.. 2_.... ._, .. .4-- - ::.g' ._.._ ._:. -. - :__..._. r-I——---------- - ------ ----- ----—--- -- ---- ---------' --------—'-- -------- -----i-I - - -------- - - First Floor F -O" 52 EVANS-11x17-10.1( Q - Q M A-1 - SCALE: 1/4" = 1' e-M > Q B1 Q Q 0 2' 4' 8' V O C � • A �o � — — — — — — — — — — - — — — — — — — — — — — — — WALK IN BATH ®co 04 � - 00 0n BATH ~ cc 2668 2668 0 5 `r' M } CLOSET � / ( CIs Linco 2668 N cv 2668 2668 DOWN 2668 s _ a 00 CLOSET 'CD) U Fo BEDROOM 3 0 BEDROOM 2 KING Oo 5 KING 5 Q� z LO Z /, 1 I p _ O _._.. - ._ _.._..... LL �-2'-&' 4'-3" Ilk 4'-3" O 9'-3" 13'-6" �' 9'-3" 2' Q � 36' (/) Second Floor A-1 SCALE: 1/4" = 1'-0" 52 EVANS-11x17-10.' ' T.O.F. EL= 29.4'± FINISH GRADE OVER D-BOX= 20.6'± PROPOSED VENT WITH CHARCOAL GENERAL NOTES FINISH GRADE OVER CHAMBERS= 18.6' - 22.0 FILTER TO ABOVE GRADE f PROVIDE EXTENSION RISER REMOVABLE WATER-TIGHT COVER OVER SLOPE @ 2% MIN. OVER SYSTEM 3/4"TO 1-1/2" DOUBLE WASHED WITH COVER OVER INLET& RISER TO WITHIN 6"OF FINISHED GRADE STONE TO CROWN OF PIPE 1• UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION OUTLET TO WITHIN 6"OF F.G. 4" SCHEDULE 40 PVC ACCESS BOX WITH COVER TO GRADE METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL FINISH GRADE , , 5" DIA. OUTLETS) MIN SLOPE 1% (SEE NOTE#21) 2"OF 1/8"TO 1/2"DOUBLE WASHED CODE AND ANY APPLICABLE LOCAL RULES. @ FND. EL.= 24.0'± F.G. OVER TANK EL.= 22.Q - 23,5 STONE OR GEOTEXTILE FILTER FABRIC 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE I t - PLACE RISERS ON ALL DESIGN ENGINEER. PROPOSED 4" 'MAX TOP OF SAS- 17.00' CHAMBERS WITH EXISTING 4" SCH. O PVC 4"PVC TEE SEE NOTE 23 6.QQ� SEE 5.0'MAX 23 ' 3 SYSTEM UNLESS 4"SCHEDULE 40 VC PARE WITH NOTED.WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEWER PIPE t.- SEWER PIPE BREAKOUT EL= 16.50 INLET PIPES TO 6"OF _ FINISHED GRADE 6" 3" 3"DROP MAX ^ L-20± 4. TO PREVENT BREAKOUT,THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 2"DROP MIN 3" 9 MAN-sioPe�,%' PROVIDE WATERTIGHT � g ELEVATION = 16.50' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A h' PVC IN FROM �JOINTS (TYP.) o &qp 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 101, 14" "`19 E4" EPTIC TANK 4"PVC OUT TO O � � Q 0 THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. CONTRACTOR TO PROVIDE . LEACHING FACILITY o0 00 Q � � � � � 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. SPECIFIED DROP BETWEEN 12" 00 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. OUTLET TEE INLET AND OUTLET CONTRACTOR CONTRACTOR SHALL 16.40' p�o MIN. 16.23' 2' 00 0 = = = = = 00 SHALL VERIFY SIZE 48" VERIFY CONDITION OF oo � 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION OF EXISTING TEES GAS BAFFLE 6"CRUSHED STONE °° o00 oo FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY o0 0° _ NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE 4 0� I 4 0. 4 0, 4 0' AND DESIGN ENGINEER. 3 OUTLET DISTRIBUTION BOX 8'S' �P) 4.83' ' TO BE INSTALLED ON A LEVEL STABLE (�,P) 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. BENCHMARK ELEVATION OF 24.00 -- 25.0' ESTABLISHED ON A NAIL SET IN TREE AS SHOWN ON THIS PLAN. ------------------- - BASE. FIRST TWO FEET OF OUTLET � PIPES TO BE LAID LEVEL. 14.QQ' GROUND WATER ELEV.= 7•20' CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION 12 83'- 9. EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK 5' THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT MIN. -� CROSS SECTION VIEW 2 - 500 GALLON H-20 CHAMBERS CHAMBER END 'VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES `CONTRACTOR TO VERIFY EXISTING SEPTIC TANK PROFILE H-20 DISTRIBUTION BOX DETAIL TYPICAL CHAMBER PROFILE H-20 CHAMBER DETAILS TO THE DESIGN ENGINEER. ELEVATION PRIOR TO ANY WORK & NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE -._ �- 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING T • j ! 11�� . Q 1►C�f TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM .a1� 4 C PERC NO. 15322 APPROPRIATE AUTHORITY. / • �' �'"l• _. INSPECTOR: Donald Desmarais, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED UNDER MORE THAN 3 FEET OF COVER OR LOCATED UNDER PAVEMENT, DRIVES, OR 12 ?J i • a• `, EVALUATOR: Michael Pimentel, C.S.E TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING. i�� �' )I(,) C:" '.' • + C.S.E.APPROVAL DATE: Oct. 1999 #58 ./ r> >/ W + April 11,2017 13• DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. DECK EXISTING 08� DATE: 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE 3-BEDROOM , it i + . . + ' ; TEST PIT#: 1 �� -• � �� � MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. DWELLING W r ELEV TOP= 18.20' REPLACE ALL UNSUITABLE MATERIAL NTH CLEAN COARSE SAND FREE FROM CLAY, � • �4 (WALK-OUT) "=' .._-. ,.� * , ij v . �` 5C ' • `� FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). °° : �� s ` = ♦ f'` ELEV WATER= < 7.20' '° •• _ d t all 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN a tl f'f ' ` PERC RATE _ <2 mpi SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. v ... I HC DECK ii .!'� �- Hi . sIC1� . • •. . . f . ,� �� • • +[ J ZO N E 2 e +r%'�`\ • ' •,•: f DEPTH OF PERC= 20" - 38" 16. PROPOSED PROJECT IS LOCATED WITHIN: } ~ f - ' ASSESSOR'S MAP 141 LOT 88 (1 C ; : ' ', •• • " _., h•• + • • + '� • ` M� TEXTURAL CLASS: 1 - • { • ' OWNER OF RECORD: DAVID C. RODDY MAP 142 4) :. ,� - o„ MAP 141 (2 0 t' • LOCUS �, 18.29 ADDRESS: 58 EVANS STREET LOT 87 � LOT 88 ' T k . +� • • = ��� i ( Fill BARNSTABLE, MA 02655 �' `� 12,876±S.F. �. . 0• y. J 16" 16.87' h ��L 9 A �6 or . . 1 • ra n •• • M y% � `�, � ) �� '�= -+- ��. Loamy Sand FEMA FLOOD ZONE X �� II 20" 10Yr 3/2 16.53' COMMUNITY PANEL# 25001 C0563J 170 (g • " . pM 11 1 • 17. DEED REFERENCE: L.C.C.#170956 Perc �` • '• r 38" Loamy Sand 15 03' w R.R. TIE RETAINING t1�t� ``� . f. 7 F 18. PLAN REFERENCE: L.C. PLAN#18366-E B 10Yr 5/8 1t �^1 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. p'�1 �% WALL (TYP) ,� • • rq►� • •+ \� :LA4, C/ I$y 42" 14.70' Z4 > • • • • , 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY 31 J . FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY n. FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. • i 21. A 4 PERFORATED SCH.40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A S; DECK EXISTING • • . . . • ` • • •� . � .�} . •, . , {, f�� , „ Med-Fine Sand 3 BEDROOM .• •\\• !. it _.�: 10. L,nr: 1 /f� w . DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A -27 DWELLING SAS DIMENSIONS & SETBACKS - C 2.5Y 6/1 REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. TOF = 29.4'± SCALE: 1"-20' "I-, BFE = 22.3'± LOCUS PLAN 22. OWNER/APPLICANT/CONTRACTOR SHALL BE RESPONSIBLE TO OBTAIN ANY AND ALL U:R,#52/3 \2� (WALK-OUT) REQUIRED PERMITS AND APPROVALS FOR THIS PROJECT. ENCLOSED SWING-TIES PORCH SCALE: 1" = 1000' 23. IN ACCORDANCE WITH 310 CMR 15.401 -15.405,THE FOLLOWING LOCAL UPGRADE 26 DESCRIPTION HC DC 13Z' .29 7 APPROVALS ARE REQUESTED FROM 310 CMR 15.221 (7):�� (1.) A 2.00'WAIVER (3.00'-5.00') FOR THE MAXIMUM COVER OVER THE LEACHING FACILITY. No Mottling, Standing or Weeping Observed 25 -4 CORNER OF STONE (1) 40.8' 13.2' -- (2.) A 0.20'WAIVER(3.00'-3.20) FOR THE MAXIMUM COVER OVER THE DISTRIBUTION BOX. R�I (S� CORNER OF STONE(2) 40.0' 38.0' DESIGN DATA TEST PIT DATA -- ---__. 24 N \ Q DECK PERC NO. 15322 LEGEND V- CORNER OF STONE(3) 52.4 40.9 OG��� OCF N 25 12"OAK TREE TO BE NUMBER OF BEDROOMS (EXISTING) 3 ,`` i,.,x.. J � O� , � WALK REMOVED CORNER OF STONE (4) 53.1' 20.1' INSPECTOR: Donald Desmarais, R.S. �} �� EXISTING SPOT GRADE EVALUATOR: Michael Pimentel, C.S.E -23 ------/ 2�. WAY EX. INV=19.9'± 1 ~� NUMBER OF BEDROOMS (DESIGN) 3 _; EXISTING CONTOUR L Zd, \ /-WOOD FENCF C.S.E.APPROVAL DATE: � DESIGN FLOW 110 GAUDAY/BEDROOM Oct. 1999 _/ `22 \23 0 / 'f" PROPOSED VENT PIPE; 2017 PROPOSED CONTOUR \ ,/ DATE: April11, APPROX. LOCATION �22 `�C+ EXACT LOCATION PER TOTAL DESIGN FLOW 330 GAL/DAY TEST PIT#: 2 0 PROPOSED SPOT GRADE OF WATERLINE \ BIT' \ 13„ OWNER DESIGN FLOW x 200 % = 660 GAUDAY DRIVEWAY Q UTYP) USHY_ \ ELEV TOP= 21.00' GAS EXISTING GAS LINE T 22- USE EXISTING 1,000 GALLON SEPTIC TANK < 7 20' D/H/W EXISTING OVERHEAD WIRE ELEV WATER= -21 PERC RATE = W W- EXISTING WATERLINE 14" EXISTING 1,000 GALLON SEPTIC TANK f 20 TP 2 -22 Benchmark INSTALL 2 - 500 GAL. CHAMBERS W/ AGGREGATE DEPTH OF PERC= TEST PIT LOCATION � � 23" 12" 21x0' TO BE UTILIZED IN THIS DESIGN Nail Set in Tree TEXTURAL CLASS: 1 7' PS �° �"� Elevation =24.00' SIDEWALL CAPACITY LP EXISTING LEACHING PIT Approx. M.S.L. (LENGTH + WIDTH) (2 SIDES) (2' HIGH) (0.74 GPD/S.F.) = GAL/DAY - (25.0' + 12.83') (2) (7) (0.74 GPD/S.F.) = 112.0 GAL/DAY Q EXISTING 1,000 GALLON SEPTIC TANK VPS 20 --- ... .. -21 5� O O 9" 011 21 �, PROP. H-20 PROPOSED 4" SOLID SCHEDULE 40 PVC PIPE P �D-Box BOTTOM CAPACITY 1s Ful W (LENGTH x WIDTH) (0.74 GPD/S.F.) = GAL/DAY 16" 19.67' ❑ PROPOSED H-20 DISTRIBUTION BOX EXISTING LEACHING PIT TO BE MAP 141 y Sand PUMPED, AND REMOVED IN C 7 LOT 89 \ (25.0'x 12.83') (0.74 GPD/S.F.) = 237.4 GAL/DAY A/E L 10Yr /2 PROPOSED 500 GALLON H-20 LEACHING CHAMBER ACCORDANCE WITH TITLE 5 �TP 1 \ 20 20" 19.33' \ �TW N 18x2' i` TOTALS: Loamy Sand \ `r \ 2 B 10Yr 5/8 REV. DATE BY APP'D. DESCRIPTION 9 17 TOTAL LEACHING - TOTAL NUMBER ACHING F CHAMBERS AREA 472.2 SQ.FT. 42^ 17.50 PROPOSED SEPTIC SYSTEM UPGRADE/ �� � 1 \ \ TOTAL LEACHING CAPACITY 349.4 GAL./DAYAWy PREPARED FOR: CAPEWIDE ENTERPRISES `r Med-Fine Sand PROPOSED INSPECTION PORT \ 2.5Y 6/1 Csv 80� w \ \ \ PROPOSED TWO (2) 500 GALLON C A N�, �o �. LOCATED AT H 20 LEACHING CHAMBERS W/ 58 EVANS STREET ��r • SURROUNDING AGGREGATE OSTERVILLE, MA 02655 \ / SCALE: 1 INCH = 10 FT. DATE: APRIL 24,2017 132" 10.00, 0 5 10 20 40 FEET NOTES: 1.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF No Mottling, Standing or Weeping Observed \ � PREPARED BY: T1 THE PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST JC ENGINEERING INC. PIT DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL - - BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. RESERVED FOR BOARD OF HEALTH USE 2854 CRANBERRY HIGHWAY SITE PLAN 2.) ENTIRE PROPERTY IS LOCATED WITHIN THE ESTUARINE WATERSHED EAST WAREHAM, MA 02538 SCALE: 1"= 10' AREA. I 508.273.0377 Drawn By: BJW Designed By: BJW TChecked By: MCP JOB No.3782