Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0065 FIRST AVENUE - Health
65 FIRST AVE,..Wk�, 0 TOWN OF BARNSTABLE LOCATION _ �� 7t1Zf1' SEWAGE# . c§61.5-- sue VILLAGE ASSESSOR'S MAP&PARCEL 11C-4 INSTALLER'S NAME&PHONE NO., f SEPTIC TANK CAPACITY - AE��_Sf7-1 LEACHING FACILITY:(type) kC-Lot (size) , .g3 X,jt- NO.OF BEDROOMS t OWNER IL PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility �-�,•�v Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) (� Feet Edge of Wetland and Leaching Facility.(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY /�„y �� �i?t/Y.-•ww»� t° . r. �� � SRC �� o _ � �� i � u � � t v � ,��,.._ �` r 4W I No. D Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF'BARNSTABLE, MASSACHUSETTS ZIPPfiration for Disposal *pstrm Construction Permit Application for a Permit to Construct( ) Repair/Upgrade( ) Abandon( ) ❑Complete System [�J'lndividual Components Location Address or Lot No. (rs'P rs�- e-lve Owner's Name,Address,and Tel.No. o8-q00-3S 9 v6(eaut`fIle. Chr;s4- m Raiss QJd er .i Pu,3,kar Lane_ Assessor's Map/Parcel 114, A/6 A4& U Installer'ss Name,Address,and Tel.No. ,5-og•'?h I-9,Ij9 Designer's Name,Address,and Tel.No. :5-Us - �6c"�ZF 1 LOYISE'RX�-1 Uy���r�G �i1 E �ne✓�..('`1'(5 CL3� YV1a,��►'i 8'`-- i 45' MA Type of Building: Dwelling No.of Bedrooms 3 Lot Size 'ol sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �� Q gpd Design flow provided ��3�4 gpd Plan Date 1.11 U 11, Number of sheets f Revision Date Title T, ,5- _& ,Fi � 0s ir_rtS Size of Septic Tank XIS t'� 11*,W4 qQQ Type of S.A.S. t Description of Soil g©, ©g Nature of Re s or Alterations(Answer when applicable) 4 -(U &A � - �10 �Uo 9m �ch 1CA11Yl in M 9, 3,,t) X � Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental C and no place the system in operation until a Certificate of Compliance has been issued by this Board of Health. i ed Date Application Approved by - Date Application Disapproved trey Date for the following reasons on Permit No. Date Issued ! r2s No. D /� 1 ...` _.-- Fee tL_J��"i _ .�.e THE COMMONWE, 'fh,F�F MASSACHUSET,TS Entered in computer: PUBLIC HEALTH DIVISION - TOW O PF BARNSTABLE, MASSACHUSETTS Yes 2pplication for -Misposal 6pstem'tonstruction Vermit Application for a Permit to Construct( ) Repair(/Upgrade( ) Abandon( ) [:]Complete System ©endividual Components Location Address or Lot No.( S P,r-64-• A'oe- Ue. Owner's Name,Address,.and Tel.No. v�S y�D- 35S 9 05*cU1 11e.. 0,hr; -;ne. ReissQdder� l rn t� Assessor's Map/Parcel j j(,, , o Installer's Name,Address,and Tel.No. 5 oF5•')7 r -9 Designer's Name,Address,and Tel.No. SOS -?4::.a - USy/ Cord 4+' C00strLX --10VX,-r ,C_ ow is ewe Cry`,*gees°try 43St K�tai�,si- 145,T� `cJC I/S - r I g9 A n r4• Ua(o`? Type of Building: Dwelling No.of Bedrooms 3 Lot Size a. �� sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures r Design Flow(min.required) ,3,3 U gpd Design flow provided 3 w4, gpd Plan Date ; Number of sheets I Revision Date Title ,• 5 i 49.t; &r.S Avenap_ US f V lle ,- Size of Septic Tank Type of S.A.S.C2 10 kin q cd -J (2jYj11)L4<11 Description of Soil f Nature of Repairs or Alterations(Answer when applicable) CT•(c) l..;'8 )c - l4 l U I-r, .5 Date last inspected: r' Agreement: r g The undersigned agrees to ensure the construction and maintenance of��trrhe afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code-and n ott6"place the,system in operation until a Certificate of Compliance has been issued by this Board of Health. / = gtied Date / J Application Approved by U ! Date ``� Application Disapproved Date x , for the following reasons' l ,r Permit No. "" Date Issued -- -- ------`---- ------ - _. . - _..... _ - ----- .� THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(,, Upgraded( ) Abandoned( )by i a �� R is /���p�e at (0.!^EM4_ A Uenve_ has been constructed in accor with the provisions of Title 5 and the for Disposal System Construction Permit No i t d Installer Neale �nviS ty e • -. oc— Designer 9 - e` ri #bedrooms J-► Approved design flow _ gpd The issuance of this permit shall not be c n/strued as a guarantee that the syste will fun i , as deigned. Date � / Inspector -----No.---------- ----- ----------MZE - -- -- ---_ --- ----------------- --- -- ----_------Fee COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNS TABLE,MASSACHUSETTS misposal 6pstem Construction permit Permission is hereby granted to Construct( ) Repair(A< Upgrade( ) Abandon( ) System located at ApirlluE { and as described in the above Application for Disposal System Construction Permit. 'The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. " Provided:Const ctio must be completed within three years of the date of this permit. Date Approved by ✓ /f- r I V RUG-17-2012 10:34 From:BDRTOLOTTI CONST 5084289399 To:15087906304 P.1/1 f }yA FROM :down cape engineering inc FAX NO. :15083629880 Aug. 16 2012 10:25AM P1 • r ti wo•r x 201) Wu 8tr�+t,,'fUycc>�mis�,IWAI 02601 C9�FIn0, SQR•962-M Fux' i11R ��°u°t53o� Y ti IlDesn�,r�c°: .�a�.J✓� �� �H�e..�f T.nri��llAa:�: �0 r" !v l �`Ld /►LG��- Q Q ' n - p 7() AI J �r � l�d1d�)f'd`19q: �' `� -.....rr.f� ram/6 h, ILT' ,,�C>�I"1' Wi WaS iara7lt:cl ri,permit to WSTW1 It s, tic systeFr, lit Ave, 1�a�ed c1rl a rtcxip,�,c1rR�.o by T cultif9 r.bLd the .4c0k sySt'(ul a.IV'VL "3 .irl:;taUnd• I•L1bDtADtJa'fly acc—,r,Tdiza& to I.1le9 4eilai2, wMDIL MELY 1L 1116t Tliaor f1pnYvnd ChIM&M R"U''ll 8S 108Tr l V%10"tzort of, the: diwhal-niduu box find/0r 2&9'Izr,tank" 1. aGrtafy t1%t the oe,^it1r. xrfen•criuc;r3 ahl lvl, rAm inuLaUed with ialljOr L1R11FW (:L.a- gj:eatUr t Pn 10' lgteTL� 1r1f)CZWJ11 Of't<1C SAS 4r wlY vu-itioal rdocario n ul Rng(;I=PoTu�lt uY for tir�t,i� ay,3tI,:�1}�111;� L11 R.GClT7(�.4+�u;�, vPifih Sla�c ,'�T,ctr,a,t},2�auIP1�GDA. 1'lttu scvi:,7i►u ear Gelti furl Luc-b-c2thy daszL?litz to fob'w, � H 'AP r• h DAN18L A. _ OJAL-A ontil6b�C1`°ti .it�'a7fs�L121%� CIVIL No.48502 tiw 8-T Stowp gulf:-T Fua � � r�!)rui �9.ltiY. �t)!!'6 ` ,�: t' � ik.: T Ta CZl,�1xTL '"FC[�3..�5': �M ��I►r AS I t;� Cry. 12/11/2020 ShowAsbuilt(1700x2800) TOWN OF BARNSTABLE LOCATION ��S rl t2$T � SEWAGE N c4013- � VILLAGE Stir--12Lt1 i.i7 ASSESSOR'S MAP&PARCEL I IC-4,6, INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY.(type) --Clil-IC It (size) 93K� NO.OF BEDROOMS 3 .J-'jtQ6kL GiI.bK7t''i� OWNER I�t=l.5$FELt2 PERMIT DATE: -13— COMPLIANCE DATE: Jt ' Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility +�• Feel Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) r,d,—. Feet FURNISHED BY /r4ty �i as• 0 https://itsqldb.town.barnstable.ma.us:8431/Home/ShowAsbuilt?mp=116046&sq=2 1/1 h 'C fl ti .. - - t. lfp ' �TFtg Pbl Department of Regulatory Services +� ELAMSTAHLE, 4 Public Health I�AiIl®lIl liyatte �Z n6 ,� 200 Main Street,Hyunuis MA 02601 7 Date Scheduled— Tine ]Fee Pdl. `oil Szeitabulity Assessment for S age, buispposval Pcrronned 13y: 4 D C i Witnessed By.; LOCATION IO & GENE RA L J[N7[+'®RNIATION -- /� • Location Address /� �rJ, e, Owner's Name Address Assessor's Map/Parcel; '`l� Cngincer's Mauro V Ol l�Vim- Q NBW CONSTRUCTION R8PA1R Telephone it U+ ! 6a Land Use Slopes(%)— / /v Surface Stones Distance's from: Open Water Body'` / It Possible Wet Arco /V./A-- fl Drinking Water Well ft Dralhage Way / / ft Properly Llne ft Oilier ft 6 �] '� � LS-rr.r.i ame`d mensions of lot,exact locations of lest holes 8c pert tests, locale wetlands'In proninuly to boles) r" 'IJ 10 \ -T I �- Parent material(gcologic)_�V�w��' DcpLh Lv 13vdroclr, �f d _ * ---�cNtii io Groa'nuwalcr.—Siuiiuing'YYa[er in'rlole:' WeejJllig Owl) Fit 01ti:e y Estimated Seasonal High Dioundwater DE TEMENATION F OR SJLASGNA]L HIGH WA7['aGR TAB LE, 4 Method Used: Depth Observed standing in obs.Bole: In, Depth to sell IPIotl1.58:.�_ T �III, DcpLh to weeping,from side of obs.hole: ___ It.l, dolt I1dwuLvY Adf u9(ment„a�„ - fC. lndcx Well✓# Reading Dale: Index Well level AaJ,lilt bl' A4J,Ovou ldwater Level Observation Hole If ' [into at 9" Depth of Perc a''_ Tlu'ic al G" !^A Slott Pre-soak Time @ ' I g i L-)0 r' �, Time(9''-6") Z • LRutn Min./Inch A(/j/�� Site Suitability Assessment: Site Passed_ Site,'-Failed: Additional Testing Needed(Y(N) " Original: Public Health Diyi:iion Observation Holt Data To Be Completed on Back------ ""If Percolation test is to be miducted vviL16iu 100' of yvefla nd, you must first UOILi y tl➢c. .Ma�rnstable Conservation Division at least 061E (1) weelc prioir to begim.111.0g. Q:\SG TLC\PLI2CPORD,9.DOC 1)r`EP.0BSTrHV ��� •I��- fi�rr _ �CPIh from '. ��®" TIOL { LOG Soil onSail surrace(in.) Texture (USDA)_. Soil Color Soil (A9unsell) Mottlin Other U g (Structure,Stones'; Boulders, a Con isle c ' r , a eI. 5� , y2 Depth from Soil horizon 110.le # Surface(in.) Soil Texture Soil Color (USDA) Soil — (Mansell) Mottlier ng (Structur ,OeIStones, noulders. f}/q!__--_ /.sv !� S� /0 y �[J/ Consis enc 90 Qravel— 1 r `3 ,U y&C/ 2 De th crorn ON][ E, LOG' SoilNorizon Roil Hole # Surface(in). Soil Color (USDA) Soil Other (Mansell) Moftling (,!structure,Stones,Boulders. Coosistengy. 2`L pr-m— DE 01?,slE][��Al7C�Q�l ]f���]E _ Depth fi-om Soil Horizon ]LOG n Soil Texture Old Surface(in.) Soil Color Soil (USDA) ,• her (Munsell) Moftling (Structure,tStones; Boulders, Consistent_ y_%Ornyell Nrvu�i u"nosurince Rate Iona: Above_500))ear•flood boundary No yes Within 500 year boundary No - Yes. _m Within I oo year flood boundary No� ale t➢� oa➢l�a�enira➢➢y`_�u¢r�➢ng](D���aiot�s lYpaterial DoeS at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? P: >(f not, "That is the deptll of naturally occurring I)ervibus maral11W .. _ A certify that o (dat4— e)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 Ole required training, expertise and exile inner demriaed in Y 1O CACZ 15,0" natur Sige / - I Q:1SEPTfC\PERCrORM.D0C f II Y , • it •,,�„�> �N ' Town of Barnstable ' Barnstable �pF'THE Tp�y 0 Regulatory Services Department e"aC I nn MASSaLE. � Public Health Division .9 MASS. 1639. ffD"'A`a, 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7011 0470 0001 4525 7345 July 5, 2012 Mr& Mrs David Reissfelder 65 First Avenue Osterville, MA 02532 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5. The septic system located at 65 First Ave, Osterville,MA was last inspected on 5/31/2012,by Patrick M. O'Connell, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed".under the guidelines of the 1995 TITLE 5(310 CMR 15.00) due to the following: • System is in hydraulic failure You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. PER ORDER O THE BOARD OF HEALTH Thomas McKean, R.S. CHO Agent of the Board of Health ' Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\65 First Ave.Ost.SenttoOst.doc r t , Town of Barnstable Barnstable P�pFSHF Tp�� y� tv �. °� Regulatory Services Department e"a� 9 nA MSS. o! public Health Division IW- A MSS. 0 �A 1639. �0 rfDµAt>. 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7011 0470 0001 4525 7338 July 5, 2012 Mr& Mrs David Reissfelder 9 Walnut Road Wenham, MA 01984 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5. The septic system located at 65 First Ave, Osterville, MA was last inspected on 5/31/2012, by Patrick M. O'Connell, a certified septic inspector for the State of Massachusetts.. The inspection of the septic system showed that the system"Failed" under the guidelines of the 1995 TITLE 5(310 CMR 15.00) due to the following: 0 System is in hydraulic failure You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. PER ORDER OF THE BOARD OF HEALTH PToma?McKean, R. . CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\65 First Ave.Ost.SenttoWenham.doc rf • * �- `� 141 ru n f1J ru. r •- u7 Postage Certified Feel ��j y e B 426 Postma®� 0 Return Receipt Fee. s(Endorsement Required)p �~`n 6 L Y ResMdted Delivery Fee , \�I. (Endorsement Required) 0 Total Postage&Fees 7J 1.a��� V �' --- ——— Mr& Mrs David Reissfelder------ 1 9 Walnut Road Wenham; MA 01984 Certified Mail Provides: ® A mailing receipt o A unique identifier for your mailpiece a A record of delivery kept by the Postal Service for two years Important Reminders: m Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. o Certified Mail is not available for any cloLss of international mail. n NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Retum Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 38111 to the article and add applicable postage to cover the fee.Endorse mailpiece Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt.is required. a For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery'". c If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3600,August 2006(Reverse)PSN 7630-02-000-9047 .> U.S.POSTAGE>>PITNEY BOWES ' '� Town of Barnstable Public Health Division /�f 0'�L�'�— 200 Main Street 77 7 ���� 639 0� � •.� 'RFD ran+" Hyannis,MA 02601 f : ZIP 02601 $ 005�7C0 ' {. 00013614.75JUN. 26. 2012. 'r . - � 7011 0470 ' 0001 4525 7222 RETURN RECEIPT R1= CE�TEC Mr & Mrs David Reissfelder ist ICE 9 Walnut Road vid NOTICE 2std E Wenham, MA_01984 �a uyT;iPN TO SEXDER NOT DELIVERABLE AS ADDRESSED UNABLE TO FORWARD BC, .02601400200 *2984-01136-26-4.4 0� ;-an? 11...J l_i . _ - p.\�� ,leg.. `� � .u...+r'r 1 i $. • • • .91 • ...-. .: ON COMPLETE THIS SECTIONON DELIVERY B / • - COMPLETE THIS SECTI E Complete items 1,2,and 3.Also complete A. Signature - I item 4 if Restricted Delivery is desired. ❑AgentX ■ Print your name and address on the reverse ❑Addressee I so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery o Attach this card to the back of the mailpiece, or on'the front if space permits. D. Is delivery address different from item 19 ❑Yes j 1. Article Addressed to: If YES,enter delivery address below: ❑ No I I I — -- I I 1 Mr& Mr ---David Reissfelder 9 Wa nutRoad _ I Ltham, MA 01984 3. Service Type 1 ]Certified Mail ❑Express Mail ❑ Registered ❑Return Receipt for Merchandise I ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes \ 2. Article Number 7011 0 4 7 0` 0 0 01 4525 7 22 2 (fiansfer from service Iabeo I ' f PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-lw I �,\ r THE Town of Barnstable Barnstable l°�y P °-� Regulatory Services Department. m`caC . 9IIA MAS83.3LE,o! public Health Division Q D D MASS. 0 4 t639. �m oN1A`6. 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7011 0470 0001 4525 7222 June 25, 2012 Mr& Mrs David Reissfelder 9 Walnut Road Wenham, MA 01984 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5. The septic system located at 65 First Ave, Osterville, MA was last inspected on 5/31/2012,,by.Patrick M. O'Connell, a certified septic inspector for the State of Massachusetts: The inspection of the septic system showed that the system"Failed" under the guidelines of the 1995 TITLE 5(310 CMR 15.00); due to,the following: 0 System is in hydraulic failure You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. PER ORDER OF TH BOARD OF HEALTH Thomas McKean, R.S. CHO Agent of the Board of Health Document2 SHE Town of Barnstable Barnstabe �p T� Regulatory Services Department M4meficaC i . i 9IIAftN1;CABLE,) public Health Division m Q nnss. a O 1679 ArfD�A, 200 Main Street, y Hyannis MA'02601007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 70110470 0001 4525 7222 June 25, 2012 Mr & Mrs David Reissfelder 9 Walnut Road - Wenham, MA 01984 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,Title 5. The septic system located at 65 First Ave, Osterville,MA was last inspected on 5/31/2012,by Patrick M. O'Connell, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed"under the guidelines of the 1995 TITLE 5(310 CMR 15.00); due to the following: • System is in hydraulic failure You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. PER ORDER OF TH BOARD OF HEALTH Thomas McKean, R.S. CHO Agent of the Board of Health Document2 Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=6612 t tt i i t�i�F i 1 t �`•> -yea,,rr.�ure.a,rrsriYa�� - Logged In As: Parcel Detail Monday,June 25 2012 Parcel Lookup Parcel Info (Parcel ID 116-046 I Developot LOT 36 OR PT OF LOT 3 Location 65 FIRST AVENUE I Pri Frontage 100 Sec Road ) Sec -- Frontage . village OSTERVILLE ( Fire District C-O-MM Town sewer exists at this address No I Road Index 0541 Asbuilt Septic Scan: Interactive'i' J 116046_1 Map t Owner Info owner REISSFELDER, DAVID W& CHRISTINE I Co-owner Streets 9 WALNUT RD ( Street2 City WENHAM I State. MA zip 01984 Country - Land Info Acres. 0.28 Use Single Fam MDL-01. ( zoning RC Nghbd 0111 Topography I Road Utilities ) Location Construction Info Building 1 of 1 Year Roof - I Ext g' I Mi(39oJ ; Built 1910 I Struct Gable/Hip wall Wood Shin le 31 Living 1938 Roof As h/F GIs/Cm AC Central I 7 w°K 1 Area -- I Cover P P ) . Type A5, 12 Int Bed 7 6 t21 12 { Style Colonial I wall Plastered ) Rooms 3 Bedrooms Model Residential I Int Hardwood I Batn 2 Full I rus woK: Floor Rooms DAS-, j gBAS 2" Grade Average Plus I Type Hot Water Total I Rooms 8 Rooms I 25: Stories 2 Stories I Heat Gas I Found- Conc. Block Fuel -- - ation - Gross 3099 Area I' Permit History http://issgl2/intranet/propdata/ParcelDetaii.aspx?ID=6612 6/25/2012 � G � {�y�Q�+ J � � � � dzt� � u �� Commonwealth of Massachusetts = Title 5 Official Inspection ' Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ww 65 First Ave Property Address Reissfelder Owner Owner's Name information is Osterville MA 02655 Ma 31, 2012 required for y every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form: Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. - Important:When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your Patrick M.'O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name 189 Cammett Road Company Address Marstons Mills MA 02648 Cityrrown State Zip Code 508-428-1779 S1:12855 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 AA May 31 , 2012 Job# 12-86 1 ector's Sign lure 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. LCCam{ U b l5ins-11/10 Title 5 Official InWdForm. bsurface Sewage Disposal System•Page 1 of 17 - !1 - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -:Not for Voluntary Assessments 65 First Ave Property Address It Reissfelder y,. k Owner Owner's Name information is required for Osterville MA, . '02655 May 31, 2012 !T every page. ,. Cit Y own State Zip Code Date of Inspection I B. Certification'(cont.) Inspection Summary: Check A,B,C,D or E/always complete'all of Section"D c A) System Passes: a; ❑ 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: ' R � I B) System Conditionally Passes: 4 ❑ 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. . a + Check the box for"yes", ,'no"or"not determined",(Y, N, ND) for the following statements:If"not determined," please explain. t The septic tank is metal and over 20 years old*or;the septic Itank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying,septic tank.as approved by the ' Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑,.Y ❑ .N ❑ ND (Explain below): .� i i l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System form - Not for Voluntary Assessments 65 First Ave Property Address Reissfelder Owner Owner's Name information is Osterville MA- 02655 May 31 2012 required for � Y every page. City/Town ` State Zip Code Date of Inspection B. Certification (cont.) 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): c ❑ distribution box is leveled or replaced ❑ Y 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):v ❑ broken pipe(s) are replaced ;` ❑ Y -' ❑ N ❑ ND (Explain below): ❑ obstruction is removed 4_ []-Y ❑ N ❑ ND (Explain below): j. C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health,in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh r t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17» . . r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary'Assessments 65 First Ave Property Address Reissfelder Owner Owner's Name T information is Osterville MA 02655, May 31 2012 required for Y every page. Cityrrown 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. El The system has a septic tank and SAS and the SAS is wilthil m:a Zone 1 0l 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 determirie 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: b You must indicate "Yes" or`;No" to each of the following for all inspections: Yes No . m Backup of sewage into facility or system component due to overloaded or ® Elclogged 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 ® D 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•11/10 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 4 of 17 ' r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 65 First Ave Property Address Reissfelder Owner Owner's Name information is required for Osterville MA 02655 May 31, 2012 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any'portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Any portion of cesspool or privy is within,100 feet of a surface water supply or tributary to a surface water supply. ❑ ®, Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a'cesspool or privy is within 50 feet of a private water supply well. ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 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 2000gpd- 10,000gpd. ® . ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health.to determine what will be- necessary to correct the failure. ' E) Large Systems: 'To be'considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of.a surface drinking water supply ' ` ❑ the system is within 200:feet of a tributary to a surface drinking water supply ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official InspectionForm Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 65 First Ave Property Address Reissfelder Owner Owner's Name information is Osterville MA 02655 May 31, 2012 required for. y every page. Cityrrown ., 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.❑ w 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 El 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 t r 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 x t5ins-11/10 ' Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 s F r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 65 First Ave Property Address Reissfelder Owner Owner's Name information is required for Osterville MA 02655 May 31, 2012 - every page. City[To y wn State Zip Code Date of Inspection D. System Information . Description: . Number of current residents: 0 Does residence have a garbage grinder?• ® _Yes ❑ No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes IN No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ® Yes ❑ No- N/A Irrigation Water meter readings, if available(last'2 years usage (gpd)): System. Detail: 9 Sump pump? f ❑ Yes ® No Last date of occupancy: D tenown Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design,flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No ; Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No" I b Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 ..t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 65 First Ave - Property Address Rei§sfelder Owner Owner's Name information is Osterville required for MA•• 02655 May 31, 2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.)` Last date of occupancy/use: Date Other(describe below): General,lnfo'rmation Pumping Records: ; Source of information: Unknown Was system pumped as part of the inspection? ' ❑ 'Yes ®. No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single.cesspool t ❑. n Overflow cesspool ❑ Privy a a ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ h 'Innovative/Alternative technology, Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest T inspection of the I/A system by•system operator under contract ,❑ Tight.tank. Attach a copy of the DEP approval.-4 ❑ '• Other(describe): t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 s Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 65 First Ave ` Property Address Reissfelder Owner Owner's Name information is Osterville required for - MA 02655 May 31, 2012 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: Compliance date: 9/8/78 ` Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade:. feet Material of construction: - ® cast iron ❑ 40 PVC . ❑ other(explain): ' Distance from private water supply well or suction line: feet. Comments (on condition of joints, venting, evidence of leakage, etc.): r Septic Tank(locate on site plan): 2' , Depth below.grade: feet Material of construction: ®concrete -, ❑ metal ❑ fiberglass •R❑ polyethylene ❑ other(explain) • r If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy,of certificate) ❑ .Yes ❑ No` Dimensions: 8.5' long x 5.2'wide- 1000 gal. Sludge depth: t5ins-t!1/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 , Commonwealth of Massachusetts Title 5 Official Inspection Form "s Subsurface Sewage Disposal System form - Not for Voluntary Assessments 65 First Ave Property Address y Reissfelder Owner Owner's Name information is y required for Osterville MA 02655 May 31', 2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont:) ' Septic Tank(cont.) t Distance from top of sludge to bottom of outlet tee or baffle .26" Y Scum thickness _ Distance from,top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 10" Measured How were dimensions determined? - Comments (on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels.as related to outlet invert, evidence of leakage, etc.): . Observed solids on top of outlet tee;and staining to op of structure indicating hydraulic failure. Ft Grease Trap(locate on site plan): Depth below grade: F feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: . Scum thickness r Distance from top of scum to top of outlet tee 6r baffle Distance from bottom of scum to bottom of outlet tee or baffle , Date of last pumping: Date ; •t5ins-11/10 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 10 of 17 . Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System:Form - Not for Voluntary Assessments. M 65 First Ave 'Property Address ` Reissfelder t Owner Owner's Name information is required for Cisterville MA 02655 May 31, 2012 ,- every page. Cityrrown 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: 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-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 i i Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 65 First Ave F Property Address R eissfelder _ Owner Owner's Name information is y required for Osterville MA' 02655: May 31, 2012 - every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan):+ 01. Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Previously full to top. Pump Chamber(locate on site plan): • ` Pumps in working order:' ❑ Yes ❑ No Alarms in working order: " ❑ Yes 0 No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: c i t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 65 First Ave Property Address .Reissfelder Owner 'Owner's Name information is required for Osterville MA- 02655 May 31, 2012 every page. CityrTown State 'Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits - - number: One 6x6 pit ❑ ,leaching chambers number: ❑ leaching galleries number: 0 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.): Plt in hydraulic failure 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 r Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑`Yes ❑ •No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System'.Page 13 of 17 _ s Commonwealth of Massachusetts. Title 5 Official' Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 65 First Ave ` Property Address 3 Reissfelder ` Owner Owner's Name ' information is , required for Osteryille MA 02655 ' May 3.1, 2012 every page. City/Town , State Zip Code Date of Inspection D. System Information (cont.) Comments (note,condition of soil,-signs,of hydraulic failure, leve_I of pond ing;condition of vegetation, etc.): Privy(locate on.site plan):' Materials of construction: Dimensions - t Depth of solids Comments (note condition.of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 7 t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 , r Commonwealth of Massachusetts _ . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments p . 65 First Ave -- — Property Address ` Reissfelder Owner Owner's Name information is Osterville - MA 02655 _ May 31 2012 required for - --"—— State Zip Code Date of Inspection every page. City/Town 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: ' r ® hand-sketch in the area below ` ❑ drawing attached separately • �s Front ., '•, r rr'r r i r r r r r r r r r r r r r r `r♦r♦r♦r♦r♦r♦r♦r♦r♦r♦r♦r r,♦ ♦ , r r r r r r / . / r r r r r r r r r r r ♦ r / r r r r r r r r r r r r r r r r r ♦ r . ♦ r r r r r r r r r ., 34 29 f ' 35 4'5 • �a a , 0 F ' is v \ Commonwealth of Massachusetts W Title 5 .Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 65 First Ave Property Address Reissfelder Owner Owner's Name information is Osterville MA 02655 May 31, 2012 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (coat.) Site Exam: '® Check Slope ® Surface water ® Check cellar ® Shallow wells " Estimated depth to high ground 'water: - N/A feet Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans onrecord 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: 0 Checked with local excavators, installers-(attach documentation) ` `. Accessed USGS database-explain: You must describe how you'established the high ground water elevation: • Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 65 First Ave M Property Address Reissfelder Owner Owner's Name information is required for Osterville MA 02655 May 31, 2012 t every page. Cityrrown 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 t5ins•11110, - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 a 7 -5 3 LOCATION SEWAGE PERMIT NO. VIULAGE Le �� I N S T A LLER'S NAME & ADDRESS 0 V 11(o ®a-6 B U I'L D E R OR OWNER DATE PERMIT ISSUED _ DATE COMPLIANCE ISSUED G !/ J � � w� � �� .-� - - - - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. ...........oF... !<'`l.Sf .. .��°---------------------..._.........-------- Appliratiou for Disposal Works Toustrurtivaa Firmit Application is hereby made for a Permit to Construct ( ) or Repair (Z11 an Individual Sewage Disposal System at rs fi � v C's r-O 1 E i �F -------------------------s ------------ n(� I ,p Location-Address or Lot No. Lg,v �v-e Owner• r_ Address a 1 ..._...._ f w r........._..._r:_.....---•-•--------- -------•-----........_....-----------•---••-•-----•......_............._........-•---•----•--•---- Installer Address Type of Building Size Lot............................Sq. feet U _••_-•_________________•-__Expansion Attic Garbage Grinder (Dwelling—No. of Bedrooms._. aOther—Type ) Other—Type of Building ............................ No. of persons.....____________._..__.__.. Showers ( ) — Cafeteria ( ) Q, Other fixtures .---••-••--••-•-•--------------- - --------------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow......................._....................gallons. P4 Septic Tank—Liquid*capacitylooQ-ga lons Length................ Width---------------- Diameter................ Depth................ W x Disposal*Trench—No./!�!"91_ -- th1__._._.C�L�_S�6'$a�l Length.................... Total leaching area....................sq. ft. Seepage Pit No_____________________ Diarrteter.._...__.__..__.___. �epth below inlet_._.__.____._._.____ Total leaching area..................sq. ft. Z Other Distribution box (4� Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date....................................... aTest Pit No. 1................minutes per inch Depth of Test Pit-_-____-________-___ Depth to ground water.......................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �+ •-•--------------------------------------------------•---------------------------------.......--•••-......................................................... ® Description of Soil......................................................................................................................................................................... x W ---------------------------- ------------------------- -- ----------------------- --••••-••••-......•----- ``// UNature of Repairs or Alterations—Answer when applicable._____ 1<-..__..___ o......... . ......................... -------=------------------•-----................................... ................................................. ................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI'N:;=. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. 3 ,� Signe ........ .._ -- Date Application Approved By......... / ..... _....� -------------- ...'_ r _, Date Application Disapproved for the following reasons-----------------------------------------------------------------------------------------....................... -------- ------------ --- ---- ------------------------------- �, 7 Date Permit No.......___________— ------------•••----• Issued--•--- �_•----••--•----------- Date _�61 IVb THE COMMONWEALTH OF MASSACHUSETTS BOAR OF HEALTH r ............... 0F... . .Arel 4.f e.....----------------..........._.......__ Appliration for Pisp.aial Works Tomitrnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair 411"an Individual Sewage Disposal System at: ar6tdd �� --•----_____•...... .................•-• -•• ••• ••-•-••----•--•--•----•--•••• •••-••••..__...••--••--•-...... .••-----••--•••....••••••••-•--•••..._.._..............._--••-- Location Address or Lot No. ............. ISM • •• ................................................... Owner Address w `!� < ........ `.r...._......••••••••-- •----•--••................ .....•-•-- ---....-------------•--------.....___-•_-•- Installer Address dType of Building Size Lot____________________ ___...Sq. feet U Dwelling—No. of Bedrooms.__ :__________________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) 11� Ga Desl n Flow____________________________________________gallons per person per day. Total daily flow.. Other fixtures •--•----- •--•-------___------ W �g g P P P Y Y ............................................gallons. WSeptic Tank—Liquid capacity/QAQ.ga lon Length __ _______ Width................ Diameter....._ ___ Depth................ Disposal,Trench—No. x `s?._ th __. ! Length____________________ Total leaching area....................sq. ft. Seepage Pit No---------_--_---- Dian-Teter.....................ai,�_ epth below inlet__...______________. Total leaching area..................sq. ft. Z Other Distribution box ( Dosing tank Hi Percolation Test Results Performed by.......................................................................... Date........................................ '. aTest Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water_.___-_-____________---. (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R, ------------------------------------------- --......... -••••••-•-----•-----....' .. ODescription of Soil......••-•---••-•--_..:---------•••--•----•--------------•--_____•••••-•--••-----=-----------••- ,': --------------------- ---------------------- ----------------------- W --••----••-•-----------------------------------------••---••----------•----,- ------ -------------�� /................. ----------... ....... UNature of Repairs or Alterations—Answet when applicable._____-- / !____ rw-- -_.___�° �_3 t "9_ _________________________ -' --•---•-------------------------------------------------------------------------........................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITi.sj. 5 of the State Sanitary Code--The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. r � � Date I Application Approved By........-, ,, - 1 � ' .. .......... .. . Date:.`_ Application Disapproved for the following reasons:............................................................. _____-____._____-_______------ ............-----------•-•-------------•-•-•------- •---- ...••--•---••-----._......._..-••-----------•---••--•-•--•----• ----------------•--------------•-----------------------__.-------._...._ Date Permit No........>______ri � ,C Issued Date THE COMMONWEALTH OF MASSACHUSETTS ,BOARD. OF HEALTH ........................._OF........& ................................... �pr�ifir��r oaf f�vrnt��i�nrr TH�SJS, O CERTIFY, That the Individual Sewa Dis osaI System constructed ( ) or Repaired 00< by > -/ `•1!."" ^!�': .�. .. M `!•J� !o .......................................................... —Insta at........ . '----•---.d6.rs--+-•-------� ..... ........... � `�:r��-�`-. � -------'-- --- ---•-••-----------•------ has been installed in accordance with the provisions of TIT r 5 of The tate Sanitary Coe as described in the application for Disposal Works Construction Permit No.:___ _._.___. 5_____. . . dated...... _____ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE'THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................................................:..•••-•--•••••-•-•••••. Inspector..................... ......................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH eh(S�a...T. ..................� .................OF.... •i••• _3_. �C! .................................... FEE d-d..0 ®--...... �. Disposal Works Tonotrudion Vrrmit Permission is hereby granted•••• -••4W. 41%'t�--r....4r_& Ps '...................................................................... to Construct ( ) or Repair ( an Individual Sewage Disp al Syst atNo............0.6 ....--`---•-/�t Y"s--•_.... �1�° - � �--------------------- -•----•-------•-----------•--------------------•-•---- street as shown on the application for Disposal Works Construction PerHm No.___.a. . ___ ed.... -•-••-�•---�--..`.-:-'- •.• ofHeaBoar DATE..-- .r �' ......................................... ----- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS {r w� FEB 1. 1 .z 13 440 �jvw BORTOLOTTI CONSTRUCTION, INC. 765 WAKEBY ROAD,MA'RSTONS MILLS,MA 02G48 508-771-9399 508428-8926 FAX: 508428-9399 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: { Date of Inspection: 62 8 v o hispecto ' Name: f� Owner's Name and Address: , CERTIFICATION STATEMENT: I certify that I have.personally inspected the sewage disposal system at this address and'that the informa- tion reported below is true,accurate and complete as of the time of inspection.The inspection was per- formed based on my training and experience in the proper function and maintenance of on-site sewage: disposal tems. The System: Passes Conditionally Passes Needs FAEvn y Local AprovingAuthorityFails Inspector'sSignatur Dater�OlG� The System Inspector shall submit a copy of this inspection report to the Approving authority within thir- ty(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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION Stt MARY: A)SYS PASSES: PI have not found any information which ii:dicates that(lie system violates any of the failure criteria,as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. , B)SYSTEM CONDITIONALLY PASSES; One or more system components need to be replaced or repaired. The system,upon comple- tion of the replacement or repair,passes inspection. Indicate yes,nor,or not determined(Y,N,OR ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exftltration,or tank failure is imminent. Tile system will pass inspection if the existing sep- tic tank is replaced with a conforming septic tank as approved by The Board of Health. Sewage backkup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of The Board of Health):, - 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM;INSPECTION FORM PA RT A - CERTIFICATION (continued) Broken pipe(s)replaced Obstruction is removed Distribution Box is levelled or replaced The System required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of The Board of Health): Broken pipe(s)are replaced Obstruction is-removed r 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 the public health, safety and the environment. 1)SYSTEM WH.L PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 Feet of a surface water Cesspool or privy is within 50 Feet of a bordering vegetated wetland or a salt marsh. 2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND,PUB.LIC WATER SUPPLIER,IF APPROPRIATE)DETERMINES THAT..THE SYSTEM,IS FUNCTION- ING IN A MANNER THAT PROTECT THE PUBLIC-HEALTH.:AND.SAFETY AND THE ENVIRONMENT: f The system has a septic tank and soil absorption system and is within 100 Feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is with a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 Feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 Feet but 50 Feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from the facility and the presence of ammonia nitrogen and nitrate nitrogen,is equal to or less than 5 ppm. D)SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CIvIR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of efluent 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 clog- ged SAS or cesspool - Liquid depth in cesspool,is lesi Than 6"below"invert or available volume is less than 1/2 day,flow. f Y Required pumping more titan 4 times in the'last year DW due to clogged or obstructed pipe(s). Number of times pumped -2- f , ..: {', SUBSURFACE'SEWAGE;DISPOSAL SYSTEM-,INSPECTION FORM PART A CERTIFICATION (continued) Any portion of the Soil Absorption System,cesspool or privy is below,the high groundwater elevation. Any portion of a 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 I 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliforin bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: The following criteria apply to a`large system in addition to the criteria above: The design flow of a system is 10,000 gpd or greater(Large:System)and the system is a significant threat to public*health-and safety.and the environment becausep"e,or more of the following conditions exist:. .. ..._ . .F y ' A The system is wdhm 400 Feet of a'surface dunking.water supply "-The system is within 2007et.ofialtributary,to•a surface drinking water.supply The system is located in a nitrogen sensitive area Interim Wellhead.Protection Area (IWPA):or a mapped Zone Il of;a public;water supply,well..,,. y} The owner or operator of any such system shall bring the system and facility into full compliance with the ; groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Check if the following have been done: - ✓ Pumping information was requested of the owner,occupant,and Board of Health. ✓. None of the system components have been pumped for atleast two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As-built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-UP-The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. 'All;system components;excluding the Soil Absorption System,have been located on site. The septic tank manholes were uncovered,opened,And the intenor,.of.the septic tank was in- ;r;• .;_,spected for,condition of baffles or tees,.material of construction;dimensions,depth of liquid, depth of sludge,depth of scum. V The size and location of the ,Soil Absorptio i System on the site ha's`been determined based on existing information or approximated by non-intrusive methods:`s -3 SUBSURFACE SEWAGE DISP,OSAL.SYSTEM INSPECTION FORM PART B CHECKLIST(continued) V" The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PAART C. SYSTEM INFORMATION ` FLOW CONDITIONS RF.SInENTLAL: Design Flow:_,330 gallons Number of Bedrooms: 3 Number of Current Residents: Garbage Grinder: Laundry Connected"I'o Systcm: 44j&6 Seasonal Use: Water Meter Reading ,if available: Last Date of Occupancy: (' ALJLNDCiSTRIAJ `Type of Establishment: > Design Flow: gallons/day Grease Trap.,Present;,(yes or�no) Industrial Waste Holding Tank Present: Non-Sanitary Waste Discharged To The Title V System: Water Meter Readings,If Available: Last Date of Occupancy: OTHER: Describe) Last Date of Occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System Pumped as part of inspection: If yes,volume pumped: gallons Reason for pumping: TYPE OF SYSTEM: Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy Shared System(If yes,attach previous_inspection records, if any) Other,(explain): APPROXIMATE AGE of all components,date installed(if known)and:source•of information;, 2s�o Sewage.odors detected when arriving at the site: ��` -�. ..tom ♦`. ." * 1 Tl .SUBSURFACE SEWAGE llISP'OSAL;`SYSL.1'.lEM NSPEC ON FORM PART C GENERAL`'INFORMATION (continued) SEPTIC TANK: ✓ Depth below grade: I '_ Material of Construction: -,"Concrete metal FRP_Other (explain) Dimisions: `6:5 n[. x S Sludge Depth: /4. Scum Thickness: /�;x Distance from top of sludge to bottom of outlet tee or baffle: x Distance from bottom of scum to bottom of outlet tee or baffle: ! `'baffle: Comments:(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid. I el in relation o o det invert,structural int grity,evi ence of leakage etc.) d — �i 09 `P GREASE TRAP: Depth Below Grade: w Material of Construction: concrete_metal_FRP_Other (explain) Dimensions: Scum Thickness: Distance from top of scum to top of outlet tee or baffler r;Y Comments:-(recommendation for-.pumping,condition_of,inlct,and,oullet tees or balllbs;depth of liquid level•irrrelation-to-outlet-invert,-structuural integrity,-evidencc`of leakage,e(c.) TIGHT OR HOLDING TANK: i00 Depth Below Grade: Material of Construction—concrete-metal_FRP_Other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm Level: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal,evid6te of solids car over,evidence of leaks a into or out box,etc.) N PUMP CHAMBER.3'/!D '':R,� k::,:"b tt >x� :'; r, .-IiP .c s�, Z< ?`">t Pump is in.working order:_ ...Comments:.(note.condition of pump chamber,condition:of pumps and,appurtenances,etc.)v `SUBSURFACE.SEWAGE DISPOSAL'SYSTEM;I,NSP_ECTION FORM PART C SYSTEM INFORMATION (continued) SOIL ABSORPTION SYSTEM(SAS): (Locate on site plan,.if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: Leaching pits,number: Leaching chambers, number: Leaching galleries,number: Leaching trenches, number,length: Leaching fields, number,dimensions: Overflow cesspool, number: Comments;(note condition of soil,,�signs of hydraulic ilure�evel of ponding,c ndition f ve//getation etc.) 1900 D C. CESSPOOLS: ; 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(cesspool must be pumped as part of inspection) Comments: (note condition of soilk,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) PRIVY: Materials of construction: Dimensions: Depth of Solids: Comments: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) 7 -6- SUBSURFACE SEWAGE DISPOSAUSVSTEM INSPECTION FORM. PART C SYSTEM INFORMATION (contimied) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent references, landmarks or benchmarks. Locate all wells within 100 Feet. �X i DEPTH TO GROUNDWATER: Depth to groundwater: /8 Feet a, 5. Method of Determination or Approximation: DH L'ri' -7- ALL TE LL SYSTEM PROFILE MARKI DS WITHC MAGNETIC TTAPEAOR BE NOTES PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. est otie� 1. DATUM IS APPROX. NGVD ,, g ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE: COVERS TO WITHIN 3" GRADE TOP FOUND. EL. 32.3' 2. MUNICIPAL WATER IS EXISTING \ FILTER FABRIC OVER STONE 9 MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 32.5' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. Locus 4. DESIGN LOADING FOR ALL PROPOSED PRECAST PRECAST H-10 West RISERS (TrP.) BLOCKS OR UNITS TO BE AASHO H-� a ° 2 , PRECAST RISERS O 31.5 4"0SCH40 PVC MORT,R ALL PIPES LEVEL 1ST 2' COMF'JNENTS H-10 5. PIPE JOINTS TO BE MADE WATERTIGHT. D 4 (TYP.) Day ENDS 10" EXISTING 14" ,oQaeoeo o, SIDES 29.$3' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE `- ° WITH 310 CMR 15.000 (TITLE 5.) TEE SEPTIC TANK** TEE : °° o 0 0 0 0 0 0 oa000000ao � °°°°°° aooa000aoao °° °o°o°o0 010? o 0 0 0 0 o a o 0 0 oo°o°o 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND GAS BAFFLE::' o�o�o 0 0_ N aooaooaoao � ° 0��00�0���� o�o�o�o� NOT TO BE USED FOR LOT LINE STAKING OR ANY c°°°°°° �aoaoa000ao °o°o °°°°°°°° °°°°°° ° ° ° ° 27.0' 29.32 29.15 °°°°°°°° °°°°°° OTHER PURPOSE. 6" MIN. SUMP L12" MIN. INT. DIM. H-10 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. 8• PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 0 3/4"-1-1/2" DOUBLE WASHED STONE (2) UNITS REQUIRED 9. COMPONENTS NOT TO BE BACKFILLED OR 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 30' X 9.E3' CONCEALED WITHOUT INSPECTION BY BOARD OF Ave antucket COMPACTION. (15.221 [21) HEALTH AND PERMISSION OBTAINED FROM BOARD Seoview sound �d OF HEALTH. ( 2.1% SLOPE) ( 1 % SLOPE) 10. CONTRACTOR SHALL BE RESPONSIBLE FOR FOUNDATION- EXIST. SEPTIC TANK 38' LEACHING CALLING DIGSAFE (1-888-344-7233) AND LOCUS MAP D' BOX 17' FACILITY VERIFYING THE LOCATION OF ALL UNDERGROUND & 20.5' BOTTOM TH-2 OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF NOT TO SCALE THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL "INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT NO GROUNDWATER FOUND WORK. UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE 11. ANY UNSUITABLE MATERIAL ENCOUNTERED ASSESSORS MAP 116 PARCEL 46 PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM WITH 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE SHALL BE REMOVED 5' BENEATH AND AROUND THE CONDITIONS IF NOT SUITABLE PROPOSED LEACHING FACILITY. 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. SYSTEM DESIGN: x 29.75 GARBAGE DISPOSER IS NOT ALLOWED DESIGN FLOW: 3 BEDROOMS @ 110 GPD = 330 GPD USE A 330 GPD DESIGN FLOW 29.25 SEPTIC TANK: 330 GPD (2) = 660 29.9 I **RE-USE EXISTING 1000 GAL. SEPTIC TANK 29.56 � I x��o LEACHING: 2q.•0� I � 0.05 °a SIDES: 2 (30 + 9.83) 2 (.74) = 118 GPD FENCE J �o \rl � x 29.00 TEST HOLE L � � �` 9 99 29. 29 BOTTOM 30 x 9.83 (.74) = 218 GPD O LOGS �' 29.73 �xL9./9 I� I x 29 4 sHELL I I =� TOTAL: 454 S.F. 336 GPD 1 ENGINEER: ARNE H. OJALA, PE, SE \ TM 1 TH 2 DRIVE / 7 3 I (�/1 USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) ' 32 `' � � x'30.7 � � �9.04 � , , , 2 WITH 2.5 STONE AT SIDES, 4 AT ENDS AND 5 WITNESS: D. DESMARAIS, IRS \ �.60 - f 3.06 BENCHMARK �30 1 -3rs45 8.90'.P, BETWEEN UNITS DATE: JULY 17, 2012 3313 x ti COR STONE STE 31. o 7 4 EL. = 31.7' PERC. RATE _ < 2 MIN/INCH I I \ z � I I 3 .09 *-3 13694 1 I C CLASS SOILS P# fi 4 31.19 0 o m I x 32.83 � 25' MA 4 ELEV. ELEV. II �A23' *-317_7g -10 APPROVED DATE BOARD OF HEALTH ' 0" - 31 .7' 0" 31 .5' I x 32.5 31.97LOT AREA I m Ap Ap C) 33122 1 13$I8 32.70 12,384 SF I� SL SL z I LPIT 32\39 DECK ISTING DWELLING �Z9x�) �551 1OYR 4/2 1OYR 4/2 9 � ; � A I TOP FND. 12" 120' I73 � I EL.=32.3' ��� TITLE 5 SITE PLAN .76 BW BW 7 33.63 21 / I OF TOP S.TANK - N LS LS I EL.=31.5' `, ST, 2 48 3 .9 �� - G x 33.42 ` 29. 65 FIRST AVENUE oHwiREs 30.17 34" 28.8' 34" 28.6' 3 84 � � `�� 98 � 29.17 *\33.85 OSTERVILLE \ 32.27 GAS METE �4.06 PREPARED FOR 4 00, PERC o C 12 BORTOLOTTI CONSTRUCTION/ 34.5U C. REISSFELDER MS MS JULY 18, 2012 2.5Y 7/4 2.5Y 7/4 1"OF Mgss �jH OF ALgS off 508-362-4541 sq� I fax 508-362-9880 ,moo UAwIEL ti� . �`' GAIJIE3LA. tiG A +o OJA.A �� • downcape.com OJALA CIVIL 132 20.7 132 20.5 �� o Q doWI1 cope engineering inc» o i Ids,gE502 ) ' pg8, ., FG, 7f �L civil engineers NO GROUNDWATER ENCOUNTERED Scale: 1 = 20 ` , .L 9vy°� �ss�a A E land surveyors 939 Main Street ( Rte 6A) 2- > 84 0 10 20 50 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675