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0047 FOX HOLLOW LANE - Health
s 47 Fox Hollow9ba0 terville A= 145-006-010 k TOWN OF BA/RNSTABLE LOCATION r®V (40LA.,QuJ LAME—SEWAGE# 01� VILLAGE ®�'TFZ�.�ILC_L ASSESSOR'S MAP&PARCEL `/��- "did INSTALLER'S NAME&PHONE NO.CAPGcut a 6 'EuT 4cftin/Rep 4 7-t&rj SEPTIC TANK CAPACITY k,ogxp LEACHING FACILITY:(type)(1)Soo 15 C_i4AA 4oeg_5 (size) ( 3.4 S � NO.OF BEDROOMS OWNER MA-R4 � SVSAAl f" LLA(tu PERMIT DATE: �--►() p J Q l'2 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility WA 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) '7 3s� Feet FURNISHED BY C Lo t z 6 �/QjROD 2�.� vof a PmAT 3,4 g. 2 A RLowr 4 2- 3 I z L_5 : b-3 is •� 1 No. 6 O/ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DAVISRA - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for ;Disposal 6pstem ConstrULtion permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.i.f-7 J=jDX HoLL p W (,AjvJ(5 Owner's Narpe,Address,and Tel.No. Assessor'sMap/Parcel Q/U D5� jy*aC �Ms.�1 14�i,i0 0S� Installer's Name,Address,and Tel.No. 5 p$—471 492 77 Designer's Name,Address,and Tel.No. 50`8-all 3-0 3-17 G s'FfPR254f C ►� kfWY (F. kA<6W-JKJ Type of Building: 4- Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building i 1 167JTJ 4L, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided `f' gpd Plan Date & /:�^ ;X 0 19 Number of sheets I Revision Date Title 47 a x l4a Li.ou) IAA1C &S"> KyiLi_ L Size of Septic Tank ,01)0 60 -C.iri 0 Type of S.A.S. &o4,L44p,\J Ci4AC &OU Description of Soil ��t� _ t� P i.41 T� Nature of Repairs or Alterations(Answer when applicable) US 1 ,0 ? 6FALLO&) 5'�L '(C, -go C64ci.,�(LG— 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 He Sign Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued 7 Y&4 7 N 7 0/ 6 Fee No.. P Entered in computer: t-," THE COMMONWEWLTH OF MASSACHUSETTS A., PUBLIC HEALTH OVA=N - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 21pplicatiol for Mispo.sal *pstem Construction Permit Application for a Permit to Construct Repair Upgrade( ) Abandon El Complete System [:1 Individual Components 1an Location Address or Lot No.'P_7 1=0Y lea(�OU3 6 Owner's Na"rqe,Address,and Tel.No. OSl M44C. Alf-A14 Assessor's Map/Parcel'. 1 �(5 IN'- 0/ -r 0 4-7 Hot_,LoLj i_,tj Os:-r Installer's Name,Address,and Tel.No. 5oR-q7j-%3S77 Designer's Name,Address,and Tel.No. CAFQ4J1DG I25o :Tc- ZNJC. 15:5 5-0kJA4,F7XV_d4X ,. ST- MA_�WJC6fsv�" =5;tf d 4ttm (a.AA4A6W4AA1 Type of Building: 4- Dwelling No.of Bedrooms Lot Size —sq.ft. Garbage Grinder Other Type of Building Pf;9(b6-QT1ArL,, No.of Persons Showers( Cafeteria( Other Fixtures Design Flow(min.required) 330 gpd Design flow provided q-9 gpd Plan Date—6 ;L 0 V9 Number of sheets Revision Date Title - 4:7 Fox koLL-ow L4&mt- D�rt�c� tu_4 V Size of Septic Tank 1000 6z4•L"O Type of S.A.S. 'Too 64-U-01i Description of Soil AkQ SAYA TS 5 CE P CAO Nature of Repairs or Alterations(Answer when applicable) use5' C-xt,5rtPe 1poo (z4( Lp&) �tSF1r1C-_ T'k)uJtc_ -ro NIDJ 9-ao D_40k _T71_1 (�) -500 C,-"4 Cj_hW& < tjj(* 44Fj_-ET- Of- A e*rcZ- Q 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 He�alt .S�i C_x,Signg A 0 Ilk Date Application Approved by Date -7116h Cy Application Disapproved by Date 7- for the following reasons -7 Permit No.. 15—i — .20 Date Issued J!_- ...... --------- -------------------------- - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certifirat �of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed Repaired(A Upgraded Abandoned by_C_A1)Fu.)tbwe at 470y, 1+.6L4.0WLAj 6� has been constructed in accordance with the provisions of Title 5 and the for Disp6sal System Construction Permit No.dated -7 J/ Installer CAP—LLOtbG Designer -Te% JF --A )C- #bedrooms 3 Approved design flow gpd The issuance of this permit shallot ot be construed as a guarantee that the system lcill i���C6 designed Date J3 Inspector - ------------------------------------------- ------------------:-------------------------------------------------------------------------------- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,- MASSACHUSETTS-Disposal *pstpm Construction Permit Permission is hereby granted to Construct Repair A) Upgrade Abandon System located at 441 2 L4iJE 0Q1S70QV141_<___ 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. Cal Provided:Construction mustb completed within three years of the date of this peimit. Date :2 Approved by Aug. 3. 2018 7;5?AM - No. 2483 P. 1 i' 'own of Barnstable Regulatory Services s ,M,r�r,►�,.a, i Richard V, Scali, Interim Director L6)9 � Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 R Office; 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 8-2'18 Sewage Permit# A018' a®7 Assessor's MapTarcel IV 5/ 0 Designer: TC,. Enl3(,ne,"(,ri t Truer, Installer: C-aee.wMe, Address: lWf C.ranbofg yt(nww,Y Address: �1,5-5 Cowimec-cCa� GFreJ Ewa 1AJnr ur }1 fl 025�$ IpS`n�2�, �(� 02�a`� On '1-10 — a01% Cp ew►cle. C-n�" (fses was issued a permit to install a (date) (installer) septic system at �_/ rOX 00116 W LGtNe... based on a design drawn by (address) "$ C rng(,nuxio arc , dated Sur�c� 1 Z 26 I B / (designer) V 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 satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Dotal Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed ce with.the terms of the RA approval letters(if applicable) �a� t+° A44n S �g JOHN L Gm CHURCHILL& N (Installer Signatdre) C1 No 1887 igner's Signature) (Affix Des' er' mp Here) PL SE RETURN TO ARNSTABLE PUBLIC HEAILT DI SION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QASeptidDesigner Certification Form Rev 8-14.13.doc DATE: 0� 1 T $95.00 FEE*: • BARNSTABLE, y MASS. s639•�fD Town of Barnstable REC,BY:MAC A SCHED.DATE: Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-8624644 Paul J.Canniff,D.M.D. FAX: 508-790-6304 Junichi Sawayanagi Donald A.Guadagnoli,M.D. Alternate:Cecile Sullivan,RN,MSN VARIANCE REQUEST FORM LOCATION Property Address: 47 Fox Hollow Lane, Osterville,MA Assessor's Map and Parcel Number: Map 145,Parcel 10 Size of Lot: 45,402 s.f. Wetlands Within 300 Ft. Yes X_ Business Name: No Subdivision Name: APPLICANT'S NAME: Marc J.&Susan I. Allain Phone Did the owner of the property authorize you to represent him or her? Yes X No PROPERTY OWNER'S NAME CONTACT PERSON Name: Marc J.&Susan I. Allain Name: Michael Pimentel,EIT,CSE Address: 47 Fox Hollow Lane,Osterville,MA Address:2854 Cranberry Highway,E.Wareham,MA 02538 Phone: Phone: 508-273-0377 EMAIL: mnimentel(a@icengineerineinc.com VARIANCE FROM REGULATION(List Res.) REASON FOR VARIANCE(May attach if more space needed) See attached Appendix A NATURE OF WORK: House Addition House Renovation .Repair of Failed Septic System X Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in S separate,collated packets. Five(5)copies of the completed variance request form Five(5)copies of engineered plan submitted(e.g.septic system plans) Five(5)copies of MA DEP approval letter for Innovative/Alternative septic system(when proposing an I/A system,only). Five(5)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) A completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian Signed letter stating that the property or business owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only). Full menu—Five(5)copies of full menu submitted(for grease trap variance requests only). _ *$95.00 variance request application fee collected (No fee for lifeguard modification renewals , grease trap variance renewals [same owner/lessee only],outside dining variance renewals[same owner/lessee only],and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Paul J.Canniff,Chairman NOT APPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL Donald A.Guadagnoli,M.D. [Type here] JC ENGINEERING, Inc. as Civil & Environmental Engineering 2854 Cranberry Highway East Wareham, Massachusetts 02538 Ph. 508-2 73-03 77—Fax 508-273-0367 MEETING NOTICE Dear Abutter: You are hereby notified that there will be a public meeting on Tuesday, June 26, 2018 at 3:00 PM in the Hearing Room Public on the second floor in the Barnstable Town Hall, which is located at 367 Main Street, Hyannis, MA 02601. This meeting is to present a variance request associated with a septic upgrade project located at 47 Fox Hollow Lane, Osterville, Massachusetts. Due to the physical constraints of the property and the existence of an Isolated Vegetative Wetland within 100 feet of the proposed work, the following local variance is requested. Local Variance Request (Isolated Vegetative Wetlands): The following local variance is requested from Article 1, Section 360-1: (L) A 26.3' variance (100.0' - 73.7') for the setback from the SAS to the Isolated Vegetative Wetlands. The application and plans are available for review at the Barnstable Health Department, 200 Main Street, Hyannis, MA Monday through Friday (excluding holidays) from 8:30 a.m. to 4:30 p.m. i o JC ENGINEERING, Inc. Civil &-Environmental Engineering 0 G 2854 Cranberry Highway East Wareham Massachusetts 02538 Ph. 508-273-0377—Fax 508-273-0367 APPENDIX A Due to the physical constraints of the property and the existence of an Isolated Vegetative Wetland within 100 feet of the proposed work, the following local variance is requested. Local Variance Request (Isolated Vegetative Wetland): The following local variance is requested from Article 1, Section 360-1: (1.) A 26.3' variance (100.0' - 73.7') for the setback from the SAS to the Isolated Vegetative Wetlands. a EXISTING FIRST FLOOR EXISTING SECOND FLOOR GARAGE BEDROOM (18'x12') BATHROOM (9,x8,) BEDROOM (12'x11') BATH ROOM KITCHEN (10'x7') (12'x11') DINING ROOM LIVING ROOM BEDROOM (12''x11') (14'x11') (12'x15') EXIST. FLOOR PLAN PREPARED BY: 47 FOX HOLLOW LANE JC ENGINEERING, INC. OSTERVILLE, MA 02655 2854 CRANBERRY HIGHWAY EAST WAREHAM, MA 02538 NTS PH: (508)273-0377 I Board of Health Abutter List for Map & Parcel(s): '145006010' 1 ' Direct abutters (no set distance) and the properties located across the street. Total Count: 6 rq Close Map&Parcel Ownerl Owner2 Addressl Address 2 Mailing Country Deed CityState2ip MASSACHUSETTS 144009 AUDUBON SOCIETY 208 SOUTH GREAT RD LINCOLN,MA 01773 9593/228 INC i SMALOVSCHI,TATIANA NANTUCKET,MA 145006009 &AZIEV,SHUKHRAT 11 GOLD STAR DRIVE 02554 29820/276 I 145006010 ALLAIN,MARC I& 47 FOX HOLLOW LN OSTERVILLE,MA 21473/331 SUSANI 02655 1 145006012 CHUTE,VALERIE J& VALERIE J CHUTE 30 FOX HOLLOW LANE OSTERVILLE,MA 23667/33 I CHRISTOPHER W TRS LIVING TRUST 02655 145038 FRANK,LESTER E& OSTERVILLE,MA CYNTHIA A 52 KING ARTHUR DR 02655 C173018 j 145039 SYLVESTER,MARK F& OVERLAND PARK, REGINA M 14117 GRANT KS 66221 C177754 1 This list by itself does NOT constitute a certified list of abutters and is provided only as an aid to the determination of abutters.If a certified list of abutters is required,contact the Assessing Division to have this list certified.The owner and address data on this list is from the Town of Barnstable Assessor's database as of 6/8/2018. >, a _ ,r Town of Barnstable Geographic Information System June 8, 2018 0 1 r PALjWOU?--j-q;;WB,9,- W, -N cp ED �L n P �A 10 % 0 In �o 'k,O "N"0 Nl�N & �9 X r oi I V? le v N or --------- ......, "eN � N Y a0y Z\1 OPP,e X1 4N o "VI j k r o N, N, a A Y r Y /vp 60, PC 7 kl*X4 irK P4 zo 46' YN X 7�& UJI x � 4� 0 282 , C.,Q ix DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map: 145 Parcel:006010 Board of Health boundary determination or regulatory interpretation. Enlargements beyond a scale of Selected Parcel. 1"=100'may not meet established map accuracy standards. The parcel lines on this map Abutter List Type-Direct abutters(no set distance)and the properties located are only graphic representations of Assessor's tax parcels. They are not true property across the street. Abutters W!%4"_ E boundaries and do not represent accurate relationships to physical features on the map such as building locations. Buffer DEED RESTRICTION Whereas,Marc I Allain and Susan I.Allain, of 47 Fox Hollow Lane,Osterville, Massachusetts 02665 ("Owners"),are the owners of the land shown as Lot 10 on plan recorded with the Barnstable County Registry of Deeds in Plan Book 392,Page 78,located at 47 Fox Hollow Lane,Barnstable(Osterville),Barnstable County,Massachusetts,record title to which is evidenced by deed recorded with said Registry of Deeds in Book 21473,Page 331 (hereinafter, the"Lot");and Whereas,Owners have agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in an home on the Lot as a pre- condition P condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000,State Environmental Code,Title V,Minimum Requirements for the Subsurface Disposal of Sanitary Sewage;and Whereas,the Town of Barnstable Board of Health,as a pre-condition to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code,Title V,Minimum Requirements for the Subsurface Disposal of Sanitary Sewage,is requiring that the agreement for the restriction on the number of bedrooms in any house constructed or maintained on the Lot be put on record with the Barnstable County Registry of Deeds and/or the Barnstable Registry District of the Land Court, as applicable,by recording this document. Now,therefore,Owners do hereby place and impose the following restriction upon the Lot in accordance with their agreement with the Town of Barnstable Board of Health,which said restriction shall run with the land and be binding upon all successors in title: The dwelling constructed or maintained upon the Lot shall contain no more than three(3) bedrooms unless and until it is connected to the municipal sewer or the Board of Health of the Town of Barnstable permits otherwise. } Property Address: 47 Fox Hollow Lane,Osterville,Massachusetts i For title,see deed recorded with said Registry of Deeds in Book 21473;Page 331. f f Executed as a sealed instrument this 2day of t) )2018. e arC lain Susan I.Allain COMMONWEALTH OF MASSACHUSETTS Barnstable,ss. On this day of ,2018,before me,the undersigned notary public,personally appeared Marc J.Allain and Susan I.Allain, who proved to me through satisfactory evidence of identification,which was N(� �.. , or 0 who is known by me and to me]mown,to be the persons whose names are signed on the preceding or attached document, and acknowledged to me that they signed it voluntarily for its stated purpose and as their free act and deed. W ema 4 iY8'K.G Notary Public MILENA 0.'TERZlYSKA My Commission Expires: 0 Z Z 2 0 Y Pu1 k Oommon%W1h of Mawchusft MYCa nrftM F*uxy2Z 2019 +� f f ' 2 BARNSTABLE REGISTRY OF DEEDS John F. Meade, Register Town of Barnstable P11r t Departinent of Regulatory Services uattst+r�to Y Public health Division Date ' r � �, s679 200 Main Street,Iigann(s MA 02601 Date Scheduled Time Pee Pd.__!i�'C' SOU Suitability Assessment or Seiva e Disposal.. / Podnrmod.By,_! I cl\(iQ� I iA1i��(�I "IT Sf' p ?- . . ._. I ii Witnessed By: LOCATION&.GLA NE4 RAL W ORMATION , 1-oc4dcn Address t[�- -�` 7 1 Gt tZ) ( (• Owner's Nomo(` A LQ.E 5 sJ 5t4a 4((_A(rJ 0 S-tGD_V ILL t" Addrese q-'7 r-0)((4,11, Assessor'sMnp/Parcoj: 1`7� /0L%./0/ D' Enghtoer CFtCEc✓,p` c '���5 C(<_;;)'?-(�`� �,. 'sNeale ?4. t,=T)C_(Nej7Cf AJCz i NEW CONS7TRUUC170N REPAIR Tele hone it 500-<(--1-7- LanJ Us.• )1'eScC Ft} tG, C �J Slopea(96) _c� �t' Surface Stance 'r" 61 Distances from: Open Water Body fl I osalblc Wot•Area ft Drinking Water Well G ft Dmlhage Way_ I—Oft Property Line 7 ft Other {t SI MTCHt(Street name,dimensions of lot,exact locations of test holes&pore lasts,loonto wetlands in proximity to holes) i 1 s,.oar�,"oedut esemaamr C(���GS F� P f0.,n/ j�' Depth to Bedrock Depth to Groundwater: Standing Water In Rojo: /> f ���/ 156 S Weeping tfom M,Pnoa � ��6I P `S Esdmaled Seasonal High Oroundwater J DI; I MINA ON FOR SEASONAL'IIIOH WATER TABLE Method Used: fr"C o a .D' Vr•:l,r•�1 Depth Observed standing In obs.hole[ � ' In, Depot to sell mottles: III.' Dedth10weepingfromsideofobs.holat > 7 ^�—ln, OrdundwalerAJJustmunt�(,�__ _fe. lndax Wet1-8 Roeding l)ato: Ind.x Wall level ArU,.ihatbr,,,,,_Adj.Oroundwaterd-ovel,,,,-, PERCOLATION TEST Observation Hole It Tlmo at 9" Depth of Pero Time at 6" Stan Pre-soak71ma® C' Time(9"-V) End Pre-soak *sel pert lk{sS -i+'p aTs aaVA 5 �rj- j Uri Q-IQ Rate Mln./lacit. Site Suitability Assessment: Slta Passed 14: Site Palled: Addldonal Teat ng Needed(YIN) /V Odginel: Public Health Division Obaerktlon Hole Data To Be Completed on B ack------- - ***If percolation test is to be conducted within 100'of wetlands you inust first notify the. Burnstable Conse{•vation Divisiou at least one(1)week prior to beginning. Q:1SEp'r1CV SRCFORM.DOC ' DEEP,OBSERVATION HOLE LOG Hole# I Doptit from Soil Horizon Sol Torturo SdII Color Soil• Other Surface(In.) (USDA) .(Munsell) Mottling (Stnuoturo,Sionel.,Boulden. lalatency,96't3ravel) DEEP OBSERVATION HOU LOG Hole# Depth from Soil Prod on Sell Texture Sell Color Soil Other Surrkco(in.) (USDA) (Munseli) Mottling (Structure,Slonw,Eouldcra. ' ConflstCnay.%Orlivell DEEP OBSERVATION HOLE LOG Hole#T Depth from Sall Horizon Soil Texture Sell Color Soli Odrer Surracc(to.) (USDA) (Muosclp Mottling (Stntcturo,Stones,flouldcrs,. DREP OBSERVATION HOLE LOG Hole# Depth from Sol]Horizon Solt Texture Soil Color Boll Other Surface(In.) (U$DA) (Munsell) Mottling (Structure,S(ones',Boulders, Flood Insurance Rate Max Above500 year flood boundary No � Yes Within 500 year boundary No_ Yes , Within 100 year flood boundary No.,\ / Yes Death of Nnturallv Occurring Pervions Material Does at least four fcct of naturally occurring pervious mntorlal exist in all arena observed thrpughout tile area proposed for the soil absorptibn system? If not,what Is the depth of naturally occurring pervious materlal? Certification r\ G I certify that on �v � /(date)I have passed the soil evaluator examination approved by the Department ofEnvlronmental Protection and that the above analysis was performed by me consistent with the required training,ex ordse rrhd experience described in 10 CMR 15.017. it-1 Signature Al/� Q-.\4En rlr TERCPORM,DOC } •-Marc J. & Susan I. Allain 47 Fox Hollow Lane Osterville, MA 02655 June 8, 2018 Board of Health Town of Barnstable 200 Main Street Hyannis, MA 02601 Re: Declaration of Authorization 47 Fox Hollow Lane, Osterville, MA 02655 Dear Members of the Board: Let it be known that We, Marc J. & Susan I. Allain (owners of 47 Fox Hollow Lane in Osterville, Massachusetts), do hereby authorize JC Engineering, Inc. of East Wareham, MA 02538 to represent our interest regarding the upgrade of the septic system located at 47 Fox Hollow Lane, Osterville, Massachusetts in meetings both public and private. Sincerely, Marc J. & Susan I. Allain f Town of Barnstable Barnstable Board of Health j mica j ,7 MASS. 200 Main Street, Hyannis MA 02601 ��t63gy �0 2007 fp AAJ+s Office: 508-862-4644 Paul Canniff,D.M.D. FAX: 508-790-6304 Junichi Sawayanagi 'Donald Guadagnoli,M.D. June 27, 2018 Mr. Michael Pimentel JC Engineering, Inc. 2854 Cranberry Highway East Wareham, MA 02538 RE: 47 Fox Hollow Lane, Osterville A = 145-006-010 Dear Mr. Pimentel, You are granted a variance on behalf of your client, Marc and Susan Allain, to construct an onsite sewage disposal system at 47 Fox Hollow Lane, Osterville . The variance granted is as follows: Section 360-1 of the Town of Barnstable Code To install the soil absorption system 73.7 feet away from the edge of a wetland, in lieu of the minimum 100 feet separation distance required. These variances are granted with the following conditions: . (1) No more than three (3) bedrooms are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. (2) The applicant shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds restricting the property to three bedrooms maximum. A copy of the recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction permit. Q:\W PFILES\PimentalAllain47FoxHollowVariances2018.docx ( ) The septic stem shall be installed in strict accordance with the revised engineered plans dated June 12, 2018. (5) The designing engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the revised engineered plans dated June 12, 2018. These variances are granted because the proposed plan appears to meet the maximum feasible design standards contained within the State Environmental Code, Title 5 and local Health Regulations. The engineer designed the septic system to be located in an area to attempt to maximize setbacks to wetlands. Sincerely yours VrV 4Pan ,A Chairman Q:\WPFILES\PimentaIAllain47FoxHoIIowVariances2018.docx r� DATE: $95.00 FEE*- * BARNSTABLE, • � 9 MASS. o �A,O� Town of Barnstable �,BY: SCHED.DATE ��' Board of Health MIN 200 Main Street,Hyannis MA 02601 Office: 508-8624644 Paul J.Canniff,D.M.D. FAX: 508-790-6304 Junichi Sawayanagi Donald A.Guadagnoli,M.D. Alternate:Cecile Sullivan,RN,MSN r VARIANCE REQUEST FORM 10AC8 5 AAE- LOCATION Property Address: 47 Fox Hollow Lane, Osterville,MA Assessor's Map and Parcel Number: _Map 145,Parcel 10 Size of Lot: 45,402 s.f. Wetlands Within 300 Ft. Yes X Business Name: No Subdivision Name: APPLICANT'S NAME: Marc J. &Susan I. Allain Phone Did the owner of the property authorize you to represent him or her? Yes X No PROPERTY OWNER'S NAME CONTACT PERSON Name: Marc J.& Susan L Allain Name: Michael Pimentel,EIT,CSE Address: 47 Fox Hollow Lane,Osterville,MA Address:2854 Cranberry Highway,E.Wareham,MA 02538 Phone: Phone: 508-273-0377 EMAIL: inpimentel@jcen int? eeringinc.com VARIANCE FROM REGULATION(List Res.) REASON FOR VARIANCE(May attach if more space needed) _See attached Appendix A NATURE OF WORK: House Addition- House Renovation Repair of Failed Septic System X Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in S separate,collated packets. Five(5)copies of the completed variance request form Five(5)copies of engineered plan submitted(e.g.septic system plans) Five(5)copies of MA DEP approval letter for Innovative/Alternative septic system(when proposing an I/A system,only). Five(5)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) A completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian — Signed letter stating that the property or business owner authorized you to represent him/her for this request — Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only). Full menu—Five(5)copies of full menu submitted(for grease trap variance requests only). *$95.00 variance request application fee collected (No fee for lifeguard modification renewals , grease trap variance renewals [same owner/lessee only],outside dining variance renewals[same owner/lessee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Paul J.Canniff,Chairman NOT APPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL Donald A.Guadagnoli,M.D. [Type here] f � t 4 JC ENGINEERING, Inc. R 7, �Q ti Civil & Environmental Engineering 0 ° 2854 Cranberry Highway East Wareham, Massachusetts 02538 Ph. 508-273-0377—Fax 508-273-0367 MEETING NOTICE Dear Abutter: You are hereby notified that there will be a public meeting on Tuesday, June 26, 2018 at 3:00 PM in the Hearing Room Public on the second floor in the Barnstable Town Hall, which is located at 367 Main Street, Hyannis, MA 02601. This meeting is to present a variance request associated with a septic upgrade project located at 47 Fox Hollow Lane, Osterville, Massachusetts. Due to the physical constraints of the property and the existence of an Isolated Vegetative Wetland within 100 feet of the proposed work, the following local variance is requested. Local Variance Request (Isolated Vegetative Wetlands): The following local variance is requested from Article 1, Section 360-1: (L) A 26.3'variance (100.0' - 737) for the setback from the SAS to the Isolated Vegetative Wetlands. The application and plans are available for review at the Barnstable Health Department, 200 Main Street, Hyannis, MA Monday through Friday (excluding holidays) from 8:30 a.m. to 4:30 p.m. r o � JC ENGINEERING, Inc. Civil & Environmental Engineering.' 0.0 2854 Cranberry Highway r East Wareham, Massachusetts 02538 Ph, 508-273-0377—Fax 508-273-0367 APPENDIX A Due to the physical constraints of the property and the existence of an Isolated Vegetative Wetland within 100 feet of the proposed work, the following local variance is requested. Local Variance Request (Isolated Vegetative Wetland): The following local variance is requested from Article 1, Section 360-1: (1.) A 26.3' variance (100.0' - 73.7) for the setback from the SAS to the Isolated Vegetative Wetlands. EXISTING FIRST FLOOR EXISTING SECOND FLOOR GARAGE BEDROOM (18'x12') BATHROOM (9x8) BEDROOM (12'x11') BATH ROOM KITCHEN (10'xT) (12'x11') DINING ROOM LIVING ROOM BEDROOM (12'x11') (14'x11') (12'x15') EXIST. FLOOR PLAN PREPARED BY: 47 FOX HOLLOW LANE JC ENGINEERING, INC. OSTERVILLE, MA 02655 2854 CRANBERRY HIGHWAY NTS EAST WAREHAM, MA 02538 PH: (508)273-0377 Board of Health Abutter List for Map & Parcel(s); '145006010' Direct abutters (no set distance) and the properties located across the street. Total Count: 6 Close Mailing Map&Parcel Owners Owner2 Addressl Address 2 CityStateZip Country Deed i MASSACHUSETTS LINCOLN,MA 144009 AUDUBON SOCIETY 208 SOUTH GREAT RD 01773 9593/228 I INC i 145006009 SMALOVSCHI,TATIANA NANTUCKEf,MA &AZIEV,SHUKHRAT 11 GOLD STAR DRIVE 02554 29820/276! E 145006010 ALLAIN,MARC I& 47 FOX HOLLOW LN OSTERVILLE,MA 21473/331 SUSANI 02655 1 E 145006012 CHUTE,VALERIE I& VALERIE I CHUTE OSTERVILLE 30 FOX HOLLOW LANE MA i CHRISTOPHER W TRS LIVING TRUST 02655 23667/33 FRANK,LESTER E& OSTERVILLE,MA I 145038 CYNTHIA A 52 KING ARTHUR DR 02655 C173018 i I 145039 SYLVESTER,MARK F& 14117 GRANT OVERLAND PARK, C177754 i REGINA M KS 66221 This list by itself does NOT constitute a certified list of abutters and is provided only as an aid to the determination of abutters.If a certified list of abutters is required,contact the Assessing Division to have this list certified.The owner and address data on this list is from the Town of Barnstable Assessors database as of 6/81201 B. Town of Barnstable Geographic Information System June 8, 2018 i rl o a A ' x FAL6'�t7r8d Ln T cq �� cQv�i - S.Cn.' �s 0� XX -17 v4e= o a Q a y F <xpk ,r e I• rj JQ;O COS tet fZ44 t 0 .,,✓"Q fit'`` ,✓ 41 'ate f '�f "v,. g• -=W' 0 @, p„ - = E ��^4 ' 6 s,� "Pr AA � �-y, s"a'o �yq. ' 'tea . . .. , c <� �c;. ® QI A r A N A Y-a•+3" '4�� y V t�� aON Na�, ' d 63, - Are e C a.a ,�"✓'- @-us..•.�- -ate°':3 » a f t `-`.`.. z.,-- ' O � E 1] �,,...v S�aG o QI� ✓`"� ; O r" .ti - �.�F'; 5,.. •.'<.�,..1> § I Y��`kA.F =�: �- o ` .,. .�' �%yr DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map: 145 Parcel:006010 Board of Health boundary determination or regulatory interpretation. Enlargements beyond a scale of Selected Parcel a FAX Abutter List Type-Direct abutters no set distance properties 1"=100'may not meet established map accuracy standards. The parcel lines on this map yp ( )and the r0 ertlES located ..6;�. are only graphic representations of Assessor's tax parcels. They are not true property across the street. Abutters - �`'��"_"'_"'' boundaries and do not represent accurate relationships to physical features on the map ?, such as building locations. Buffer S f' m Ln r- ,•n Certified Mail Fee tlJ $ �q(Q ra Extra Services&Fees(check box,add es propdete �414J ❑Return Receipt(hardtop» $ O ❑Return Receipt(electronic) $ pcstm ❑Certified Mail Restricted Delivery $ X'"Ffe C ❑O Adult Signature Required $ ❑Adult Signature Restricted Delivery$ C3 Postage r Prop ID: 145039 - - r- SYLVESTER,MARK F®INA M ! f�� 0 14117 GRANT �` OVERLAND PARK, KS 66221 Certified Mail service provides the following benefits: ■.A receipt(this portion of the Certified Mail label). for an electronic return receiptrsee a retail s A unique identifier for your mailpiece. associate for assistance.To receive a duplicate n Electronic verification of delivery or attempted return receipt for no additional fee,present this, delivery. 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Adult signature restricted delivery service,which ■Certified Mail service is notavailable for requires the signee to tie at least 21 years of age international mail. and provides delivery to the addressee specified ■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent with Certified Mail service.However,the purchase (not available at retail). of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a certain Priority Mail items. , " ` USPS postmark If you would like a postmark on�. ®For an additional fee,and with a proper _. _this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail item at a Post Office'"for the following services: 1 postmarking.If you don't need a postmark on this Return receipt service,which provides a record-—Certified Mail receipt,detach the barcoded portion of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply You can request a hardcopy return receipt or an_ appropriate postage,and deposit the mailpiece."W electronic version.For a hardcopy return receipt - complete PS Form 3811,Domestic Return _ Receipt attach PS Form 3811 to your mailpiece; IMPOIITAN7:Save this receipt for your records. Ps Forth 3800,April 2015(Reverse)PSN 7530-02-000-9047 "' - Ln - (_U Certified Mail Fee r $ . Extra Services&Fees(check bar,add fee as propda ) - ^!^\; ❑Return Receipt(hardcopy $ • 4~ O ❑Return Receipt(electronic) $ ykz \� dstmark 7 O ❑Certlfled Mall Restricted Delivery $ .a9 1jer.9- s O ❑Adult Signature Required $ "{ []Adult Signature Restricted Delivery$ C3 Postage PS- o Prop ID: 145038 N OFRANK,LESTER E&CYNTHIA A 52 KING ARTHUR DR __._ ........... �`- OSTERVILLE,MA 02655 ------------------- Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique Identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. USPS®-postmarked Certified Mail receipt to the ■A record of delivery(including the recipient's retail associate. signature)that is retained by the Postal Service- Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,OF to the addressee's authorized agent Important Reminders. d Adult signature service,which requires the ■You may purchase Certified Mail service with. signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which ■Certified Mail service is notavailable for requires the signee to be at least 21 years of age International mail. and provides delivery to the addressee specified ■Insurance coverage Is notavailable for purchase by name,or to the addressee's authorized agent with Certified Mail service.However,the purchase (not available at retail). of Certified Mail service does not change the ■'To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of malling,it should bears certain Priority Mail items. . - - USPS postmark If you would like a postmark on ■For an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request-' Certified Mail Item at a Post Office.for the following services: t postmarking,it you don't need a postmark on this -Return receipt service,which provides a record__Certified Mail receipt,detach the barcoded portion of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply You can request a hardcopy return receipt or an .appropriate postage,and deposit the mailpiece. electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Return Receipt attach PS Form 3811 to your mailpiece, "1Mpomamr Save this receipt for your records. Ps Form 3800,April 2015(Reverse)PSN 7530-02-WD-9047 '' - �rq •. N Iti 0 Certified Mail Fee ru $ EExtra Services&Fees(checkbaly add app date) I. ❑Return Receipt(hercico $py) $ �S rq ❑Return Receipt(electronic) Posl Ri!rk Q -❑Certified Mail Restricted 0 [very. $ .iay�.,raro O ❑Adult Signature Required $ ❑Adult Signature Restricted Delivery$ p Postage nj - --_- - _ -^- USPS.h26 C3 Prop ID: 145006009 aSMALOVSCHI,TATIANA&AZIEV, 1 o I I GOLD STAR DRIVE �________6 ____•_____ 17- NANTUCKET, MA 02554 Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt;see a retail ■A unique identifier for your mailpiece, associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. USPS®-postmarked Certified Mail receipt to the e A record of delivery(including the recipient's retail associate. signature)that is retained by the Postal Service' Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or" to the addressee's authorized agent. Important Reminders. Adult signature service;which requires the a You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class WHO,First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which ■Certified Mail service is notavailable for requires the signee to tie at least 21 years of age intemational mail. and provides delivery to the addressee specified n Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent with Certified Mail service.However,the purchase (not available at retail). of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a certain Priority,Mail items. USPS postmark.If you would like a postmark on ®For an additional fee,and with a proper F „ this Certified Mail receipt,please present your endorsement on the mailpiece,you may request .,Certified Mail item at a Post Office-for the following services: ) postmarking.If you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion-. of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply r You can request a hardcopy return receipt or an_,appropriate postage,and deposit the mailpiece.r., electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Return i Receipt attach PS Form 3811 to your mailpiece;'IMPORTANT.Save this ieeeipt for your records, PS Farm 3800,April 2o15(Reverse)PSN 7530-02.000.9047 - •.it, • ' .n, N r . ,a Certified Mail Fee . w\ 17 fU $ )v rl- Extra Services&Fees(check SOX.add fee as M pd ) y 3.. ❑Return Receipt(hard-P» $ - ❑Return Receipt(eleotronic) $ 1,pp J C3 []Certified Mail Restricted Delivery $ ere V� ♦3 ❑Adult Signature Required $ _ �9 p c,QZV ❑ Restricted Signature Rescted Delivery$ I-J [7 o Prop ID: 144009 V �0 MASSACHUSETTS AUDUBON a 208 SOUTH GREAT RD `--___: LINCO.LN,MA 01773 Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail labeq. for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. USPSO-postmarked Certified Mail receipt to the- ■A record of delivery(including the recipient's retail associate. signature)that is retained by the Postal Service'" Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent Important Reminders. Adult signature service,which requires the ■You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which ■Certified Mail service is notavailable for requires the signee to be at least 21 years of age intemational mail. and provides delivery to the addressee specified ■Insurance coverage is not available for purchase by name,or to the addressee's authorized agent with Certified Mail service.However,the purchase (not available at retail). of Certfied Mail service does not change the ■To ensure that your Certified Mail receipt is Insurance coverage automatically included with accepted as legal proof of mailing,it should beara certain Priority Mail items. USPS postmark If you would like a postmark an` n For an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail hem at a Post Office'"for the following services: 1 postmarking.If you don't need a postmark on this Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply You can request a hardcopy return receipt or an - appropriate postage,and deposit the mailpiece. electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Retum Receipt;attach PS Form 3811 to your mailpiece; 1MPORTAKIII Save this receipt for your records: PS Form 3800,April 2015(Reverse)PSN 7630-02-000.9047 - - - C3 •, MEMO It Ln p Certified Mail Fee � $ fa ry Cee& ees(chockha),add fee as app priafe) 4 101 .❑Retum Receipt(hardcopy) $ -. ` C3 ❑Retum Receipt(electronic) $ �,. Postmarks;;: is ❑Certified Mail Restricted Delivery $ •F.1,0F9-; ❑Adult Signature Required $ ❑Atluit Signature Restricted Delivery$ I C7 -O-9e_ -� p► (�2 -3 Prop ID: 145006012 © CHUTE, VALERIE J& VALERIE J CHUTE LIVING TRUSTrq T-69 C3 30'FOX HOLLOW LANE-' OSTERVLLE,MA 02655 Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a reta ■A unique identifier for your mailpiece. associate for tissistance.To receive ad upliil cate ■Electronic verification of delivery or attempted' return receipt for no additional fee,present this delivery. USPS®-postmarked Certified Mail receipt to the ■A record of delivery(including the recipient's retail associate. signature)that is retained by the Postal Service' Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or Important Reminders to the addressee's authorized agent P Adult signature service,which requires the ■You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Maile,First-Class Package Service®, available at retail). or Priority Mail®service. -Adult signature restricted delivery service,which •Certified Mail service is notavailable for requires the signee to be at least 21 years W age International mail. and provides delivery to the addressee specified ■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent with Certified Mail service.However,the purchase (not available at retail). of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is Insurance coverage automatically included with accepted as legal proof of mailing,it should bear a certain Priority Mail items.. W,' USPS postmark If you would like a postmark on o For an additional fee,and with a proper this Certified Mail receipt,please resent your endorsement on the mailpiece,you may request Certified Mail item at a Post Office for the following services: I postmarking.If you don't need a postmark on this -Return receipt service,which provides a record-- Certified Mail receipt,detach the barcoded portlort of delivery(including the recipient's signature). of this label,affix it to the mailplece,apply You can request a hardcopy return receipt or an, appropriate postage,and deposit the mailpiece. electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Retum ° Receipt;attach PS Form 3811 to your mailpiece; IMPORTANP Save this mcelpt for your records. Ps Form 3800,April 2016(Reverse)PSN 7530-02-000.9047 `s Marc J. & Susan I. Allain 47 Fox Hollow Lane Osterville,MA 02655 June 8, 2018 Board of Health Town of Barnstable 200 Main Street Hyannis, MA 02601 Re: Declaration of Authorization 47 Fox Hollow Lane, Osterville, MA 02655 Dear Members of the Board: Let it be known that We, Marc J. & Susan I. Allain(owners of 47 Fox Hollow Lane in Osterville, Massachusetts), do hereby authorize JC Engineering, Inc. of East Wareham, MA 02538 to represent our interest regarding the upgrade of the septic system located at 47 Fox Hollow Lane, Osterville, Massachusetts in meetings both public and private. Sincerely, Marc J. & Susan I. Allain TRANS. NO.: CITY/TOWN: Osterville APPLICANT: Marc J. & Susan I. Allain ADDRESS: 47 Fox Hollow Lane, Osterville,.MA 02655 DESIGN FLOW: 330 gpd REVIEWED BY: DATE: N/A OK NO GENERAL Legal boundaries denoted 310 CMR 15.220(4)(a)] X Street, Lot,tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u) X Locus Provided 310 CMR 15.2204(t) X Plan proper scale? (1"=40' for plot plans, I"= 20' or fewer for components) 310 CMR 15.220(4) X Easements shown 310 CMR 15.220(4)(b) X System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]- if not, a variance is required 310 CMR 15.412(4) X Location of impervious surfaces (driveways, parking areas etc.) [310 CMR 15.220(4)(d) X Location all buildings existing and proposed 310 CMR 15.220(4)(c) X Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] X System Calculations [310 CMR 15.220(4)(0] X daily flow X septic tank capacity (required andprovided) X soil absorption system (required andprovided) X whether system designed for garbage grinder X North arrow [310 CMR 15.220(4)(g)] X Existing and ro osed contours 310 CMR 15.220(4)(g)] X Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h)] X Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and (i)] X Location and date of percolation tests (performed at proper elevation?) 310 CMR 15.220(4)(i)] X Percolation test results match loading rate? 310 CMR 15.242] X Certification statement by Soil Evaluator [310 CMR 15.220(4)0)] X Observed and Adjusted groundwater (method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n) X Adress 47 Fox Hollow Lane, Osterville MA, 02655 Sheet I of 7 N/A OK NO Location of every water supply, public and private, [310 CMR 15.220(4)(k) X within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply X within 250 feet of the proposed system location in the case X within 150 feet of the proposed system location in the case of private water supply wells X Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. [310 CMR 15.220(4)(1)] X Water lines and other subsurface utilities located [310 CMR 15.220(4)(m) (if water line cross see 310 CMR 15.211(1) 1 ) X Profile of system showing invert elevations of all system components and the bottom of the SAS 310 CMR15.220(4)(o)] X Stamp of designer [310 CMR 15.220(1) and 310 CMR 15.220(2) X Stamp of Registered Land Surveyor(required if construction activities within 5 ft. of lot line) [310 CMR 15.220(3) X Test Holes adequate (two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2) or as approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] X Test hole adequate to demonstrate four feet of suitable material? 310 CMR 15.103(4) X Test Holes adequate to confirm adequate groundwater separation? 310 CMR 15.103(3)] X Benchmark within 50-75' of system 310 CMR 15.220(4)O X Materials specifications noted? [various sections of 310 CMR 15.000] X System components not> 36" deep (unless Local Upgrade Approval or LUA requested) 310 CMR 15.405(1(b)] X Adress 47 Fox Hollow Lane, Osterville MA, 02655 Sheet 2 of 7 N/A OK NO SEPTIC TANK Size OK? [310 CMR 15.223(1)] X Inlet tee located ten inches below flow line 310 CMR 15.227(6) X Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR 15.227(6)] X Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)] X Note regarding installation on stable compacted base [310 CMR 15.228(1)] t X Separation between inlet and outlet tees (no less than liquid depth) 310 CMR 15.227(2) X Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for upgrades under LUA [310 CMR 15.405(1)(k) X Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR 15.232(3)(f) X Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" (b 7/07) [310 CMR 15.228(2)] X Access to within 6 " of grade - one port for systems<I 000gpd, two for systems>1000 gpd 310 CMR 15.228(2)] X All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] X > 10 ft from building foundation 310 CMR 15.211(1) X Buoyancy calculation Required/Done 310 CMR 15.221(8) X H-20 Where appropriate? 310 CMR 15.226(3) X Setbacks from resources [310 CMR 15.211 X Multi-Compartment'Tanks Required when other than single-family dwelling or flow>1000 g d 310 CMR 15.223(1)(b) X First compartment 200% daily flow; Second compartment 100% daily flow 310 CMR 15.224(2) and (3) X "U" pipe through or over baffle, outlet of each compartment with gas baffle or approved filter [310 CMR 15.224(4)] X Adress 47 Fox Hollow Lane, Osterville MA, 02655 Sheet 3 of 7 N/A OK NO BUILDING SEWER AND OTHER PIPING3 � Located at least ten feet from any water line? [310 CMR 15.222(2)] X Disposal piping at least 18" below water line (when water and sewer cross, see 310 CMR 15.211(1)[1 ) X Cleanouts required/provided ? [310 CMR 15.222(8)] X Thrust blocks specified in force mains? 310 CMR 15.221(6)(c) X Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222(6)] X Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) 310 CMR 15.251(9) and 310 CMR 15.252(2)(c) X Siphon problem/(leachfield below pump chamber) X Endca s or vent manifoldspecified? X Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 CMR 15.252(2)(h)] X Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) X DISTRIBUTION BOX ; Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] X Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a) X Riser if deeper than 9" 310 CMR 15.232(3)(f)] X Inside minimum dimension 12" [310 CMR 15.232(2)(b) X Minimum sum 6" [310 CMR15.232(3)(e) X Watertight cover if<2000gpd); waterproof manhole if>2000gpd 310 CMR 15.232(3)(d) X PUMP CHAMBERS b ' Capacity (emergency storage above working=design flow)? [310 CMR 231(2)] X Proper setbacks 310 CMR 15.211 (same as septic tanks)] X Watertight 20-in minium access manhole at least 20" MUST BE TO GRADE [310 CMR 15.231(5)] X Service components accessible (not too deep with piping, disconnects accessible) X Alarm floats - alarm on circuit separate from pumps specified? X Exceeds two units must have two pumps operating in lead-lag mode. 310 CMR 15.231(6) and (8) X Stable Compacted Base 310 CMR 15.221(2)] X Buoyancy calculations needed ? Provided? [310 CMR 15.221(8)] X Adress 47 Fox Hollow Lane, Osterville MA, 02655 Sheet 4 of 7 N/A OK NO SOIL ABSORPTION SYSTEMS(SAS) GENERAL. °;s�: `i Calculations correct? X 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] X Required separation to groundwater? 310 CMR 15.212)] X Aggregatespecified as double washed [310 CMR 1.5.247(2)] X System Venting required/provided? (system under driveway or >36" deep) 310 CMR 15.241 X Inspection ports specified and within 3"final grade? [310 CMR 15.240(13)] X Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document] X GALLERIES,PITS CHAMBERS *310 CMRi15 253i' Chambers and Gal. in trench configuration supplied with inlet every 20 ft. 310 CMR 15.253(6)] X Each structure with one inspection manhole (if>2000 gpd must be to grade) [310 CMR 15.253(2)] X Aggregate I' minimum- 4' maximum. 310 CMR 15.253(1)(b) X 2' sidewall credit maximum 310 CMR 15.253(1)(a) X In bed configuration, inlet every 40 s . ft. 310 CMR 15.253(6)] X TRENCHES 310 CMR 15.251 Width 2'minimum 3' maximum [310 CMR 15.251(1)(b) X 100 feet- maximum length 310 CMR 15.251(1)(a) X Minimum separation 2x effective depth or width whichever greater Qx if reserve between trenches) 310 CMR 251(1)(d)] X Situated along contours 310 CMR 15.251(2) X Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] X BED SAS,(Maximum size of bed O_Ffield'5000.gpd) ,, ;- � ,$ _ _ ,} minimum 2 distribution lines [310 CMR 15.252(2)(a) X Maximum separation between lines 6' 310 CM R15.252(2)(d)] X Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e) X Aggregate depth below discharge pipes 6" minimum, 12" maximum. 310 CMR 15.252(2)(g)] X Separation between beds 10' minimum. 310 CMR 15.252(2)(0 X Bottom area used in calculations only 310 CMR 15.252 2 (i) X Adress 47 Fox Hollow Lane, Osterville MA, 02655 Sheet 5 of 7 i N/A OK NO DID- THE PLAN INVOLVE " � �� �;, h�� �y�44 Pressure Dosed System ? Provided pump and piping calculations as required 310 CMR 15.220(4)(r) X Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and UA Remedial Use A provals] X If used in gravelless system - make sure jet is directed as not to scour soil interface Guidance Document X Inspections once per year(systems<2000 gpd) or quarterly (>2000g d) good to note on plan [310 CMR 15.254(2)(d) X Construction in fill - Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)? X Impervious barrier and/or retaining wall ? Guidance Document] X Impervious barrier installation must be supervised by designer 310 CMR 15.255(2)(b)] X Retaining wall must be designed by Registered Professional Engineer 310 CMR 15.255(2)(a)] X Side slope not exceed 3:1 ? [310 CMR 15.255(2)] X Breakout requirements met? [310 CMR 15.252(2) and Guidance Document] X At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] X Gravelless System[UA Ap rovdl-Letters) NR Check DEP Approval letters for credits and design conditions X If used with pressure dosing do not allow pressure discharge to scour soil interface X Alternative Septic System[EA Approval Letters]' Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? X Is the technology being properly applied and does it meet all DEP Approval Conditions? X Is there a note on the plan regarding the requirement for perpetual maintenance agreement? X Any alarms involved on separate circuits X Did the applicant submit an operation and maintenance manual? X Has applicant submitted a copy of a maintenance X Ydrtances Are the variances listed on the plan ? [310 CMR 15.220 (4)( )] X RLS Stamp necessary on plan if a component is within five feet of property line 310 CMR 15.412(4) X New construction or increased flow proposed - [Refer to 310 CMR 15.414] X Adress 47 Fox Hollow Lane, Osterville MA, 02655 Sheet 6 of 7 I N/A OK NO Nitrogen Sensitive`Ar`easr " % v-,,, f .K �. Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR 15.216 - also refer to Policy regarding upgrades of such existing systems] X Is the system proposed on the same lot as served by private well ? [310 CMR 15.214(2)] X Are the nitrogen loads proposed in compliance? [310 CMR 15.216(l)] X Miscellaneous f , Pumping to septic tank ? 310 CMR 15.229] X Shared System [310 CMR 15.290] X Adress 47 Fox Hollow Lane, Osterville MA, 02655 Sheet 7 of 7 Town of Barnstable P# Department of Regulatory Services Public Health Division Date � Z• �z. 200 Main Street,HynnnIs MA 02601 KY, � �- Date Scheduled Time _ Fee Soil Sui ahi ty Assessment for Se e Disposal Ii} Performed lCn�A I im��� i T S� Witnesse P / J� d Ey: LOCATION&.GENERAL INFORMATION , Locadon Address Owner's Name MAP-C.�5U5A4A1 41_LAaW 'l {=)V, E-�LL0 eel C,�! J . O STL- _V t[,(f Address 4 7 r—O)e l'-�©c.Z©� �-A6 0$•T' l S 0 0(/ 0/ s Name T f n� E IS sGs-�� D Assessor's Map/Parcel:` � t�r © Engineer's Name �C NEW CONSTRUCTION REPAIR Telephone# -50? -7—••qq0 9 77. �� , O � A ' Land Use•__ J 1 S t Q t� G Slopes(96) ��� /� Surface Stones Distances firm: Open Water Body, ®e ft Possible'Wet•Area y'�� ft Drinking Water Well >'�G- ft Dmihage Way V ft Property Line ft Other tt SKETCH:(Street name,dimensions of lot,exact locations of test holes&pore tests,locate wetlands•tn proximity to holes) C A 1rz W �.n Parent material(geologic) �/� ' Plain • g Depth to 9adrook (� Depth to Groundwater. Standing Water in Hole: > i�5!o I �v S Weeping tYotn PI Pnoa ) a 6"' v Estimated Seasonal High Groundwater > / «h '� 8 v S NATION FOR SEASONALMIGH WATER TABLE Method Used: Depth Observed standing In obs,hole: I•a G In, Depth to soil mottles: Dellth to weeping from side of obs.hole: 1 0 ln, .Groundwater Adjustment A fY• Index Weil-# Reading Date: Index Well level Adj4actor, , Adj.Groundwater-1eval, PERCOLATION TEST UutaL� Observation f Hole# 4- Time at 9" Depth of Pero J Time At 6 J Start Pro-soak Time® + Time(9"41 See Pere -•e4 � a-11a3S,&AA A HndPro-aoak _�-- Rate Miu./Inch . Site Suitability Assessment: Sito Passed Site Failed: Additional Testing Needed(Y/N) .r V 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 Conselr vation Division at least one(1)week prior to beginning. , Q:ISEPTICU'ERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# Depth from Solt Horizon Soil Texture Sdil Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stoned;Boulders. or , tsistency.%t3rayell r , •("1 f DEEP OBSERVATION HOLE LOG Hole# Depth from Soll Horizon Soil Texture Soil Color Soil Other Surface(In.)'" (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onslatmov. Otgvell • rla1�' DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Conslitoncy. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. consistency, atilvell Flood Insurance Rate Map: Above 500 year flood boundary No Yes Z Within 500 year boundary No-7 Yes a' 'Within L00 year flood boundary No. Yes Depth of Naturally occurring Pervious Materlal Does at least four feet of naturally occurring pervious material exist in all areas observed thrpughout the area proposed for the soil absorption system? /Q If not,what is the depth of naturally occurring pervious material? . ?` r.: Certification R t d I certify that on I0:)1' /p � (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, _xVP s d experience described in 10 CMR 15.017. ' t// Signature Date • Q:1$BpTIC�PBRCPORM.DOC ' Ln .. • r- 'o . . cO Certified Mail Fee -r Extra Services&Fees(check box,add fee as appropriate) ❑Return Receipt(hanioopy) $ 9• Vj [:]Return Receipt(electronic) $ Q P031ark , l r�Certified Mall Restricted Delivery $ HAto p ❑Adu❑ NltSignatureRequired $ Adult Signature Restricted Delivery$ tr O 0 Postage — --- —--- a— r.q Total Postage and Ln $ ! ALLAIN, MARC`J & S111 N 1 r-qse�rro �� 47 FOX HOLLOW LN N s`'eere"dApt."° _ -OSTERVILLE, MA 02655 r. r r r rrr•r. Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate r Electronic verification of delivery or attempted return receipt for no additional fee,present this. delivery. USPS®-postmarked Certified Mail receipt to the s A record of delivery(including the recipient's retail associate. signature)that is retained by the Postal Service- Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,of to the addressee's authorized agent Important Reminders: Adult signature service,which requires the r You may purchase Certified Mall service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retail). or Priority MOO service. Adult signature restricted delivery service,which ■Certified Mail service is notavailable for requires the signee to be at least 21 years of age International mail'- and provides delivery to the addressee specified u Insurance coverage is notavaliable for purchase by name,or to the addressee's authorizei44 with Certified Mail service.However,the purchase (not available at retail). LA of Certified Mail service does not change the •To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a. certain Priority Mail items. USPS postmark.If you would like a postmark on ■For an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail Rem at a Post Office-for ! the following services: postmarking.if you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion of delivery(including the recipient's signature). of this label,affix It to the mailpiece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece.- electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Return Receipt attach PS Form 3811 to your mailpiece; IMPORTANT:Save this receipt for your records. Ps Form 3800,April 2015(Reverse)PSN 7530-02-000.9047 Ila ® Complete its ;and 3. Signa e ® Print your name address on the reverse X C �✓"�"v❑Agent so that L can;Zrn the card to you. ❑Addressee ® Attach this card to the back of the mailpiece, B eceived by(Printed N m C. Dat of elivve-ry or on the front if space permits. SV S�[R ,� `� �0 . Is elivery address different from item 1? ❑Yes l If YES,enter delivery address below: ❑No 4 At-LAIN, MARC J & SUSAN I � _=47 FOX HOLLOW LN STERVILLE, MA 02655 II��III�I III I�I I II II II I I I III II I II II I I�III III 3. Service Type ❑Priority Mail express® ❑Adult Signature ❑Registered Mal1TM ❑Adul!Signature Restricted Delivery ❑Registered Mail Restricted certified Mail® elivery j 9590 9402 1933 6123 1776 85 ❑Certified Mail Restricted Delivery Merchandise.Receipt for ❑Collect on Delivery ❑Collect on Delivery Restricted Delivery ❑Signature ConfirmatlonT Grtirle Ni imher?ransfer from SeN/Ce/abeQ all ❑Signature Confirmation 01 4 9 8 8 =2 7 5 t- ,I'I Restricted Delivery Restricted Delivery PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt USPS TRACKING# •f ^ '^-,r.,s '*' First-Class Mail Ik Postage&Fees Paid USPS i Permit No.G-10 9590 9402 1W%1�3 1776 85 United States •Sender:Please print your name,address,and ZIP+4®in this box• Postal Service Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 I I I � F fME Tp�, Town of Barnstable Barnstable Regulatory Services Department j iARN5rAHLL 9q, 1639. ,� Public Health Division �foMA�a 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4988 0275 April 30, 2018 ALLAIN, MARC J & SUSAN I 47 FOX HOLLOW LN OSTERVILLE, MA 02655 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 47 Fox Hollow Lane, Osterville, MA was inspected on 04/17/2018 by James D. Sears, 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: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1) year 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 omas McKean, R. ., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\47 Fox Hollow Lane Osterville.doc ii IME 11, Town of Barnstable BARN9TABLE. g Regulatory Services Department rfD MA'S A 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 REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged 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 ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments # � ` 47 Fox Hollow Lane 15 Property Address 4:'+ Marc Allain Owner Owner's Name ;Cry information is required for every osterville MA 02655 4-17-18 page. City/Town 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 A. General Information �S��t /a9lo8 filling out forms ��puunulpl��y on the computer, � H OF , use only the tab �``�ya��t Assq�x key to move your 1. Inspector: =�oa Cy cursor-do not James D.Sears ?S JAMES ;m use the return Name of Inspector SEARS key, Capewide Enterprises ' Company Name s, c?°RTiP�EQ o`` 153 Commercial Street /F 5 I N S?�G`\```�� Company Address n IIIt Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S1623 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 16.340 of Title 5(310 CMR 16.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 4-20.18 spector'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 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.00c rer.611S Tile 5 OfScial Inspection Form:Subsurfeee Sewage Disposal System-Pagel of 17- ,c V,5 bZ a5ed YU dH OZ:2 8 U ZZ JdV 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 47 Fox Hollow Lane Property Address Marc Allain Owner Owner's Name information is required for every Osterville MA 02655 4-17-18 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E 1 always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Failed system-Leaching. The system is a 1000 Gal. Tank D Box and four chambers. 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'inot 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.doc rev.5116 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Pape 2 of 17 52 a5ed xed dH 1,242 81,2 ZZ udV f Commonwealth of Massachusetts Title 5 Official Inspection Form C Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 47 Fox Hollow Lane Property Address Marc Allain Owner Owner's Name information is required for every Osterville MA 02655 4-17-18 page. Cityrrown State Zip Code Date of Inspection B. Certification (cant.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumpslalarms 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: ❑ 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 t.5ins.doc•rev.6lt6 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Fogs 3 of 17 gZ a6ed xed did 062 860Z ZZ JdV Commonwealth of Massachusetts Title 5 Official Inspection Form 1,1i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 47 Fox Hollow Lane Property Address Marc Allain Owner Owners Name information is required for every Osterville MA 02655 4-17-18 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, ❑ 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 INOMW is less than 6" below invert or available volume is less than '/z day flow4&4C#Iva t5ins.doc-rev.6115 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 �Z abed xed dH 02 81,0Z ZZ JdV Commonwealth of Massachusetts Title 5 Official Inspection Form d Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 47 Fox Hollow Lane Property Address Marc Allain Owner Owner's Name informatics is required for every Osterville MA 02656 4-17-18 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. t5im.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 5 of 17 8Z al5ed xeJ dH Z2:2 8602 ZZ Jd'd Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 47 Fox Hollow Lane v Property Address Marc Allain Owner Owner's Name information is required for every Osterville MA C2655 4-17-18 page. City/Town State Zip Corse 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 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)] 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 t5ns.eoc-rev.6116 Title 5 Offidal Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 6Z a5ed XeJ dH Z2:2 81.0Z ZZ JdV Commonwealth of Massachusetts Title 5 Official Inspection Form (/< Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 4V I s 47 Fox Hollow Lane Property Address Marc Allain Owner Owners Name information is required for every Osterville MA 02655 4-17-18 page. City/Town State Zip Code Date of Inspection D. System Information Description: 1000 Gal. Tank D Box and four chambers. 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage 2016-69,0000als g ( y g (gpd)) 2017-60,000GaI s Detail: Sump pump? ❑ Yes ® No Present Last date of occupancy: Date Commercialllndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seatsipersonslsq.ft., etc.), Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc-rev.W6 Title 5 Official Inepeelion Form:Subsurface Sewage Disposal System•Page 70117 0£ a5ed xez! dH H:2 860E ZZ udf Commonwealth of Massachusetts Title 5 Official Inspection Form IX Subsurface Sewage Disposal System Form-Not for Voluntary Assessments kV,- - .ok 47 Fox Hollow Lane Property Address Marc Allain Owner Owner's Name information is required for every Osterville MA 02655 4-17-18 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: NA 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): t5hs.doc•rev.BM6 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 6£ a5ed xed dH £2:62 960Z ZZ add <t� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 47 Fox Hollow Lane Property Address Marc Allain Owner Owner's Name information is required for every Osterville MA C2655 4-17-18 page. ChyrTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: NA Tank leaching 1997 permit #97-141. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: p 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 Septic Tank(locate on site plan): Depth below grade: feces 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 1000 Gala Precast H-10 Dimensions: 3" Sludge depth: 15ins.doc raw.6116 Title 5 Offidal Inspection Form Sut)surWA Sewage Disposal System-Page 9 of 17 Z£ a5ed xed dH bE:2 860Z ZZ Jdy Commonwealth of Massachusetts ui Title 5 Official Inspection Form ff Subsurface Sewage Disposal System Form -Not for Voluntary Assessments LS v 47 Fox Hollow Lane Property Address Marc Allain Owner Owner's Name information Is required for every Osterville MA 02655 4-17-18 page. Cityf"rown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 27" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Asbuilt•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 level. Note: Tank has been full to cover w14"solid's on top of inlet tee. Tank and cover's at 15" below grade. 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.doc-rev.6116 Title 5 Official Inspection Fxm:Subsurface Sewage Disposal System•Page 10 or 17 ££ a5ed xed dH 17 ::2 S MZ ZZ JdV Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 47 Fox Hollow Lane Property Address Marc Allain Owner Owner's Neme information is required for every Osterville MA 02655 4-17-18 page. Cityfrown 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.): i Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No I$ins doc-rev.6116 Title 5 Official tlspect*n Form:Subsurface Sewage Disposal System•Page 11 of 17 �£ a5ed xed dH tZ:2 21,0Z ZZ JdV Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 47 Fox Hollow Lane Property Address Marc Allain Owner Owner's Name information is required for every Osterville MA 02655 4-17-18 page. CitylTown State Zip Code Date of Inspection D. System Information (cont,) Distribution Box(if present must be opened) (locate on site plan): 2" 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.): H-10- D Box is 16"xl6"-3' below grade in stone drive. Box is over full and loaded w/solid's. 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.doc•rev.6116 Tile 5 Official Inspection Form:Subsurface Sewage Disposal System•Pape 12 of 17 qE a5ed xeJ dH t72:2 81.0Z ZZ JdV Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �v 47 Fox Hollow Lane Property Address Marc Allain Owner Owner's Name information is required for every Osterville MA 02655 4-17-18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number. ® leaching chambers number: 4 ❑ 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.): Leaching is four infiltrators w/4' stone. Chamber's are full and loaded w/solid carry over. Need to replace leaching 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 15ins.doc-rev,6116 Title 5 Of iclel Inspection Form.Subsurface Sewage Disposal system-Page 13 of 17 gE a5ed xed dH 92:2 81,0Z ZZ add Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 47 Fox Hollow Lane Property Address Marc Allain Owner Owner's Name information is required for every Osterville MA 02655 4-17-18 page. cityrrown 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.): 15ins.doc rev.6(16 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 L£ a5ed Y2J dH 2:2 860Z ZZ Jcf/ Commonwealth of Massachusetts Title 5 Official Inspection Form ` Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 47 Fox Hollow Lane Property Address Marc Alain Owr>er Owner's Name information is required for every Osterville MA 02655 4-17-18 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 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 15iis.doc•rev.6116 Title 5 Otficial Inspection Form Subsurlace Sewage Disposal System•Page 15 of 17 g£ a5ed xed dH 52:2 ME ZZ JdV OS-r'- q rRdto .7� n A l3R�t� F i 1 i 1 6£ a5ed X2J dH 2:2 Me ZZ JdV Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 47 Fox Hollow Lane `J Property Address Marc Allain owner Owners Name information is required for every Osterville MA 02655 4-17-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells 81 N° Estimated depth to igh ground water: 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 propertylobservation hole within 150 feet of SAS) ❑ Checked with local Board of HeaRh-explain: ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Abutting area 8' no G.W. proben seen. Before filing this Inspection Report,please see Report Completeness Checklist on next page. l5ins.doc-rev.&16 Title 5 official Inspedor Form:Subsurface Sewage Disposal System-Page 16 of 17 0 0,V a5ed xeJ dH 9Z:2 860E ZZ JdV y Commonwealth of Massachusetts ,, Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments L: 47 Fox Hollow Lane Property Address Marc Allain Owner Owners Name Information is required for every Osterville MA 02655 4-17-1 i3 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 I5ins.doc•rev.6116 Tide 5Ofdcial Inspection Form.Subsurface Sewage Disposal System Pape 17 of 17 6� a6ed xed dH 9Z:6Z 860E ZZ add TOWN OF BARNSTABLE LOCATION -7 , SEWAGE# IY4- W;AGE 091` fy' � ASSESSOR'S MAP& LOT l t�Q B Ih INSTALLER'S NAME&PHONE NO. Irv,c, SEPTIC TANK CAPACITY l.®oc-, 15 L:ACHING FACILITY: (type) �� �-i y �'u`?� (size) 9`�f NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: �� "a b'J COMPLIANCE DATE: 3 3 l 9"7 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by �., �. � , -/pis ty .. r.� -- .�� i �,. No. L / r-^ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for �Digogar *pftem eongtruction 3permit Application for a Permit to Construct( )Repair(Y)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 7 / f::i7-X tta 1'0W) osw rgdl Owner's Name,Address and Tel.No. Assessor's Map/Parcel ; , f S -PC �~ ' -f—�Al Instal is Name,Address and Tel.No. Designer's Name,Address and Tel.No. Type of Building: �1 Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 3 d gallons per day. Calculated daily flow -3 32) gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Fir c_-T ?— 1 60 o/Ql -- Type of S.A.S. r,'L7--K le 2.S Description of Soil Nature of Repairs or Alterations(Answer when applicable) CT�I� strew /SG T.�.�C ,t--?'�6L7-0 s✓f_y D 5�/7rf /'-/ �� .i a1.:.Q•-vim- 'I 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 F yironmental Code an not to place the system in operation until a Certifi- cate of Compliance has been iss f _ Signed Date Application Approved by Date e3 Application Disapproved for the following reasons l Permit No. -7 Date Issued No. / r Fee �y THE COMMONWEALTH OF MASSACHUSETTS entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF"BARNSTABLE., MASSACHUSETTS f 2pprication for Miopooar *potem.Congtruction Permit Application for a Permit to Construct( )Repair <Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. TiiqZC rto{ Qt.J CF3r ff Y/ Owner's Name,Address and Tel.No. ' Assessor's Map/Parcel'="f `�t S -oo6 6,O ��✓ `L6` ✓ Inst��s Name Adder,and T�e�. . 1 Designer's Name,Address and Tel.No. U Type of Building: DwellingNo.of Bedrooms Lot Size s .ft. Garbage Grinder 9 g ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures > Design Flow 3 d gallons per day.'fCalculated daily flow 3 3a gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank t "E-- 1000 glal ` Type of S.A.`S. -��`�`�`o"/ `d' 7 n (4 Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: j Agreement: f 1 The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system j in accordance with the provisions of Title 5 of thS,-nvironmental'Code jrnot to lace the system in operation until a Certifi- cate of Compliance has bee�,ue449y" of-Health Signed , Date Application Approved.by � Date 3 Application Disapproved for the following reasons 7. Permit No. / j Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS 'Certificate of Compliance THIS IS TO Cf'ERI , t t the On- ewage Disposal System Constructed( )Repaired (Upgraded( ) Abandoned( )by 2 4 r � o—e at '`� V*uX t�'M o►ti - D STD R-J t«�_ ha een constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. '' - dated -5 9 .2 Installer Designer The issuance of this permit gha-8 lot be�n7p, ed as a guarantee that the system wil)Z nc 6gp as designed. Date Inspectors No. / � '' SC�I —..------ --------------------Fee' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mwi5pogal *p5tem Con$truction Vermit Permission is hereby granted to Construct( )Repair( pgrade Abandon( ) System located at 7 Lc and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: 9 Approved by r 1iY NOTICE: This Form is to be used for the Repair of Failed Septic Systems Only CERTIFICATION OF SKETCH AND APPLICATION FORA DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLA�1 hereby certify that the application for disposal works construction permit signed by me dated 3 Z55 concerning the property located at LI7 J=o�, ���''J o&7— meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED: DATE: 3`C�J 77 LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. j:ccrt ✓o�� �.�. `' O d t r TOWN OF BARNSTABLE LOCATION 1'V t >I��-�� SEWAGE # VILLAGE OSj�'"`�� ��'�' ASSESSOR'S MAP & LOT N3�-br6 Olh INSTALLER'S NAME&PHONE NO. (��-- SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO:OF BEDROOMS BUILDER OR OWNER PERMITDATE: A -15 —COMPLIANCE DATE: 3 --3 L - 9 7 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by _.I fS I / ' TOWN OF F BARNSTABLE 1 4'5 I!DCAT10Ns U_SEWAGE II VILLAGE S rl1l1c11 OT — ASSESSOR'S MAP & L ������� / .� INSTALLER'S NAME & PHONE NO. d 6�8�,. M a SEPTIC TANK CAPACITY_���� 1 " LEACHING FACILITY:(type) (si7X)_ NO. OF BEDROOMS _PRIVATE WELL OR PUBLIC WATE Cho R �J �C• BUILDER OR OWNER DATE PERMIT ISSUED: // ? 7 DATE COMPLIANCE ISSUED: A? VARIANCE GRANTED: Yes No 6&tvF y Fic NJI .- dY L6 (�~�(� THE COMMONW ALTH OF MASSACHUSETTS _ BOAR® OF HEALTH . ..................OF.. J .75- ....................................... Appliration for Disposal Works Tonstrurtion Prrutit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal Sy tem at 1 _- ..... P.L v .- _F'_•••--•6NT��Z�f I(�L;� - ---------------..�-i••--•.-® .._-__---••--•---•--____...............-- - -Location-4ddress _ t No. ?' ►.......................................... ••.. ��? ► ... .. Yc ....1M: S.t��3�® ess .. ..................................... ..-... ............................... Installer Address Type of Building Size Lot_4Sy... -____Sq. t Dwelling—No. of Bedrooms....._- ___............................Expansion Attic ( Garbage Grinder Other—Type of Building No. of persons____________________________ Showers — Cafeteria a' Other fixtures __________________________________ w Design Flow............��_____________________gallons per person per day. Total daily flow--_3_ 0__.-__-_-_:_______._____gallons. WSeptic Tank—Liquid capacity_ allons Lengthb:::6.._-_ Width9-10__- Diameter-'.... Depth.5S_.. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area............_.......sq. ft. Seepage Pit No___________________ Diameter-------�........ Dept]i below inlet....�2-.......... Total leaching area._ ...sq. ft. Z Other Distribution box *5 Dosin tank ( P '-' Percolation Test Results Performed by.. ............ Date_._._�_.�__1s,_:!M......... Test Pit No. 1... ._..minutes per inch Depth of Test Pit-_-:� ._____._.. Depth to ground water__ CQUh.4 C Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -----------------------------------•-----------------------•---•••••--•--.... ..- --•-- ........................................................ O Description of Soil..... ,D-------------------------------•------------ x U w UNature 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 iITLL, 5 of the State Sanitary Code—The undersign further agrees not to place the system in operation until a Certificate of Compliance has issued th �oaardre t ° 4SAnd.. g OP ................... Application Approved B ...........................••-- ..... !PP PP Y D Application Disapproved for the following reasons:____•-________•_____________________•____-_-_______--__---____...______________•-__-______..-_____._...___._.._ ,��((���]_7 Dater Permit No...'�1...!.. ..... Issued............. - a d? ' 07 0 No. .. _.... [/ Z GT _ Fss... �[ ... C� 1 t:7 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..0 �. ...... OF.. > � t�IS. :��......................................._ Appliratiun for Disposal Works Tonotrn.riion Vitrmit Application is hereby made for a Permit to Construct (X,) or Repair ( ) an Individual Sewage Disposal �Sygtein at: _ ......................................................... N•- CLocation-Address Lot o. A Ad ress ---....... WP .� _�.�1 F4i`�Cl -... �`' S iZ3 kA�.�... '..1. .........--•................... E- T ....... ......... . ._.... Installer Address U Type of Building Size Lot.45_1. ....Sq. eet VoDwelling—No. of Bedrooms......... ...............................Expansion Attic ($(b Garbage Grinder `4 Other—Type T e of Building ............. No. of ersons..........._.............._ Showers — Cafeteria a YP g ---------•---• P - ( ) ( ) a Other fixt es ---•••-••---•------------•--•-•• • . Design Flow...........`� ........... ...........gallons per person per day. Total daily flow.....5.130.........................gallons. W .....r .,.. ,.. r" WSeptic Tank—Liquid capacity.ti...__.gallons Length'�._._. Width :-.',�.!.._ Diameter________________ Depth.:�:-.�j.__. W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter.......g........ Depth below inlet....6........... Total leaching area.Z,00...sq. ft. Z Other Distribution box Dosin tank(� (f�►Q _ _ 1-4 Percolation Test Rests.. Performed by. f _ .1 _..� v .�. --............. Date.... .. ......... ►•a ,.a Test Pit No. L......... ....minutes per inch Depth of Test Pit....�.__La.......... Depth to ground water- _ C)�,�CAuo Wit) (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ----• # --------------------••---...........-- •--.._.........••--• ------------------------....................-------- O Description of Soil..... .^:2-.(_Z?'�vN.9. �? SC7!.C.. -"'� _C-a- I _ �M�, ..................................... W --------------------------------------------------------------------------------------------------------------------------------------------------------------••-•-------- --------- W --------••-•--------••-••--•-•---•--•-•-----••-----•----•----•----••---•----•--------•-----•-•------------••-•--•------•--...---•------------------------------------------------------••..-- UNature 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 TITL% 5 of the State Sanitary Code—The undersignyj further agrees not to place the system in operation until a Certificate of Compliance has e n issued th oa d h ` , ned.. ... -- ----------- ....... -- -• -- •--------•------•--•--- r�s Application Approved By----- •- 0-------—)..- .................................. -•--�� �_ 1- -------------- Da e Application Disapproved for the following reasons:----•------------------•--------.........--------------•------------------------------------•-•----......_••.... -----------------•--•------•••--••-•-...............----•-•....•-------------•-.......••-•••----•...------------•......-----------------------------•---•----•-•-------••----•--•••......•--•--•-••--. Issued....................... Permit No._ '. 7A� ---^ Date Date THE COMMONWEALTH OF MASSACHUSETTS �( BOARD OF HEALTH � ......... t�•4,/1��•��............OF....... �. J••y.• �'°f - �. ....... Trr#ifiratr of Tompfia'tirr THIS IS TO CERTIFY, That the In(3,vidual Sewage Disposal System constructed�) or Repaired ( ) by------ ...... r 9 1� � -----------------------•-------------........----•----...-r--•-- ................................... In'sta�llerr at---------------- 1 -�0 . 00 --••>'✓f'r'fJ 61 _--V� has been installed in accordance with the provisions of T 1,t; 5 ' TheState Sanitary Code s scribed in the application for Disposal Works Construction Permit No.. 7.-._ - ...... dated.... ---ZLC ...7 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................ :-..�!..`.. ................................ Inspector------•-•••-••-• 0--•----•-•-•------------------------••----•---. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF- HEALTH -� r .✓". .........OF... .11`.!." ?t.-, -?l_ �1 ........................ FEE. 7 / Nob..�.... �� .......... Disposal Works Tonstrurtion Prrmit Permission is hereby granted_.B ...6XCAP—:'-J. 6.......................................................................... to Construct ) or Re-air ( ) an Individual Sewage isp�o�/S�ystem,.�,'„ at No.---•............. �� al O.LL 1�-•-d-�l�sc e�i��f�.a��G�l. .�L as shown on the pplicatio for Disposal Works Constructio er it N ----- ',? ................ ... ......-•..--- =••- ........ ------..--•- B U DATE-- ----- ........ ....................................... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS - LOCATION Lot 1-0 Fox Hollow Lane NO., - -� VILLAGE _ Osterville DATE APPLICANT Roberts Realty Trust- FEE 35 ADDRESS P .O. Box 954 Duxbury, MA TELEPHONE NO. (No refundable ENGINEER Baxter & Nye, Inc. -Peter Sullivan TELEPHONE N0. 428-5131 DATE SCHEDULED IS' - 0- gS �',�0 A-M (Applicant' s signature SOIL -LOG .. , SUB-DIVISION NAME F x=1I0,c,46, ► t�s��ftd9x DATE 6-4 5- - `5 TIME g /41 EXPANSION AREA: YES v NO ty 0— -,P, J1jAkjvo,A/ ENGINEER N` TOWN WATER 4--e PRIVATE WELL ® L.o PcJ BOARD OF HEALTH • .r^(�,e per, EXCAVATOR SKETCH: .(Street name, etc. ,dimensions of lot, exact location of test holes and �J`percolation tests, locate we'tlands . in proximity to test holes) NOTES: r—max i "A Ae-tok 3 PERCOLATION RATE: L2V A L VO,PIZ—(L-I vADGbA TEST HOLE NO: �k ' ELEVATION: TEST HOLE NO: ELEVATION: 1 Lo, ,vv,_ ��as4 L c_.. 1 2 2 3 3 • 4 4 6 6 7 7 8 9 9 10 .10 12 12 13 13 14 ., �� _ 14 15 � L 15 16 16 7-� SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELDZ__LEACHING PITS • LEACHING TRENCHES UNSUITABLE FOR SUBSURFACE SEWAGE. REASONS :- NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION ORIGINAL: COMPLETED IN ENTIRETY BY P . E. AND RETURNED TO BOARD OF HEALTH COPY: RETAINED' BY ,APPLICANT w SHE 7.0� DEQE File No. SE 3-157.1 _ t0 ('to be provided by DEQ'1-.! r __ _�+ --��--- r I l.-� Commonwealth Oit /Town:Barnstable __� 1., i EAB-Y9TIHLL. r )' of Massachusetts 9 ��� •��-s Roberts Realty �� � -� �p�:639•�v0� Applicant Order of Conditions MASSACHUSETTS WETLANDS PROTECTION ACT G.L. c. 131, § 40 -TOWN OF BARNSTABLE WETLANDS PROTECTION BY-LAW, Ch. 3, Article XXVII FROM: BARNSTABLE CONSERVATION COMMISSION To Roberts Realty Robert Burpee & Robert Cunningham (Name of Applicant) (Name of property owner) P.O. Box 954 P.O. Box 954 Address Duxbury, MA 02332 Address pUxh11rV,, mA 09312 This Order is issued and delivered as follows: by hand delivery to applicant or representative on (date) XX by certified mail, return receipt requested on March 23, 1987 (date) This project is located at Lot #10 Fox Hollow Lane, Osterville Barnstable Assessor's Map # 145 Lot 6-10 The property is recorded at the Registry of Deeds in Barnstable Book 3454 Page 264 Notice of Intent dated Jan. 20, 1987 Date of Hearing March 3, 1987 This Order is issued on March 23, 1987 Findings The Barnstable Conservation Commission has reviewed the above-referenced Notice of Intent and plans and has held a public hearing on the project. Based on the information available to the Barnstable Conservation Com- mission at this time, the Barnstable Conservation Commission has determined that the area on which the proposed work is to be done is significant to the following interests in accordance with the Presumptions of Significo�nce set forth in the regulations for each Area Subject to Protection Under the Act. (check as A : RTICLE 2ONLY Pubc water supply Storm damage prevention X Erosion Control L Private water supply Prevention of pollution «'ildlife Y Ground water supply ❑ Land containing shellfish Recreational Flood control = Fisheries Aesthetic Therefore, the Barnstable Conservation Committee hereby finds that the following conditions are necessary, un accordance with the Performance Standards set forth in the regulations, to protect those interests checked abo\,e. The Barnstable Conservation Committee orders that all work shall be performed in accordance with said conditions and with the Notice of Intent referenced above. To the extent that the following conditions modify or differ from the plans, specifications or other proposals submitted with the Notice of Intent, the conditions shall control. GENERAL CONDITIONS 1. Failure to comply with all conditions stated herein,and with all related statutes and other regulatory measures, shall be deemed cause to revoke or modify this Order. 2. This Order does not grant any property rights or any exclusive privileges; it does not authorize any injury to private property or invasion of private rights. 3. This Order does not relieve the permittee or any other person of the necessity of complying with all other applicable federal, state or local statutes, ordinances, by-laws or regulations. 4. The work authorized hereunder shall be completed within three years from the date of this Order unless either of the following apply: (a) the work is a maintenance dredging project as provided for in the Act; or (b) the time for completion has been extended to a specified date more than three years, but less than five years,from the date of issuance and both that date and the special circumstances warranting the extended time period are set forth in this Order. 5. This Order may be extended by the issuing authority for one or more periods of up to three years each upon application to the issuing authority at least 30 days prior to the expiration date of the Order. 6. Any fill used in connection with this project shall be clean fill, containing no trash, refuse, rubbish or debris, including but not limited to lumber,bricks,plaster,wire,lath,paper,cardboard,pipe, tires, ashes,refrigerators, motor vehicles or parts of any of the foregoing. 7. No work shall be undertaken until all administrative appeal periods from this Order have elapsed or, if such an appeal has been filed, until all proceedings before the Department have been completed. 8. No work shall be undertaken until the Final Order has been recorded in the Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title of the affected property. In the case of recorded land, the Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land upon which the proposed work is to be done. In the case of registered land, the Final Order shall also be noted on the Land Court Certificate of Title of the owner of the land upon which the proposed work is to be done. The recording information shall be submitted to the Barnstable Conservation Co on the form at the end of this Order prior to commencement of the work. 9. A sign shall be displayed at the site not less than two square feet or more than three square feet in size bear- ing the words, "Massachusetts Department of Environmental (duality Engineering. 1 Lc: - iaa v�.• ' 10. Where the Department of Environmental Quahty Engineering is requested to make a determination and to issue a Superseding Order, the Conservation Commission shall be a party to all agency proceedings and heal•- ings before the Department. 11. Immediately following completion, the project shall be certified to be as per these conditions and plans, in writing, to the Barnstable Conservation Commission by the project engineer who shall be registered in the state of Mass. engineer the applicant shall forthwith request, in writinry 12. Upon certification by the project pp � q �, that a Certificate of Compliance be issued statuig that the work has been satisfactorily completed. 13. Prior to any work being done at the site, all legal advertising bills incurred by the petitioner in relation to the Wetlands Hearing held on this project shall be paid. 14. This Order is issued under Article XXVII of the Town of Barnstable Bv-La,=.s as well as under ilIass. G.L. Ch. 131, sec. 40. The Barnstable Conservation Comrrdssion or Conservation Officer shall be notified no more than two weeks nor less than two days prior to the commencement of work, and have the authority to issue an Enforcement.Order if the terms or intent of this Order are not complied with. 15. It is the applicant's responsibility to provide all contractors with a copy of this Order and to ensure that ail workers are informed of the conditions of this Order before they begin work at the site. r 16. The work shall conform to the following plans and special conditions: PLANS: Title Dated Signed and Stamped by: On File with: Rev. March 4, 1987 Commission Certified Plot Plan Dec. 29, 1986 Peter Sullivan, P.E. Barnstable Conservation Special Conditions (Use additional paper if necessary) 1. All areas disturbed during construction shall be revegetated immediately following completion of work at the site. No areas shall be left unvegetated or unmulched for more than 60 days. 2. This approval is contingent upon approval by the Board of Health of the subsurface sewage disposal system. 3. Dry wells shall be installed to handle roof runoff. 4. The driveway shall be constructed of pervious material. 5. The work limit shall be established as shown on the approved plan. Staked hay bales shall be set at the work limit prior to the start of work at the site and maintained throughout construction. 6. A 10' X 10' deck may be constructed to the side of the house. 7. All wooden portions of the deck shall be CCA-treated or the equivalent. No creosote-treated material may be used. 8. Where possible, trees of significant size (6" diameter or greater) shall be preserved. 9. Approval shall be contingent upon receipt of a revised plan indicating the footprint of the approved deck. 10. There shall be no disturbance beyond the work limit line, including the cutting of trees and clearing of brush without prior approval of the Conservation Comrlission. Particular care shall be taken in the removal of trees at the house site so as to prevent tree-fall damage beyond the established work limit. 11. Any existing encroachment of the work limit line established for Lot -10 under SE 3-1291 shall be addressed under the present Order of Conditions (Leave Space Blank) Special Conditions (Continued) : 11. according to the following protocol: A. The fill (including soil and bark mulch) east of the wetland shall be removed -in its entirety and the area replanted. B. All areas filled within 35' of the edge of wetlands shall be planted and diligently maintained in indigenous shrubbery (planted 4' on center) and woody groundcover (i.e. , bittersweet, Virginia creeper, etc. ) . C. The area beyond the foregoing buffer strip shall be planted and maintainea in appropriate groundcover. 12. Any fill removed in construction of the driveway shall be placed beyond Conservation -Commission jurisdiction. Barnstable Issued By Conservation Commission Signature(s) w qw 5,—1�, a, — - C 61 Thi Order must be signed by a majority Xthe Conservation Commission. On-this 23rd day of March 19 87 before me personally appeared Mark Robinson _ to me known to be the person described in and who executed the foregoing instrument and acknowledged that he/she executed the same as hi er ee act and deed. November 28, 1991 4tary lic My commission expires The applicant,the owner,any person aggrieved by this Order,any owner of land abutting the land upon which the proposed work is to be done or any ten residents of the city or town in which such land is located are hereby notified of their right to request the Department of Environmental Quality Engineering to issue a Superseding Order, providing the request is made by certified mail or hand delivery to the Department within ten days from the date of issuance of this Order. A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and the applicant. ------------------ -------.......—......................._............................................................................................................................................... Detach on Dotted Line and Submit to the Issuer of this Order Prior to Commencement of Work. To Barnstable Conservation Commission (Issuing Authority) PLEASE BE ADVISED THAT THE ORDER OF CONDITIONS FOR THE PROJECT AT FILE NUMBER HAS BEEN RECORDED AT THE REGISTRY OF ON (DATE) If recorded land, the instrument number which identifies this transaction is If registered land, the document number which identifies this transaction is Signed Applicant ! _., - �: 11 3o za 17 - U-nuTY t SSM t�:rT - : . :. _ •�'_ � - .II, �. `mod 19.i ,�� � 1 :g T t _ 19 46, I O25F ID b� 17E_S1GN .:TA s t tJ��Fit t-Y 3 �3= �Z-cx�Nt bAl Y PLOW. 33 G pD -�- 5E'PTIG. 33OX It5o 4-95 V 51= I Oo0 lsi -rA N 41L {47 LOd t� o F_i cR M'S PO S&L. 'PIT USE ( I 10=64,4 L,, a1 51=e WAU-APEA= 150►1 51 F. ! A AAA c' 3-7-7 G►V, 1�, \\ Tp�F : 35P T07A1.- -'S l6t`I= 4 Z-7 GF.D• TOTAL- 'mil\-Y GRP, � 3 •� �87 'P OLA-rin N .{:ZATt N OP. 1-X---SS -"i SST p4:235 M t'aL FgA44 e-emm -To I~G L rcv.1 . l NV I N V ,L, I ttY y z 9'o 4V1T 3d t „ 1 jQV, l tJv. `Ta N K P-1l0? RAW TO MLT NZb �cr� ' 1l1 L-� l-�x�4T IC7N O I LLE 98_ w 9, 196+ -t GI✓tzT11PY TOAT 744fr' kAOuSE ;9-Oyq►U t� XTER N YE r t�JC. W 1714 T'NE -Sl P a L-j tJ E REG z.�A I..Al1 b Rvr=1(D .S i A f-Un,i' #K rz-sau .e t�IC-N-'S'dF THE OS-1"t=TzV i LLJc-v M�55, ow}-s d.F ��b t S IJcr1, A-PT�Grp►t�T'V-DZ142't5 .--r Y -MOST 1 OG�h►' t� vjl-r *l N THE? #L-coU P Ai t J I s Nc rr a tJ .tom I tJ S-T C;,- -- U M i`1-T }-vvtEF� �T 4G o�TT5 5{-lbw N � v'S o . J ii `ti H ,at�r_....Ma FINISH GRADE OVER D-BOX= 36.8�± PROP. VENT WITH CHARCOAL FILTER TO ABOVE GRADE T.O.F. EL.- 37.6 ± FINISH GRADE OVER CHAMBERS= 36.5' - 37.0' GENERAL NOTE SLOPE 2% MIN. OVER SYSTEM 3/4"TO 1-1/2" DOUBLE WASHED f PROVIDE EXTENSION RISER H-20 RISER WITH WATERTIGHT °O STONE TO CROWN OF PIPE H-20 CONIC. RISER WITH WATERTIGHT 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION WITH COVER OVER INLET& FRAME AND COVER TO GRADE OUTLET TO WITHIN 6"OF F.G. CAST IRON FRAME AND COVER TO INSPECTION PORT WI1 H ACCESS METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL OU FINISH GRADE GRADE OVER ALL PIPED CHAMBERS BOX TO F.G. (SEE NOTE 21) 2" OF 1/8" TO 1/2" DOUBLE WASHED CODE AND ANY APPLICABLE LOCAL RULES. @ FND. EL.= 37.0'± F.G. OVER TANK EL. = 36.0�± 5" DIA. OUTLET(S) STONE OR GEOTEXTILE FILTER FABRIC -__-_ 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE [�4" SCHEDULE 40 PVC } DESIGN ENGINEER. PROPOSED 4" 9;; MIN. 1 MIN SLOPE 1% I TOP OF SAS= 34.00� -� SCH. 40 PVC 36 MAX.N. 33.00' 39" MIN.MAX 3. 4" SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL BREAKOUT EL = 33.50, SYSTEM UNLESS OTHERWISE NOTED. 6" 3„ 3 3" DROP MAX 9„ SEWER PIPE L-4O�F 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 2" DROP MIN MIN.SLOPE@ 1% PROVIDE WATERTIGHT o 0 o ELEVATION = 33.50' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 13" 4' PVC IN FROM JOINTS TYP. �Cp O p 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF 14" ''' SEPTIC TANK 4" PVC OUT TO 0 0 0 0 0 0 0 0 o THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. I LEACHING FACILITY o CD 5. SLOPE ALL SOLID PIPE AT 1.0%MINIMUM. CONTRACTOR TO PROVIDE f0-, \\ o00 o o SPECIFIED DROP BETWEEN INLET AND OUTLET CONTRACTOR CONTRACTOR SHALL , 12 6' , oo °° 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. OUTLET TEE 33.35 MIN. 33.1$ 2 o 0 0 o 0 SHALL VERIFY SIZE 48' VERIFY CONDITION OF o0 00 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION F AND EXISTING TEE AS GAS BAFFLE 6" CRUSHED STONE o 0 CD oo FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SE OVER MECHANICALLY oo NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE �) � � � j � 4.G' � � � � AND DESIGN ENGINEER. 4.0 8.5' (TYP) - I � I 4.0' 4.0' 3 OUTLET DISTRIBUTION BOX (n,P') 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. BENCHMARK ELEVATION OF 35.00, TO BE INSTALLED ON A LEVEL STABLE 25.0' ESTABLISHED ON A NAIL IN A PINE TREE AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET 31 .00' GROUND WATER ELEV.= < 26.00' 12 83 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION PIPES TO BE LAID LEVEL. THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK 2 - 500 GALLON CHAMBERS 5' MIN. CHAMBI_. END VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES CROSS SECTION VIEW PROF TYPICAL CHAMBER PROFILE {_{ �- n TO THE DESIGN ENGINEER. RO H-20 D i� it i j JX DETAIL H-20 C H l ` DETAILS 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONIC. STRUCTURES SHALL BE MADE WATERTIGHT. NOT TO SCALE NOT TO SCALE NOT TO SCALE -- -- -- -�"-- - - _ - _ 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING ,d � r� I , TEST PIT DATA I REGULATIONS, OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM NOTES: ' �OC�O /CO 7`'_- _ �, '" P '' 15664 APPROPRIATE AUTHORITY. PERC NO. 1. MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF I \'�!r I �' ' " INSPECTOR: Donald Desmarais 12, ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED Fill r4p. O�4 tA_ rr !Q !u '• ! UNDER MORE THAN 3 FEET OF COVER OR LOCATED UNDER PAVEMENT, DRIVES, OR EACH SEPTIC SYSTEM COMPONENT. �tiT/ Itzi yvL r!} EVALUATOR: Michael Pimentel, EIT TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING. 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF C UT NF / C-S.E. APPROVAL DATE: Oct. 1999 WITH TEST ) �\.� i t • • May 9 2018 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. THE PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY W DATE: Y PIT DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL C�S, TELFLI"n"Ir- - * :� " 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE 4Of ' ' ti .'' tj�" TEST PIT#: 1 - -- -" --- . ' ''.•„ ' MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY, BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. .�� _E •t r n b 0Y _';; ! ! •�' ELEV TOP= 36.50' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, 3.) PORTION OF PROPERTY IS LOCATED WITHIN A DEP APPROVED ZONE 11, �� �-ELECTRIC t trr r ' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). r- tt 1/ t ! ELEV WATER= < 26.00' THE GROUNDWATER PROTECTION OVERLAY DISTRICT AND THE 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN ESTUARINE WATERSHEDS. \ � i� PERC RATE - <2 min./inch' f - SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. p Q ZONE ' 2 :�` ' A g( DEPTH OF PERC= 16. PROPOSED PROJECT IS LOCATED WITHIN: S6 501 S N = "� :` ASSESSOR'S MAP 145 LOT 10 6>80 SF M TEXTURAL CLASS: 1 - ��J Y m4� F 3r• •� OWNER OF RECORD. MARC J. & SUSAN 1. ALLAIN O �� 0 \ • • O m .,�. 0" 36.50' Z P'� LOCUS �� ADDRESS: 47 FOX HOLLOW LANE p Q `, + •+� OSTERVILLE, MA 02655 °' `'� o a , � \'� ) . • Fill p • `sue % //� i;; 8" 35.83' FEMA FLOOD ZONE X \ �,�, , �•. COMMUNITY PANEL# 25001C0544J 1 j .4' ti• '�� '` �k we 17. DEED REFERENCE: DEED BOOK 21473, PAGE 331 N` ,.� �f �. �� I • • 18. PLAN REFERENCE: PLAN BOOK 392, PAGE 78 MAP 145 ,I . ti ranberry ! it Benchmark f. � Q,, 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. LOT 9 Nail in Pine Tree ) Bogs ! X Elev. =35.00' r J;] 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY r` FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY Approx. M.S.L. �� �� �.. / �• Medium Sand c,Iu PROPOSED 4" PVC VEN'? / OG 'Qo '- �► - - _- �` r' j C 2.5Y 6/6 FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. PIPE; EXACT LOCATION / i w ��. S2 7, • ' f/ �; _ O PER OWNERSO h ` -- -. _�%' t '"` 21. A 4" PERFORATED SCH. 40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A ~ z `. DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A �� REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. w Ga j / j •r �/ 22. THE FOLLOWING VARIANCE TO THE LOCAL BOARD OF HEALTH REGULATIONS IS REQUESTED: o �� / / �� /'' LOCUS PLAN ISOLATED VEGETATIVE OWETLANDS OR THE SETBACK FROM THE LEACHING FACILITY TO THE MAP 145 1 �� LOT 38 j' . �`�' ��' SCALE: 1"= 1000' j >` �� / 126 26.00 No Mottling, Standing or Weeping Observed k PROPOSED INSPECTION PORT LEGEND p r,�� w � ' � _ _ _ _ -�.__ ._•______._ . � 'Perc Rate per Perc No. 4235, dated TP /^ z _ 5-15-1985 on file with the Barnstable '�`'�•--� ,,.. ,�,� ���� � •- .� � / 50x0' EXISTING SPOT GRADE PROPOSED 2 -500 GALLON • pRQX H-20 LEACHING CHAMBERS k 73.7 `�E1,'V `~ ' 4 RIFPi-��C E �"J1 I NUMBER OF BEDROOMS (DESIGN} 3 Board of Health ____. r - - - EXISTING CONTOUR WITH AGGREGATE DESIGN FLOW 110 GAUDAY/BEDROOM r� PROPOSED CONTOUR PROPOSED H-20 TOTAL DESIGN FLOW 330 GAUDAY TEST F" 'T DATA 501PROPOSED SPOT GRADE L.!� V " -LIIVF ;Tyne DISTRIBUTION BOX- 3: / J r DESIGN FLOW x 200 % = 660 GAUDAY PERC NO. 15664 SIGHT POLE--A / EXISTING UNDERGROUND CABLE GARAGE % �© ,��' USE EXISTING 1,000 GALLON SEPTIC TANK INSPECTOR: Donald Desmarais SLAB= 37.2' 3� / ROPOSED EVALUATOR: Michael Pimentel, EIT EXISTING UNDERGROUND ELECTRIC ELECTRIC < HAYBALE LINE METER 0.9' C.S.E. APPROVAL DATE: Oct. 1999 TOF = 37.6' `z __ DATE: May 9, 2018 EXISTING WATER LINE i FFE= 38.4" o ' SWING-TIES SCALE: 1"=20' INSTALL 2 - 500 GAL. CHAMBERS w/ AGGREGATE TEST PIT#: 2 0 - ' N ` % TEST PIT LOCATION #47 rBUSH DESCRIPTION HC-1 HC-2 SIDEWALL CAPACITY ELEV TOP= 36.50' ! <26.00' EXISTING 1 000 GALLON SEPTIC TANK EXISTING � / (NP) � (LENGTH + WIDTH) (2 SIDES) (2 HIGH) (0.74 GPD/S.F.) = GAUDAY ELEV WATER= , 3-BEDROOM N \ / ` 0 5 CORNER OF STONE (1) 15.5 27.1 , DWELLING v �5� 1g62 (25.0 + 12.83) ( 2 ) ( 2 ) ( 0.74 GPD/S.F.) = 112.0 GAUDAY PERC RATE _ ` ` 3 CORNER OF STONE (2) 28.3' 35.T - - - - PROPOSED 4" SOLID SCHEDULE 40 PVC PIPE DEPTH OF PERC= \ CORNER OF STONE (3) 37.4' 27.6' BOTTOM CAPACITY PROPOSED H-20 DISTRIBUTION BOX i (LENGTH x WIDTH) (0.74 GPD/S.F.) = GAUDAY TEXTURAL CLASS: 1 MAP 145 �, MAP 145 `� J \ \ CORNER OF STONE (4) 29.0' 14.9' (25.0' x 12.83') (0.74 GPD/S.F.) = 237.4 GAUDAY PROPOSED 500 GALLON H-20 LEACHING CHAMBER LOT 39 � � _ , o I 0 LOT 10 LP 45,402 ± S.F. "� TOTALS: o" 36.50' 0 R` TOTAL NUMBER OF CHAMBERS 2 Fill REV. DATE BY APP'D. DESCRIPTION 12o Aa 5g TOTAL LEACHING AREA 472.2 SQ.FT. 8„ 35 83' PROPOSED SEPTIC SYSTEM UPGRADE S 0� TOTAL LEACHING CAPACITY 349.4 GAL./DAY �62 PREPARED FOR: MAP 144 MARC J. & SUSAN I. ALLAIN LOT 9 j P 3) 0 25 p`- � LOCATED AT t (2 73.7' TO WETLAN ° 4> 47 FOX HOLLOW LANE ° C Medium Sand OSTERVILLE, MA 02655 2.5Y 6/6 SCALE: 1 INCH = 20 FT. DATE: JUNE 12, 2018 �$6 1) 0 10 20 40 80 FEET N �tN OF �S`rq � c HC-T-� rn r° JOHN L ,n PREPARED BY: � N ~ ' HC-2� ` - RESERVED FOR BOARD OF HEALTH USE o CNUR CIVIL JR. `"; JC ENGINEERING, INC. CIVIL �' SLAB N 41807 2854 CRANBERRY HIGHWAY LP 126" 26.00, r EAST WAREHAM, MA 02538 SITE PLAN w __ FULL 508.273.0377 m BA��"n�rtrT No Mottling, Standing or Weeping Observed SCALE: 1"=20' Drawn By: SJI Designed By:SJI Checked By: MCP JOB No.4164