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HomeMy WebLinkAbout0066 FOX HOLLOW LANE - Health 66 Fox HollowLane Osterville F/R A. J 45 =006011 , c.. a ...a - - -. - ..�-:. -.. :•+ __ _., ._ -.. .: -6 �-.. -,_ -. V G Q W st Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments iV M 66 Fox Hollw Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Osterville s MA 02655 5-14-10' 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. A. General Information �0 3 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 City/Town State Zip Code 508-495-0905 S13971 Telephone Number License Number B. Certification 1. I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evalu on by the Local Approving Authority 5-16-10 Inspector'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 is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner.shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner, and copies sent to the buyer; if,applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. I� t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 t Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary'Assessments 66 Fox Hollw Rd Property Address Bank Owned (Contact David.Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Osterville MA 02655 5-14-10 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: I - ® 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: System is in good working order with no sign of failure. 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. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined,"please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of`Health. t vA 3d * 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. ND Explain: ❑ 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 ❑ obstruction is removed t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 i Commonwealth of Massachusetts '. Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 66 Fox Hollw Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is Osterville MA 02655 5-14-10 required for every - page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced = ,.w. ;• ; ND Explain: ❑ 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 ❑ obstruction is removed ;. . ►. . ND Explain: - t 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. A 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 mannerwhich 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 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 aseptic tar k'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. t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal.System•Page 3 of 15 "s .k Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 66 Fox Hollw Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Osterville MA 02655 5-14-10 page. City/Town State Zip Code Date of Inspection B. Certification (cone.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 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: v You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ . ® Liquid depth in cesspool is less than 6° below invert or available volume is less than '/z day flow . _;• Required pumping more than 4.times in the last year NOT due to clogged or ❑ ® obstructed pipe(s). Number of times pumped:, ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ®• Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. t5insp official document•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 r Commonwealth of Massachusetts Title 5 Official .Inspection Form Subsurface Sewage Disposal System Form -Not for.Voluntary Assessments M 66 Fox Hollw Rd Property Address Bank Owned (Contact David Holt c@ Today Real Estate'l 800-966 2448)- Owner Owner's Name information is Osterville MA 02655 5-14-10 required for every ' page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure-Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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 CM 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 ❑' ❑" r the system is within 400 feet of a surface drinking water supply ❑ '� . ❑, the system is within 200 feet of a tributary to a surface drinking water supply 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. . t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M r 66 Fox Hollw Rd Property Address Bank Owned (Contact David.Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Osterville MA 02655 5-14-10 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes"or "no" as to each of the following: -Yes No r M . ❑ ® Pumping information was provided by the owner, occupant, or Board of Health Were ere an of the system components pumped out in the previous two weeks? Y Y P p p ® - ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? 0 ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal.System Form -Not for'Voluntary Assessments s M 66 Fox Hollw Rd Property Address Bank Owned (Contact David.Holt @ Today Real Estate 1-800-966-2448), Owner Owner's Name information is required for every Osterville MA 02655 5-14,-10 page. City/Town State Zip Code Date of Inspection 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 Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ®, No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage•(gpd)): . Sump pump? _ ❑ Yes ® No 5-2010 Last date of occupancy: Date P Y� •" , Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on.310 CMR 15.203); Gallons per day(gpd) Basis of design flow(seats/persons/sq:ft.,'etc.): Grease trap present? - ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: ,, - Last date of occupancy/use: Date Other(describe): t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments i a 9 P Y rY 66 Fox Hollw Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Osterville MA 02655 5-14-10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: ` Source of information: N/A 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): Approximate age of all components, date installed (if known) and source of information: 2004 Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts . s W Title 5 Official Inspection Form. Subsurface Sewage Disposal System.Form =Not for Voluntary Assessments 66 Fox Hollw Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Osteryille_ MA 02655 5-14-10 • page. City/Town State Zip Code .Date of Inspection I D. System Information (cont.) : Building Sewer(locate on site plan):. Depth below grade: ,�:26" , feet Material of construction: ❑ cast iron 0 40 PVC ❑..other(explain): Distance from,private water supply well or suction line: feet Comments (on condition of joints,venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): : • gig; ;,' <�- . Depth below grade:.- 20"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: , x years Is age confirmed by.a Certificate of Compliance?,i(attach ar copy of certificate) ❑ Yes ❑ No ------------------------------------------------------------ ------------------------------------------------------------- Dimensions: 1000 Gal • - " Sludge depth: .12 Y. 20„ Distance from top of sludge to bottom of outlet tee or baffle . Scum thickness, y } 0 Distance-from top of scumAo top of outlet tee or baffle' 6".. Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Tape t5insp official document•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form ^ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 66 Fox Hollw Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Osterville MA 02655 5-14-10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: , ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date 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): t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts Y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for,Voluntary Assessments M 66 Fox Hollw Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is H. required for every Osterville MA 02655 5-14-10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) ' Tight or Holding Tank (cont.) y .` Dimensions: Capacity: gallons Design Flow: _ gallons per day Alarm present: ❑° Yes ❑ No Alarm level: Alarm in working order: :< .❑ Yes ❑ No Date of last pumping: Date . Comments (condition of alarm and float switches, etc.):, *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ' '❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): ` Good condition with water at working level Pump Chamber(locate on site plan); r Pumps in working order: f El Yes ❑ No, - ' Alarms in working order: ❑ ,Yes ❑ No t5insp official document•03/08 Title 5 Official Inspecbon Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 ,Official Inspection Form Subsurface Sewage Disposal.System Form -Not for:Voluntary Assessments �M 66 Fox Hollw Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Osterville MA 02655 5-14-10 page. City/Town- State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): f Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: . . ❑ leaching pits number: ® leaching chambers number: 2-500's ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool " number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach chambers in good condition with stain line at 6"from bottom of chamber. ' t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 Commonwealth of Massachusetts Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form =Not for Voluntary Assessments-, 66 Fox Hollw Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name " information is required for every Osterville MA 02655 5-14-10 page. Pity/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration -; Depth —top of liquid to inlet invert i Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure,,level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of'soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp official document•03/08 Tide 5 Official Inspection Form:Subs p urface Sewage Disposal System•Page 13 of 115 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 66 Fox Hollw Rd Property Address Bank Owned(Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Osterville MA 02655 5-14-10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch 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. 3 g r. t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection` Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM ' 66 Fox Hollw Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Osterville MA 02655 5-14-10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope, ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10, feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health explain: ® Checked with local excavators, installers-(attach documentation) ® Accessed USGS database - explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 1 W. t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 / // TOWN OF BARNSTABLE LOCATION �O(� �o� /{9�[yw SEWAGE #. .�. VILLAGE..,,.. ©S. XI—Q,, k.�t ASSESSOR'S hriAP&, L.OT �= INSTAL. ER'S NAME&PHONE NO. SEPTIC TANK-CAPACITY LiACHING'FACILIry.:.(typa) C Gst^1�e�5 (Bf7.4 NO,OF BEDROOMS WILDER CAR OWNER. PERM r DATE,:,.—,,,.^, C:OId6.IUANC E DATE: - Separation Distance Between the; Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility beet Privite dater Supply Well and Leaching Facility ( f any wells exist on site or within 200 feet of leaching facility) Feet Edge 0 Wedand and Leaching Facility.(If any wetkinds exist within 300 fees of leaebing farilil - F'ec uriilshed b D 41 v D-3 TOWN OF BARNSTABLE ff LOCA.TION I� ` SEWAGE.# � 10Lt- VII.LAGE (ASSESSOR'S MAP & LOT �s06 O - INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ��' See 00o 'LEACHING FACILITY: (type) SOU196WZ(size) lam 2c a6 LC c�f 140.OF BEDROOMS BUILDER OR OWNER C Itl S 1J PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ; Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) ' Feet Furnished by Al. �. i 3 �- p � G3. � � �� No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN•:OF BARNSTABLE, MASSACHUSETTS application for ;Digpooat Opetem Construction Permit Application for a Permit to Construct( . )Repair/(Upgrade( )Abandon( ) El Complete System Individual Components Location Address or Lot No. A cli Owner's Name,Address and Tel.No S i��e Ct-1-�s t�Pv L � O U a;,l Assessor's Map/Parcel Installer's Name ddress,and Tel.No. Designer's Name,Address and Tel.No. � �-act Type of Building: Dwelling No.of Bedrooms Lot Size� ft sq. . Garbage Gnnf er Other Type of Building N�tl2 No.of Persons �� Showers(�)Cafeteria( Other Fixtures Design Flow ) gallons per day. Calculated daily flow �J gallons. Plan Date 118 Number of sheets Revision Date Title G , Size of Septic Tank Type of S.A.S. �a 5 Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last.inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with,the provisio s of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss d y t is Board of t . Signed Date Z//;o 4v— Application Approved by Date Application Disapproved for the following rea Permit No. Date Issued No. _ - �' Fee THE COMMONWEALTH OF MASSACHUSETTS THE in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS 01pprication for Miopoaf bpgtem Cottgtruction Permit Application for a Permit to Construct( . )Rep Upgrade( )Abandon( ) ❑Complete System Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. ,+ Assessor'sMap/Parcel OSl�sv�l�e C1{fLtS t�Pt\�`f� �,tJ� Installer's Name,Address,and Tel.No.t Designer's Name,Address and Tel.No. i �J � �j+\fly' o t). Sv C S 1 - 6oL48- 53\a 5Li 6-i9�. Type of Building: Dwelling No�of Bedrooms Lot Size _ so.ft. Garbage Grinder( � Other Type of Building— !�'� No.of Persons r� Showers(� Cafeteria Other Fixtures Design Flow gallons per day. Calculated daily flows gallons. Plan Date i \ 1 e1 r�Number of sheets Revision Date =�d Title t •:s ize of Septic Tank < -,- Type of S.A.S. - Boa S�. (2 N C . .�r•.� Description of Soil 1. 'Nature of Repairs,or Alterations(Answer when applicable) S�' 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 provisiTs of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health, Signe ./A Y/,v h f f "_1> /I Date ' Application Approved by r�. ! �/ �/I !V of 7 Date a>` Application Disapproved for the following rean s / l s Permit No. '` �i Date Issued ---------------- ---- — — — THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded ) Abandoned( )by at / has been constructed{in accordance with the ov'si°� s of Title 5 and the for Disposal System Construction Permit No h dated �1 J Installer / 1 "'� Designer .. i � c� \ bfunction .The issuanceof this permit shall not be construed as a guarantee that the s, stem will as de tgned. Date 1 I 1 t A 1()L( Inspector 11-` iA . . . . . � r� --�� ---- --- ------- -------- — -- No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Digool *pgtem Con5tructiou Permit Permission is hereby granted to Construct( )Repai ( /^)�UpgradAbandon( ) System located at�D�e 75t � _ VN I/t P and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to r comply with Title 5 and the following local provisions or special conditions. Provided: Construction rAust be ompleted within three years of the date of this permit._Date:_ r'Ij, Approved by ° } _ 02/06/2015 23: 13 FAX 1�001/002 Town of Barnstable Regulatory Services Thomas F. Geiler,Director ► BAFtVe'[ABLE. MAK Public Health Division e ` Thomas McKean,Director 200 Main Street,Hyannis,INA 02601 Office: 508-862-4644 Fax: 508-790-6304 - Installer& Designer Certification Form Date: 11/10/04 Designer: Shay Environmental Services. Inc. Installer: Robert Septic Services. Address: P.O. Box 627 East Falmouth Address: 5 Trenton Street MA 02536 Yarmouth, MA On 11/09/04 Robert Septic Service was issued a permit to install a (date) (installer) septic system at 66 roxhollow Road. Centerville, MA based on a design drawn by (address) Shav Environmental Services, Inc. dated 11/08/04 (designer) XX 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. 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 $ Vocal Regulations. Plan revision or certified as-built by designer to follow. . r+of nstal a 's nature.) CARMEN oy�N E. .SHAY oc��e T)JYU A A 0).q T No:"1:181 Designer's Signature) (Affix Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Heal th'Septic/Dcsigncr Certification Form NOV-10-2004 WED 10:29AM ID: PRGE: 1 t s_ TOWNS �OF PBARRN�STABLE , / LO CATION �` ""' v" — SEVAGE# �`�_6,% VILLAGE_ ASSESSOR'S MAP& LOT �s� � INSTALLER'S'NAME&c PHONE NO SEPTIC TANK CAPACITY LEACHING FACIA ITY: (type) (size) NO.OF BEDROOMS j BUILDER OR OWNER 3 PERMTTDATE: COMPLIANCE DATE: � -- Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet =� Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within.300 feet of leaching facility) Feet i Furnished by A �, 3 FA."LED INSPECTION T -p.' COMMONWEALTH OF MASSACHUSETTS f°prre EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIR$7: i W DEPARTMENT OF ENVIRONMENTAL PROTECTION W OCT 2 7 2004 TOWN OF BARNSTABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT- SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 66 FOX HOLLOW LANE OSTERVILLE,MA 02655 Owner's Name: CHRIS DUNN Owner's Address: 66 FOX HOLLOW LANE OSTERVILLE,MA 02655 Date of Inspection: 10/13/04 EUff Name of Inspector: (please print) JOHN GRACI,INC. Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of T' le 5(310 CMR 15.000). The system: _ Passes _ Condition y asses _ Needs F Evaluation by the Local Approving Authority X Fails Inspector's Signature: Date: 10/13/04 The system inspector shall submi copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspe ion.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner s all 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. Notes and Comments SYSTEM FAILED TITLE V INSPECTION.LEACH FIELD WASPONDING,LIQUID LEVEL IS FULL OVER OUTLET TEE IN SEPTIC TANK-PIT IS IN HYDRAULIC FAILURE. ****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. Title 5 Incnentinn Fnrm 6/1 5/?000 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 66 FOX HOLLOW LANE OSTERVILLE,MA 02655 Owner: CHRIS DUNN Date of Inspection: 10/13/04 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: SYSTEM FAILED TITLE V INSPECTION.LEACH FIELD WASPONDING,LIQUID LEVEL IS FULL OVER OUTLET TEE IN SEPTIC TANK-PIT IS IN HYDRAULIC FAILURE. 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. Answer yes,no or not determined(Y,N,ND)in the for the following statements. if"not determined"please explain. n/a 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. ND explain: n/a n/a 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 _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a 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 _obstruction is removed ND explain: n/a Page 3 of 11 ' OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 66 FOX HOLLOW LANE OSTERVILLE,MA 02655 Owner: CHRIS DUNN Date of Inspection: 10/13/04 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 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 n/a "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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: n/a Z Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 66 FOX HOLLOW LANE OSTERVILLE,MA 02655 Owner: CHRIS DUNN Date of Inspection: 10/13/04 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No X _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X _ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than'h day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped SYSTEM HAS NOT BEEN PUMPED IN TWO YEARS PER OWNER. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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.] YES (Yes/No)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. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X 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. d Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 66 FOX HOLLOW LANE OSTERVILLE,MA 02655 - Owner: CHRIS DUNN Date of Inspection: 10/13/04 Check if the following have been done.You must indicate"yes" or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period'? X Have large volumes of water been introduced to the system recently or as part of this inspection? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) t X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out X _ Were al system components,excluding the SAS,located on site'? X _ 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? X _ 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: Yes no X _ Existing information.For example,a plan at the Board of Health. X _ 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(3)(b)] s Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 66 FOX HOLLOW LANE OSTERVILLE,MA 02655 Owner: CHRIS DUNN Date of Inspection: 10/13/04 FLOW CONDITIONS RESIDENTIAL 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 Number of current residents:4 Does residence have a garbage grinder(yes or no):NO Is laundry on a separate sewage system(yes or no):NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)):Ala Sump pump(yes or no): NO Last date of occupancy: n/a 40(3 COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sqft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a . Last date of occupancy/use: n/a OTHER(describe): n/a ' GENERAL INFORMATION Pumping Records Source of information: SYSTEM HAS NOT BEEN PUMPED IN TWO YEARS PER OWNER. Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X 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) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: 16 YRS.PER OWNER Were sewage odors detected when arriving at the site(yes or no):NO ' Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 66 FOX HOLLOW LANE OSTERVILLE,MA 02655 Owner: CHRIS DUNN Date of Inspection: 10/13/04 BUILDING SEWER(locate on site plan) Depth below grade:30" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade:24" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) - Dimensions: L 8' 6"H 5' 7" W 4' 10"" Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle:30" Scum thickness: 4" Distance from top of scum to top of outlet tee or baffle: 0" Distance from bottom of scum to bottom of outlet tee or baffle: 0" How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.LIQUID LEVEL IS OVER TEE- RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as-related to outlet invert,evidence of leakage,etc.): n/a r Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 66 FOX HOLLOW LANE OSTERVILLE,MA 02655 Owner: CHRIS DUNN Date of Inspection: 10/13/04 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:_(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: n/a 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.): DID NOT EXPOSE PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a R Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 66 FOX HOLLOW LANE OSTERVILLE,MA 02655 Owner: CHRIS DUNN Date of Inspection: 10/13/04 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6'X 6' leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): LIQUID LEVEL IN LEACH PIT IS FULL OVER ALL PIPES AND WAS PONDING.THE PIT IS PAST THE EFFECTIVE DEPTH OF LEACHING AND IN HYDRAULIC FAILURE. BOTTOM IS AT 10 FT. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): n/a 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 66 FOX HOLLOW LANE OSTERVILLE,MA 02655 Owner: CHRIS DUNN Date of Inspection: 10/13/04 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. 6 o L, Ak ZSq Ab Z� AC q2W � 3 to Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 66 FOX HOLLOW LANE OSTERVILLE,MA 02655 Owner: CHRIS DUNN Date of Inspection: 10/13/04 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: HAND AUGER- 12+FT. i 11 TOWN OF BARNSTABLE LOCATION Ac 9�k/�dA) G,Iv , SEWAGE-# 73 VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME Cz PHONE NO. _/Qe f20'-36*l5' SEPTIC TANK CAPACITY /GYRO r, LEACHING FACILITY:(type) �( (size) V/DO NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER PWAG BUILDER OR OWNER gier-6 DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �� P 1., No.K�.. ..r.� !`aM A` Fims..... ....... r` I d THE COMONWE LTH OF MASSACHUSETTS BOAR® OF HEALTH e -- s l L 1."C� -q...............OF..... .�F: ................................... Applira#iun for Diupuuttl Works Tomitrnrtiun ramit Application is hereby made for a Permit to Construct (' or Repair ( ) an Individual Sewage Disposal S stem at`` 'A."• 'A Location-Addres o No. ess Installer 0 Address Type of Building ' Size Lot.Z�} .�_......Sq. feet U Dwelling—No. of Bed rooms..... ..................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria dOther fixt res ...------•---------------•--•-•---•--------•---•-------------------•-•-----••---•-•---•-----•---•••------•---------•---......----------..._..._------ W Design Flow._._.......5?......................gallons per person per day. Total daily flow......... .0..................... WSeptic Tank—Liquid capacityICMallons Length.0777G. Width+.IC). Diameter................ DepthtD=�8_ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area... sq. ft. Seepage Pit No.......:............ Diameter......��....... De t i below inlet...- Total leaching area ._.__sq. ft. -__-•- Z Other Distribution box (� Dosin tank '4 Percolation Test Results Performed by--. X. `� _G_� ............... Date...... ....... Test Pit No. 1_. .........minutes per inch Depth of Test Pit---XZ.......... Depth to ground water.._. ' O_(Zo Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --••----• ------ --------•-•----•••--- ----------•...._...... ....... v O Description of Soil..` )7:z... s l --.S.?12 t.L...�....1......__Cl� _���'C+ + ----------------------------- V .....--------•-••--•--•------•••------•-------•-----------•---•-•---------------•---------------•--•••••--•••••-••-•-••••••-•----••-•----•--•--•.....--................................................. -----•-•-•-•---------------------••-•----•---------------•-------•-•---•--•----•--•-----------------------•--•--•-••--•--•--•--•---------•--••••---•-----••-----•••---------------------•------•••------ 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 TITI U 5 of the State Sanitary ode—The undersigned fur)jr rees not to place the system in operation until a Certificate of Compliance has jeel issued by heVboa of li tSigned_ . ..:. . .. .... ... .............. •••. t Application Approved By.. ----- - ........................ Date' Application Disapproved for the following reasons:................................................................................................................ ....................••------...--•---•--.............---.......----•-...-....-------------•--........-----------------•••--••••-•-•--•----•--------------••----•-----•--•----.....•---••-•••--------•--- Date PermitNo._-- ---•-•-•----,-•-__--- Issued_....................................................... r O FEB. .. � THE COMMONWE LTH OF MASSACHUSETTS —�-� BOARD OF HEALTH l...UuJ...f ...............OF.......?.,\: .t - ...................................... Appliration for Dispood Works Tons rnrtion Prrmi# Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: -- {-v... c�cLov .rA fJ-C�---- ----------------•-•--- --- -.............................. .-- ........._..........------------ ......................... r:t.' Lo:Z�ion'-Addres � �v S ... 1+.......Z �AiL5 Z�'N �ss a •^ ��'----- ---------•• 'Address .....____-----'�-----------......_____•. Installer (', ,, Type of Building Size Lot_?-!,t��__.....Sq. feet U Dwelling—No. of Bedrooms.....3..................................Expansion Attic ( ) Garbage Grinder ( ) PL4Other—T e of Building No. of persons............................ Showers — Cafeteria Pa Other fix d res -----•------------------------------------------------._.....----------------------------------------------------......._..•••-.....•--•••-•-•-••-••-• W Design Flow............ .............................gallons per person per day. Total daily flow........-aJ3Q.............__._.._gallons. WSeptic Tank—Liquid capacitylCt allons Length..O.—.G. Width.4_--l.C).. Diameter................ Depth't.;>.-.16.. x Disposal Trench—No. ._____•--_--------•_ Width.................... Total Length.................... Total leaching area___________ sq. ft. Seepage Pit No____________________ Diameter._.._t Zn._..._. De t i below inlet._.'- . Total leaching area.2 .........sq. ft. Z Other Distribution box (Y j Dosin'y tank ( y ` , � _/ ~' Percolation Test Results Performed by-_-6AN ._.(...... _______________________________ Date.....5/X-,7s _ . _•..._.. Test Pit No. 1._�2....minutes per inch Depth of Test Pit...Y&.......... Depth to ground water.._.NQT C0UWT�iN Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ......................... ------------- ---- -'----------_ --------- ------------- O Description of Soil... .' __ tl!1 �2��'. � =•-•-....`-- .........�.-'!�C. ...................................... x W U •-•----------- •........ ------------------------- ----------------------------•...... .-------------- --•-----------------------------•••--••••••••-••-••---•••••-------•-•••••--••------•••••-••••••-•••--••••--•---•--------••-•••••---••----••-••-••--••••••••-••-••-•-•••-•••••............•••--•'-•_...•• 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 iITIE 5 of the State Sanitar ode—The undersigned fur r grees not to place the system in operation until a Certificate of Compliance has `ee issued by e boa of F j Signed. n � � f 3 r ........ Date Application Approved By. : rd.rd.,✓•;rti (---------------------------------------------- � f at Application Disapproved for the following reasons:................................................. -----•----------------------------------••••-._...------_... -•..................................�--•-'...........----------------..................----•--....---•---••-•--•••-•-•-.....••••-••-•--•--•---•••••••-•••-•••••-••-•--•---••••••-••-••-••-•--•••'-'-'-'- Date Permit No..Li __..._ Issued_________•_____________ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........... .t":.................................. (Intif irate of Toutphatt le THIS IS TO CERTIFY Tha the Individual,.Sewage Disposal System constructed (�) or Repaired ( ) by.............. ..... ......... ...�--....."'r..::��1_\......_._-In al er '---...__ . at...............Lc?_----�t.j...•ux..... 41�1-L- -(�1.)-....(�1.L! t I r ..... has been installed in accordance with the provisions of T� of The State Sanitary Code Zd. cribed in the application for Disposal Works Construction Permit No.6!`...E-31.............. dated_-..___ y.._ ...._._........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARAE T AT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.........................3... 1t K` . .... Inspector....---'--•...._.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF/�EAR L)=H ..............OF.....TYNo-u..L 7 FEE--=---�---•-•--•--- Disposal Works Tnns#rnrtion rrmit_ Permission i hereby granted... r ........_-•- .... ` ....::::�.. `�'fci ... to Const�ruct��(� or Repair ( ) an Individual Sewage isposal System at No....i---(•! `.... l Street as shown on the application for Disposal Works Construction Permit N Dated__! ... .... ............... ---•----- ----- �_ Board of Health . DATE................• j �-- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS r4 DEQE File No. SE 3-1572 (bP� 4 ITo be provided by DEQE) !.„ Commonwealth of Massachusetts IAHT3TJBGr. % Cityrrown:Barnstable `�.-� °o, 1639. � Applicant Roberts Realty 'fc rAY Order of Conditions MASSACHUSETTS WETLANDS PROTECTION ACT z 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 Duxbury, MA 02332 This Order is issued and delivered as follows: C by hand delivery to applicant or representative on (date) )i by certified mail, return receipt requested on Marr•h 25 19R7 (date) This project is located at rot 411 Fox Hn1 1 nw r anP, nctPrvi 1 1 P Barnstable Assessor's Map # 145 Lot _b-11 The property is recorded at the Registry of n PdG in Rarngtahl P Book 3454 Page 264 Cc.rtifir?to fif rooictorprl) Notice of Intent dated Jan 2Q, 1987 Date of Hearing March 31, 1987 This Order is issued on March 23, 1 987 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 Significance set forth in the regulations for each Area Subject to Protection Under the Act (check as appropriate): ARTICLE 27 ONLY ❑ Public water supply ❑ Storm damage prevention ?E Erosion Control Private water supply N Prevention of pollution = Wildlife X Ground water supply ❑ Land containing shellfish Recreational ❑ Flood control ❑ Fisheries - Aesthetic Therefore, the Barnstable Conservation Committee hereby finds that the following conditions are necessary, in r tect those interests checked above. in the regulations, to 0 Standards set forth P accordance with the Performance St 1� 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 Fri rn s t ah i P ron 4P rva t;on Commis_.ion, 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 Quality Engineering. cr I_1r,71 i'uc i�uuiuci 10. Where the Department of Environmental Quality 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 hear- 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. 12. Upon certification by the project engineer the applicant shall forthwith request, in writing. that a Certificate of Compliance be issued stating 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 By-Law,s as well as under Mass. G.L. Ch. 131, sec. 40.The Barnstable Conservation Commission 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 all workers are informed of the conditions of this Order before they begin work at the site. 16. The work shall conform to the following plans and special conditions PLANS: Title Dated Signed and Stamped bN: On File with: Commission Certified Plot Plan Oct. 1986 Peter Sullivan, P.E. Barnstabje conservation Rev. Dec. 12, 1986 March 4, 1987 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'. All wooden .portions of the deck shall be CCA-treated or the equivalent. No creosote-treated material may be used. 7. A 10' X 10' deck may be constructed to the side of the house. 8. 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 Commission. 9. Where possible, trees of significant size (6" diameter or greater) shall be preserved. 10. Approval shall be contingent upon receipt of a revised plan indicating the footprint of the approved deck. 11. Any existing encroachment of the work limit line established for Lot nll under SE 3-1291 shall be addressed under the present Order of Conditions by the planting and diligent maintenance of a 35' buffer strip extending landward o the edge of wetlands. This area shall be established in indigenous shrubs ..................................................................................................................................................................................... (Leave Space Blank) Special Conditions (Continued) : 11. (planted 4' on center) and woody groundcover (i.e. bittersweet, Virginia creeper, etc. ) . The area .beyond the foregoing buffer strip shall be planted and maintained in appropriate groundcover. Issued By Barnstable Conservation Commission Signature(s) jisOmustigned by a majority of t e Conservation.Commission. 23rd March 87 On this day of _ 19 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 his/h fre ct and deed. C3--�� Nnvemher 2R, 1 A91 b 'i of c 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 MATE) If recorded land, the instrument number which identifies this transaction is If registered land, the document number which identifies this transaction is Signed Applicant r ' wtTI.�.Nb ��•�11tJ� �K 12 �o� �� . w44 19 'T ib4- ' 10 m o r am ., • PLT' • ' R u �i SULLEVAN _ I NO. 2J733' s I ICJ t..E Ffi.Mt LY 3 13 ? ?_ i . ... a M m _ i`ice" . USE I o00 CXA L �=ra tip•_ - ' I dt s i?o 54l_ T u 5 C ► �ac�G-�,4L„ .. 5I DEWALL.�� c •35 5, F, 1 $pTTL71� A - i 13 51 45 ' � iC�L�'t'"1 N t F ►N Z MIN cf . t. SS �4� as - '� . a •� aid _ � -: ' ` Lam/' �p oao_ _ _ • `/ , , , . s c�A,�Till, �.�R l'1G l 5EPTI r i9•,!p ot LCCA t �--�-• , L , WO 'k�A7V-p- " 4� Y. ' ' 'S'� Avg q 1°► ' - r I zTI�' TEAT' tJR�O(GW� a t' U 1 „ .. ;4►�+ta �'�•�F� �EQI;,I S TZ'�I��N�'s 4� T�� I ,. , . 11 1.O Teo yj I-r 1 N -r t~I'-' _�==1-�X�l� � U M�J'T '�JTzV� i 9 *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. SECTION A -A ALI. OUTLET PIPES FROM THE 10' ruin. from--- DISTRIBUTION Box SHALL BE ---------------- Existing Foundation house to septic tank PROFILE VIEW OF LEACHING SYSTEM 1? - I/ CONCRETE COVER __-.___ -. SET LEVEL FOR AT LEAST z FT. -Y I _ TOP OF FOUNDATION = ELEV. 100.00 (Assumed) Septic tank cc re must be OUTLET _ within 6 in. of finished grade •` i---_tirade over Sepik Tank -- 99.00 _ __Grade over D-BOY -- 99.00 �-"dada over SAS - ELEV® 99.00 : KNOCKOUTS _ -a/�•ee i �/z e..A.�"fin7. aa/ r/a• P�.a r.-b- INSPECTION --- 15 5 OUTLET "� 12' 04LET S 3 HOLE H-20within 6 in 0.02 DIST. BOX _ 3' Maximum Cover ToO of SAS-Elev.=96.50 �_LH-Il .01 or CraatxS= 0.01O per fool 1- ` , - 2 10, -- uT - --- -.---__ o 0 . 4' - SCH. 40 Te i7538' CD Euo O o Effective Depth o 0 0 0 o PLAN SECTION CROSS-SECTION_ FROM EXIST. FDl1NDATIDN rn ui crt Lo ,n 20' - C3 0 2 Units 2 8.5' = 17' c) [V M r I CONCRETE FULL fOUNDA 'y II � t0 ui o o 4+ Imo.- !9' I 4' al rn IT. 3.S - 5�-� f-3.5' 6 in.of 3/4"-1 ,/z• (D 11 ; 25• 3 HOLE H-20 DISTRIBUTION BOX SYSTEM PROFILE c compacted tee stone ; d Q) � t2' a Effective Length NOT TO SCALE Not t0 Scale -- � Effective Width � ----- ' ' 5 d SOIL ABSORPTION SYSTEM (SAS) ----- - c c c o s in.of 3/a'-t 1/2" 0 500 - C H-20 LEACHING UNITS / WIGGINS PRECAST GENERAL NOTES ---- ---- - ----� composted stone m .. - -- - NOTF' ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE Bottom of Test Hole 1 Ele- 87.00 Not to Scale 1. Contractor IS responsible for Dind u notification __ and protection of all underground utilities and pipes. L --- -- - w Obs. Groundwater - Test Hole 1 Elev.= NONE OBSERVED 2. The septic tank and dis 1 " st box shall be set level on 6" of 3/4"--1 1�2" stone. 3. Backfill should be clean sand or gravel with no ---- -- stones over 3" in size. - LOT #4 4. This system is subject to inspection during installation by Carmen E. Shay - Environmental Services, Inc. 5. The contractor shall install this system in accordance with Title V of the Massachusetts state code, the approved plan P E R C 0 LAT I V N I T EST and Local Regulations. - - - 6. If, during installation the contractor encounters any Date of Percolation Test: MAY 15, 1985 soil conditions or site conditions that are different Test Performed By. BAXTER & NYE from those shown on the soil log or in our design Results Witnessed By: (BARNSTABLE B.O.H.) installation must halt & immediate notification be EXCAVATOR: UNKNOWN made to Carmen E. Shay - Environmental Services, Inc. Percolation Rate: Less Than 2 MPI ® 24" /' 7. No vehicle or heavy machinery shall drive over the PtJpS / septic system unless noted as H-20 septic components. LOT #12 ����� 8. Install Tuf-Tite gas baffles or equals on all outlet tee ends. O� 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. 10. All solid piping, tees & fittings shall be 4" diameter lest Hole No. 1 Schedule 40 NSF PVC pipes with water tight joints. DEPTH SOILS ELEV. 9� 11. Municipal Water Is Connected to The Residence and Abutting ----------- 0 99.00 3� ����P ,' LOT #3 Properties Within 150 Feet. THE PROPERTY LINESAND WETLAND DELINEATION ARE APPROXIMATE AND 10 �/ / COMPILED FROM THE SURVEY PLAN GENERATED BY _o"-a" A; 98.2s1 Imo/ BAXTER & NYE OF OSTERVILLE, MA, ENTITLED "CERTIFIED PLOT PLAN OF LOT 11 FOXHOLLOW LANE, OSTERVILLE, MA" y �- - DATED AUGUST 9, 1984 & THE DEED DESCRIPTION ( BOOK 6280 PAGE 288) 10 YR 5/6 - ------ ---�\ ��= ' 2a" Bw 97 00, � IT SHOULD BE USED FOR NO PURPOSE OTHER THAN a' - \ THE SEPTIC SYSTEM INSTALLATION. Med. - Sand 96 2.5 Y 8/8 96 00 _ 10 .6' EXISTING REMOVED TO LEACH FACIIL FACILITATE NEW SEPTIC OUT SYSTEMAND INSTALLATION PLACE OR 24"-36' C, _ Med-Coarse �\ - Sand i� 9$ NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE 2.5 Y 7/4 \ FROM THE EXISTING LEACH PIT TO BE DISPOSED 36"_122" C2 87.17 / OF AS PER BOARD OF HEALTH SPECIFICATIONS. WETLANDS ARE PRESENT WITHIN 200' OF THE PROPERTY AS SHOWN DECK EXISTING ASSESSORS MAP 145, PARCEL 006/01 11 3 BEDROOM EXISTING - --- __ LOT # 12 HOUSE GARAGE LEGEND LOT #1 1 #ss Perc #1 I DENOTES PROPOSED Depth to Perc: 24" to 46" I 21,657 Square Feet _ oq 104X11 SPOT GRADE Perc Rate= Less Than 2 MPI C14 Groundwater Not Observed I % � IIC7;1veL iI i DENOTES EX ISTING No Observed ESHWT 11XIST. 1000 gal. X 104,46 = None 6eptic Tank SPOT GRADE ADJUSTED H2O Elev. 22 A&R4A6-T- I PODRIVEWAY PL PROPERTY LINE '0 -- 96P PROPOSED CONTOUR a i -ram- = - -: �� HI t '� - - - - - -97 EXISTING CONTOUR I r AIR 60 - ---- - PROJECT BENCH MARK � � ' r �..� �.�• �` ' :__�•" TOP OF FOUNDATION I i ---z5' iJ r�� DEEP TEST HOLE & 2-18" DIAM. ACCESS MANHOLES ELEV. = 100.00 (Assumed) Failed 1 I TEST HOLE #1 PERCOLATION TEST LOCATION 8, Leach Pit I 1 i ELEV.= 99.00 � \� - 6 FOOT STOCKADE FENCE 14 4.74 ET _ PLOT P LAN I _ at� ET u T T �/�� T /� �T -3 V I'•r THE ACCESS COVERS FOR THE SEPTIC TANK. F' OX l l O L L/ O I/ lf,_A 1 V -.- D BOA AND LEACHING COMPONENT SET DEEPER THAN 6 INCHES BELOW FlNISHED OFF PROPOSED SEPTIC SYSTEM UPGRADE � r 1 �^'.:=�--•,� _ ::�r •-. ._. DEEPER - GRADE SHALL BE RAISED TO w0114IN 6" of (40 FOOT RIGHT OF WAY) STEEL REINFORCED PRECAST CONCRETE FINISHED GRADE. PREPARED FOR PLAN VIEW VIE'W INSTALL 11LIF-111117 GAS BAFFLES OR EQUALS CHRISTOPHER 8c ANN DUNN 3-24" REMOVABLE COVERS I + AT i ..__- 4• # 66 FOXHOLLOW LANE 3" min. clearance ' MET INLET m .T l z- Tin. Inlet to wallet e• mmin. 1J•. OUTLET OSTERVILLE, MA s' -r ---- $ +__ 5' -7' Design Calculations REPARED BY: E$- * 4'-0' min. o a..ede. Liquid depth _ 0o Number of Bedrooms: 3 Equivalent to 330 Gal./Day (330 Gal./Day Min. per Title V) S C�1 R�I�'N E. ,SHA Y ;•+ �_ Garbage Grinder: No Leaching Capacity Proposed: 330 Gal./Day Minimum (Min. Per Title V) Septic Tank - 2 x 330 Gal./Day = 660 USE EXIST. 1,000 GAL. Septic Tank. 4 -10• 0 20 40 50 hE. ENVIRONMENTAL SERVICES, INC. CROSS SECTION END-SECTION SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch Bottom Area: 0.74 gal/sq. ft. x 300sq. ft. = 222.00 gallons No. 1181 P.O. BOX 627 Sidewall Area: 0.74 gal./sq. ft. x 148 sq. ft. = 109.50 gallons - PF �° EAST FALMOUTH, MA 02536 TYPICAL 1000 GALLON SEPTIC TANK Providing: = 331.50 gallons SCALE: 1"=20' Sgti TAR ST E Pa TEL/FAX : 508-548-0796 NOT TO SCALE Use: (2) PRECAST 500-C UNITS, HAVING A 2' EFFECTIVE DEPTH, 1 =20' DRAWN BY: CES DATE: NOV. 8, 2004 TO BE USED WITH 3.5' OF WASHED STONE ON THE SIDES AND 4' OF WASHED STONE ON THE ENDS. PROJECT#SD657 FILENAME: SD657PP.DWG SHEET 1 OF 1