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HomeMy WebLinkAbout0020 GRAND ISLAND DRIVE - Health t7stetv file A== 0`72-01 4 / ti 4�1 n i E t - -. Anne McCrea Sullivan 286 Adams Street Milton, Mass. 0218b A . , a _ i TOWN OF BARNSTABLE — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION OWNER AND INSTALLER INFORMATION r ADDRESS: 20 Grand Island DrrOvgter 'HarborsMAP NO.®,7,7 PARCEL NO.Q7 4ON6 OWNER NAME: Anne M. (Falvey) *Su=llivan VILLAGE /(lam INSTALLAT ON DATE: lqk I BY: ^~ 'l ADDRE S: CERT. NO. ..-.- ,''ys.4"�t:ca!`,' `��'.. •i�jiw.•_'. *`'P`=�+A'-_,�--=3—+" - At}_Srar ,d v.^.x ..:y,..'a ... n�-�i''.'^`m_+..-'a'.."'."�, ..f"'...' -.,... ,. � Si'","t" .:dr_ ,,:..'L Wi1l � J•�c _ e `4 " t� NK INFORMATION .✓ °" LOCAT*IONS OF TAN L : K se StefCAPACITY fl�Q4g •TYPE Steel AGE FUEL/CHEMICAL ; tu , a 04 ; ` , �IYie.i.W.M1.:..r:..u+lr., •'�h a te. TESTING CER:T T.F I CAT`, �N •C ] PASS 'C ] . FAIL DATE , .. LEAK DETECTS aON C W CHECK IF N/A TYPE/BRAND t rAl ZONE OF CONTR I 6UT I•N C 7 YES. �W], NO E,T.O�BE- REMOY.ED FIRE DEPT. PERMIT LSSUEDt,C7..YES, , C. ,;].y NO .,. ; DATE ✓ CONSERVATION CV'] CHECK IF N/A DATE t BOAR D• OF HEALTH"` TAG NO.,E ] TE: PLEASE •PROVIDE: A SKETCHY SHOW IN6 THE,,,aTANK LOCATION. ON THE; BACKw'yOF THIS CARD .:..'".f.°`"~ 'S�"."'"",'""'^+w,wf,,,,.,vt^+•+.r,..•'?'"r..,"}""�"`. 'AaK''" _. +,".n° .,.urns. ,i,t.,_..,. .. -.' _.,.«..�....' ..A.. :,._�. `w. r.4s•:`:,s�...,.!�s�.i.,.awsLvui•+, ,4.r.....Y .,.fs Vie..t.9: txtfn . ..w.,..m.,*fhni. „S.. :_fi w.: .rfx } Oar 0� `f Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 Grand Island Drive c;► Property Address Delorey Owner Owner's Name / information is ,v/ Ma 02655 10/27/2020 required for every OSterville State Zip Code Date of Inspection page City/Town . inspection results must be submitted on this form. Inspection forms may not be alte red s`in any way.Please see completeness checklist at the end of the form. Important:when. A. Inspector Information ( oa— filling out forms on the computer, Sean M. Jones use only the tab key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. 74 Beldan Lane Company Address Centerville Ma 02632 ' State Zip Code C�Y/Town 774-248-4850 smjonestitle5@gmaii.com, SI4522 sean@smjonestitle5.com License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 16.340 of Title 5 (310 CMR 16.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection 1 have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 10/27/2020 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 has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note:This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Tdie 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1-of 18 t5insp.dx-rev.7/2812018 f , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 Grand Island Drive Property Address Delore Owner Owner's Name information is Osterville Ma 02655 10/27/2020 required for every CitylTown State Zip Code Date of Inspection page. C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: The property located at 20 Grand Island Dr Osterville is served by a Title V septic system consisting of 2 1500 gallon septic tanks, distribution box and 5 rows of 5 Infiltrators. Although the system was found to be in proper working condition at the time of inspection this report does not guarantee future performance under similar or increased usage. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. 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): t5lnsp.doc•rev.712612018 Title 5 official inspection Form:Subsurface sewage Disposal System•Page 2 of 18 f I Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 20 Grand Island Drive UF e Property Address Delore Owner Owner's Name information is Ma 02655 10/27/2020 required for every Osterville page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumpslalarms not operational. System will pass with Board of Health approval if pumpslalarms are repaired. ❑ 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): ❑ Y N ND(Explain below:. obstruction is removed ❑ ❑ ❑ ) 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if.. the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7128/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 3 of 18" Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 Grand Island Drive Property Address Delorey Owner Owner's Name information is Osterville Ma 02655 10/27I2020 required for every state Zip Code Date of Inspection page. CitylTown C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. system will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and so absorption systfaceem (SAS)ter and the SAS is within 100 feet of a surface water supply o tributary to a❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well*". Method used to determine distance: '*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool El ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Title 5 offidat Inspection Forth:Subsurface sewage oisposal system•Page 4 of 18 t5lnsp.doc•rev.M62018 f Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 20 Grand Island Drive Property Address Delore Owner Owner's Name information is Ma 02655 10/27/2020 required for every Csterville page. CitylTown State Zip Code Date of Inspection C. Inspection Summary (cunt.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No Static liquid level in the distribution box above outlet invert due to an overloaded_ ❑ ® or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow El1 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. El ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified , laboratory,for fecal collform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5`ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- El gpd. El ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design floor of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El Elthe system is locatedin a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well Title 5 Official Inspection Form:subsurrace Sewage Disposal system•Page 5 of 18 Mnsp.doc•rev.7128r2018 f } Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments U 20 Grand Island Drive Property Address Delore Owner Owners Name 10/27/2020 rville information is OSte Ma 02655 required for every Osteown State Zip Code Date of Inspection page. C. Inspection Summary (cont.) Y If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large systema il failed.or fa I d owner or operator of any large system considered a significant threat underSect under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® El 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? 0 El Was the site inspected for signs of br eak 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? ® El information 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)] TQIe 5 Official Inspection Form:Subsurface sewage Disposal System•Page 6 of 18 tsinsp.doc•rev.7262018 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal sat System Form-Not for Voluntary Assessments sp y ..Vi 20 Grand Island Drive Property Address Delore Owner Owner's Name information is Osterville Ma 02655 10/27/2020 required for every cityfrown State Zip Code Date of Inspection page. D. System Information 1. Residential Flow Conditions: 8 8 Number of bedrooms (design): Number of bedrooms(actual): 880 gpd DESIGN flow based on 310 CMR 15.203 (for example:.110.gpd x#of bedrooms): Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection. ❑ Yes ® No information in this report.) Yes ® 'No Laundry system inspected? ❑ Seasonal use? El Yes No Water meter readings, if available(last 2 years usage(gpd)): Detail: property has irrigation system Sump pump? ❑ .Yes ® No current Last date of occupancy: gate Title 5 Official inspection Form:SubSUftGe Sewage Disposal system=Page 7 of 18, t5insp.doc rev.7/26I20 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1W Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 Grand Island Drive Property Address Delore Owner Owner's Name information is Osterville Ma 02655 10/27/2020 required for every CityRown State Zip Code Date of Inspection page. D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 t5insp.doc•rev.7/26/2018 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 Grand Island Drive Property Address Delorey Owner Owner's Name information is Osterville Ma 02655 10/27/2020 required for every Cityrrown state Zip Code Date of Inspection page. t D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system [� Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes, attach previous inspection records, if any) [] Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a.copy of latest inspection of the I/A system by system operator under contract El Tight tank. Attach a copy of the DEP approval. [] Other(describe): Approximate age of all components, date installed (if known)and source of information: system installed 6/18/2010 El Were sewage odors detected when arriving at the site? Were ® No 5. Building Sewer(locate on site plan): 3.5 Depth below grade: feet Material of construction: ❑cast iron ❑40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting, evidence of leakage, etc.): Joints in good condition, no leakage, vented through roof. -rrtle 5 ofrldal Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 t5lmp.doc•rev.W26=18 < Commonwealth of Massachusetts • - Form fficial Inspection Title 5 o p Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Grand Island Drive Property Address Delore Owner Owner's Name information is Osterville Ma 02655 10J27/2020 required for every Cityrrown State Zip Code Date of Inspection page. D. System Information (cont.) 6. Septic Tank(locate on site plan): 32" &36" Depth below grade: feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) _ I If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No 1500 gallons& 1500 gallons Dimensions: 5" &3" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 3' &3.5' 0" &0" Scum thickness 7" &7" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 10" & 10" Opened covers and took How were dimensions determined? measurements Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): System has 2 separate 1500 gallon septic tanks. Both tanks in good condition, no need for pumping now. Tanks had water level at outlet invert. Access covers are on risers Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 t5insp.doc-rev.M 2018 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 Grand Island Drive Property Address Delore Owner Owner's Name information is Osterville Ma 02655 10/27/2020 required for every Citvfrown State Zip Code Date of Inspection page. D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet r Material of construction: ❑concrete ❑ metal El fiberglass ❑ polyethylene ❑ other.(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Title 5 official inspedion Form:Subsurraoo Sewage Disposal System•Page 11 of 18 t5insp.d6c=rev,.7/260018 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Grand Island Drive Property Address Delore Owner Owner's Name information is Osterville Ma 02655 10/27/2020 required for every City/Town State Zip Code Date of Inspection page. D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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 9. Distribution Box(if present must be opened) (locate on site plan): 0" 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.): Distribution box was video inspected and found level and in good condition with no rot. Water level was even with outlet inverts with no signs of past backup. Access cover is on a riser Title 5 Official Inspection Form:subsurface Sewage Disposal System•Page 12 of 18 t5insp.doc•rev.7126r2018 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 Grand Island Drive Property Address Delorey Owner Owner's Name information is Osterviile Ma 02655 10/27/2020 required for every CitylTown State Zip Code Date of Inspection page. D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: El Yes El No" Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances; etc.): *If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: 25 Infiltrators, ® leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ . leaching fields number, dimensions: overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 15insp:doc•trey:7f2812418 Commonwealth of Massachusetts I Ti Title 5 Official Inspection Form meets Subsurface Sewage Disposal System Form Not for Voluntary Assess 20 Grand Island Drive Property Address Delore Owner Owner's Name information is Osterville Ma 02655 10/27/2020 required for every City/Town State Zip Code Date of Inspection page. D. System Information (cont.) 11. Soil Absorption System(SAS)(cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): s.a.s. consists of 5 rows of 5 Infiltrators each. No lush vegetation, no signs of past overloading 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer p Y 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.): Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 t5insp.doc•rev.UW2018 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 Grand Island Drive "+ Property Address Delore Owner Owner's Name information is "' terville Ma 02655 10/27/2020 required for every State Zip Code Date of Inspection paw Cityrrown D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, + etc.): Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 15 of 1A t5insp.doc•rev.7/2612018 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 Grand Island Drive Property Address Delore Owner Owner's Name information is Ma 02655 10/27/2020 CiylTow required for every Otyfrowlle n State Zip Code Date of Inspection page. D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage p Y 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 A 1 18.-a Z 2.3 -iD r 1✓ 3 42-0 A.� 4 34-b 131 Z3--a ctss�tA6 3 —a •i 43-� Title 5 official Irupection Form:Subsu face Sewage Disposal System•Page 16 of 18 ttiinsp.doc•rev.7f2612018 Commonwealth of Massachusetts Title 5 Official Inspection Form } Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 Grand Island Drive Property Address Delore Owner Owners Name information is Ma 02655 10/27/2020 required for every OSterville page. CitylTown -State Zip Code Date of Inspection D. System Information (coot.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells 12'+ Estimated depth to high 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: pate ❑ 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: Groundwater was established by accessing town of Barnstable groundwater contour maps. Before filing this Inspection Report, please see Report Completeness Checklist on next page. Title 5 official Inspection Forth:Subsurface Sewage Disposal System•Page 17 of 18 15insp.doc-rev.7126/2018 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 Grand island Drive Property Address Delorey Owner Owner's Name information is Osterville Ma 02655 10/27/2020 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8:Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp doe,rev.7/2612018 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 TOWN OF BARNSTABLE LOCATION 20 +' 1-SLA#JJ> Di2SEWAGE# 170 VILLAGE 0�,'(OW L-'g ASSESSOR'S MAoP�&PARCEL��� 1-0 I INSTALLER'S NAME&PHONE NO. 'ES 14c) t.ga q7,D 0 SEPTIC TANK CAPACITY 0- X iS'bD a-%.k LEACHING FACILITY.(type) WFILT1Ek'Ta" (size) NO.OF BEDROOMS OWNER iS tj uLLi 0,0 ® PERMIT DATE: -1" i 0 COMPLIANCE DATE: D Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 1;P 1`Z— Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) A Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) A Feet FURNISHED BY �, � �� o, `t ��-� �� � �� � � � �� . � � '��—� . � � - �®� ,� ���� ���� � © �(� � � ��� � � ����. � �$� � Fee 00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppricatfou for Mioo-gal 6r5tem Coumructiou Vermtt Application for a Permit to Construct(71- Repair( ) Upgrade IV, Abandon( ) Complete System ❑Individual Components Location Address or Lot No. 20 6RP V .TS LAW b 'Q2, Owner's Name,Address,and �N►�3� Stlt.U� 0! 76 2✓tt Assessor's Map/Parcel 'Mpt9 '12- 1 Z0g'2 Sre-X 14A Was & Installer's Na e Tddres�andTe7.No �i � —� Design is Name,Address and T .No. AND 61C-7W(C'5 f'o' goX 707- P""_rb;JS M 1 t4S MA t'o trr m t a! Sr, . Umrr5 4), - TI� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) SO gpd Design flow provided �/,3 gpd Plan Date M" 1 . ZD i ® Number of sheets Revision Date Title SII�P'f1 e A-Dtr A0A1 P Size of Septic Tank ol-)L /�_CD GAri- Type of S.A.S. t'Aj J_72.L_r0" Description of Soil 5 E$ PL4"� Nature of Repairs or Alterations(Answer when applicable) cu— J�ei.J IS 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 Enviromn al Code and not to place the system in operation until a Certificate of Compliance has been issued by this oard of Health. / Si ne Date (® + f Z Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. Date Date Issued - — — — -- - ------------- �- No. )/(� er— �D ---�,.:,.-Jy. ? Fee 0 % e c�--- Entered in computer J THE=MMONWEALTH OF MASSACHUSETTS p. :� ,,r �PUjlLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS-- Yes =;` f Rpprication for M`ig6g;al *p!5tem Construction Permit Application for a Permit to Construct T). Repair O Upgrade( Abandon( j Complete System Individual Components V i Location Address or Lot No.> /�,n, C7t/cojv Ss(,o�„o (/�, Owner's Name,Address,and Te.No. 10.-VI i ,CNN€ SULLJD�xA osra✓`gwt Assessor's Map/Parcel �I� z, �� L� -2-02'2 Q SI;jL 14AIWD&S Install'er's Ne,a Address,and Ief.No. J� � pu -�_ Design is Name,Address and Te.No. n'1 LND �F/W(G6s P'D, N)L )wPi,LS A4A (019 MA-J#J s1S,­ UN17`5 W, r74 Type of Building: Q Dwelling No.of Bedrooms (] Lot Size kCrP�q, ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) '9 rO gpd Design'flow provided 113 gpd Plan Date N1� � yp 10 Number of sheets Revision Date Title `J 4Tt C yP6&A-Dl✓_ AEPA i P PIA-IJ i Size of Septic Tank a X (-00 GAi- Type of S.A.S. (N F!i--MA-TO/LS Description of Soil S 4LE7 PI-A-?� Nature of Repairs or Alterations(Answer when applicable) N E7W 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 Environme al Code and not to place the system in operation until a Certificate of Compliance has been issued by this oard of Health. ,� ( � - _ S• ned Date , Application Approved by Date 9 /194.)d Application Disapproved by: Date for the following reasons Permit No. ,.r Q Date Issued /} Iq THE COMMONWEALTH OF MASSACHUSETTS / BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the OnlUeRL ' Sewage Disposal System Constructed ( ) Repaired ( SOUpgraded (K) Abandoned( )by �IkMes ('tU u�.(- S a IQ Cti AJ VT CD. at 2-0 6/2.1PrNl) :TIS c�,XA1D 1L If l__5 , OS/7_ffr .2/ll-- has been constructed in accordance �,, / with the provisions of Title 5 an the for Disposal System Construction Permit No. �'" / 40 dated 6 /`(1`�Jlcs Installer 1WM ES ftyt-C�'L Designer� L,}w l? S���1 C.-S #bedrooms Approved design flow 13 gpd The issuance of thi pe it shall not be construed as a guarantee that the system w&funcPion as designe Date .- ( �0 Inspector n" )2,Lr -- —..----_-- ------ — ----- ----- No.� 1�61 1� Fee � • _._ `y THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS Ti6poml *pztem Confstruction Permit Perm ission'is hereby granted to Construct O Repair ( K) Upgrade (V--•) Abandon ( ) System located at Z.o G/L"b TSt.AfJ)> o I1=12.1/[1.1 mA and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of h s pe it. Date �� 9l '',�� Approved by f Town of Barnstable , oFTHE r Regulatory Services Thomas F. Geiler, Director BARNSTABLE, ASS.M ' Public Health Division y MASS. g 1639• ♦� °rFOMArA Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: W g) o Sewage Permit# a01 'Assessor's Map/Parcel D, 1 Installer& Designer Certification Form' Designer: Lr4 �. qjn o Installer: S Address: P-0 60 av3D Address: �, O, bo,,L 617 (IJ, M A D253 On (p - ) D J Nn 93 two was issued a permit to install a (date) (installer) septic stem at Zp 6A,W,b -�s p y CAstJ® �i2. based on a design drawn by . (address) )_1066TLIO dated (designer) Wf Jurvt 7; Z 4,iao n 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. Stripout (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 & Local Re ulations.. Plan revision or certified as-built by designer,to follow. Stripout (if requir cted and the soils were found satisfactory. FMgss� _ LINC;A J. c� o PIN). . �� Clot. - (Installer's Signature) o No. 465o4 /s r eR�`����� G ( esigner''s Signature) (Xff-6 Desi er amp 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:\office forms\designercertification form.doc TRANS. NO.: CITY,`IO«--N-: APPLICA1-T: ADDRESS: DESIGN FLOW: q t '3 gpd REVIENVED BY: DATE: N/A OK , NO GEt'ERAT Legal'boundaries denoted 310 CMR 15.220(4)(a)] Street; Lot, tax parcel number and lot number noted on plan [310 Locus Pro-,sided [310 CMR 15.2204(t) Plan proper scale? (1"=40' for plot plans, 1"=20'or fewer for components} 310 CMR 15.220(4)] Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for up ades - if not, a variance is required [310 CMR 15.412(4)] Location of impervious surfaces (driveways,parking areas etc.) LZ [310 CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CMR 15.220(4)(c)] Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] System Calculations [310 CMR 15.220(4)(f) daily flow septic tank capacity(required andprovided) soil absorption system(required andprovided) whether system designed for garbage grinder t� North arrow [310 CMR 15.220(4)(g)] C/ Existing and proposed contours [310 CMR 15.220(4)(g)] c/ Location and log of deep observation holes (existing grade el. on ,. each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and(i)] - Location and date of percolation tests(performed at proper elevation?) [310 CMR 15.220(4)(1)] Percolation test results match loading rate? 310 CMR 15.242] Certification statement by Soil Evaluator 310 CMR 15.220(4)0)] Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR \ 15.220(4)(n)] Address -Z'0 6raA 1 S GYJ ` yr d SCR �`�. Sheet 1 of 7 NIA OK NO (iLocation of every water supply,public and private, [310 CMR 115.)20i4)(k)� Lhin ^400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply within 250 feet.of the proposed system location in the case Within 150 feet of the proposed system location in the case J of private water supply wells 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)] . Water lines and other subsurface utilities located[310 CMR 15.220(4)(m) (if water line cross see 310 CMR 15.211(1)[1]) Profile of system showing invert elevations of all system components and the bottom of the SAS 310 CMR15.220(4)(o)] Stamp of designer[310 CMR 15.220(1) and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor(required if construction activities within 5 ft. of lot fine) 310 CMR 15.220(3) 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)] Test hole adequate to demonstrate four feet of suitable material? 310 CMR 15.103(4 Test Holes adequate to confirm adequate groundwater separation? [310 CMR 15.103(3)] Benchmark within 50-75' of system[310 CMR 15.220(4) ] Materials specifications noted? [various sections of 310 CMR f 15.000 System components not>36" deep (unless Local Upgrade Approval or LUA requested) [310 CMR 15.405(1(b)] Address ZO G�4 J g�'°°'� STe,.� �� Sheet 2 of 7 r N/A OK No SEPT IC TANK G 4 Size OK? 310 CMR 15.223(1)] Inlet tee located ten inches below flow line [310 CMR 15.227(6)] Outlet tee 14" or 14" +5"per foot for increase ft depth[310 CMR f 15.227(6)] Outlet tee with gas baffle or approved filter[310 CMR 15.227(4)] ✓ Note regarding installation on stable compacted base [310 CMR 15.228(1)] Separation between inlet and outlet tees(no less than liquid depth) 310 CMR 15.227 2 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) 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)] Three access covers (inlet and outlet must be 20" or greater)- Ll middle access at least 8" (by 7/07) [310 CMR 15.228(2) Access to within 6 " of grade -one port for systems<1000gpd, two fors stems>1000 gpd 310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > 10 ft from building foundation 310 CMR 15.211(1)] Buoyancy calculation Required/Done [310 CMR 15.221(8)] H-20 Where appropriate? 310 CMR 15.226(3) Setbacks from resources [310 CMR 15.211] 1VIulh.�omparhnent�anks , � ' Required when other than single-family dwelling or flow>1000 d 310 CMR 15.223(1)(b)] First compartment 200%daily flow; Second compartment 100% e/ daily flow [310 CMR 15.224(2) and(3)] "U"pipe through or over baffle,outlet of each compartment with gas baffle or approved filter[310 CMR 15.224(4) 0S�.,rv.I cl,PPr nf7 N/A OK NO BDILDIi�kG,SERER AND O..-T. R�iPI�TG _:�_F_-r_ _.-.__. . .. : '. _. .:.; _ . .- _... ..: ;.•. Located at least ten feet from any water line?[310 CMR 15?22(2)] Disposal piping at least 18 below water lute(when water and , sewer cross, see 310 CMR 15.211(1)[1 ) Cleanouts r uired/ rovided? [310 CMR 15.222(8)] Thrust blocks specified in force mains?310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] Si hon problem/(leachfield below pump chamber Endcaps or vent manifoldspecified? 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) Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a) 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) Riser if deeper than 9" 310 CMR 15.232(3)(f) Inside minimum dimension 12" [310 CMR 15.232(2)(b)] Minimum sum 6" [310 CMR15.232(3) e Watertight cover if<2000gpd);waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] - Capacity(emergency storage above working--design flow)? [310 CMR 231 2 ] Proper setbacks 310 CMR 15.211 (same as tic tanks)] Watertight 20-in mmium access manhole at least 20"MUST BE TO GRADE 310 CMR 15.231(5)] Service components accessible(not too deep with piping, c.� disconnects accessible) Alarm floats-alarm on circuit separate from pumpsspecified? Exceeds two units must have two pumps operating in lead-lag mode. 310 CMR 15.231(6)and(8)] Stable Compacted Base 310 CUR 15.221(2) Buoyancy calculations needed?Provided? [310 CMR 15.221(8)] Address Zo 411- cQ ` rS f'' G S Sheet 4 of 7 N/A OK NO SOIL A$SOR 'TIOLY SY. 11!I $( Aj GEl t'RAL - Calculations correct. 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] Required separation to groundwater? [310 CMR 15.212)] Aggregate specified as double washed [310 CMR 15.247 2 ] System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.241] Inspection ports specified and within 3"final grade? [310 CMR 15.240(13 Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document GALTERIESPITs,`.CH�VIBERS 3i0.CMR15 253. z . .: ° _. _ Chambers and.Gal. in trench configuration supplied with inlet every 20 ft. 310 CMR 15.253(6)] Each structure with one inspection manhole(if>2000 gpd must v be to grade) 310 CMR 15.253(2)] Aggregate 1'minimum-4'maximum. [310 CMR 15.253(1) 2' sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration,inlet eve 40 s . ft. [310 CMR 15.253 6)] ✓� TRENC ��0 CM�15 25I i Width 2'minimum 3'maximum [310 CMR 15.251 1)(b) f% 100 feet-maximum length 310 CMR 15.251(1)(a Minimum separation 2x effective depth or width whichever greater 3x if reserve between trenches) [310 CMR 251(1)(d)] Situated along contours (310 CMR 15.251(2)] Breakout OK? [310 CMR 15.211(l)[4] and Guidance Document] BED�SASr(Maximnm s�ze;of bed or,field 5000 ggd) minimum 2 distribution lines 310 CMR 15.252(2)(a)] Maximum separation between lines 6' P10 CM R15.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e) Aggregate depth below discharge pipes 6"minimum, 1211 t/ maximum. [310 CMR 15.252(2)O] Separation between beds 10'minimum. [310 CMR 15.252(2)(f)] �- Bottom area used in calculations only 310 CMR 15.252(2)(i vU (9 ._�S� �`� chPPr S Af 7 it N/A OK NO t_ Pressure Dosed,System ? Provided pump and piping calculations as required 310 CMR 15.220(4)(r Pressure dosing required on all systems>2000gpd or alternative Ci systems under remedial approval[310 CMR 15.254(2) and I/A Remedial Use Approvals] If used in gravelless system-make sure jet is directed as not to scour soil interface Guidance Document Inspections once per year(systems<2000 gpd)or quarterly (>2000 d) good to note on plan[310 CMR 15.254(2)(d)] Construction in fill -Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)? Impervious barrier and/or retaining wall? Guidance Document] Impervious barrier installation must be supervised by designer 310 CMR 15.255(2)(b)] Retaining wall must be designed by Registered Professional Engineer[310 CMR. 15.255(2)(a)] Side slope not exceed 3:1 ? [310 CMR 15.255(2)] l� Breakout requirements met? [310 CMR 15.252(2) and L� Guidance Document] At least 5& from impervious barrier to edge of SAS (10& recommended) [310 CMR 15.255 (2)(e)] Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge L_____ to scour soil interface Alterfratcve�e _tic N Y_stem[I/A A royal�e1tersj. Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding-the requirement for perpetual maintenance agreement? L. Any alarms involved on separate circuits U_ Did the applicant submit an operation and maintenance manual? Has applicant submitted a copy of a maintenance ;. r Variances _.:. Y > Are the variances listed on the plan? [310 CMR 15.220 t� (4)( RLS Stamp necessary on plan if a component is within five feet of pro erty line 310 CMR 15.412(4)] New construction or increased flow proposed-[Refer to 310 CMR 15.414] // Address Sheet 6 of 7 N/A OK NO 'Nfxogen Sensrtcve�reas � �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] Is the system proposed on the same lot as served by private well ? [310 CUR 15.214(2 Are the nitrogen loads proposed incompliance? [310 CMR 15.216(l)] Turnping to septic tank? [ 310 CMR 15.229 Shared System [310 CMR 15.290] Address Sheet 7 of 7 Town of Barnstable P# f 2 e?l Department of Regulatory Services Public Health Division Date ��6, 200 Main Street,Hyannis MA 02601 a Ep M1a � r Date Scheduled o/10 do ... Time Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By: = ✓Y��/lllzw Witnessed By: LOCATION& GENERAL INFORMATION / Location Address -I Owner's Name 4,y,q.{ 5-v/1t L" �j LO Gr-a�. T Sl� © -Lv- _5f Address ZfJ6 Z q 15I�-r' 4Ar16 zr^ l 1 � Assessor's Map/Parcel v.7 Z / O 1 cI Engineer's Name Ed 5 Ar ,e_ NEW CONSTRUCTION REPAIR Telephone# ?o UVCP Land Use eb/ Cl Slopes(%) � o� t1 � Surface Stones Distances from: Open Water Body ft Possible Wet Area-ft Drinking Water Well _&/,�Lft Drainage Way Z-715d ft . Property line Iv. F! ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 03 cr /'tea _ •�i .�. �' Y� ` Parent material(geologic) L r` Depth to Bedrock Depth to Groundwater. Standing Water in Hole: �i p Weeping from Pit Face 1140 t r Estimated Seasonal High Groundwater 2 J DETE NATION FOR SEASONAL HIGH WATER TABLE Method Used: _ - Depth Observed standing in obs.hole: �v __in, Depth to soil mottles: `emu in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment Index Well# ` Reading Date:2 Index Well level Adl.factor. ,�Adj.Groundwater Level, PERCOLATION TEST Observation Hole# Time at 9" Depth of Perc 6 2// Time at 6" Start Pre-soak Time @ ',2 O _ 'lime(911•6") End Pre-soak l� '•j Rate MinJlnch Z 1. Z wk`v► Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:ISEPI'ICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) 2- ��A Z(2411 UYW 1/ /vim-��� � t� �i� •s��o 73"� s 6 � `' DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.% 76,YA 51 6 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell Mottling (Structure,Stones,Boulders. Consistency. O ve ti DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell Mottling (Structure,Stones,Boulders. Consi ten Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes V Within 500 year boundary No= Yes Within 100 year flood boundary No,T_ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervio material exist in all areas observed throughout the area proposed for the soil absorption system? t. If not,what is the depth of naturally occurring p a vious material? ..�. Certi6catl°n I certify that o / //99ir(date)I have passed the soil evaluator examination approved by the Department of vironmental Protection and that the above analysis was performed by me consistent with En the required trai 'ng, xpertis an xperience described in 310 CNM 15.017. Signatur - Uh-G Date Q:\.SEPTl0PERCFORM.DOC Raise Covers to within 6" o.1= D-Box Riser Extension TOP OF FND HOUSE EL 20" 5 to within 6"of grade STANDARD NOTES TOP OF COTTAGE EL 19. 8 finish grade install risers as needed (20.0) House (Ig 9) house 1) THIS PLAN IS FOR THE �i�f / REPAIR OF A SEPTIC SYSTEM. 9 6 Cotter e 19.7 Cottage Proposed 2) ALL INSTALLATION PROCEDURES AND .MATERIALS SHALL CONFORM TO 310 CUR 15.000, THE STATE ENVIRONMENTAL CODE, Install CO. with Screw Cap TITLE 5, AND THE TOWN OF _��Barnst ble -_..._ SUBSURFACE DISPOSAL REGULATIONS. to within 6" of Grade D-�� !DB ) 3) NO DETERMINATION ,HAS BEEN MADE AS TO COMPLIANCE OF AVAILABLE PROPERTY INFORMATION WITH RECORDED DEEDS -- ( FG 18"0 obs .Fort WIS'oreu, cap to grade OR ZONING REGULATIONS. .._._., os shown on plan. Vent ----- FG = 17.0 4) THIS PROPERTY IS SERVICED BY TOWN WATER 175 ,2 VIN 3"MAX Install Wye 5) THERE'' ARE NO KNOWN WELLS' WITHIN 150' OF THE PROPOSED SOIL ABSORPTION SYSTEM Proposed Cottage „ 3°4> 2 4' 6) ALL COVERS OF SYSTEM COMPONENTS SHALL BE BROUGHT TO WITHIN 6 OF FINISHED GRADE 16.8 1 10 14" 17 - 7 ALL SYSTEM COMPONENTS SHALL REMAIN ACCESSIBLE FOR INSPECTION. NO STRUCTURES SHALL BE LOCATED DIRECTLY' Proposed Cottage In � � ) Existing House ,/ •., roposed Cottage In Top 14.60 UPON OR ABOVE THE COMPONENT ACCESS LOCATIONS WHICH WOULD INTERFERE WITH THE PERFORMANCE ACCESS INSPECTION 15, 3 i ,� Proposed House Inv INSTALL GAS BAFFLE 161 5 ADS 1600 BD H,2'O Units 1.3 ' � or 6" PUMPING OR REPAIR, p AND ZABEL FILTER Proposed House Inv ( J 3 1 8 NO DRIVEWAY, PARKING OR TURNING AREA OR OTHER IMPERVIOUS AREA SHALL BE LOCATED ABOVE A SOIL ABSORPTION c��,oc�c Bot 13.27 ) , R c�cac coo 14.21 w SYSTEM EXCEPT WHEN VENTING HAS BEEN PROVIDED AND H 20 COMPONENTS ARE USED.6„ STONE BASE 4.6 6' STONE BASE " b 13.27 ' OR COMPACTED BASE INVERT EL ,� X 14.48 .PROPOSED LEACHING FACILITY BOTTOM EL 9) SEPTIC TANKS, GREASE TRAPS, DOSING CHAMBERS AND DISTRIBUTION BOXES SHALL BE PLACED ON A 6" STONE BASE ) Proposed Cottage fJVER Five (5) Trenches with �, TO ENSURE STABILITY AND PREVENT SETTLING. Proposed Two (2/ (H-10) and House Inv 5 ADS 1600 BD (H20) Units �o, 22' TOTAL LENGTH = 31'-Y' `�I O 10) OUTLET DISTRIBUTION LINES AFTER THE D--BOX SHALL REMAIN LEVEL FOR A MINIMUM OF THE FIRST TWO FEET. 1, 500 Gal Septic Tanks Bottom Test Hole El 11 ALL SYSTEM COMPONENTS SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10' S' -- 0.03 s = d.ni7 s -� o.©1 TH. ,�1 ) OF DRIVEWAYS OR PARKING OR TURNING AREAS, IN WHICH' CASE H-20 COMPONENTS SHALL BE USED. 11.0' 12) ALL BUILDING SEWER LINES SHALL HAVE AN INNER DIAMETER OF 4" AND SHALL BE CAST-IRON OR SCHEDULE 40 PVC: ]� 13) THE DEPTH OF THE TOP OF ALL SYSTEM COMPONENTS SHALL NOT EXCEED 36 UNLESS VENTING HAS BEEN PROVIDED. Existing Laundry .1./e tail A 14 N T AREAS OF EXCAVATION EN STING GRADES ALL B REESTABLISHED UNLESS NOTED AS PROPOSED CONTOURS. 2nd Floor ) I HE , ST RAD SHALL E 1st Floor Main House to be abeadoned and remomd N , Proposed storage 15) IF SOILS ARE ENCOUNTERED DURING THL' EXCAVATION OF THE SOIL ABSORPTION SYSTEM, THAT DIFFER NOTABLY FROM Bth Bdr 2r #1 B2dr Cottage room / FG i4'5 THE DEEP OBSERVATION HOLE LOG, CONTACT A & M LAND SERVICES AND TOWN BOH BEFORE PROCEEDING. Bdr 12 ode ?'op _4.60 To 4.6o �T�Io 70 14.so To 4.60 16) CONTRACTOR TO VERIFY LOCATION OF ALL UNDERGROUND UTILITIES. PRIOR TO CONSTRUCTION #3 Kit -�; � .Bdr L ys�' ,c�� =1.3" �11.3" l L1.3" � i.3" Z1.3" 17) CHANGES OR REVISIONS TO SEPTIC DESIGN REQUIRE NOTIFICATION #3 Kit pc rking Bat IS.27 Bot 13.27 Bot 13.27 Bot 13.27 Bot 13,27 TO A & M LAND SERVICES AND TOWN BOH FOR REVIEW AND APPROVAL. Living Bdr 34" 68" 34" 68" 34" 68" 34" 68" 34" Clos Bth . � .Bdr Bdr #1 _ 18) CONTRACTOR SHALL NOTIFY TOWN AND DESIGN ENGINEER AT LEAST Family 5 ¢ Shed Five 5 Ro ws 31' -� 3" Lora Din # � ) g' 24 - 48 HOURS PRIOR TO INSPECTIDN(S). (16" x 34" x 75" H20) ADS 1600 Units 19) MAGNETIC TAPE TO BE PLACED OVER ALL COMPONENTS ACCESS POINTS. � Family Bth 2nd Floor Garage Floor Plans Floor Plans Floor Plan N.T.S. N.T S. 1St Floor N°T S. _ All outlets shown. �+ T/� � j' ]'') �]�► �p are 2' stubs only. rJ 1 V'l V / 1 f`� Map 72 rt.° % Number of Bedrooms: 8 m MAXIMUM .FEASIBLE COMPLIANCES Garbage Grinder: NO Parcel 18 N 56°35'50"� .r,�, � �o f��,, �� �,f�-,Izrle .tx'otr! 11.98' ,, I pp�.' �, e�'--tee 01_11!`°�'C"es$Pool Design Flow: 880 L) VARIANCE TO THE SASS DEPTH BEING GREATER THAN 3. H2O UNITS ARE PROPOSED 0„ E ate, �. �, • B' , l �24 � � .'?,� (110 Gal/BR/Day x Number of BR) S 0ti°17 2 ti°� �� � (310 CUR 15.221(7)) - Outlet shown Septic Tanks' Two 2 1500 41.95t,J ` �- \ 'a �' d �,s is 2' stubs only: ad" sN 0 \ 2,4 ' (Minimum Design flow X 200%) Gal.. t o ° OEe 0 Existing Cesspool WeerNOTE.- Garage Hie Leaching Area: L \ t Detail Layout Existing Laundry in garage to be abandoned r„ led 1 and removed. Proposed Storage Room. (25 Units x 6.25 x 7.9 SF LF - 1,234 SF wooded ` 34 SF 0 74 9 3 GPD � •� Absrre�ter 4 � ''� �� `" ' 1 2 x -- 1 N. T.S. yR \ M' Remo � ` Pipes ? ,tt 1j � i\ roptO " G Provided - GPD Required �- D Reserve A � ``; ` 913 8B� 33 / t , Grade PD _ GP , ,y Prop. �- Pave DB *, Driveway i HOLE LOG rent N 56035'50" E' I ` �' ` ` �-��_ ;` '" `,, Test Hole 1 N�TES. 8 83' l g ; - '�j y.,, /ramp o rush saannd till cesspool 1 r hrt ~`" I�,J C.cr to (EL 17.0 ) Title 5 310 CaIR 1550 , 6 Grade ,. ,, 1�a "r2 Dp h 1 v Soil Sit Soil .p G y , a (Se detail for inl is end outietsl'° Prop 1 p �Cn Horizon (USur' Color �I Proposed iiq i,/ Proposed` `".. Parcel 15 f) DA (Munsell) Parcel not within Zone II Contribution to be $loved, ed r''" TB.If Z'L 19.20 1,500 Gal 6 Gra e x 1500 Gal " and re vved f // ti ` s$ 0 - 12" 16,0 Fill / Cor Patio Propod Storage S--Tank S-Tank #1 roam,, j BSI baraglccl 9 ~ •., '° m� ,," .., t,�� .,,� �` 2" - 16" 16.7 E LOAMY SAND foYR5/1 Owner o Record ".,° r, *. 0, Sullivan, Anne T.R. AES Deal Estate Trust 1 0 r ,f � `'•., ` ,''�•. :•'' ``.�' t ./'' '`-. 6" - 36" 14. B LOAMY SAND 7.5YR5/6 Patio ' 1 r Abandon eststii�g cesspool ^ •' ' :q Pump, crush send AU per c� 36" 144" 5.0 MED SAND 10YR7�6 f 0 Reference ASSESSORS MAP LOT Title 5 310 CAf t i5.0 G ' 14 , ,^ Deed .Ref ,, �� , °'.E�ist, Propose ,,''�, ' ! �� ^`` �°�,, cap r� C1345 � ,. Reloaste exist r`'I ° Inv out. � .,�,\ �,,, outlet in ,% Cottage Cotter e o ` Cone ,. Deep Obs Hole Date: 4/16/1D a �c'er Sep ,/� Repa 13 B r / * �",+ f Inv aSoil Evaluator. ED STDNEPlan R [ ence C, Upgra de P1 11 ' TOF 19.8 Witnessed By: David W, Stanton Perc Rate: < 22 MIN/'IN 6 2" 15354 91 `^•............ C, bra MI r' �, ,r � f , 8 f' ,, ',^ �^ L. C. Plan l 1to/'` / ., Soil Survey Description: CARVER P In motet 1 `' C 1. Geologic Material: GLACIAL OU7 ASE A10PRA1NE ,. /DIl Depth to StandingWater: NA r !, ,' Depth Weeping NA Barns to b1 e, 1�'.L A B D to We � Water: cry ! Depth to Mottling(Color): NA 10- pV ;' Cellar � r/ , Est Seasonal High GW NA r ~ t USGS Observation Well: NA ,.�` -,, f� Located At '. Date of Last Measurement: NA Comments /`� I CERTIFY THAT I AM CURRENTLY APPROVED BY THE DEPARTMENT OF V Grand Island Drive 0. 74f Acres Bldg 20 - .gyp ,� ENVIRONMENTAL PROTECTION PURSUANT TO 310 C•MR 15.017 TO CONDUCT Map 72 , 5 Bdr ;.' ,^. / �p �, f f SOIL EVALUATIONS AND THAT THE ABOVE ANALYSIS' HAS .BEEN PERFORMED Os t er v ll e, MA Parcel 13 `;, TOE' = 20.5 •J �� BY ME CONSISTENT WITH THE REQUIRED TRAINING, EXPERTISE, AND EXPERIENCE r' \ ✓ ;'' DESCRIBED IN 310 CMR 15.. 017 I FURTHER CERTIFY THAT THE RESULTS OF MY ,VEEP OBSERVATION SOIL EVALUATION A5' INDICATED ON THE ATTACHED SOIL EVALUATION FORM, Applicant 1_1U ARE ACCURATE' AND IN ACCORDANCE WITH 310 CMR 15..100 THROUGH 15.107 Anne Z�lll1 Va 1� - _ 208> t Harbors Fiad � Oyster a r ors (EL = 18.5 ) Dl ) ev Soil Soil Soil I O,J (r 1 111 11 1 Y�C L" VCJtJ � �ft) Horizon Texture Color J t. Q r,r (USDA) (Munsell) , ASSESSORS MAP 72 LOT 14 l� � ` p r 0 �- 81 17.7 OEA LOAMY SAND 'oo 13 & SCALE'' 1 � � '0' DATE' Ma„� 6, 2010 North L . `f 8" - 28" 16.2 B LOAMY SAND 7.5YR5/6 EDWARD A. STONE, CERTIFIED SOIL EVALUATOR REV. June 7 2010 cU l`, f 28" - 144" 6.5 C MED SAND 10YR716 Bay 'A CW PREPARED BY 901y `1 iw Locus ,, ' A �c M Land Services ( , A. 618 Main Street Unit 3 STAGE ^ !NflF rMAS West Yarmouth, MA 02673 Deep Obs Hale Date: 4/16/f0 � bra_�$�'g � r IS1�na , IM Soil Evaluator: ED STONE ` Witnessed By: David W. Stanton s ism. p� L1NDA�° `�� Ph. (508) 737-1 7 7 or anmlandt Comcast.net Dj-1V2 \ Q ,r` Pere Rate: �� + o PINTU m Soil Survey Description: CARVER ! . 9 GW- y Geologic Material: GLACIAL OUrWASH MORRAINS / t4D,46504 O ,� GRAPHIC S C ALE O Ster ,.-` Depth to Standing Water: NA .o ,Q 1"Iarbors \ ti �°' Depth to Weeping Water: NA 'Qp FGIST� C�� i W, 20 0 10 20 40 s0 Golf Club West ��,r'' Depth to Mottling(Color): NA SSIONA� Est Seasonal High Well: NA ` Bay , �r'" USGS Observation Well: NA Cotuit , QQ r,.- Date of Last Measurement: NA y ` Comments: IN FEET ) Seapuit River ) i� 1 inch �= 20 ft. Locus Map- �;% Dwg. # 1036.dwg N.Ts