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HomeMy WebLinkAbout0134 GREAT BAY ROAD - Health 134 Creat Bay Road OsterviIie P • ; � A = 072 '-033 _ L Commonwealth of Massachusetts -7a- Q? Title 5 Official Inspection ,Form FI4 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments fir. 134 Great Bay rd .. Property Address Pascucci Michael P & Hope H h Owner Owner's Name/ .information is Osterville✓ Ma 02655 6/17/20 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information �l l�c�filling out forms on the computer, use only the tab Michael DiBuono key to move your Name of Inspector cursor-do not DiBuono Sewer And Drain use the return Company Name key. 35 Content Lane _ rob Company Address Cotuit Ma 02635 City/Town State- Zip Code Bucn 508-364-9587 S113522 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection' I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving,Authority 4. ❑ Fails 6/19/20 Inspector's Signature iDate 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. t5insp.doc•rev.7/26/2018 1 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 16 dommonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments t� 134 Great Bay rd Property Address P Y Pascucci Michael P & Hope H Owner Owner's Name information is required for every Osterville Ma 02655 6/17/20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System contains a 1500 Gallon septic tank as well as a 1000 Gallon pump chamber, a concrete distribution box And a leach field of concrete chambers in stone. 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 134 Great Bay rd M Property Address Pascucci Michael P & Hope H Owner Owner's Name information is Osterville Ma 02655 6/17/20 required for every page. City[Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): h r Evaluation it r f Health: '3) Furt a aluat on is Required by Board d o ❑ 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.7/26/2018 _' Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 134 Great Bay rd Property Address Pascucci Michael P & Hope H Owner Owner's Name information is required for every Osterville Ma 02655 6/17/20 page. City/Town State Zip Code Date of Inspection 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 soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS.and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No El ® 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts :. Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments' 134 Great Bay rd Property Address Pascucci Michael P & Hope H Owner Owner's Name information is required for every Osterville Ma 02655 6/17/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow El ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high'ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or prvy-is within a Zone 1 of,a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.], ® The system is a cesspool serving a facility with a design flow of 2000 gpd- El 10,000 gpd. ❑ ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure.. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No El ❑ 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 El 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 t5insp.doc-rev.7/26/2018 r Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form = �a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 134 Great Bay rd Property Address Pascucci Michael P & Hope H Owner Owner's Name information is required for every Osterville Ma 02655 6/17/20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any.question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 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? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system'components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Z ❑ 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.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V � 134 Great Bay rd ' Property Address Pascucci Michael P & Hope H Owner Owner's Name information is Osterville Ma 02655 6/17/20 required for every page. Cityrrown State Zip Code Date of Inspection D..System Information 1. Residential Flow Conditions: ' Number of bedrooms (design): 5 Number of bedrooms (actual):. 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of.bedrooms): 550 Description: Number of current residents: ,. tR 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 N No information in this report;) Laundry system inspected? ® Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, available last 2 ears usage d 328 9 ( Y 9 ;(gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 134 Great Bay rd Property Address Pascucci Michael P & Hope H Owner Owner's Name information is required for every Osterville Ma 02655 6/17/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: . Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Not provided Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form I a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �V 134 Great Bay rd Property Address Pascucci Michael P & Hope H Owner Owner's Name information is required for every Osterville -Ma 02655 6/17/20 page. City(rown State Zip Code Date of Inspection 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 ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 2008 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 2 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.): t5insp.doc•rev.7/26/2018- Title 5 Official Inspection Four:Subsurface Sewage Disposal System•Page 9 of 18 a Commonwealth of Massachusetts Title 5 Official Inspection Form I o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .� � 134 Great Bay rd V� Property Address Pascucci Michael P & Hope H Owner Owner's Name information is required for every Osterville Ma 02655 6/17/20 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 6. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1500 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?'(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Sludge depth: 3 Distance from top of sludge to bottom of outlet tee or baffle 24" 311 Scum thickness 4„ Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 3011 How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 cam, Commonwealth of Massachusetts l Title 5 Official Inspection Form - - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 134 Great Bay rd Property Address Pascucci Michael P & Hope H Owner Owner's Name information is required for every Osterville Ma 02655 6/17/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene. ❑ other(explain): Dimensions: Scum thickness - Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts x Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form =Not for Voluntary Assessments u- 134 Great Bay rd Property Address Pascucci Michael P & Hope H Owner Owner's Name information is Osterville Ma 02655 6/17/20 required for every page. City/Town State Zip Code Date of Inspection 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.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Functioning as designed 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 ' Commonwealth of Massachusetts Title 5 Official Inspection Form f Subsurface Sewage Disposal System Form -Not for Voluntary Assessments P 134 Great Bay rd Property Address Pascucci Michael P & Hope Owner Owner's Name + ' information is required for every Osterville Ma 02655 6/17/20 page. City/Town State " Zip Code Date of Inspection D. System Information (cone.) 10. Pump Chamber(locate on site plan):; Pumps in working order: y®' :Yes ❑ No* Alarms in working order: ®`Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):' All in good working order at time of inspection * 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: t } Type. 7 . ❑ leaching pits - , number: a 12 . ® leaching chambers number. ❑ leaching galleries number: ❑ -leaching trenches'r number,,length: ❑ leach ing::fields. " _ number, dimensions: ` ❑ overflow cesspool number.- innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts �u Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 134 Great Bay rd Property Address Pascucci Michael P & Hope H Owner Owner's Name information is required for every Osterville Ma 02655 6/17/20 page. City/Town State Zip Code Date of Inspection 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.): Dry. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth-top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l5insp.doc•rev.1116/2011 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 134 Great Bay rd Property Address Pascucci Michael P & Hope H Owner Owner's Name information is Ma 02655 6/17/20 required for every Ostervllle : page. City/Town State Zip Code Date of Inspection D. System Information (cont) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 + r. c Commonwealth of Massachusetts ,, Title 5 Official Inspection Form = Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 134 Great Bay rd Property Address Pascucci Michael P & Hope H Owner Owner's Name information is required for every Osterville Ma 02655 6/17/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts , Title 5 Offic at., Inspection •Form } { �- Subsurface Sewage Disposal-System Form - Not for•Voluntary,-Assessments ° , is e e 134 Great Bay rd Property Address _ Pascucci Michael P & Hope H A Owner Owner's Name ; , information is Osterville. . Ma - 02655 6/17/20 required for every ° ` page. q Cltylrown . ! State Zip Code Date of Inspection D. System Information (cont.) r 14. Sketch Of Sewage Disposal System:' Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks-or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters . the building. Check one of the boxes below: K 4. fl t• ® hand-sketch in the area below ❑ drawing attached separately (vLw 8 117-1 , t5insp:doc-rev.`7/26/2018 r:, Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 r r - cam\ Commonwealth of Massachusetts Title 5 Official Inspection Forme Fio Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 134 Great Bay rd Property Address Pascucci Michael P & Hope H Owner Owner's Name information is required for every Osterville Ma 02655 6/17/20 page. CityTrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ' ❑ Surface water ❑ Check cellar ' ❑ Shallow wells Estimated depth to high ground water: 1 feeett 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 8 Date , ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health explain: r ❑ Checked with local excavators, installers- (attach documentation)' ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Test hole data Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts �e Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 134 Great Bay rd Property Address Pascucci Michael P & Hope H Owner Owner's Name information is required for every Cisterville Ma 02655 6/17/20 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.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments3S 134 Great Bay Road, Osterville MA 02655 y\v Property Address \ Jeffrey Cohen Owner Owners Name information is 175 Federal Street, Boston MA ' 02110. May 6 2008 _ required for , . every 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. Important: A. General Information When filling out forms on the computer,use 1. Inspector: - - only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name � 189 Cammett Road Company Address .; Marstons Mills MA 1,02648 =' City/Town State ?Zip Code „508-428-1779 SI 12855 .Telephone Number License Number --- _. 4:" B. Certification- I certify that I have personally-inspected the sewage disposal system at this address allId that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am.a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the I n^al AJ[?ro!linr As!►h rity vv�r) May 6 2008 Insp ctor's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board A 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 gg at that time. This inspection does not address how the system will perform in the future under J the same or different conditions of use. i 08,108 Cohen.doc•M06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 134 Great Bay Road, Osterville MA 02655 Property Address Jeffrey Cohen Owner Owners Name information is required for 175 Federal Street, Boston MA 02110 May 6, 2008 every page. Cityrrown 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 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: Tank has liquid only and is not in need of pumping at this time. Pump is functioning properly, leaching system had no standing water or evidence of historic ponding. 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. "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 08-106 Cohen.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 134 Great Bay Road, Osterville MA 02655 Property Address Jeffrey Cohen Owner Owners Name information is 175 Federal Street, Boston MA 02110 May required for y 6, 2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced 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: 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. 08-106 Cohen.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments. 134 Great Bay Road Osterville MA 02655 Property Address Jeffrey Cohen Owner Owners Name information is required for 175 Federal Street, Boston MA 02110 May 6, 2008 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) i 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: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool, ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow ❑ ® 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. 08-106 Cohen.doc-08/06 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 134 Great Bay Road, Osterville MA 02655 Property Address Jeffrey Cohen Owner Owners Name information is 175 Federal Street Boston MA 02110 May required for � y 6, 2008 every page. Cityfrown 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 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Sect;on,D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a'tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considere d a significant threat Y g eat 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. ' 08-106 Cehen.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 134 Great Bay Road, Osterville MA 02655 Property Address Jeffrey Cohen Owner Owners Name information is required for 175 Federal Street, Boston MA 02110 May 6, 2008 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)) 08-106 Cohen.doc•08I06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 134 Great Bay Road, Osterville MA 02655 Property Address Jeffrey Cohen Owner Owners Name information is 175 Federal Street, Boston MA 02110 May 6 required for y 2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 Number of current residents: 0 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage 315,000 gal. _ ( Y 9 (gpd)): 431 gpd. Sump pump? ❑ Yes ® No Last date of occupancy: Unknown 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): 08-106 Cohen.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 'Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 134 Great Bay Road Osterville MA 02655 Property Address Jeffrey Cohen Owner Owners Name information is required for 175 Federal Street, Boston MA 02110 May 6, 2008 every page. Cltylrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Tank pumped every spring. Was system pumped as part of the inspection? . ❑ .Yes ® No If yes, volume pumped: t 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Installed 2004 Were sewage odors detected when arriving at the site? ❑ Yes ® No 08-106 Cohen.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 f 'Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 134 Great Bay Road, Osterville MA 02655 Property Address Jeffrey Cohen Owner Owners Name information is 175 Federal Street, Boston required for MA 02110 May 6, 2008 every page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 3' 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.): Septic Tank(locate on site plan): Depth below grade: 3' feet Material of construction: ®concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: - years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No ------------------------------------------------------------------------------------------------------------------------------- Dimensions: 10.5' long x 5.8'wide- 1500 gal. Sludge depth: 0" Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 011 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Measured 08-106 Cohen.doc•08/06 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 134 Great Bay Road Osterville MA 02655 Property Address Jeffrey Cohen Owner Owners Name information is required for 175 Federal Street, Boston MA 02110 May 6, 2008 every page. Cltylrown 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 had liquid only, no solids. Tees are intact and clear with liquid level at bottom of outlet invert. Grease Trap (locate on sl'te 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): I 08-106 Cohen.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 134 Great Bay Road Osterville MA 02655 Property Address Jeffrey Cohen Owner Owners Name information is required for 175 Federal Street, Boston MA 02110 May 6, 2008 every page. Ctty/rown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) 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): 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.): No solids or high stains present. Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No Alarms in working order: ®-Yes ❑ No 08-106 Cohen.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page i i of i5 'Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 134 Great Bay Road, Osterville MA 02655 Property Address Jeffrey Cohen Owner Owners Name information is required for 175 Federal Street, Boston MA 02110 May 6, 2008 every page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Chamber is structurally sound and pump is functioning properly. Floats are properly positioned and alarm is operable Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 12/500 gal drywells ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching chambers have no standing water or sidewall stains indicating chambers have never had standing water(ponding). 08-106 Cohen.doc-08/06 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 134 Great Bay Road, Osterville MA 02655 Property Address Jeffrey Cohen Owner Owners Name information is required for 175 Federal Street, Boston MA 02110 May 6, 2008 every page. City/Town State Zip Code pate 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 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.): 08-106 Cohen.cloc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 134 Great Bay Road, Osterville MA 02655 Property Address Jeffrey Cohen Owner Owner's Name information is y required for 175 Federal Street, Boston MA 02110 May 6, 2008 every 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. 28 42 29 CA cove @ grade T PC .;� 'Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 134 Great Bay Road Osterville MA 02655 Property Address Jeffrey Cohen Owner Owners Name information is 175 Federal Street, Boston required for MA 02110 May$, 2008 every 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 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)I ❑ _ Accessed USGS database-explain: You must describe how you established the high ground water elevation: A perc test was performed prior to construction and system was engineered to be more than 5 feet from groundwater. system is elevated on property higher than road and open water at rear of property. 08-106 Cohen.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 Town of Barnstable OF THE Tp� Regulatory Services BMWSTABLE, ; Thomas F. Geiler,Director v^ 1 `fig Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would be listed on the "Disposal Works Construction Permit". If you should have any questions regarding this report,. please contact the certified Septic System Inspector who conducted the inspection. a Q:\SEPTIC\Disclaimer Private Septic Inspections.DOC L RECEIVED SULLIVAN ENGINEERING INC. MAR 2 6 2004 7 PARKER ROAD/P O BOX 659 TOWN OF BARNSTABLE OSTERVILLE, NIA 02655 HEALTH'DEPT. Peter Sullivan P. E. Mass Registration No. 29733 psullpe@aol.com phone 508-428-3344 fax 508-428-3115 March 23, 2004 Public Health Division Town of Barnstable 200 Main Street Hyannis, MA 02601 RE: 134 Great Bay Road, Osterville Dear Board of Health, This letter is to advise that I inspected the installation of the septic system at the above referenced-property and found that it.was installed in substantial compliance with the design plan that was filed. I trust this meets your present needs. If you have any questions, please feel free to call. Ve truly yours, Peter Sullivan PE Sullivan Engineering Inc. Cc: Jeffrey Cohen- } � t `�� - .',Jk !'•}::'s. - ,.. .���_ _i.-.. .1� . . ..fie yq, s..Y� ,��'g.: 8 Members of American Society of Civil Engineers, Boston Society of Civil Engineers, r JUL 2 2 2003 Town of Barnstable Board of Health P.O. Box 534,Hyannis MA 02601 Susan G.Rask,RS. Office: 508-862-4644 Sumner Kaufman,MSPH FAX: 508-790-6304 Wayne Miller,M.D. July 17,2003 Mr. Peter Sullivan,P.E. Box 659 7 Parker Road Osterville,MA 02655 Dear Mr. Sullivan, You are granted approval to construct an onsite sewage disposal system design ed Road to e connected to a six bedroom home and a one bedroom cottage at 134 Y Osterville,Massachusetts. The approval is granted with the following conditions: 1)The septic system shall be constructed in accordance with the revised plans. 2) The designing engineer shall Supervise the construction of the septic system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the submitted plans. Sincere yours, Wa e Mil er', D. Chairman _ BOARD F HEALTH - TOWN OF BARNSTABLE Q:HEALTH/WP/Sull7Beds �iHE tq� ,v DATE: FSSt 1AIINSTAJIM HA88. 9qj i619 ,0�' REC. BY Town of Barnstable S=D_ DATE: Board of Health 367 Main Street, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Ralph A.Murphy,M.D. VARIANCE REQUEST FORM LOCATION Property Address: 1'5y G PgA- B,,v - 'R[acl OsVeryA-2:' Assessor's Map and Parcel Number: 07 Z —0 33 Size of Lot: I.Z3 AC Wetlands Within 300 Ft. Yes ✓ Business Name: No Subdivision Name: APPLICANT'S NAME: S v c C r� Phone r j�,• Li $ 3 3 y Did the owner of the property authorize you to represent or her? - Yes t/' No PROPERTY OWNER'S NAME CONTACT PERSON Name: -�e4rfy Coy,1,e r" Name: Q - WWWAIVIN C 39 falty� Oa1� Dr., 7 Park-er P cl► Address: W�.X�an� /Y1 Address: b erv:\\ (Yl Phone: Phone: S03- 4 Zo° VARIANCE FROM REGULATION(fast Reg.) REASON FOR VARIANCE(May attach if more space needed) NATURE OF WORK: House Addition 1 House Renovation ®'Repair of Failed'Septic System 1:3 Checklist(to be completed by office staff-person receiving variance request application) _ Four(4)copies of the completed variance request form _ Four(4)copies of engineered plan submitted(e.g.septic system plans) — Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) , _ Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/lessee only],outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) . Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G.Rask,R.S.,Chairman NOT APPROVED Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL s Ralph A.Murphy,M.D. Q:/WP/VARIRE4 No. 1U��� s Fee THE COMMONWEALTH OF MASSACHUSETTS r d Fjntered`incomputer: J Yes PUBLIC HEALTH DIVISION -' TOWN OF BARNSTABLE, MASSACHUSETTS ZIpplication for Zigooal *p5tem Construction Permit Application fora Permit to Constnict( )Repair( )Upgrade(K)Abandon( ) X Complete System ❑Individual Components Location Address or Lot No. t,:5 L1 G Ra A r B A Y Ro A n Owner's Name,Address and Tel.No. a SteRviL_Le , /)1,4-s 3-E1=FRGy 'S. C0116Av Assessor's Map/Parcel 33 GL.L/v Jq/-d bY"- /N `7Z p 133 WA)YLAIVD 10AS5, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.SO 9--4 2 Fs-3 3 t{ q IV/�N�ILGIII�/eE21/1/fi I/1/G� rK.c2 2D Cs1E12VIL1,6 Type of Building: Su Dwelling No.of Bedrooms Lot Size 1 0 23 A Gt. Garbage Grinder(VJO Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 7 7© gallons per day. Calculated daily flow — � 7 gallons. Plan Date M4 L\/ tI , 2OOv2- Number of sheets 1 Revision Date I 03 Title PrroP©SE D st-rE I M Pray/ Ai EAIr 5 /6-00 C_ALLays Type of S.A.S.�`X3�` L�qe /`yy (3 ED%tri2. Kl Size of Septic Tank yp �`I Di EI✓s,5 Description of Soil O-• 3 Lo t4wl 3'0 117 � B R W. Co,4r5E SAND 1 q - 3(vi, SfiR F3rt�.► CaarsE 5R/vD . �� �I2 K. G'1 s N• i32v CuArsc-sAryD, y 2 al Gr'ls H• BRrE . C.r�/�rs� S�Ai7� Nature of Repairs or Alterations(Answer when applicable) DESIGNING ENGINEER MUST SUPERVISE INMLbkTI0N AND CERTIFY IN WRITING Date last inspected: THE SYSTEM WAS INSTALLED IN STRICT ACCORDAi.CE TO PLAN. 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 TiIts 5 of the Enheth. mental Code and not to place the system in operation until a Certifi- cate of Compliance has been ' by Board of Signed Date Application Approved by �► Date 02 Application Disapproved for a following reasons Permit No. 2 fl U 2- 212- Date Issued -Z lkfir) -29 '' Now # k Fee XX + r" j THE COMMONWEALTH OF MASSACHUSETTS ,' Y� re -in computer: Yes �r PUBLIC H��►`L�H DIVISION =TOWN OF BARNSTABLE ,M SSACHUSETTS RpOlicati in-for Migpogaf 6 pgtem Congtruction Permit Applicationfor a Permit to Construct )Repair'( ).Upgrade(X�Abandon(` ) Complete System ❑Individual Components' Location Address orfiLot No. l'S N 6 A. fi,RAY �+ �, O ner7srNName,Addre s and Tel.No. ost�2Vlt..tr�`�-fYfAs s '� 'v Ct��EA.�v Assessor's.Map/Parcel 33 4F �'pK E Installer's Name,Address,and Tel.No. yy �. Designer's Name,Address and Tel.No.So 5--�{z e 3 3 t,d �c' 1 P L I VAR NGINl3B2�►Y� (NG �� os-e2 Vs t.I-a ass y Type of Building: 1 Dwelling No.of Bedfooms_ Lot Size 23 q�t. Garbage Grinder(VO) Other Type,of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow' ' gallons per day. Calculated daily flow �" �7 gallons. 7 --� P1an,Date CTL4 L- 007— Number of sheets Revision Date to/1 Bea s Title ProISOSESE U 5f re 1 M proValm ayy-5 uu Size of Septic Tank /600 GL,41 L.O/t/s Type of S.A.S. Atx31' L-EAchIV 15 ED rZ p�{users; r Description of Soil 0- 3'� L-o AM 0 3�1117" 6 RP, -COArs E ,SAND 1 9"- 3(.�� S t R 43ri�► Catarsf sg1Vp . '34, — y-," DK. G'ts14.I3t2V. CaArS&.SA�D, G�r'Is H• 6R.t�1 . fr.ArSF S'.gyn r 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 provisions of Titler 5 of the En onmental Code and not to place the system in operation until a Certifi- cate of Compliance has been tssted,by this Board of Iveafth. Signed f /9 Date JJ Application Approved by Y Date /U2' Application Disapproved for a following reasons ` 411, ' Permit No. :2 t/ v 2- Date Issued { S VJ THE COMMONWEALTH OF MASSACHUSETTSl BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded Abandoned( )by --, —at 13L4 G-rEp't B,A?lr 2a.4D , 0s1' 2 Vl L_LL' hfA ss has been constructe in ccordance with the provisions of Title 5 and the for Disposal System Construction Permit No. a Uo,�-�O/R dated w U'P Installer Designer The issuance of this permit shall not be construed as a guarantee that the systern}}wfhi function as designed. Date b OG Ll Inspector ----------------------------------------- No. a �d a - �92 ? i _ {' Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS - Migpo!W*0gtem Congtruction Permit '* Permission is hereby granted to Construct( )Repair.( )Upgrade.()()Abandon( ) System located at 13y 641E-4 7" &411 R61.4b r and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title�5 and the following local provisions or special conditions. Provided: Construct on must be completed within three years of the date of this t. Date: /a Approved by J� �- TOWN OF BARNSTABLE LOCATION1 '>`" �a y �^� SEWAGE # VILLAGE ®S ZY-I61`114Z ASSESSOR'S MAP & LOT 02-033 INSTALLER'S NAME&PHONE NO. �����!/ 1���� ' 7 7� -�✓�'9� _ SEPTIC TANK CAPACITY ,✓�®a ��� 1�� �Gi�l��/� LEACHING FACILITY: (type) 17, " 54�1, OW/1 45, 0/i(size) NO.OF BEDROOMS BUILDER OR OWNER Ile 4 PERMITDATE: 7 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Tab le°to the Bottom.of Leaching Facility Feet Private Water Supply Well and Leac -ng 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 A ,4 z- 3s, 43- ya6 83 - z4 ' A7 .51 D 7-- yf' 0 S 7 �u�ttr e west- ©uy� 7 and epma7 GATE 9/19/01r r. r ----PROPERTY A O O R E S S t 1 34 Great BaY-Road-`-- 6 �j . -_ bstervil e,Mass. / on lho aboyo dolo,, I Inapootod the oop►lo syflo'M at the abovo addrO33 Thls iyslom conslali of (he (ollowIngl 1 . 1 -1500 gallon. septic tank. 2. i,1 -Pump .chamber 3 . 2-leach trenches. 12 'X32 'X1 ' RECEIVED 8eieo on my Inspection, I cortlfy the following oondltlonu 4 4 . This is a title five septic system. ( 78 Code ) ' OCT 0 9 2001 5. The septic system is in proper working order at the present time. TOWHEOALTHDEPT BLE 6. System was installed8/3/93 ( 8 years old ) 510NATVRLI„/ Kame : .! YjsQattr--.J.+_--_-- Company: Jo, • ph_P _ N• comb.r�b Son , Inc , Addre55 : Box 66-_ __Once-rYill � � x� ,- OZ6�Y-006b Phone :__ 508_11_S TM15 CERTIFICATION OOCS NOT CONSTITVTC A OVARANTY OR. WARRANTY JOSEPH P, MACOMBER & SON, INC, T+nki-Qi i iPooll.t,r 40hllf ldr Pvmp d 4 Initfllid Town 3twfr Conniotlonl P.O. 8oz 66 Cintinllh, MA 02637-0066 775JJJB 77$441z 1. e 1 .. COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL, PROTECTION i TITLE 5 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 134 Great Bay Road Osterville,Mass. , Owner's Name: Michael Barach Owner's Address: Same , Date of Inspection: Name of Inspector: (please print) J.P. Macomber Jr. Company Name:Joseph P. Macomber & Son Inc Mailing Address: P.O. Box 66 r'pnter-ille Na 02632 Telephone Number: 508-775-3338 CERTIFICATION STATEMENT l certify that 1 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. l am a DEP approved system inspector pursuant to S tion 15.340 of Title 5(310 CMR 15.000). The system: Conditionally Passes' Needs Further Evaluation by the Local Approving Authority _ Fai Inspector's Signaturasmit Date: The system inspector shal 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. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that Mime.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I Page 2 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 1 Property Address: 134 Great Bay Road Osterville,Mass. Owner: Michael Barach m'`{ Date of Inspection: 9/1 9/01 Inspectio ry: Check A,B,C,D or E/ALWAYS complete all of Section D A., System Passes: 4D I have not found any information hick 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 septicsystem is in proper working order at the Dresent time. 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. •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: w 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: Z�0 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: 2 Page 3 of I 1 W _ nA OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 134 Great Bay Road Ostervi le,Mass Owner: Michael Barach Date of Inspection: 9/19/01 C. Further Evaluation is Required by the Board of Health: 4/0 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: Wt , 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: �Q The system has a septic tank and soil absorption system (SA'S)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. " 4/0 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 frortl a private water supply well". Method used to determine distance v4S�J/Yc �a�J. "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: 3 L ^.Page 4 of I 1 t n OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 134 Great Bay Road Osterville,Mass. Owner:Michael Barach - Date of Inspection: 9/19/01 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No Dackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ischarge 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 /„�.j��X $y�`x ; Liquid depth in4esspoa4►is less than 6"below invert or available volume is less than 'h day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number 2 of times pumped�. 1y portion of the SAS, cesspool or privy is below high ground water elevation.5 !/ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface — water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. :Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for 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/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 he 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(Iinterim Wellhead Protection Area IWPA)or a mapped Zone 11 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. 4 Page 5 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:1 34 Great Bay Road s ervi e, ass. 0wner:Michae1 arac Date of Inspection: 9 01 Check if the following have been done. You must indicate`yes"or"no"as to each of the following: Yes No , Pumping information was provided by the owner,occupant, or Board of Health Were any of the system components pumped out in the previous two weeks? as_ H 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? ,Z/_ Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up-?- Was the site inspected for signs of break out ? Were all system components,c-x luding the SAS, located on site ? Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of thee 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: Yes no 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(3)(b)J t 5 Page 6 of 1 I OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1 34 Great Bay Road T Osterville,Mass. - Owner: Michael Barach Date of Inspection: 9/1 9/o 1 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): `9 Number of bedrooms(actual): F ,J DESIGN flow based on 310 C 15.203 (for example: 110 gpd x# of bedrooms): )p Number of current residents: Does residence have a garbage grinder(yes or no): $ Is laundry on a separate sewage system Oyes or no):— [if yes separate inspection required] Laundry system inspectedA( es or no): Pis Seasonal use: (yes or no): e ��y� Water meter readings, if avar able(last 2 years usage(gpd)): ,�"f,,.� /'mow Sump pump(yes or no): �j ,�s `7+ Last date of occupancy: -� ^ �o COMM ERCIAL/INDUSTRIAL Type of establishment: AJ,¢ Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc Grease trap present(yes or no): Industrial waste holding tank present(yes or no):Xv/ Non-sanitary waste discharged to the Title 5 system(yes or no):.l Water meter readings, if available: Last date of occupancy/use: _ OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: _ r� Was system pumped as part of the inspection(yes or no): If yes, volume pumped: gallons-- How was quantity pumped determined? Reason for pumping: Yep OF SYSTEM tic tank,distribution box,soil absorption system gle cesspool ,fo 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 4d Attach a copy ofthe DEP approval �v Other(describe): Approxi ate age of all comp n nts,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no):Id 6 I_- Page 7 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued); Property Address: 134 Great Bay Road Osterville,Mass, Owner: Michael Barach Date of Inspection: 9/19/01 BUILDING SEWER(locate on site plan) �i Depth below grade: _ — Materials of con struct ion:16Ocast iron ✓40 PVC other(explain): ,fJ Distance from private water supply well or suction line: /(I/7` Comments(on condition of joints, venting, evidence of leakage, etc.): Joints annear t1c1ht -Nc) evidence of S stem is vented through the house vents. SEPTIC TANK: locate on site plan) 167b d4kJovi c/ Depth below grade: M erial of construction: concrete.f/O meta I4JOfiberglass olyethylene Ztother(explain) If tank is metal list age: is age confirmed by a Certificate of Compliance(yes or no)�.(attach a copy of certificate) �/ Dimensions: m Z"Vz" WwAt, � Sludge depth: Distance from top 9f sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle,: Distance from bottom of scum to bottom of outlet tee o baffle: How were dimensions determined: ���"��' Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels .as related to outlet invert, evidence of leakage,etc.): Pump septic tank annually Inlet &outlet teeG arp ;n place_ The tank is structural 1y Gntrnrl and chnwc nn evidence of leakage. GREASE TRAP (locate on site plan) ' Depth below grade: Material of construction:(concrete&meta tdtfi bergl assjtX po I yethyl en vtAoth er x (explain): A 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: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Grease trap is not present 7 Page 8 of I I OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:1 34 Great Bay Road s ervi e, Owner:Michael Barach Date of Inspection: 9 1 9 01 TIGHT or HOLDING TANIsd/We-(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction:V14 concrete VA—metal l/6fiberglass 4 polyethylene 4?,# other(explain): Dimensions. Capaciry: allons' Design Flow: gallons/day J' ' Alarm present(yes or no): Alarm level: Ai/Q Alarm in working order(yes or no): /� Date of last pumping: (jA Comments(condition of alarm and float switches, etc.): Tight —orhoiding tanks are DISTRIBUTION BOX: (if present must be o ened locate on ' P )( site plan) i 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 has two laterals No evidence� of leakage into or nnt of the ox.No evidence of solids carry over PUMP CHAMBERAAoe4locate on site plan) Pumps in working order(yes or no;: Alarms in working order(yes or no): Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump chamber is present.Pump is in working or er, -oa s are in working order. pump chamber is structurally sound. * 8 , _' Page 9 of I 1 8 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1 34 Great Bay Road Ostervi e,Mass. Owner: Michael Barach .Date of Inspection: 9 1 9 O1 SOIL ABSORPTION SYSTEM (SAS): locate on site plan,excavation not required) „ 2— leaching trenches. 12 X32 ' X1 ' I�j�jSAS not loc ted explain why: Type leaching pits, number: V leaching chambers, number. a leaching galleries, number: a �qyy f } leaching trenches,number, length: �'' X..�L /Y/ .!J leaching fields, number, dimensions: 10 overflow cesspool, number. . dZo innovative/altemative system Type/name of technology:l/� �;,�p ��dnt S Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Loamy sand to medium sand to coarse sand.No signs of hydraulic fA i l ure or nondi ngSoi is are dry.Vegetation is normal. CESSPOOLSt&g_(cesspool must be pumped as part'af inspection)(locate on site plan) . Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: ./j19 Depth of scum layer: 14)14 Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no):4A „ Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Cesspools are not present PRIVYAj4t(locate on site plan) Materials of construction: j¢ Dimensions: y Depth of solids: WO Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy is not present � r Page !0 of I 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C - SYSTEM INFORMATION (continued) Property Address: 134 Great Bay Road Osterville,Mass. Owner: Michael Barach Date of Inspection: 9/19/01 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. 9-y rJ f jam. ..�✓kr S u w 0 ; l , 10 s, 4 tS. Page I 1 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Michael Barach 134 Great Bay Road Owner: Osterville,Mass. Date of Inspection:9/19/01 ; SITE EXAM Slope ' Surface water Check cellar Shallow wells Estimated depth to ground water feet , f Plea indicate (check)all methods.used to determine the high ground water elevation: x Obtained from system design plans on record- If checked,date of design plan reviewed: _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: Used; Engineer Drawn plans- SeP pag,Qc 13914 Top of Ground �OY1 • ���eet . Groundwater.t.,�r�t=eet Below Bottom o Therefore, the vertical separation distance between the bottom of the leaching pit and the adjusted groundwater table is feet. II L •rtrnrn.—n:r�*--n—srrr.—mr•nm.s•-.nas+r.rrar::me*s*r1+s�-+nrm m-n�u rra�r.eert is-n .�, TURN OF Barnstable BOARD OF HEALTH SUIISURFACR SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION •.•.r•• �T••. ::t—�.f:f.�.�TTt�t1T1'R.'fTf T1rMT1flPI'1T1'1�.•.'I^71TrtlRlOr�TT�/Cnpf/.�'10AR.�f�`I�7 rants .:-rrr-•r•-, ._..� -TYPO OR PRINT CI.EARL1•- PROPERTY INSPECTED - STREET ADDRESS 134 Great Bay Road Osterville;Mass.' ' ASSESSORS MAP, BLOCK AND PARCEL # 072-030 OWNER' s NAME Michael Bafach PART D - CERTIFICATION, NAME OF INSPECTOR Joseph P. Macomber Jr. COMPANY NAME Joseph P. Macomber & Svn: Inc F COMPANY ADDRESS P.O. Box 66 Centervilhe Ma 02632 . Street Town or City State LIP COMPANY TELEPHONE (508 ) 775 - 3338 FAX ( 508 ) 790_ 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate, and omplete as of the time of inspection . The inspection was 'performed and any - recommendations regardilig upgrade , maintenance, and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one: 4.• ' System PASSED The inspection which I have conducted has not found any information which indicates that, the system fails to adequately protect public health or, the environment as defined in 310 CMR 16 ,303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* \ The inspection w}Iich I have con Octed has found 'that the system fails to Protect the public health and the environment in accordance with Title .5 , 310 CMR 15 . 303 , and as specifically noted on PART C' - FAILURE CRITERIA of this inspection form , ' a r1 Inspector Si gnatur Date �' �72�?d ` ne copy of this e ification must be provided to the OWNER, the BUYER ( where applicable and the 130ARD OF HEALTH. * If the inspection FAILED, the owner or..`operator shall upgrade- the within one year of the date of the inspection, unless allow.edorrequiredm otherwise as provided in 3.10 CMR 15 . 305 . partd .doc AU -22-2001 13:48 COTTON REAL ESTATE 508 420 3151 P.04 46 i TOTAL P.04 TOWN OF SARIVSTAB[.E „, LOCATION /3 y m 3 cSrey t SEWAGE VILLAGEtfPrv.1/P w _ ASSESSOR'S. MAP d LOT INSTALLER'S NAME fe PHONE NO. ,�s,h f7 l/D SEPTIC TANK CAPACITY v 00 } LEACI32NG FACILITY.{t o_ FPe) (seze� od"Ia y3a.,� -i O NO. OP BEDROOMS z PRivATE WELL: OR PUBLIC WATE Aj �DERR OWNER L /,' Cc-✓ r U, DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED 9 3 m x" VARIANCE GRANTER- Yes NaV O - A Oi To Be Lo.catedjoro tnsiauai�w�. ' Ilg 1000 6AL.SEPIC TWi( 2- Of 118- -Pet` k CALV.W PN45` ` o 0 0 0 0 0 0 0 0 is r> C)TO n NN 4 lAUM BOX Glly.WK am C 3/4"-1 112" f Rwoa fa Wn O GWash ed Stone) O MW Me PAT RAdc t loam l.�--- 12' IfR v FtMT SUM . f GATE VANE Leac; naf jkn AA t uc PW ON EL-1s+ Cr( RNP pl fL�164 i —Nc W Off 1=264 X.. OM =' Note: :~:::::► Existing 9 Fin. Floor E1.=10.6'-+ Plumbing Test Pit Data ..' 4' PVC ® .02 ft/ft Indicates ® Indicates - Perc Groundwater Test _ 7.08 Ground El.= 3.40 Footing 6.48 Loam 3.15 Gray ediumNO.?, 1 Pit Fine Sand 2.15 c. Joll r P.E. Test By. B/ack�ne •4 Sand 115 Test Date: 6/8/92 Witness: , , Perc Rate: Design Flow.. :Titie 5 (5 Bedroom) 5 5 BOR x 110 GPD/BDR = 550 GPR or r Septic Tank Requirements: 1.5 x 550 GPD = 825 Gal use' 1,000 Gallon Tank Ground E1.= " o R.3.36 5.36 Pit No. 2 Leaching Facility Requirements: Test B}/., C. Jol/y P.E, per B.O.H. Revs For 'On—Site Sewage Di .36 Test Dote: 6/9/9Z Based On Perc <2 Min. nch Use A Hcot .86 ' G: Dunning BlO.H. SF—IDay. � = Application Area Required (AA)= Flow Min. nch _ y .75 Gol. SF/Day — 73 <2 GPD- / Perc Rate: � AA - 550 Leaching Fac#1ty Provided: Lor Use 2 Leaching FieldsA plication Area Provided 2(32 x x1` 1.86 768 SF > 734.SF a. y A y o �" /• / / / Gate' & °f I \ Fence tag Omwool (To Be Mod) / f o h / New P/anfings \" p I O 0`o r O lo9 Shrubs, Perreni6/s 4 0 Q. & Annuals ' �.wn\ \ 0 r �J S•r cs / \ ��� 0 o r Fueldw7 Tory. s I. — _ _ — Be Rem. �• _ r2 0 \ proposed Feldst�ne p 0^ �I J: I\th Decorative Fence 0ver 1 p ;. f o0 �. Top\ Wall E1=8.0'j / - e c 3 o Top �en ce EI=1 Q.5 Max. \o� To tal . sigh t Va>jes Q°° Bo t tol� 0f. Wall I= Varies Match\Pro ose� Grade \ dam r es / (b• dot B m^ 20 New Plan t/ngs o 00 p0 Shrubs, Perrenials \ p p o 00 / r & Annuals — \`` \ ban do0 doodo tea/ rguson, Robert L '�'+ — 0 0 ooBoro a0 I oy s . �y6'+ o 0010 0 od' c ' ,4 ...Vent o aoo o vocy�Fen — g JO � V E 8 CONINIONAVEALTH OF MASSAC14USETTS CL'TIVE OFFICE OF,E.NVIRONMENTAL AFFAIRS /pit► D RTNIENT OF E V IRON'�1E1TAL PROTECTION ~l�v IrO ONE TER STREET. BOSTON. NIA O:IQS 617-29:-5400 c l0 0 0A ar ti s Ig 9 \VILLI.AV f- �pllg6� J ` -� TRUDYCOXT tan Govemc• ARGEO PAUL CE I DAD B.STRLMS Lt.Governor y `UBSURFACE'SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissionrr PART A CERTIFICATION Property Address:--'/3 4 (u�Aa �y r S "`(62Address of Owner: w�QJ k) - u V.Q �S Date of Inspection: 4n�/4 ,/0 (If different) © 1\, C5 A C�6 f Name of Inspector. CiY I am a DEP approved system inspector pursuant to Section )5.34A of Title 5 (310 CMR 15.000) Company Name: _ aL,L� ' E7�G" y e",s Mailing Address: 'P© 1Y1V-Sf?0'p2Q ^(A9L- m26CL9 Telephone Number: (Spo2E,/ [.j=-2­3- /(L Zo CERTIFICATION STATEMENT I certif\ that I have personall% inspected the sev,age disposal system at this address and that the information reported below is true. accurate and complete as of the time of inspec o-.. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposa systems. The system: Passes Conditionalh Passes _ ',eed� Funhe- E,aluat;on e Local Approving Authorir\ _ F : s Inspector's Signature: Date: L The System Inspector sha!' submit a copy of this inspection report to the Approving Authoritv within thirty (30) days of completing this inspection. If the system is a shared system or has a design flo" of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department.of Environmental Protection. The orig:na! should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, Or D: A] SYSTEM PASSES: _ I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. 411\ COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the Wond Wide Web htW//WWw magnet state ma.us)aer 0 Pnnied on Recyued Paper 4 1).S^ if '{ �'3 r i•Jt r•a t t t r.^s f ..�>r s rr-,'•''t. SUBSURFACE- SEWAGE DISPOSAL SYSTEM INSPECTION FORM 11 1"?1, s{, I ,! 'Ir� {j�1I. F. ;, F;ART�A w) ✓ I'3 _IF. r, - M���`' � Yt! e ( Y3 1* a CrE�RTIFICA�YTION,(eonttipnue+yd)[i t✓.t RE @�. .''t�C Alt. ..cr'r d.a-it F°r%�I:17'e 'Y[" C I,��.r'Rd'�,1L Jt,'.4 r p y -�3 L1 G v,ef- � 20/� ®s,f Pro ert Address: c,/ n ,•,i.r -if) r:�r�V fi .r.Ve.C1..t3 es.r.n -2.(fitt, , , ° •, Owner: L✓!�► 2 k S e'�+,,�r X�'! Date of Inspection: kr sr+ r:'r a!.l ,1- -Y�; 6],SYSTEM�CONDITIONALLY,PASSES tcontlnued s,t-f� Setnage backup or breakout or,high static water level observed.in the distribution box is due to broken or obstructed pipets) or due to a broken, settled or uneven dist'bution.box. The."erp will.pass inspection'if.(with,approval,of.the r :Ai�ur,:rc!'3 Board of Health] �Descritie°observations° ,te f V21 L+',`#ta2._$'3Alilt:li?Bilt •'.broken pipelsl,are"repla6d8 "obstruction is removed h gliT,Rs� • 5( distribution box is levelled or re-laced �'.->,'l �` �. `�-f'i. .t'._',y ... k.ha 4.,� �'Ifl'jl'.✓Id+.1�3'11 C!"� The system equired.puinpirig'more'tha-n four times a year.'due to Ix \okem or�obstructed pipe(sl*,,The system will, pass t , 'y '•, , , .'inLspecttion it (with approval of the Board of Health) ; - :7 ,� ,.a_�_. rrt�ta r}rig Pto 5r�i trq tb}okenpipel'si are '.replacedr#oi19Z llt;tnaaa5ut� �ot�.q�ns mYea b c,t,%A ,s rr obstruction is removedt' -�ls'a . a ._ .,�jlrs..r� i; ,srt C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: /1?M3T t '3'. i:.IJ�F :l1i?t :(i}!?.� �:3:'L+IJ: -f,C,7(tE�tti�t(`!lI �'-1: 1ri1�1 t}flb e?$1�ti.16 �iti' 15 S`.19i�,'/2 IL�2.C�C1d=11 �?aN$? �•"!1 v='.'7J+7s(,t f(16P1r+, ,y,? R. -�'i.j i,:�•^'1 Yl,h�j l ui Conditions`exist-which'require-further-evaluation by•the Board of.Health.in ord6r."to determine if.the system_is failing to;protect the; public health, safen•and the environment. :rNt*�t'r. �;',T .�^�;2vt k?o•az•`1 vcs�:,3� 3;.z•no to 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSMM'.IS-NOT FUNCTIONING'S IN A MANNER ., . WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE EN`VMMMENT:.^C.i4br.o1' Cesspool or prn� is within 50,feet of a surface water,, t f bordering vegetated wetland or•a salt marsh./ d _ Cesspool or prig, i within 50 feet o a bo de g ege h ; a} d t 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATEL SUPPLIER, IF APPROPRIATE) DETERMINES THAT "t Vlt:'iTHE SYSTEM IS.FUNCTIONINGAN'A MANNERJHAT PROTECTS;THE^jKI)C HEALTH AND.SAFETY AND,THE ,• c aril ir,sz „ENVIRONMENT:�Yiu 'at x:n: 9'Il t�t5�- 1 ,r.:s :' ,(1: ra nat) nx,�9b o izti 1^ rnc!t;y, , e.r �.) E �i l<Y2 ,trlf '1 `*3, .s,b.:i.`ic'li. 3l;9 L1 ?Yi s?, k{� liJ<)•t2.lti,r:}i?17 r3Zf �:f1•v7tlFi iatr;_>tCr?11'J7 1:1,-:tfl15NIDCgSgG.104 TO 3)"i ti� The system has a septic tank and soil absorption.system(SAS).and the:SAS,is within.100 feet to a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and_the,SAS_is within,a_Zone I of a public,w'ater4supn!,y;twell. _ The system has a septic tank and soil absorption system and the SAS is.within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and the SAS is.less than 100 feet but 50 feet or more from.a private water supply well, unless a well water analysis for coliform feria and volatile organic compounds indicates that i':i o rthe.well,is free from pollution from,that facility and•the7 presence darnmonia_•nitrogen and nitrate nitrogen is.eq'ual to or less than 5 ppm. Method used to determine distance,•-!.. 6pptortmaUon not valid) y , ._ 3) w,OTHER .w _.r......... s.._,.-_,..._..._.... �._._.__.._._.,........r.wk.;�,..,��._:... . _ _ ._..,..._ _.._:� . - ^995 a •P/cY'>••+r-. -,'i i.t�'i",-.:'4 'f, J,17 ,r 5:i'•{2 '1 i�I ,L s,. "�:.f -,o i,:::: `:14.t`• .#:;di iJ::3n .Jt?:.":r.: "22.i,�1 iv^ �lei, � f • ,7i i r` _....,.,_....•,. `t'v.. .ye t.� rT?{1:!',',2?�tti cirl�rtf,Cl+';ny .7 2`•(2 r•':Lf'7 :[::l.i,� �.lY`o-qq4 L'i ti[,�3t 10 :r° +t.} 't 31 S,'}_t 13 r::Y°l:1q:tlrJ� j J t t`Ic . . i#1':tic:tt!:7_ •fyJ -2��f'.LY:3Y! ", 11 rt a:}t:);l i� I S'' ir? : J .'rthA .,'4 .`i`t •.5.wf1. 4 yi,A?i'ii:�1 G Sr •{r�;f;,i 4•f ,c�P3.:c;;f1t f it;:, _ CI'.I:Sr -''ri Z t�,irni9'i3-1�275'.1f5 Yll 2:':-i.`t:: `'jfn 2t > 1�3% a .!.. � =.,..�Y .i'k f: ��'i.F • ..(.. '.,` _rt �'.r yTt\. -t#.-,-- .7:..4 a.-�..w7a:YF aw'rN t' WH; �!1-:'': #la 'Al' ';'.'' , .r<. :"t'','1.°, ') ^.Utif�:7, Pi �srt3 ..+ it -.'>;� V��:^4_t'!31i?�•'J1i" ,t1ii�5'u1''J 2t ;','Ti :•Jrt :,? ;� ;Y:� , ,. .52 3'A! �!'i •? ,it'111 41' l . 'ri,.�f i;a 1 .,. zi t r:r;-_{ r' k ,sq ° F• rt:,,. 3 r , - i. :1 r.a !1� e w. Y.`k -3• it ir(i1�:«'B St 2 i.,., +'f" .•�, '}^."t' %a 1Vdf., (revioed 0�/25/9�) yr ..Page-2 of 10 �;`,t. :'.u.•.,n: en,no:a; SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM t:FICiri 'P"•O1T"J3°_Ieif r4aYraY2 fw':+'PART A') ,r.lJ3a %� .dA`1.P.F1'1F. C�'.,O• - . '- CERTIFI AT N-(continued) Property Address `,,�3 _e Owner Date of�rtspection l�.a 35a DJ,.SYSTEM FAILS You must indicate either-"Yes':,or "No*"'a<to each of the following .' '� �•- I-have determined.thaf the system violates one or more of the following failure criteria a<'defined in 310 CMR 15.303 The basis for this determination iii identified below.- The Board of Health should be coritacted to determine what will be necessary to;correct" 'the failure;.. !Io4 so$to.il,iso no Tii'z io 25Y" ii: jor 9f1'p1btli MUrn`uo'' :snob ns-A 9'dfr! 3nirJLfaOR�rfli 31 ��tr;'1 Yes, No -.. _. ... r1.tE �yi rhR R� err •fin 'e rif ra fXt••arn.:.:�i , - nfbr rr•"�—": 1 ^t11 aY? ._' Backup of sewage.into facility•or system' cortmponent due to an,overloaded Felogged SAS or cesspool �,» eh• �iflt:DrF �t1a14:irSS].7"r'�6^I f4^1-rpt;,"r.n ,•.•�•�rlr., .,R'+ia•rl yi ',h9;1�•^ ,r '.rowan airi-rl •raa'nr'vti•••%n�y =w*-.•s-�ri•e ` Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or 'lytr j.Ft1�a 9S ,ie,I),•y901.Moll,cesspool.,9�1JL3r.)lIP1d'n•ri-� )C?r4 rV.Sd't-3i:b'N ip'd?itif:#,+'•{1/!?F;16.� ..�'tali$Q,f6fi1 Pnil3,ir'} ' ,*i 7 ii{;i), z;71 zrrit'ac rLst as Static liquid level in the distribution boa above outlet invert due-to an overloaded or clogged S4,5 or cesspool. ' -. f+,'�i? fii1V.:'.$)'.�iC>I1i>J-E itlt��'!,6.'f �S tf 9)LT�t .b9r1i,"r1K�+3,U16 t?�IlifiiOQ;1�?�.I�,T;!'1Eirl,�tfty�';t7yr1.�y4 .. . • ,• � ': , Liquid depth in cesspool is less'than 6" below invert or available volume is less Mthan 112 day flov.. .(}U• 6Ci 9 E♦wy� its iClt l�+01 §x9;lwClttai i+h./ 9rZlllar,b io .i+i--io :4. ...Reouired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe si. ^umber o'times pumped :sitiuuanl'Tu;nI,Ji s>z"mi) 3s10?91 Mn 190t)msl�/e ri i �� ,•. cr4e,.: Am ponlon o`the Soil Absorption 5�stem, cesspool or privy'.is below the high;grou��,ndwater elevanon r� ^q 4 gvC.ri .r}-.-+yv� ^,nii�� +dryy .FI ^4 hi.il•aY ra .,rain`. •.n. .,..alJ:o t1; ��( Any por,ton o:alcesspool 'or'ori,� is within 100afeet'of a surface water supph•or tnbutan•to a sunace water•suppl) iU''n@lilt;^.U? f bAnj�`portlon'o{a'ces`spoo,�o�pn� 's' rthA�nca'Zone I'of a public'well'��' '' `f 'n 5 y�T ' — ..2 tC7 rti�`?']`J .''��iJ1J 16 tO J'l Ft?`:ta •L)!L'}•3't F;J lil.,}a.:t :`�(C f'I jfY11 L� .fYQ1+7tJ•a21:07 3 c•II�Jrfil'.: ?�'ii 1+� Z": tfy�. .. .. Arry=por o- o a cesspool or pri�ti is within 50 feet of a private water supph well 9T .. 74 9�i7F ta'1lrinr1 15 IAtY1Ari Fpo or`,'o a cesspool or prn,'lstle`ss'thari 100 feetrb`ui g eater thank feet`from'a privaie'Naier supply well with no acceptable water qualm analysis. If the well has been analyzed to be acceptable;attach cop%-'ot well water analysis for coliform bacteria. volatile organic compounds, ammonia nitrogen and nitrate nitrogen. EJ LARGE SYSTEM FAILS:o, :;riv.tc•)rts ,' r,a, !`est.os .'.«a1 u179,1, 3 1,!'si 3::F+.c , , You must indicate either "Yes" g� or "No" as to each of the following: :d'�,."•Uc �i j •i ns:�5:,75F1,, . . The following criteria appi% to large systems in addition to the criteria above: The system serves a fecilit, with a design flow of 10,000 gpd or greater (Large System) and the system is a significant'threat to public health and safety and the environment because one or more of the.following conditions exist: Yes No . the system is within 400 feet of a surface drinking water supply r _ 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 11 of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment•program requirements of 314.CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) pay 3 of 20 '?bVAI 143P(2.11 35A:di t b:,3F;..t?vr.! Sl'BSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM tb.tirPyijci:,)p ytC�PART,`BsT>37. CHKKLIST t3!`�...e Property'Address e'_* Owner: ✓ Date of I ectfon:. kVAA.W>j .-�Q .' ,• �i�;/Q��/ � }.. : ._ � •:;�']t F�f��,+�`ddf��19 f+J��,`J-i 4f "�J�" tt!."L°�'f- Yr+l't3t k.:Ldr:.'tl?f"�Clr'i�-:Fid!'_ 1t�lU hdT .40C,4f Pit O Chit 01 Orr fi1',Vhly rt31i4r t�°t4'fJrslluy�vtf i7 n1UrtS IQ vla @Jy$1Cir{'tr,3jo'(2 vie;M$ 31 r+1:7 :}i id 04"W 1,sll is+tit'b w tp,�& w 8,j bluriAd r(il�§f-1 JO b�aad qHT. '.wol9r+betlombl zl no1fG+liiJi-fib =713� 03 Check if the following have been done:,You must indicate either Yes" or No' as to each of the following: '. e�3z; -5t+i Yes No yl ��u.• ft'cP empin`g r orr�tahon�wias�p�ruovtd ubY�th�e °atner¢oL'upynt.1orRBOavdYOlf Hea�thr 9fyAw41 TJ'qw:A">E� .y 04 No Le�oY�h s tem�componentsl�ave been.ppumped m.7orRa��east two:weeks�and ithes�ysrem•has been receiving normal, flow rates - during that period. Large .volumes of water have not been introduced into the system recently`or as pan of•this inspection. t' '-00v;q:) 10 2P"G Lt'J�j titl5 to 01 J 'I r(i& JoU:f1c.tCi+}ittb ? If f7: i J19t r j:t a!< As built,plans have beer, obtained and exarmnecl , Note if-they are not available with N/A. vU}1 frRy iiP rS ii 0tr41 ti ^37t!t"1G4 tii t�Evi�U�i vnt ii4� �"ci r'�rit�e91.}i Io�3qus",I rtt r;�9U:Yir{?11 .:,The facility or dwelling was inspected for,signs of sewage.back up. :: 2'SiiitQ 'r3f'�.i,}�rfrj 4;)bijpl.t{I)qu.`h TPA trssv iej 4ri1 ni +!3tni1 b ntrlf gi.rn `grmc;-',u•a b1 ;;n,t1'i — The system does not receivenon-sanitary or industrial waste flow. f3tigr i.t� _'.;111'!0 1�•;:rtu X — ,ATI_e site vian'er�i5 getji�rFSlgn�fobreakouy to 3ooa2�a .r!9Tt^r�.rtU::+jSCtt,"kA i:C? 9T l'U rr:;"n lt1.fl /� 1 sysfem component, excluding the Soil Aqyorptio System, have been located on the•site:„ ^� r rStC15.'t�-,;N '.S)L�r:.:c �•..J ClrfrtJ t...r ,v i1.q,yuc �ar:�+. �Jal.us 5trz �( 1,ir:i,�t 1;).:�.a{:c:a.c ,,..v, ��'-1 =,'1A - �•. — The septic,tank manholes %ererunncoverred, o&en�e'doand�the interior of the septic tabk4wa�,lnspeded for condition of baffles or tees. matena! o*construction. dimensions,'deptn of liquid,.epth of sludge,depth of scum. .. ' SI$�M`'Jla�fi'..i�Y3`�-'it"•93b'ht(! f+.TC ty-.rt 0' -r?Lrd7Ji;'4, 'dyrio +O.It•'`'fi::r.,.� .,)•;.:-:a The size and location.of the Soil Absorption System on the site has been determined based on: The fatuityi+one, iano occupants. if different from owne were royided with information on the proper maintenance of —,.(IV! t^..5 n' =ary,11(i n 4.-01• 1.,,l Jl , P A3_Ai , ,7 "-- if fit.(; &CP •&;,JU 31 ,-if p i et r•:r ttj •v rr:L,Jt:7or. J u•. '.'y' tnP ,,... .....,_, ?r33 ?f Y,It GG t91�Ia ll,$u 5u ace.lDisposaas 'ema SS; r31 qs5'{iEa'fi f13'i�1 mai ligw 9n7 31 a;a•tl_.,^.5 /?,J64i] ':lfv.+ '31j1ri0 �''c -- .. .. _. ... r".fJifl 3)f,�t n IJ:13; C+G�ttSt;4 Sai'7Sr•r}Lr uai3V."STO� =,.�GJ�1D 5`1.'��^.l 9,"1:�Ce ,. : !C� Existing iniormati'on. Ea. Plan at B.O H. _ Determined in the field of an, of the failure'criteria related to Part C is at issue, approximation of distance J unacceptable Iti.302i31t)] ;�nivcgiloT Sdj la r'ac9{i i5 "o. '. a "s� .<"i s tr•�1:, 9;r)rr' a 3t' �s,nC:a£rt'Flit] �1 1 oY flnrh lCS nl ?;n,) v: Z _ *_•. _ cii.�i i> + c-' �'_,f, :rr'.f 1?�": ✓t +:,:il.r: +f'ti.; "tire :-J'1� �; rc.�1�F l�. 1.'{:]i`!h it b U !Si.],PF: iiJ ;)uG �5i:i!z'{G 3�1'Ie, 1 )9iS�31,SJ` t'.i)p odor . ',rlrtCi.tZ+rJ17 tie�f)i>t Clflti 9��'. lUc b 10 J,.l :`l�'o tlrri;i-.'t:1 ,71];°•{'S .a.i) - ''S It �':^-is> .•:r.1`'1 ' Yt :i) C ? � it+�Y : �E.`O f ? .1 & nJ d . lilcl+at ylgq!7L �:i";r jl7jil.lti3i"i Ys r•`i a , . - . y 1`JrtiV.' iC ll:3r 'fi!+iUQj n ay r ,rigf Y i;iF t f " ' .C:4Sllcf.t'G'"li rJ!�JJ:h'1 tQ� i'c'wwiY57c`+5;3� &Cii 1C :7:713v lail•Ot��* i;..'•4`a1 '?r 1.- alUr'.,i0] :�;y:r :.0, 4.:^.... �''U.c :j!:i�' .,. '� .. �� ..;CSti .. (revised 04/25/97) Page 4 cf 10 SUBSURFACE-SEWAGE DISPOSAL SYSTEM INSPECTION FORM iiARC(l .1W, y'2: 1 0378V YPART'G 30AW32 37A3nA'AdUa SYSTEM'INFORMATIONe; ./ /0 ihy�ilii'tt�:' ;^C11T�Iv1St;L���l ��312/'!2 � • Propert% Address.._ws)1 G�c•-T �� �� : �S->fe,c,t, '��•� Owner: LV j/► Q . - t .. ", '•. -§� cn' , APB^.�j�ti, vi'IS�yC xS� „-,Date of trt ectlon: : �,�,1�}�4,��•.�t„� �' � �,� � •�:C-'- 5 �a�11 FLOW CONDITIONS , RESIDENTIAL. %r � r�✓} ff3Vdg. 5f9fUt� Design floN; p.d./bedro6m ior.S.A.S )nrlq.vita ;q 13)x)0J Number of bedrooms. Number of current residents b2 ybti woj x3 1fOric' Garbage g , der(yes or no'.: A fnislgx , 19dio DVq QA�, r o1i'In.') . :r?oit,uttano�10 -Laundry:co-.zected.to-system - Seasonal use t es or no`': nor ua �o IIJu+I - n- v � 'l n qq�- 67&-y 9itq ,Cj nrb,1 atist ; Water meter readings; if available (last two (21 year usage (gpd): Ny 31�errtt{t� r . . . Sump Pump Ives:or no):0C� (. f9,9 6i1.fst to.,) q ,g;if!1„5r ,irit t to:riouibno�l a)rtilr+mo 1 _-^^w .. �.�.,....,...--.-,.-.-.. seer•-..--,..,,,w..... ,,,.-,•�.,..._.._..•._.� __ Last date of occupancy - •����,i,,,;,rIF1AT :;rlr�3l COMMERCIAuNDUSTRIAL: Type of establishment. Design fiov,.. galionsida% �•�3Ea_qb l Grease trap present lees or no'_ nl6lGx�fisr;•r; ynSlYrlf,y'1105_: itbl :9dti f;un1y :s1)n0) !�hIc115f?I4i+j 7Q {.C)1Jm A. - Industr;al%taste.-Holdiog_7ank-present,-wes or,�o: Non-sanitary Kaste discharged to the Trtie 5 system''•tve"Ofno 1�nisilgmoJ'to n¢mu-noy 4;, ei�_ 936 ;Zit2i. 1%ater meter readings, if availabie fva-VSl (V1.54'- f. •)•.Y_i3+1-,r,:i:;'t Las;,Pate o; o cL;pa-.c-\ P st;:.&d t0 cn)':�+:u0 :O �'0::�14{"Of 59Jt+`. :C c$71 mt3l 9;rlkf?; OTHER: .Dekcribe »gi A Iiri„1i Last date of occuoanc-, it 'f 9+"6d TO ;31 c^sr,of •Tlu.z ;o qol .>"riaP 3•:1sd 0 391 :9!iU0 r; ^?:'QC) Of mud? ;0 ;'-OI'O6 Y011 -7rth1?i� eV.SI�C.�i'_�✓>`'��_. cS5•a-n-J!,4G 319.d znrl a ScrS>) wuH . GENERAL INFORMATION - PUMPING--,RECORDS'and source"•ofini rm t; n`iv f"o rif sb •9fivi �o ;s-i; iotn;o-bns 19Inr 9r., -� i y, 0 a O i7' Ov 7 i^,:• rii .g`•h+'A.y -rot JirFh94M`iif 9J,i • �.�.:�:��� - •:$�5�-vr��S�`fvc:�;��iy2-dt.✓L.t��v<v�",p-+ c�1 ,�tvc��7tVc:.•e_c�-.�'o~.�S�vw.'P •f�Tz-�?C1n,S���;t w`�—„ - , :?�,Sjstem:pumped:as'.Part_olans ction:_t�ses'or�no; T pe _�•��.-�c� ---'. 4a�:. br _..._..If_yes,:volume,pumped� - - gallons 1 ,._,,,_••,� -,.-.,_._.__.______�___,a__.,,..... ,_,- .,.,..--.Reason TYPE OF SYSTEM 7� Septic tank/distribution box/soil absorption system ��t�wP C�`6`"���`�. TUf;; s:: r16. tsoull Single cesspool Overflow cesspool Pricy (n,Nlgx9),w�10 girl^)tirl:•2VlU 1�s ZLF1 +,9Cf _^ )4i191�_�_ �,137:n0�Y_^.ft(y51>+J7ttf!d� f0 1-.15{r:f`! :_Shared system.(yes or no)_(if"yes, attach-previous_inspection records,.,if any)- •___r I/A Technology etc. Copy of up to date contract? _.�_ __ _--____� ,_ � r .;r • ;:�} Other t,!Aad To Y•_1 !3,,u0 '7 qof w mt:i 3G r'i,�Ft'i+.;72•,;.�.');•.tdi{?' . )of !*;,;v)o moru;d of %,) nlnrt, I•ir 1}0_, ,!sf.K'! APPROXIMATE AGE of all components, date installed (if known) and source of information: 01Q% 14 (-�Ch �rcCi�3 1�"?� sfstj - Sewage'odors"detected'wheri arriving at iIie'"s;ie',(Ives or ti tins iSl ,in ?,:.F'.'t0� •�ri(;,7 •!� 1O' �U;i£t.r5 rL,Tlt.,a')1) (revised 04/25/97) Page S of 10 01 a, a ages q to P: itt:r i • t Nfli73 t71T,3�x` rf WT?V? WO'li?I(I 3Z A.W32 33A3,9J281J2 SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM 01 e A1lItiC)P.ART dCJF 'f 2 SYSTE-M INFORMAQTI�O�N, .(continued) ' Property Address:'./,3 �F :.'�"/�2cL Owner. �v "(,>! •.�.`�',_. ;r,iaif7h?.j2rr {n 5��C3 �ws . [ ' . Date of I�e) ctrom � ,1 •4'�\}' © ;� o )c - :/OfXIC3Vtfi��dfi.fl�, BUILDING SEWER-. C.(v / �[/ '!:?L (locate on site'plan} >_. ? +ot mo'ibidl b 9 a- r�o�r-rip�3 Depth below grade: zsrra' :a.51 Jm to)c! IWMJk I Material of construction. cast iron _40 PVC other (explain" zw) • 3.'S,1� �nri.n a:;r ,eo'�1ii'.9 CWWfS., .,1-.e = - Distance from pnvafe water supply well or suction Ir-e ;�!1 'an fa Diameter �..,,... �w. �._ o. m.¢��__..;.:,.., , i�.. (!t+$)`i3j6LU :63V �l n'�!{ !?fil} J� ?�75fb��":25(Ytt1cSD1 AfL'3!ti !9!G'�f Comments: (conditiori'o(joints, venting,'evidence of leakage,'etc:) ,•tt<�'• �b zflvtmL ct`. `" (locate on site SEPTIC TANK; plan - :JAtSa3'wE1��vvlt Af��S� +A�iil7 .. _ -._- _ _ .. _..-- -- - ---- -• - ._ - - -__ .. .. -.... .. "-- ft'1'ilrl�iZ�{i!�';1351'1�.,,,�ly�, ... Depth below gradeG�tc Ic°„ Noil n ,f.»,�} Material of construction: �(concrece _meta' Fiberglass., _Polyethylene _othenexplain, _.on,o 9.rflsJ If tank is metal, Iis: age Is age confirmed b% Certificate , of Compliance -Ln (Yes,"No,l!y? flmT $r,J of 07;}'�;r,;a+l e?,r'J;`rt>t,ri?;`�+af .. <e171 Sludge depth sS Disiance from top of sludge to bottom of outie,.tee or ba-;;e 3� Scum thickness: \ct ,.:w.,,. .—. �..-:......_ •--___. _------ __ s. 7•;s �3�:•�T�1 Distance from top of scum to top of outlet tee or:ba�+{e Distance from bottom of scum to bor.om of outlet tee o• ban.e. •13 How dimensions were determined 1�`f124&uOSt(�. : ..>SGI'CAI+1JfiOVt*tl ;$JSvq•�•i'3u� Comments: irecommendation for pumping. condition of inlet and outlet tees or baffles. depth of liquid level,in,relation,to,outlet invert,struc�ur,al��;A{;�rp r._ FtS i t t,i►dl l�ir-Cr� inte•rity,revidence:of,leakage etc.v�°%� T _" r GREASE TRAP: (locate on site plan) �y✓.�-rt.•,r0�,r ��war%^ ' n7a1dY+ t:C IG1G?Si ,:G-_ ri Depth below grade: )rofita r-, wor"-w'r _ b Material of construction: concrete _metal _Fiberglass _Polyethylene —other(explain) f�it4 . iv r+F� +Fi+.ntat lUYirunar.i ••n:.n.n - (•• ..\ ,.,-.•r5 s.dy" "- Dimensions: o; qu'0 -eg01 -DA YT:nlOnff�3T r1.ia -� -Scum thickness_ s,,...a„,..m� ^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:- �� �l -z�� na:S6tra�;.i,'+ io n7euc� bnt (nwor.A ti)'bnlis z;r ;ro , _rtegnjt_ :fi iJ '.:`.'a - _ .. Comments: (recommendation for pumping, condition-of inlet and outlet tees or baffles.;depth of liquid level•in relation to•outlet insert, structural;,., ..� integrity, evidence of leakage, etc.) u (reviond 04/2S,97) Page 6 0f 10 1 �;SLIBSURFACEiSE+WAGE DISPOSAL SYSTEM INSPECTIOtiJORM ( rtniSYSTEMMINFORMATlO!�,%,46ntinued) " Property Address ,-,!�v ).; / l�� /Z S--,A-ex t�►e. `4 c-t V' �cy �� tia `U '.�-•� �'J��..'1 •�����`'.:..,zt�aib� t�'"y�o'I�6 Owner: i (/�� a a.. a rr' Date of Ins�on s '„ b '`:-� iit>7r1a{artii to �3r TIGHT OR HOLDING TANK: ;dank must be. um n por to or,at tiute .l�.me of 'ns d , tc�� r,urtt�+,-si•e,r rwp.y:�r dab«, ir� ion ,�r r Gr;C�fb]R9 `FIi�r226C1 I 4 Wil.(10 :(locate on site-plan;, _ 1 „ Depth below grade: ; . -nr6)ar� inxstq Rd gt Yr�tti" b;airsil ntaterial'o`f construction. concrete" metal Fiberglass'"°"Polyethylene '�-�'-:...-..«•..(.avn+.y.Y:.FF,.. ....•m....�a-r'�..a,..xs*,:•b�.�...r.•- .r-�+,'•:s:.:a.�(_t..� _.,�;;,;...�.�`_ _ _ _ res.,,w.a.. rr ..w.a..:cworr...onnmxr....w.wrN.:ifr.. - n4 moll ilk�t rra�fiq! Dimensions: n:t?.7urn ;zi,�or+:�ria•AK?1,i�td Capac.in•: on- galion� _` , i:('rr,Un,. s',, .,Rnirl'CF��4:: Desig floes galions;da, 7 + i'�H7{,�r{Irr1i.:1 ;2917 I��t Fttis J Alarm level Alarm in e;orKing'order _Yes. _ No rt x ._z,oiz~yr�ab pa +;nollf Erna° t:2t Date of previous pumping tycnnt rr,ioogz_Q'.V1Gt! FVo _ _'Comments' _. . _ rnr»e� Qvi!sf11!st{h (condition of inlet tee condition of alarm..and float switches, etc.) '�..,���ry�g z�7.��l r s zs..P'� 4:.. ..!p, ,.•.�,r,t'/ ..( % ..f Il .sY t f') �", �,. r � `•, •_°t � '� s .•[ ..,yr.r—.'..�-�-.�..�-.z ej - ._.��.._.,...._.....,..va...p...x-_......n+e:.... _r:w._�..•.vlwa.�ca �q�}� .N._.-aY.._�...a.�_.+-^r--^...d ti.t.+.p�- t"�ta�`.-y-'�•� ,•••�.R- "DISTRIBUTION'`BOX` w (locate on site pian. � ~-_ , .r._ »•w_.,.._...._. ...._�_..Y..�.r._...._..�. veil.._ icy#�ORc �� ri'no Death of liquid level above outie: invef: �,�`o�+QLvT 1Z,1J�1Q. Comments: io G� .(note if level and distribution Js equal, evidence of olids carryover, evidence of leakage into or out-of ox, etc.( �ao1- Zko w �'Q•1,�1>rn J i,�7u cam'=`301 i _ "1�10, _....,..._.�_... .....�..._..-._ ._.n....o_-,-. r....... ..._.._,. ••�!:'X;.'ir ip _ .. .., -� '�*u" ic':f ;�;y�� z;is�7s .. PUMP CHAMBER ""(locate on in pan— - -' _. _.�.ti,__. __.. _._., ___.._~_ r..___e__.__..._ �_.•.___.-______ __Y .__. Pumps in working order: (Yes or No'_�-S • 2Srl�sf:trnrj`'F Alarms in working order (les or No ,iyrtlb"=fla'o levai .�:ulzcl fo ?nfli2 •lira a, tsf)iti(1g4J.^I Al Comments: Irioie condition of pump chamber;condition`"of-p-,umps•and appuiteiiances,etc:) f� wiiP- .....-.,�...-....�..?.'?ilit rsy rf:Il:_.......,....a..s.....e........_......._............._....-,..-_...._..�...__..a.�. --.._-,...__�._..-_........_ ��I;JI:i!7,�ti:��(� 21t�i����A>� .. - r"iFt:�rifCrClj�. iil an.Lr4,j ic; (revised 04/25/97) i,Frap��7y,of 10 �� L'1?\:51,53 !'>PF?•f•n';t i fr'y'0jSU65URFACE}SENAGE DISPOSAL SYSTEM INSPECTION I?FORM J 3`A: PART C tt) c6e{i•. -"eRtw'r e¢��a+.tr , SYSYEIv1�I kMATION (continued) " bps/S* � Property Address:..3 G'ea T � �M Ojs .vt Owner:. . - Date of Inspection:" SOIL ABSORPTION /0" AS>. (locate on"site plan, if possible; exca)a�tion not req"uFied?but'ma�be`approximaied by non-intrusrve•meth6dsi r If not determined to be present, explain:" t' �tvT"'N{315tj .114 . "fR, .r,�R9l�yna,.7, ..'l9nJryff'I�c\�lri1 2:f..r,�jr (Jii ea,9t,: s1�s1.,:S4` n!3;J'J?�7 i2,1');1 iS� Ft,{;•a::rsi+t .. . `"TYPe:-,.,.,-,.;�-,;.M...,.......:_..,��:.....,;�.� t.:V,.:...�a...�.:.»...a.....� �,:..,w..�::••�r.:,.:....�,. -..,.�,�.�.�.:...:.,.:o,..,._w�..:.:.- e.,�....w-..-,�..,.�.: ' i'leaching pits'number._ leaching chambers, number leaching galleries, number:-, leaching trenches, number,length:` r r_1 leaching fields, number, dlrnensions. 01 1D X- IL-� tyy "o'G X^I�!O,v(1r ru, ,r rgp67 r��et,'e overflow cesspool, number. Alternative system Name of Technology." till,hwfi na,Els :o ro,,t.,a ..F�f 1is)rr �o•rt _...__Comments � . . .. .-, •-..,. ,T,. ,— �--y:--� ____ _- _-_ .__ -=mote condition of soil-signs of hydraulic=failure,=level-of ponding co do f vegetation.-.etc:)-- t'------ ' ---- ' CESSPOOLS: (locate on site plan: ---_ Number and configurxion Depth-top of liquid to inlet imer, cal .� „•.r.+^f'I -r`r rY, J fJCr 'a?i t, ��5.<s—�'i it? ',y;kfl9ttr"p� •1R yr,411 fry 2t•rit�%r Jn�rj fA -,;wr-, --r�,'�r�.`+ imp, 9. �I i �ray„ -� Depth of solids layer r s ---Depth-of Scum�lavefL. �, i,rc✓; s`�d ' t .CwA9 / 'y 1 Y.. �' - - ..r�__T- ......�..� r _r-a;?,,:r7G�^4't T` --•.may~. _"'. ��..e r.d..; -Dimensions-of - -.Materials of Indication of groundwater" inflow (cesspool must be pumped as par, of inspection!! Comments: c'•u•: ^_ ,a ?.rri t;o sri, rr ni e,!.-,;;; (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.),y-� �" o e'�rt �'`'� "(' ''` ' rn ' .,«.... :::�"�••" ._ ",a. ... �t6i ,"::,'i.._4.Ji't7 .d`..'.)tUa,'�t4.;4tii3 Ut9b £i1t7`i.i311, io --1001131'.U) (;r5"'V,S ,ti --'(W:. .•.II+ 'w..- .i._._" ....r.:, '.?... .:.�".-.<,'�:..L...�rsc: SJ:.t - rri-.•,o • r..�'. �,�s c.•��^ }f._ �'!c.> r,�r e.. +• 'i -- (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.)• (rwssed ,04/25/97) 0; " Pago"a of 10 r.AsISUB SURFACE;SEWAGE;DISPOSALS-SYSTEMINSPECT1Oy FORM 4):TPART C for YSTEM 1.FORMATION ,(continued) Property.Address j 3.14 ��}1 +�+- � �tY �4r � ,OST�,t'Ir�C G tiq a� '�. aa, Date'oi..l�et1on ,SKETCH OF SEWAGE.DISPOSAL SYSTEM: include ties to'at least two permanent,referenceslandmarks or benchmarks locate all wells within 100' (Locate where public wate ,supply;comes;into house)�m;qt��+or ti�?u zbont^,i7r±t 1► :`�7��ibn� �Fs,4i�t - b?d39� nts efidq ridet3r1';�" It tJ�&1cyJ . �.''t 9 n9U� Srf�;^1+"SaSS� .91C3ri nt7+t6•rS�(� +�n:r;, n� Ji,�/!� �it��� 4�t� +'iR��U' �TN - G+�!I�rfU ��3f7 cTtOij yt :•+_I'T, � Q a� c� MU dD 011+q,-rC7 fir f IMI �JI y:91[7�t4i5NJ^•UC' ) f18 } y+ s�?;t�6::z 7 f J^/.�%C q.-f) 1.c f i a111 �79! 32. G�- 48 . D`� St 1 f,�-,508SURFACE'•SEWAGE'DISPOSAIISYSTEM`INSPECTIO&'°FORM TPART C Y(25YSTVM INFORMATIOW(l:ontinued) Propem Address Gam, 1w Owner, S _.,..r _�; � � � •' Date of section. - �� ;nyt7wstH! to i'�6Z� 3,ST2Yc� JA �4elq �;i9W�y'r w+t f3t"3.� Depth to'Groundvrate�'f ICJ Feet r �. rdrle�r�ifl�a .tc.z��Lr+t�1i sf e n},a 9s M9 am'�q.`aYJ1 i2F,9i'1G,of 290 ilt;JIj;IF Please indicate all the methods used to determine High GrolJndwater'Elevat ion:-)+1duq' 9.srlw- o:) '00r:rwlii+v llgY+ !Is 9rrx Obtained irorri Design Plans on record Observation of Site (AbLttmg property obsenat]on hole, basement sump etc.) `Determine it from local conditions = Cnk '�%Iith Iota! Board o. neaitn �1 Chec� FEMA n1aps Check,pumping records Check local eacavaiors: installers ...l se L SCS Data Describe in %our own "oro; r.o%% \ou established the High Groundwater Elevation, (Must be completed, \ — s Wr A, (052 , Vq-V,an r I Z ':.a i AV lsw-sed 04,25'9', 10%of?Sp e TOWN OF pBARNSTABLE LOCATION !3q g t-ZAti— SEWAGE# ice 5 if VILLAGE 05T-W 0 V ASSESSOR'S MAP&PARCEL r-�NAME&PHONE NO a i�!C fc ��yo,,,y� r/�Q,^0`7 I EPTIC TANK CAPACITY /S®O LEACHING FACILITY:(type) /} 506 �� ��1, (size) NO.OF BEDROOMS OWNER E Q C d PERMIT DATE: DATE: -1-ri56P w7 5A. O 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 2s 42 29 y �ky� ° CA cove s n grade v .° j TOWN OF BARNSTABLE �L LOCATION ?7 `7 �lJd' � FJa Y I' SEWAGE # VILLAGE 05 A21 CIIA� ASSESSOR'S MAP & LOT y7.2`o 3 3 INSTALLER'S NAME&PHONE NO. ���I��!/ [�/�v 7 .71 `���/9 SEPTIC TANK CAPACITY LEACHING.FACII.ITY: (type) 17, " U'�OW/ �(size) NO.OF BEDROOMS BUILDER OR OWNER y PERMIT DATE: COMPLIANCE DATE:.3 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 Z- 35- 93 - ZQ13 � r -MV of oz 03 0 7-- o S © G TOWN OF BARNSTABLE LOCATION / 3 `I G��� ,B� f'o� SEWAGE # 37L VILLAGE �f�Pd ✓� � ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. jl �4� A � SEPTIC TANK CAPACITY /S"00 ..-LEACHING FACILITY:(type) v� tv �`� (size) �� �a x3a i NO. OF BEDROOMS j PRIVATE WELL ORCUB=WATE BUILDERR OWNER L � D�✓ DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: �� 9 VARIANCE GRANTED: Yes No ' f r ti u► THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Dispatial Worko Tonstru.rtion JIrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: 134 Great Bay Road, Osterville, MA, Lot 33 - Assessor' s Map.72, Parcel33______•_ ......_..... _--N. --u ...................................................-------------•- ----------•----------------------..._-------------_._.. Location-Address or Lot No. Donald N - LJkens same -•----------------- --••-------------------•-------•---....-----------•--__._.... .............••••-•--•-----------•••-••-----------............................................ ,, jam Owner ............................................. Address ��.KcDf�!�f�_.--..... Installer AddressPQ Q Type of Building Size Lot__5 3..z...___5 7 9+.........Sq. feet Dwelling—No. of Bedrooms..................._.-..__.._..___ _Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ............................ No. of persons............................ Showers — Cafeteria Q' Ot ej fixtures _______________________ Design Flow................................(�-cz.gallons per ��� Epp �M Total daily flow.....--5..0....--,......•........._..._.gallons. W � � Septic Tan —LYquid capacity_��gallons Length----1.0.'_..... Width......H....... Diameter................ Depth.4._...m_Ln. W Disposal r o.______2........... Width_._..12.�___._____ Total Length Total leaching area....?�_�t......_.s . ft. x P Tr �—N gt g q Seepage Pit No--------------------- Diameter-_-__:-_._________-- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( X) Dosing tank0-4 ( ) Percolation Test Results Performed by.....C. . 11_y_a.-•P•_-E.,.•...___•_•__ __________ ________ Date.6 Z 9?92_.-......___........... Test Pit No. 1....._.........minutes per inch Depth of Test Pit 2.25 Depth to ground water._2 25_•_.....•_.. Test Pit No. 2__�....____...minutes per inch Depth of Test Prt__5.50' Depth to ground water---L 50____.._._.._ _-_-_••......._.._-•------___---•-------..............•-----------------------------••---- ---- p 0' -_..` Topsoil%Subsoi_1_...2'-5:5 ' Medium Sand Descr>ption of Soil-----.....--•------•----------•--•-•-- - -------•--•------•-----•-•-----------------•----•----------------------•--- x c.� ----------------------- -------------•--•-----------------------------•----------__-------------------------•--•----•--------------_..•_----••-----------.......-- W ------•-•--•----------------------------•---------------------------------•---•-•-•••••-•••••••----------------•-----------------------------------------------•-••-------••----------•------...--••-- U Nature of Repairs or Alterations—Answer when applicable_.__Remove 2 ex i S t i n 9 C e S S poo l S ..n.. ............................. ................. --------•----------------------------------•---------------•----------------------------•-••---------•------ i..s t..11__new Title 5 system .-------•---• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complian as een issued by the board of health. Signed . �or .1 Date Application Approved By ...... ----- �v.-.- ..Z.."�-,?::L. ...........................'----------........................ Dare Application Disapproved for the following reasons- ------------------------- ---........... ..............--------...............------.....---------------:------- ------------------------- --------- --------------------------------------- --- --------------------------------------------------------.............................................----------------- ----- ...................... C� Date PermitNo. -------•l..p_-_------ ---------------------- Issued .---....----------......------------------------------ ------ Date THE COMMONWEALTH OFIMASSACH'USETTS BOARD,, OF HEALTH TOWN OF BARNSTABLE Applutttuan for Dhiposal Vorks Tons rnrtiun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: 134 Great Bay Road, Osterville, MA. ot___33____-_.Assessor's__r.1a_p__72; Parcel_.33________ ................__....__..... •---- ..... ------------.........._... • Location-Address or Lot No. J Do n a l d fJ. L Location ...s a m e t owner Address Pq Installer Address d Type of Building Size Lot..5L.5R -------__Sq. feet Dwelling—No. of Bedrooms...............5.-.•_-._---_-.-_=..__..._Expansion Attic ( ) Garbage Grinder ( ) a Other—T e of Building No. of persons............................ Showers — Cafeteria d Design Other fixtures ---------- ------•-----•-----•------- --------------.--•-------------•--•-----•-••--------••------•---••---••--------••--•---------........---•----- 110 ret/'iRF!l�*nnM 550 WDesi Flow.................................... ....gallons per P-son9 per day. Total daily flow--------•-----------------------------------gallons. 04 Septic Tank—Liquid capacity-- llons Length---- 0 Width-------91..... Diameter---------------- Depth...V- fli i_n Disposal Tjfpr�h No....._._2...._.-.-.. Width_..._l Z.......... Total Length..._32........... Total leaching area.....Z6.R......sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( X) Dosing tank ( ) aPercolation Test Results Performed by.-_---�_.._.JOI11/,__.P:_E____________________________________ Date..6/9/92_______._.._............ 14 Test Pit No. 1-------2-------minutes per inch Depth of Test Pit.._2_s 25.-..... Depth to ground water-__�A 25....._._-- fi, Test Pit No. 2... per inch Depth of Test Pit...5.50-___-- Depth to ground water_._5.50_.____._.._ R+' ----------------------------------------------------------------•-•-------------------•------------•...................................................... 0 Description of Soil---_01......2'..Topsoi•1/SubSoi.J-----2.1_-5.5_'....... edium... and--------------------..-_-------._._._....__.____________. V W UNature of Repairs or Alterations—Answer when applicable_-___Rem.o-ve 2 exJ.St1_nq..CesSDoo.ls._and................ _________________________ i n sta 1-1 n Vw Title 5__.s ys tem_- Agreement: \'^� The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the t system in operation until a Certificate of Compliance-has been issued by the board of health. , 41L- Signed .......... ! '"----------------- ----- -ems. .c1, te Application Approved BY - -3--------------------- ...... Date Date........... Application Disapproved for the following reasons- ---------------------------- -- ------------------------------------------------------------------------- -------------------------------------------- ---------------------------------------I...................-------------- -----------------=--------------------------------------------- ..............---------------- .Permit No. -----------_�---------k3 �-��--- ------- ----------- Issued ........................................................Date-------- -. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C er#tft.cak of CContylia u THIS IS 0 CERTIFY, at the Individual Sewage Disposal System constructed ( ) or Repaired ( X ) by-------------------------1�---- Installer ............................................. • Installer at .34--Greati_Ba.y---Road... : Ostervi-l-l-e= °-A- = - has been installed in accordance with the provisions of TITLE 5,4d The State Environmental Code as described in the application for Disposal Works Construction Permit No. .....7 .-...3-71,�. ............. dated ............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------------ ....................... - = - ' - ------=---- Inspector .................. .......................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �� 3�l TOWN OF BARNSTABLE �QC No.., FEE..:..................... i rya tt1 nrk �710�_r "'rn ilan amit Permission is hereby granted-------------• .. ----- -------•------------------•-----•------------••---•-•----.......--•••- to Construct ( ) or Repair ( ) an Indi dual Sewagesposal System at No..........1. 4... reat_- alr...R�.::._Ostervi_31-e_,_._"-aA=.......................................Street (ct23 ,6' as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... � r\ ................•------------------------ _-- _ Board`of Health DATE = _ ��„� FORM 36508 HOBBS Lt WARREN.INC..PUBLISHERS t Ii' 111111! i • ;' rsi siiiiiii 11 h , 1 . I c f j —Y— I U s 1 1 4 AG W)H. �4a I 1' V/-`Pt yWGbD oil �41V• �oL•Yv&ooe t .t2.a.k.r� - j i M - o ►T 4 r *r - 1' ,v 0o C7 r it r 0 '�r .{J ; y �! 6 j ._ -- Y ----7 • j L' - I' �p 1 jGh } •3 I � 4 � H,W.H b Lam. -LEI' yco I I r O .. i �i.�ET/�,GI-•�E_ �--emu' `�R�Gh-I-1------- J�'t�JO ._ _ � ; ' I U to I Rik i �I 1 / . :f�G�f l ,�i t^Cotn S✓I CG pq'>`L LA C2.. • t 1 + - } 26'-0" 24'-8" _ � O q f PERGOLA `9 / BELOW DECK #1 DEGK 2 218 21, EPAY EPAY ry � 1 3'-114" q,_G4„ q'-04" 3�_ 5 a I ' .�_I I I _t 01" 4„ _8 I��� 2-8 i 1. lilt, L- -I I I I 1 1 J 114" O 2 22 O, OS ' 11 215 L O - 1110201 1 AK TW. = 214 215 216 � oAK T+�. �X oa m 21 - �x -1(V '0x I L:\2 BUILT I ( v I GL. 6 BOOK A5E5 N I I O I I — 1: #21O BEDROOM 5 OAK FLR. d) / m - - TV 06 �— — — �— - UPPER DEN OPEN TO #. CATHEDRAL GLG FOYER BELOW — OAK FLR. O � J + p PEN TO LIVING BEDROOM 2 ti- ROOM BELOW 00 201 — I N OAK FLR. — I 211 213 BATH #3 - OS OAK FLR. ° SHWR cV MAKE-UP =Iry NOOD cv 03 — RAII>ING / -rcv MAKE-UP 20 WABOVE BATH I I I _ N w BOOKSHELF UPPER GALLERY I I BACK STAIR SHWR m F � I G® _ OAKw O6 - _Iry BALCONY I �X OAK FLR. + OAK FLR. 221 04 — — — — `fl = 0 ry O + iX O ti+ 2�x 68 (� I I ( 2O3 r, � © Z a� BATH #4 in OAK FL / ` O8 A ry + Rio LING 212 (V O SEAT �+ _ GL. Q STOR. X X OAK FLR. , O ROD $ SHELF 3 I O FLR. LAUNDRY ° POWDER RM = AK FLR. _ I 214 OAK FLR O -- SHELVES _ f -try CATHEDRAL GLG t - 21 r m OPEN TO DRESSING O m I IbX cV ROOM BELOW LATHEL�RAL GL6 OPEN Tp LIVIN6 t- L —1 I 216 ROOM' BELOW 255 C:25� GL. I 34 = 231 I PLANTERS SHELF = BACK HALL I `� 25'1 255 to OAK FLR. BEDROOM #4 236 213 I 03 _ 2 a 5'-6" ,'-8" 3'_6�� 3�_5�� �_ 4'_1" 4'_6" 6'-II" 4'-6" ?'-`{'1 �� 2'_2�� ,¢�_O11 OAK FLR. 13'-22° I 23 "r- I G THEDRAL GLG O EN TO MASTER I 5EFROOM BELOW I 24 ox Aa m O ry 218 0 FLOOR PLAIN - 02 241 PROPOSED SECOND FL — —� ROD SHELF GL' loll O �N 1/411 = I`-U" 2O ash GL. ROD 8 ELF i � 225 ) 2'-2" 4'-O" I ib'-10" C:201 � � ! BEDROOM #5,:- 215 I G — OAK FLR. Aa 28 I `fl m I I in 26 _ iv 221 t SHWR - Q I � I AT #5 I 2 AK FLR � O . r 132 133 O OAK THR 120 121 X 10'7 `,p OAK THR. 1'-0" 61.1111 15 9" I 2" om m 154 FF� pmA`jg� tV 2 131 r I22 --e� d; 5UNROOM A 131 119 2) X Aq 8 OAK FLR. ~ 124 PERGOLA Y O 113 Y _ - BLUESTONE 129 O -1 -\I9tt I 4 m 123 125 _ 106 HOSE L I$RARY O I GE N o 126 12"I 128 130 R. 107 _ — - — NTERIOR OAK FLR. — ,� — — 6 ASS WINDOW — — — _ — AK TH 2) 2 X (105 BUILT-IN BUFFET DN 4 AI5 2 2R _� X 3'-9" v 5 0 0-TA 118 ILT-I G 3 -rcV DE 5 128 I r_ �X m I Q Q( I AI'1 K I 13'i -ICV BUILT-IN BOOKSHELVES I O I + � � � PLASMA TV (B.O.) 4 AI4 2 PA OR 126 4 AI6 2 5 OAK FLR. II BUFFET II 3 AidII GLOS. 3 121 4 AI-1 6 � NTRO ° UPPER GAB. o WOOD OAK FLR. 0 8 AI'i 2 STOR. LIVING RM OAK FLR. 5.D. I ( 4'-O" G.O. O „ SHWR SEAT MAKE-UP loa ( DINING RM — COUNTER OAK FLR. II7 BUTLERS COUNTER I 15LAND I4'-0" VIKING _ 0 6A5 GOOK- -try f R. IL 3 IRE AGE: = QI I �N OAK FLR. PANTRY TOP 4 VENT / GOLDEN BLOUNT SUPERFIRE N FIREPLACE: (`1 = U + 120 HOOD S „ „ „ lu3624TV W/ 3624 PB GLAS., � FI 80X IN dJ = � _ 48 x 32 x 20 RE cv K FLR. 1 I OAK L FRAMELE55 � I FLUSH MARBLE F f' RED WATER-STRUCK BRICK O O - O GLASS HEARTH 8 5/4 MARBLE (HERRINGBONE PATTERN) YV rt) I rABOVE LINE OFENCL05URE SURROUND W/ CUSTOM WD 1/2 MAX. FLUSH JOINTS 60 x FLOOR , I ,PINE MANTLE. 16" I" FLUSH BRICK HEARTH 4 OPC'NIN6 24�� I'-8" 7'-8" I'-8" 2'_q4„ W 12 AI6 II D$L OVENS 3 ZERO SREFRIDG. MA BA I 5RIGK SURROUND W/ CUSTOM WINE - O �j COOLER I 138 CAST IRON 1O6 WOOD MANTLE. `-I GE-MAKER to -iry FREE STANDING MARBLE 4 A13 2 I I - - — I I'-O" G.O. I OVEN tV O TUB BY OWNER LIN. - 4'-O" G.O. 4_O G.O. 3-O G.O. - 5 BUILT-IN dJ q CABINETRY -KV WATERry 2 (2) lox 68 ENTERTAINMENT ! 6 AI5 5 - O GALLERY °$° Q 8 14x 6a CLOSET ' CENTER v v 2) 2°X 6 P T + tV 130 12a Eg� 3� I „ OAK FLR. I „ AI6 �I ( - 1' 122 5T R. 2 I2a 120 4,_4 I „ 121 _p I ° 01 ��62 10'-O" 5' 7„ I '-i I" t7-02 210 '� 5'-q„ 4,_O„ 4 5 3' 2' 8-I g 2 - - _r H15 HER ' ui TOILET TOILET I LET PLASMA - — $ GK EPAY WOOD TV (B.Oa � _ 4'-O" G.O. ° OUTDOOR BATH PORCH W/ H L 128 HIGH SCREEN 104 1O5 O ROD ,$ SHELF ACCESS L - — - WALL OAK FLR. 5 A FLR. 10'-0" G.O. + + — — �+ 12 BLUESTONE 108 - - tV � DOOR TO _ 8 AI3 6 = — — — GRAWL5PAGE se OAK LR. e s Q Q DRE551 NG RM o . 2) X 68 - X 125 BELOW 4-O G.O. ( 2 X 6 p POWDER RM iv o l02 -� m 5 °uv o ', SIDE ALL Q — 126 4 11ap _ II6 OAK FLR. GALLERY A AI4 O = QYr=s m I I 0 OAK FLR. 2 X 6 2 X 6 2 X 6 _ 12'� 108 O I I OAK FLR. = ONE cv ISLAND COUNTE� - `� loq AS'i ER ENTRY O � III Y V DRAWERS i OAK FLR. Q. 6 - SHELVIN6 BELOW = — � EXERCISE RM MUD RM iv 4'-0„ 4,_ „ 103 O `� 118 Ilq at117 T-IN tt X 116 mX 3 GER. TILE dJ BUILT-IN O I I OAK FLR. 105 104 103 - dl WDER RM OAK FLR. FLR. 0- 10 -IN —p N = CUB CABINETS E m tt1 r X 114 125 �� 2 tt -'cv m OAK FLR. 6 e x O I I I I p �� 115 2 X 6 `° 3 � � iv 101 112A � ox ° 13a 5'-0" G.O. 2 m I� o H05E — q O/rK THRL11 - X o- AU BIB 18'- �,_1O2„ m 102 FRONT 101 148 14� °cn iv I I 124 HOSE _ I BIB �t ZE PORCH N ►45 � � OAK,MECH. GER. TILE s o { `9 123 = p 106 10'-I I " 'I'-I I " BLUE5TONE i OX GONG. D W 2 4'-II" 2'-3" 6'-O" 9'-O" N 3'-O" 3'-4" m + �N 1. 20'-102„ 42'-12„ 113 - + N S.D. ry HOSE Q BIB 114 MASTER BED RM cA A _ C 101 Q OAK FLR. 3 p 2X6 109A 113 IO7 r' 112 o PROP05ED F I R5T FLOOR PLAN -IlY - X B 1/411 q = - - loci ry III G O 110 Aq to NEW O ' _ III GARAGE 141 26 4 RL x PNTD GONG. 0 , C14 I O � O Q CD p o 142 L r x - O � � a" 24'0 Opening Above For M.H ` ` _ v/, .i Gam'Q •�I 4 1/2 0 Galy.Pipe For From 8&Cover. NOTES Directions: From Hyannis-Follow �=.-�� 'a `� st:ms ��Float Support �`�� rys ,'��_ I. Water Supply For This Lot is Municiple Water. \ Route 28 toward Osterville; Take a _ �, ;Island Paex 2.Location of Utilities Shown on This Plan Are Approx. \\ left onto Osterville West Barnstable ^I `�. Pt _ • I At Least 72 Hours Prior to Any Excavation For This \ Road and follow to the end; Take a _1 Isabella f Pump Power Float Control To D-Box \ Project The Contractor Shall Make The Required Cables Installed in Accordance 0 \ \ Notification to DIG SAFE-1-888-344-7233 \ left onto Main Street; Take a right �, ?y a With Local Bldg.B Elec Codes \ - 3.The Contractor is Required to Secure Appropriate \ onto Parker Road; Take a right onto t�- �0C-a " 2 I I ` t ` / Permits From Town Agencies For Construction \ West Bay Road and follow over the VS •. Defined by This Plan. draw bride and continue onto Bridge - 4 0 From.Septic Precast Pum 4 Install Risers as Re uired to Within 12"of Finished g 'a I '' i = • Tank.Sch.40 PVC Chamber p Grade q Street; Take a right onto Great Bav °. 10'-0" 5.All Structures Buried Four Feet(4')or More or I Road and house is tl133. \ Subject to Vehicular lobe H-20 Loading. I • :` ' 06�1- s '...,. e` :•.tip • � . ( R l 1, t N \ 6.Septic System to be Installed in Accordance With s 310 CMR 15.00 Latest Revision And The Town of N01111 PLAN Barnstable Board of Health Regulations. e _ _ rT - 4"0 Sch.40 PVC Finished � �\ \ � \�� /do J � �t• � I^������' From Septic Tank Grade rs DESIGN DATA ' . u--/4ri v/f Ni l•N3.;,_ \. � � • �..S - � i -_$6�I • °'JGal, Guest Cottage-I Bedroom Conduit Thru Chamber No KitchenNOTEEmer enc St ra a For Power 9 Float _ Use a 1500 Gal Ion Septic Tank. g � Q a Cables To D Box Single Family-6 Bedroom Instal I Temporay Work Limit Line a Volume 60I. � Min.2CoverAlarm n E1.6.5 Inv.8.2 No Garbage Grinder O LQCUS PLAN Silt FenceW/Staked Ho Bales riorLaa Pumpon EI.6.0 Daily Flow=I10qpd x6=660gpd y � ��2"0 Sch.40 PVC SepticTank 660gpdx 200`/.= 1320gpd �� to Moving House to Limits Shown. .ILead Pump onEL5.5 Mercury FloatThreaded Pipe - Use a 1500 Gallon SepticTank. 1 SCale : I = 2000Switchs 4Rq'd , After House isMoved Remove Temporary 'Pumps off EI.4.7Check Valve LEACHING AREA 1 Work Limit aInstall Aiong 50 Foot Assessors Map 72 SecurePipeatTopB 770 qpd/0.74=1041s.f.Required Buffer Line For The Remainder ofBottom of Chamber Use Bottom Area Only �� The Construction ` �\ ParCl133 Bottom EI.3.7 6 Washed Bottom Area=28x38=1064 s.f.Provided \ \ .°'. „ one Min g° t a e' 40 .09-16 LEACHING CHAMBER DESIGN SECTION T All Piping to be Schedule 40 PVC.Use 12 (1500 GALLON SEPTIC TA NK) 4'x 8 x I-6"Conc.Flowdiffusors in a \ eOno PUMP CHAMBER DETAIL 28'x 38'Washed Stone Field as Shown. / e•ogy -Teo Not to Scale �e�E 6/_0 �� Waterproof/Seal SepticTank fi Pump 2 / , .�" — ` � ` \ Chamber W/2 Coats of Approved Sealant. FG. 10.5 4"Vent +�\ J L I Resource Line \ Contr actor Note;This Item Requires Lead \ \ \ \ \ F.G.11.0 Time. Top EI.8.92 SM9 Bot.EI,7 5 \ AL \ 9.0 dy* 8.7 1500 Gal. pump Ground Water anEl 1.25.Ground \ � � k 1 6y d � Salt Marsh � � • ` �\ \� � AL SepticTank Chamber Water Was Monitored During a Full Moon �` / oM wee ' ` Tide Cycle,May 27 a 28,2002 f d' f _ \ _ - If Encounted Remove a Replace All Unsuitable 's � ; \ \ Bedding as Material Within 5 All Around The Leaching / SM8/ h / ` Per Title 5 Chamber. j. / ` JIL \. Existing \ `P-'a(°SeO moll ems mot 38 DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM i / / / / °" " •... L Not to Scale i l 1 'IL Lawn Flog �6� \ AL Pole ��• I AL l�� bp1 /_ ^/ �LtvcPpRARY WoRlc .� L� / // f � '' �—,� NOTE Ala vt61e1E '•.#.. - N SM N. n [�(fnd) 1 I / SM6 / / �' �' Poo I ro / \ TOP of •�a // // ' / unlAs ��rOowry S: \'�� 1 Coasts/ Bonk p _`� / / L . \ �� own G oT.HOu6 e0,� Jr N, LJ _ /. / f'- mac: ��►,� �L SM5 � / +C- T GSTO Ivy � C � / \ D-laoX -StTIN / 4.4 Sh MANI OL-e . ALL_ '� /I , '-- I coMPONENT3 TO We / / I ` / 1 wn I -- H-20 bEE NOTE SAf3ov� / � Q�r• I AL 1 REM Curt t 0 \ �� _ V lieu / VAR"I IAL PLAN ; d / '�I► Ij : /� ` '\ Lawn Nof to Sca le 1 SM4� / I Lao s• >"r P'� W/I1OF STON4 8 / e I ARouNta FOR ROOF � \ \ J PRpp NO sle �/ 1 I RUtIOFF. CTYP� c 4. ]g• I FI` ELrcb Q _ O nits , / I I MOVE Exls� I O TEST 1-•IOI-L �L. 1�.0 / / � / SE p'TICT'ANK i � r / 10 11 I I WofkK LA ALONa SILT I PUMP CHAMB / 1 / O LOAM � O F ij'I / I RETAINING W/+LL / +"� 1 / E' ►0 '1R 5/3SQIj 3E SANS 19 8 STRONG 13RN COARSE SAND -7.6YR S'/L 1 SM3 I / a 3G DC: Dlc GRAM ISN 'R/y .CoArSE 1 I/ I I r-� �12 -nAND ►OYR �12 1 ' / -7 W i I zz' C SAW % Y /Oo' 81" a R 0 U N D wATERC& 6?1 C' B%/: 5LJLLIVAN E►ds1 NItGIR,NC- INc / �(N DATE O-7 11 02 1 I e / Z a r>� �I e /�1 2 yc�o / - c i ('AV Finish tk Grade WORK LIMIT LINE.SILT L wn f Filter --l` FENCE VJ/DOUOLE / / o in Fabric Compacted Fill STAKED HAY paALES �. / I GRO P W�F \ 6.S' / 0 / 4-Qo :� r',(JJa�c Pea Stone qi, ,�, / X 4� r 1p/ AI nd O SEPTIC TANK iv F I ow d i f f u so rs %J t 1 H-20 Loading 3/4"-11/2"Double /L O / I MP KL ?ArWashed s�0� O O O O /V CNANggE2 4'-0" Rig.V,00^ It a / 4' I I C, OF ce(fnd) PARTIAL �' rF ram. vent CROSS SECTION OF CHAMBER ;' FEVER 10.0' NOT TO SCALE �.l.I�AN Io Benchmark: 11 c_. r / Top of CB(fnd) WAy ` / I Elev. = 6.94' 14 n , �:� ,�.hP �06 � S 9 �� / 'I N.G.V.D. 29 rc3° Las A s?��.• '`� 8 �,�'V� � / / Rid �c.•��� 1061 ,o � ° e / APDED w�1= rauEST COTTAGE k- CS O LOT �.RGA / OG le Q3 .INCREASED, SIZE 01= St.P.Tlc SYST�ta1 Q 1,'2'?S AC J_ � J � / 04/1j, OZ NCw L_OCAT101J C F Se.PMC SYSTEM 0q1.4/OZ New ORirW-rAT,ON OF HOUSC PLAN VIEW q O ADflEo POOL CFr+cC- PER og/2o/oi II , � 5 �64° 06/20 O•L CONSERvATION COMM, LO""aNTrj Scale ' I - 20 \ ftEw ORIEN-rA-r% N OF 1a0USG AND / s E�TIC SYST%M LOCATI ON R=5.0' AODGD ADDITIONAL WORK LIMIT LINO /fjX' ,n !F2<V 1910N O[+/Z-O/OZ PAR CONStRVAT10N COMM. GOM M6NT,3 `(((� Title: PREPARED FOR: PREPARED BY.• Sullivan Engineering, PROPOSED SITE IMPROVEMENTSJeffrey J. Cohen Inc.nc. PO Box 659 PO Box 718 33 Glen Oak Dave Osterville, MA 02655 Hyannis MA 02601-0718 13 4 G R EAT B AY R OA D Wayland, Ma. (508)428-3344 (508)428-3115 fox (508)790-7902 (508)790-7905 fox v OSTERVILLE , MASS. y ' . PSOPEOaol.com topesurvOcapecod.net o V Field: WHK/MDH Draft: MDH/M.?-C> 20 0 10 20 40 80 Date: Scale: Comp.: RLH Review. RLH May 15 , 2002 As Shown Pro j. f C374_2 Drawing # C374_2Gl.dwg ATTACHMENT A 24"0Opening Above For M.H. I/2 t Sup Pipe For Frame 8 Cover NOTES \ , ra \ Directions: From H atutis-Follow �� Float Support \ Y �y St:Marys Island (. Water Supply For This Lot is Municiple Water. ill\ Route 28 toward Osterve; Take a l _ _ `i-; I ,"�� \ left onto Osterville West Barnstable �^I Pt- 2.Location of Utilities Shown on This Pion Are Approx i At Least 72 Hours Prior to An Excavation For This \ Isabella ri Y PumpPower 8 Float Control To D Box \ y \ Road and follow to the end; Take a Project The Contractor Shall Make The Required I - . ,r Cables Installed in Accordance I 0 _ \\ Notification to DIG SAFE-I-888 344-7233. \ left onto Main Street; Take a right �. �4� With Local Bldg.8 Elec Codes 1�_/-� 3.The Contractor is Required to Secure Appropriate onto Parker Road; Take a right onto - 40C-1�2t Z I' = �� / Permits From Town Agencies For Construction West Bav Road and follow over the US r " I ;� a Defined by This Plan. 4'0 From Septic draw bridge and Continue onto Bridge \ Precast Pump 4 Install Risers as Required to Within 12'�of Finished _ - Tank.Sch.40 PVC 1y o .. - •1 _ Chamber Grade. Street; Take a right onto Great Bav 10 -o" I Road d h i #13°3. ,• :'-= x_:' _• % S r ; 5.All Structures Buried Four Feet(4')or More or an house (I• `'f - Subject to Vehicular lobe H-20 Loading. f • ' =- t I�' \ 6 Septic System to be Installed in Accordance With O \ r •-• }BR 11. t _ 1 310 CMR 15.00 Latest Revision And The Town of Jr PLAN Barnstable Board of Health Regulations. 4'0 Sch.40 PVC Finished \ \ J r -mot- From Septic Tank Grade \ \ \\ y9tEr •� . � a hors DESIGN DATA 1 • A.a e.�._ Guest Cottage-I Bedroom \ \ . - _ Conduit Thru Chamber No Kitchen A NOTE: u° For Power 8 Float Gale. ° Use a 1500 Got Ion Septic Tank. Emergent St4ragoe ° Cables Chain o: To D Box — Single Family-6 Bedroom Instal l Temporay Work Limit Line `\ a Volume6vg I. oo Min.2�Cover NoGarba Garbage I \ LOCUS PLAN AlarmonEl.6.5 Inv.8.2 g Silt FenceW/Staked Ha Bales �tior Log Pump onE1.6.0 Daily Flow:llogpdx6=660gpd \ y i � \ Mercury Float 2 0 Sch.40 PVC SepticTank 660gpdx200%=1320gpd \\ to Moving House to Limits Shown. — 11 ' Lead Pump onEL5.5 r D Threaded Pipe L Use a 1500 Gallon SepticTank. Scale : I = 2000 Switchs-4Req'd After House is Moved Remove Temporary — — Pumps off EI.4.7 ' Check Valve LEACHING AREA I Work Limit 81 Install Aiong 50 Foot \ Assessors Map 72 SecurePipeatTopB 770 qpd/0.74=1041s.f.Required '\ Buffer Line For The Remainder of \ Parcel 33 Bottom of Chamber o \ The Construction Bottom El 3.7 Use Bottom Area Only \ _ \ J ` •°'' St Washed re Men Bottom Area=28x38=1064s.f.Provided �a LEACHING CHAMBER DESIGN �.� \•\ \\ \ \ SECTION a All Piping lobe Schedule 40 PVC.Use 12 (I500 GALLON SEPTIC TANK) 4'x 8 x I-6"Conc.Flowdiffusors in a PUMP CHAMBER DETAIL 28'x 38'Washed Stone Field as Shown. / �.•� \\ Beogy \\� ` _ _ ` onsev � �� Not to Scale _ \ �•� \ — — — \ �e� — Waterproof/Seal Septic Tank a Pump _ ` Chamber W/2 Coats of Approved Sealant. 8.2 F.G. 10.5 4' Vent \ ' ]lllc Resource Contractor Note:This Item RequiresLead Line \ \ F.G.I I.0 Time. Top EL 8.92 �� SM9 �IEI.Z 5 _-.-_8.6 6' � �9.0 Ground Water(a�El.l.25.Grd \ k 1 d Salt �/Onh \ \ 8 7 1500 Gal. Pump Water Was Monitored During a Full Moon —SepticTank Chamber g Tide Cycle,May 27 8 28,2002 / ` 1 - _ If Encounted Rergove 8 Replace All Unsuitable '� �✓ � \ J� \ PerdTitle o5 Material Within 5 All Around The Leaching / SAM I / \ ` ` \ f, rExist�qChamber. j e�`Seos�d�t:��3g DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM i Not to Scale % l J l Lawn flop 1 �• �` Pdo AL tJ VE613E •',#\ 0 / SM7 / /o �. Cj (ind)T(J 4�: I / SM6 AC c pPRA r=oR _ // \\ C ToP of t/n/b / �'Oow,v 5.- ' j costa/ Bank an / 1 LOCATI pH i // / // o 1 g' �► Po L`, � / ✓ E 5 Tp / SM5 AL l ice_ Tl� Nl� C-BOX -$1=TIN / I 1 4.4 7.9' "� _8— Sho � - C-OMPONLW-CS To pe I ` L wrt I _ H-2 0 bEE NOTE S ApoV� / / 1 �lE>�.l ova - ♦ n ,FAR 1 IAL PLAN i ib / �AL •I►� J�I '� r \ �xts7. j: ' �\� town � l'i' 'Motor NottoScale S,N4 ( I Loo tit_. LEAcl1 ^-T / W/1 OF S•TONc ALt_/ e 8\ / A�aouNlD FOR ROOF / I / PRpp N / I F2tJNOF�• Ro EI_1vNg� I C6 ./ t / I 4. �y' RcMOVE \ I IZ'OO n/ta 1 �� O TEST 1-{OLI EL. e.O / I woRKLIMI-rSILTI / PUMPCNAMg� O LOAM / I I FQNGG ALONG / •?�t / IrZETA1NING yV/•.L.L l"� 1 Sp_" C�/S SE 5AN0 / 1/ I .y ' � �F�Qr F_ 10 / ' / I! Conc tq STRONG QRN C.pAR6Eti--r-- 3G' 6 SAND 7.SYR S/L ; SM3 ISO, I I / Zg'_O. DI< GRAM%Sl-I OR/V.GtJA15E ' 1' yZ EC O/�ND tOYR 4r2 i 12z' I / ~ � / t0 C C►'1$N• {BRN COARS tr SAND ilo /p0, GROUND wATt. - B%/.' 54LLIVAN EWG-%Wtl'er2tNCr INe= DATE 0-7� 11 �02 ,0 I l / l GAR I � / SM2 r- I PAVED w o P.ARI<tN Finish � Grade WORK LIMIT LINE.SILT L wn J FENCE W/DOUOI_E ' /•� / a }n Filter "Compacted Fill STAKED NAY rdAL ES / ,. P GRO P wIF / k / \L \ Qs� ¢ - \ c T nG e / 0-Qox ; Pea Stone \ co c�� r IC, Q O O SCPTIc TANK Flowdiffusors � t PUn,IP M 2 H-20Loading --Washed I/2"Double /y O O / I O CIIA - Washed ts� � /• I O Q \� PARTIAL , Q vent CB(fnd 1 CROSS SECTION OF CHAMBER _ ) NOT TO SCALE SUUN n .+ / to .2 � pAve Benchmark: _ / / / Top of CB(fnd) t � Cl�ltt. a` Y � bRtvEwAY \ / `�.U� 046 9 �� / N.G.V.D. 29 � �� / Ap0E0 vv F GUES_' GOTTA.GE J- Cf O nG I�j Q3 .INCREASED" S\ZE Of-SEPTtC SYSTE.h/1 t Z3 A.C. 7— / 04 li. 02 NEw 1_OCATION OF SEPTIC $ysTEM 09 4/OZ NCI ORIEW=ATtON OF HOUSC PLAN VIEW q O .P.DPEO POOL CENCC- PER O8/2o/02 rt , 4.�•5• / �d9e t75�20 OL CaNSERVATtoN COMM, COMMraNTs Scale ' I = 20 \ 09 \�1 OZ MEw ORIENTATION OF 1�Ou5G AND 5�t>TIC SYSTCM LOCATI ON R-5.0' AODti<D ADDITIONAL WOQK LIMIT LINO Qj},� h 'REV 1910N OG/2.O/02 P!R CON5t•RVATION GOMt�/I, coMMGNTS Title: PREPARED FOR: PREPARED BY. Sullivan Engineering, Inc. CapeSury PROPOSED SI Jeffrey J. Cohen SITE IMPROVEMENTS � PO Box 659 PO Box 718 . 33 G/bin Oak Drive Osterville, MA 02655 Hyannis MA 02601-0718 134 GREAT BAY R/O�AD Wayland, Ma. (508)428-3344 (508)428-3115 fax (508)790-7902 (508)790-7905 fox OSTERV I L L S MASS. y PSOPEOool.com capesuryOcapecod.net O 20 0 70 20 40 80 V Field. WHK/MDH Draft: MDH/M.7.0. Dote: Scale: Comp.: RLH Review: RLH Moy 15 , 2002 As Shown ProJ: i C374_2 Drawing # C374_2G1.dwg ATTACHMENT A Ostervllle Revisions: NORTH BAY j O 8-4-92 D-BOX / 8-24-92 Wall, Wetland Limit, LOCUS�j _ _ _ i Pool Southeast Grea CY Rd• t wit• ---- % v ,q Y GRAND ISLAND LITTLE ISLAND y i�F WEST BAY � \ \ � JIL ,� JIL Scale: 1-2083' `/�. _=-�- - _ __ LOCUS MCA / \ f,�°' References: Assessor's Map 72 Parcel 33 l n� All GIB lem en t s- - - ''-- - - 1 Deed Reference: Book 772J Page 246 k B � � pile B each �• \ � � \ One RF f rn-_ _ he ass Mln. Area 43,560 SF Notes j \� Beach Mln. Frontage: 20 FT 1.) Property Llnes Shown Hereon Were Compiled IL / / ! of Min. Kridth 125 FT From A Plan Recorded At The Barnstable County Front Setback 30 FT Registry Of Deeds In Plan Book 78 Page 85 �d9P of of�► _ �- st s\ ? Side & Rear Setback 15 Ft And Do Not Represent An Actual Survey On f �� Gate do Qw„ '� j P �\ The Ground. / Fence lsting CaTspool 2.) Elevations Are Based On N.G V.D. r j,� /� j (To Be Feed) Zb, \rir 3) Roof Runoff To Be Directed To Drywells (To Be 25' Min. From Septic Leaching) 4.) Pool Water To Be Dispersed Over Lawn Area. 5.) Ex/st/ng Cesspools To Be Pumped And Backfilled 6.) Th/s Site Is Located In FEMA Zone A13 100 Year Flood Elevation = 12.0' / ; - �Z�, EroQp( Area Project Title: p. Proposed Contours 8 ir. Proposed Spot Grades- 8.75 JILMERCURY FLOAT SINTMES Existing Contours - - - -8- - - - f /• � -�. � = a� n Lot JJ wrT Proposed Treesdb ` q / •� � � o - �����aoa �h GreG t New Plantings r \ i \ 0 Fi\��i ,. ,. / i Shrubs, Perreni�ls 04 U o �)G i \gyp a�� \ti aL / B & Annuals O r ` a N / ; Lawny • , 0 v ,� � ,c, Underground �~ .. r Fuel OPT Tank _ F eon Rob �. l •• 6 <i. a Be Remove / 4tility Pole AILtiRoGd ' _...-- , 1, � � � I 001 CY Os ter Ole"K STEPS It O.c 'Proposed Fieldstone Wall �,o 1 �/i COROIM-5,OOo Psa WO 3 DAn � With Decorative Pence Ove-�� � � a�� /°0 (BGm s tGble) 2 RE>NroRca�WAt1S t F1AOR 4 z 4/4 z 4 W.W.M. c�l �'• To Wall EI=B.D' �' i h \ SA Tar 15S w r o.L �� -0 P\ I �° 1 I 4'EIANGED P{PRIG uro vA<vEs i ®� o• Top ence E1=10.5 max. \ P // MG. ^i \ Pro osedAs halt, , /4.AvAZAeiE ouu oacNAR�FOR ruu�Ns INrro 3Total�Height Varies Q° P Drivewy �• Bottom Of Wall = Varies Flnished Grade i \ Notes; Pumps-2 Myers WHRS 1 \2 HP Average Operation (Match\Propose Grade) Zp 76 GPM ® 16' Head. Pumps To Have Lift Out Guide Rail Min. F_l. =10.2 ce Fnd 2Z Min. Sloe l I, ° \ Il_ ��ea i System. Pumps Shall Be Installed /n Accordance WIth Man- P 3.L)4' nlGvo �, ufacturers Specifications. Alarm And Pumps To Be On \Sep- / / / / / Il i I \ 0 1 � • �o I ' '�, dam T es orate Circuits. Exact Location Of Contra/ Panel And Alarm j" To Be Located Prior To Installation. / /VY" \///� • , -v� r �• �� _ �\ • I „ „ 32' Long 4' Perforated �` I I USE IOOO GAL SEP¶C TAW 2 Of 1/8 -1/2 Washed Stone PVC .005 ft/ft Slope • ! • Q r osed a-6o ` 41 V' o o 0 0 o 0 0 0 0 o 0 0 0 0 0 NENA 4 JINCNON BOX ►.�: !l n ( n , n �ro ems• ; % f Donald N. Lukens IN ID01E INXIM GAEv unKc M C 3/4"-1 1/2') C 3/4"-1 1/2') P�90 I • ctRaruin `:• 0 GWashed Stoned O O GWashed Stone _ - 'o o ° o ',' 4'PVC fNIEi J ~ _ - o o FLOAT RACK ' New Plan tin gs \ oo b ,��'� o I,r0 / I , Shrubs, Perrenials �o"o o d o / y►` own MERDF BOAT SwT�s ; r FOR®MAN 12 6 12 & Annuals _ o °o ° a o o I I Pro; osed Security Gate r GATE VALVE \ o o L ' �J oo I 911 Main Street �abanQ c�p o 0 o I'1 N .0 • °d 00 �p �u I �i Osterville, MA �. F !1 Robert L. < S?• ��9 °Ipa o�o adc o r o �i I Q I I I GB/C?H Fed 02655 HCH WATER ALARM LAG PUMP ON EL=U4 L each in Fields ' +` '��� o 3 o 00 Q 6'.I o 0 6° o CIO,Q o Itr �' Cross-Section , ��cl o�oo° i �• r a:",':•` .;.=: .fit: r�':•:,,�,;.. PUMP ON EL=4.64rq !y 4 tent o 0.4 vacAFen 't 1 �.;: : •;. ,!•;;: -Not To Scale- PUIdrS Off EL=264 '�. � a L � ��::' ''.t.::� '!i•::'• '!1•:`:�"�:.;;i' =.;:t, �. r:;; r'9 ft 0 30' u)e / I' � A. IM. ViIson Associates Inc. BOTTOM -Ls9 - a�� --R E S ER E EL r Note: yo/i •• ' / `- 1 4 508 428 1450 FAX 420 1856 Existing house supported by a cinder block foundation. _ ,00 r Plumbing connections to new septic line at foundation :® FIn. Floor El.=10.6 f �'� / to be provided by architect. 4" PVC ® .01 fit/fit Drawing Title �'eSt P/t ®AfQ First 2' To Be Laid Level - fs `` � • , , , , , • . . . � �- ' .• Finished Grade Finished Grade Minimum Finished Grade - 10.0 `\� I �-2 nrels 4" PVC ® .02 ft/ft Minimum Sloe - 29 Indicates Indicates P Perc Groundwater 4" PVC ® .O1 ft/ft 2" SDR21 PVC 4" PVC Vent 20a � Test = Sep tic / P / 7.08 Tank Pump Box \ ' \ • 1,000 Gal. Chamber 9.23 1.0' of 3/4" - 1 1/2" Washed Stone 8.50 y ,5 �/� Je�,e,/ Ground El.= 3.40 9.06 \ Sep tic Loam Footing 1, 00 Ga/, I� 7.50 \ {P%/ f Gray/Medium 3.15 1 6.14 8.66 32' Watergate- -Utility (Pole dAey / Rep air Pit No. 5.75 � n E i Plan Fine Sand 2.15 TCsf B . C. Jolly P.E. 6" Crushed Stone (Typical) \� f / Proposed Fieldstone Wall B/acka line Y 6/9/92 6 Outlet utlInlet W/Tee Observed High Groundwater _ 2.00 lV / Top Of Wall - 9.3' 1 15 Test Date.' (Based On Site Readings Taken - Catch Bosin --- / Bottom Of Wall Varies (Match Proposed Grade) WItness: Over The Tidal Cycle During / Perc Rate: Full/New Moon Tides 6115192 - 6/30/92 Design Flow: Title 5 (5 Bedroom) Notes• / 5 BDR x 110 GPD/BDR = 550 GPD 1. Unless otherwise noted, all construction 6. D-box to be water tested for levelness. BREAKOUT CALCULATION methods and materials shall conform to 7. Existing cesspools to be pumped and P.JMLY8 CIVIL �r Septic Tank Requirements: Title V of the state environmental code backfilled with clean coarse sand. Critical Elevation = 9.16 0 and any applicable local regulations 8. Topsoil, peat and other Impervious 1.5 x 550 GPD = 825 Gal Slope = )O.5 - 6.O Use 1,000 Gallon Tank q•y '° �' , 2. Precast concrete septic tank, d-box, material shall be removed from all areas = .128 and leaching facility to withstand H-10 beneath the leaching facility and for a distance 35' Ground EL= loading unless under pavement, drives, of 25' and replaced with clean coarse sand. Loam/Topsoil 2 or travelled ways where H-20 loading .128 x 150 = 19.3 36 Pit No. Leaching Facility Requirements: shall apply. Critical E/. = 9.16 20 Subsoil Test By C. Jolly P.E. J. All pipes in the system shall be schedule r Per B.O.H. Regs. For "On-Site Sewage Disposal Construction" P P � Scale: 'i =2O 5.36 Test Date: 6/9/92 Based On Perc <2 Min. Inch Use Aeplication i,ate Of .7.5 Gal, 40 or as specified 20' > 19.3' .86 W7 tnesS: G. DUnnlnQ B.O.H. SF Day 4. No field modifications to the sewage 40 50 FEET 0 Medium Fl Application Area Required (AA)= ow Z Apply:otion Rate disposal system shall be mode without 20 Sand Perc Rate: <2 Min./Inch AA = 550 GPD _ .75 GaL/SF/Day = 734 SF prior written approval of the engineer 3.36 Leaching Faclllty Provided, _ and the loco/ board of health. Date: July 28, 1992 Dwg No: Use 2 Leaching Fields 1' Deep x 32' Long x 2' Wide 5. This system Is not designed for a Design: C.P.J. 1.86 Application Area Provided = 2(32' x x12) 768 SF garbage disposal unit. Check: 768 SF > 734 SF _. Drawn: J.VS. Job No: 2.0608.0 Sheet ) of 1