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0101 HOLLINGSWORTH ROAD - Health
Tol riollingswortif-Kstervillej— ""`" No. •- . /.:... Finc............................... THE COMMONWEALTH OF MASSACHUSETTS.. BOAR® OF HEALTH -._/ c� k.� ...............OF......�......�4.� ....................................................... for Uiipol�a1 Vorkfi C outitrurtiou rantit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at .... -.__. '...::. ........................ ---------- ........................................... or �n ocatjon-Addre�es�) -. ........ Lot No. —^_ wner n Address W G�11`s a�i�. a .......................... ..... Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................ _Expansion Attic ( ) Garbage Grinder ( ) �- Other—T e of Building No. of persons............................ Showers — Cafeteria C4Other fixtures .- •-••--•-••••............... . . ----------------------------------------------------------•------------------------------•------------ W Design Flow............................................gallons per'person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length---------------- Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-� Percolation Test Results Performed by.......................................................................... Date................................... �.] a Test Pit No. I----------------minutes per inch Depth of Test Pit.................... Depth to ground water-____________-__-__-__.. GT4 Test Pit No. 2................minutes per inch Depth of Test Pit-____--.----_-_____- Depth to ground water_.__-______----_-_--___. 9 ...••-••-••••••-------------••--••-••----•••••••••••-•••••-•••••-•-•-----•............_......_---•-•........................-••._............................. O x1�e d -L2 .............. --•------------- v Description hon o Soil_ -- - W - UNature off Repairs or Alteration Answer when applicable. ------ - 19-`---- SST Agreement: a G ' The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'T �" p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed•• •••• ... ------------- ---------------•--------------------- -•------------------------ Date Application Approved By•... �---..... ............................... ....................Da.--.............. Date Application Disapproved for the following reasons----------------------------------------------------- ........................................................... .............................•---....--------------------------------------------------------------....-••••-•--•••---••---•---••-•----•-•--. Date Permit No. ......•.................... Issued..&-'`4 . . ............................ . -- Date — ,' 140...........2r-1..... FnB...... ................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH * - t�(.. .......................I`....................OF...../3 ................................................................................... Appliratiou for Dhipogal Workii Toutitrurtion ramit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ................................... .. .............. ......................... .......... .................................................................................................. oc i n•Addr or Lot No. ...... .. ............... ................................. .. .....................................................I............................................ wne Address . ............... ............ .... Installer---................ ............. .............................................Address........................................... Tyi) of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons..............._.....__.___. Showers Cafeteria Otherfixtures ....................................................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity............gallons Length................ Width-_____--_______- Diameter................ Depth....._...._..._. W�4 Disposal Trench—No..................... Width..........._._._._.. Total Length..__................ Total leaching area....................sq. f t. Seepage Pit No_____________________ Diameter_-______-___:___-. Depth below inlet.._..............._. Total leaching area..................sq. f t. Z Other Distribution box Dosing tank Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit___.__._........._._ Depth to ground water------------------------ G14 Test Pit No. 2................minutes per inch Depth of Test Pit.._........._.__.__. Depth to ground water._____-_............_... 1:4 ............................................................................................................................................................. 0 Description of Soil........................... .-.;F _;V......................................... U ............................ .......... --------- ---------- -------------------- ....................... ---------------I .......................... ----------------------------------------------- T -------------41------------------------------------------- -------------------------------- qAtpre. Repairs or Alterations—Answer when applicable U ... .............. Q-- -- ------1-4- Agreement: V, The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T-ITLE, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu by the board of health. Signed.. ... ................... .......................................... ................................ Date Application Approved By........)a.......C.., r-;* ..........-:;. . A..W"..,....... ................................. ........................................ Date Application Disapproved for the following reasons:................................................................................................................. ........................................................................................................................................................................................................ a. Date Permit No......................................................... IssuedL.................., ...................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......OF...... ............................................................................ T-5rdifiratr of Tompliatta O S 1"W C.ERTIFI', ThV the Ipdividualji,:ewage Disposal System constructed or Repaired (� by .. ......... ...... . ... -------------- ..... .............................................................................................. . .............. ....... . .......at..................... -------- ------------------------------------------- ------------------ rovisions of TITIZ 5i with of 1��11 has been installed in accordance. o he State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated-------- -----_------------------ .............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ........................ �.. q A; THE COMMONWEALTH OF MASSACHUSETTS BOARD .OF HEALTH t. OF.....f ..........................................•............................ FEE....:................... No...................... 13- n I rhii Tonotrurtion "pamit ................................................. niission is hereby gr Permission ted.. . ................... to Q'hgtruct or epai g D Individu e ispos S s at N ...................... 7..... ......... ---------_---_-................................................................... as shown on the application for Street_,..:..... e't DAT i................ . . . . ........ Disposal Works Construction P N OV .........Aated............................................... -------------- Board of Health DATE---- ..... ......................... ......................... FORM 1255 HOBBS,& WARREN. INC., PUBLISHERS • 'J Town of Barnstable P#. ��O �Trra Department of Regulatory Services 1 aenrtarsiaM r Public Health Division Date MASS. 200 Main Street,Hyannis MA 02601 a • FFl)MA'i A f Yd Date Scheduled T G! V�^ ime Fee Pd. Soil Suitability A,ssesSment,�or Sewage Disposal I Performed-By:_ L t✓D A�7—L I`Iozis -�.1 Witnessed By: ✓r n LOCATION& GENERAL INFORMATION C?74�S 2i•-3d'S y . Location Address /-7 LG/ Owner's Name v rliGSGuc�r2%h/ ✓��. P0422 E1-G�° ` 057E°(//L 1— �!'I I 0 2lossS Address/00 6oX— 493 /-3A;1 JST/t-iS f 026:3 C Assessor's Map/Parcel: 140 — OG O,44 /3oJ2SEyG/ Engineer's Name FAG me(17 ENG/NFF'2 i (� NEW CONSTRUCTION .9 REPAIR Telephone# C 7 74� 3 Q Z ^ 3(?3 Land Use l�es f DFN T/dt C.- t' J Sl N/iir Slopes(9'oj N/'� Surface Stones .. Distances from: Open Water Body �_Ab ft Possible Wet Area �o O {( Drinking Water Well /00 ft Dralbage Way /O O ft Property Line /d _fit Other Al 1 r ft . SKETCH:(Street name,dimensions of lot,exact locations of test holes&Pere tests,locate wetlands in proximity to holes) X, ix O 'a Parent material(geologic) Depth to Bedrock � L�> D Depth to Groundwater. Standing Water in Hole: �yeeping from Ph Face Oh Estimated Seasonal High Groundwater > _� � Y ]DETERMINATION FOR SEASONAL-HIGH WATER TABLE Method Used: �?O✓I.6AJ /zA� /O/VAaL Depth Observed standing in obs.hole: Deptit to soli mtlltlee: Depth to weeping from side of obs.hole: Itt' Index Well Ir Dt, Groundwater AdJtistmcnt ft. Reading Date: Index Well levol' _ Adj.factor Adj.Groundw4ter Level _ Observation PERCOLATION TEST bate Hole# Time at 9" Depth of Pero ^�~ Time at 6" Start Pre-soak Time @ r. Time(9"-6") ERdPre-soakr�v Z C,A'f..L6 kaS Rate Min./Iuch Site Suitability Assessment: Site Passed—_ Site Falled: Additional Testing Needed(Y/N) Original: Public Health Division Observa:tion Hole Data To Be Completed on Back-------= ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1) week prior to beginning. Q:\SBPTIC\PERCFORM.DOC 114" DEEP.OBSERVATION ROLE LOG Hole# Depth from Soil Horizon Soil Texture Shcl Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. o si tency %'Gravel) a z4� -act-1 ib G�g DEEP OBSERVATION HOLE LOG Bole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consistency.%(ra ]DEEP OBSERVATION BOLE LOG Hole# Depth from . Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency, Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Withn 500 year boundary No-1-Z Yes, r Within 100 year flood boundary Nov yds..:'— Depth of atnrall Occurring Pervious Material lY t: Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? `' If not,what is the depth of naturally occurring pervious material? Certification I cettify that otiF'��L- 9 (date)I_have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and experience described in)10 CUR 15.017. Signature Date ' Q:\5EPTiC\PHRCP0RM.D0C LOCATION SEWAGE PERMIT NO. VILLAGE ' INSTALLER'S NAME D A D D R E S S J. CRAM MEDEIROSs� Trucking Bulldozing 142 Corporation Street tiT�a.is, Mass �5 nR g B UtIDE R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �� /� �vflye ®ah I E / 1v � I t <y I r r `f i two;`RsmImOPwLATB oe N TMI w ~ r J DO ,. p J7J Lia MIN vLR YJe ROOy g RL O _" -"a °- nr"r '•.'_.i. .I',fiu--,f`- R �I„- -'�91r .,i-, -_I .hl7hif-I �Srw- ^_, mnr A,-, -, . _ uL Y Q M i-, Il .d-n 7. I I I-li.I 1.-�,I I}3 Rmq71"�I:�:�11 - I• ,41p.-0 I.1.1�1p!m1:S_.��1�, �h ;�i.-1-ql n I�.!'�-��I'iir��:� '�' �i �!��,�i�f � I�1' it{4nk��{I�'Fin�tiln � b �I,'�k�!ti��+n�3� !a7 �-�-,m�'i�l._ I�hi��i�.t4-���i�k��� ;�tF�c�u.�t�r.auIm�SMr 11 I� y' -----_ II II w0 _ I " L I r i i oif Vj I I I I i - g FRONT ELEVATION LEFT ELEVATION a MP, HU I-W 49 JJJJJJ,,,,,,of r���La sue—R-— _ _ _ __ --- —L- ..—. I I p - e , , 2"m molls, I B -m'�n' n?I r,'.� t+:-�n..�a 4. t . SIul44 on _i: It4o-, rt4 P tirr. _uSi! n,+p-}.r-,�, nr 4t n l—tI �3S Y_ 51-.rn"B,ai _I ,_aI, l l i'-I 11 W 1 �tFSr Ii �19ri iE r0 Y_ A ` w V lJ Ll L , LJ L---------------------------------J LJ fllQ I I d F m .._-------- --_--_--_--_-----_--_--=--5-- --- --------------------� rca a REAR ELEVATION _ BceLe,w,-o RIGHT ELEVATION �� "GENERAL NOTES: FOUNDATION NOTES: j H.LL.•earl Ax °4N�Rere aH,LL a r. PA,°AT. J r.coxra,crOR a ALL pleeloxe o � E�noon s e Pal a r P......1.1.1.rue_Z. enoen CSaaar'C'NN5t""SOft ANSH _ IAr "185 a LL 88 ro"OC"GNMG MTM THE TO 50 ax. 0 1 vx, S."t N AOR On u,L a A ISO, 1.TIE BILL PLATE IN ea!0.w1T.f1 — — — — INTO n,SOxaT Oa NP.a OR.....Tr J 1 I 8 evEx MCNef into cox RET. - .rrTP.r y NIGHT OF fO•nN 1 ee•nAx neAaaaeO ExrEN°A nWnun Gv f MCNES W Vevrlc.11T raOn THE xOEM4 O,♦NE T.EAOe e C B __ wARORALe.ax•mx.M Har.Hr eHAu — — — (a NeTALLeo x two�a noac.......eueoxr , A veaxerea SEAL euAu ae rvorloeo uNoea fr .. _ w000 eeAx nr.r Aleu none roman um xcuee AeoveA PRasauae r...TWO slLL 1 _. - __-_______ _ _ x .OR G1,oe LH n,x.aeI1 ovewx4 At wxer EGur — -- --- — _ -- - 1 PORCH ABOVE I i p "0" H ro IN.....°a oR Hoax eu,u xo IT.ILLIT" a"aw,°LL°aIILI S ro°a"1Eo�ar°N Neun rwa INCHES AS4ve THe u i •'1 ear'»Qa I K N ° THE na u CNA.S wA I',I i i eoLreo Ll r OE— W F 3.III�wi"DOIN u':CONTRACTOR 1 xo a n$°neeeeTHE III ;;ae°roeN° � i .nox x4TEa ' EOIS ll p dx°ieO Aae r r x ARIA nu r C.FAIFP AI j ro nL viPCv verARoeR s4 r_— ... •�.'• m = LEAST ONE III CFERABLE owALL STRUCTURAL NOTES: 01xo00 rTrP, < 1�` e.US.0 HALL ac rrxoo rN nix. 1 ! 1 o m�ev,�a aeiR v°ea I F I�LLa�Yarvuc�Rwea ''. m 0Mon <~ .0 A »AL r 1 T L rRAmxG 1N T e f mx CLEAN..OM ALL nAEox i; it— r—r r— j r— 1 ,•11n ONc.ELAe r,000 x.l <9< `❑5 SeP,R.I.rO N No a L cox oa 0 ,�„N�.xTroN.L�x,eER. CIS LL0ux4� AS—LL NOT 11101E THAN ALIl 1.CiEAN ALL ono eA NINIVI NET T»e Nx w �.5_Y.TO vLeoo_S�oaa.a.nni.T i. .._._ _ _iL. J _ _ �ero L J 1 L—J r _ i...,l i JJ� aw cLµ a®exrwEM�ABLE a aHUL ee re-Eyoo e.«M. 0 ! Dee.rr. y' 1 moon wai 1.10 ° or on'ALA L o1ne1E10.5 APNLi ro 1.1 °` rY xor reEPe rH:u a Ix n-NO I ! I I.'1 I�'1 z Umu e ea A x r w SLEEPING aocnel-xo vat ;1 j 0p0 j ^CAR GARAGE 1 Q O m om Gyy aO�♦pneN eeeveo eo SLEEPING S I I I 'I4 I ro mL Y=ReTAR-R I'I m 3 O Nereo� doxlnG Ar euLpxG eeaweNe.v exre x ovrboe Ov Snwo p1e....levaeae AT OINOoee ANC 000a9 .',o_E_`B e•cone.rouxO,nox el exreao5 AMExSISION IN cexreR or uve Lo _ e.Lt rfo, AicTHAT «°xo I.-THE ce -ITS.HER '1O r i IP. v'q 1 a,0e.woo wl s o o u 1:'I I"I P A o+Nerov o iue 'o�e rr rue ve Lo,o So PSF Z S no � i Co...rr4 r I �eA.LI e"Tar oremxG uo wr sx4e r.va 10 WHO- REPRESENTSe e r oA _ a area ue C p i° rooO o _ yl -.1 a. o 1TERo1 p ExSOMN4 AT STARS levaeSENr9 - T rrrP� A OnENS1on ro r»e NmsNeo r,ce of ILe STA. .�, r it— r— �� f..rORuOTe1AL NEAOe15 r eEA19 R ALL ee,R On THE � —J _—_ ____ 4 L__ °o eLe NeA115 HALL 1 ox o,eaoo .,... I ?RiLe ueA aN uA Al N, w 1 L J L J L J 1 I r GAR.Ga Po r u ee o0o euL AS xeces RI aosra o e S o a ereeL ee.nS Su,u ce.a ox f+m a aTEeL I _ _ Am�x:,ieo x ES.wneeR nw PNowcrs - __ _--_ - SP=1D-w"Z ARE MEEo 101 mcaGu.A1 _________________ ZRANDAL IT 01 G8.01 CO �QQ(B�gGHQ y 4 ICORIIIATE ANT wee BT o oc oA NA'e r 1,Nxr, 1 P R Am4x e — caeo rue m ruAr Aa N TLWI BE bi S Rs'o7>we OLO_ER ro PESV8NT ee°o oE O° Q ` FOUNDATION PLAN - rw a w a w "' 111 1 Z } u� 6gggg Y K (L Z C8p OU ZO c9 Z N s, = o a 00 It In aW ZO �F •� Oa w ! a- a rca a ECTION A �,o i i b• > rc w e W�! 9<W ?� (0 . PORGN De S U a? ® ® eoxc.a� xoruee> ¢ m tt N Qa< ma" xwr W=W GREAROOM OININGROOM Q OJ; w G� BEO�ROEO _._.—.—.—.—.—._ _ _ ® (r��r 0 N=W plSo C xur w.0 V �� } z�>j ILI $ BATH/ ''� tr V a 03 'it, CO SD I CAR GARAGE-153 9F. � L7 p 4 ����.'".' 1. m• I 3 ww'o:co"e reo > C e� o He Tnc I C $ ILI eixx cnn>ce Door+ I C m I i m fO 4 o!lxwc>nn. LU k _ a x F W< z 44 a0 PIRST FLOOR PLAN �� Q z N K.�e•r„'.r.q. a.< g w ice>o+n er. NW �Z0 orn or co eance•r.o,.,l.P. o 0 8.r_ �O J�U rro oeo� ecNeoule W LL,'N wV Fes � N (if(L LL wrow Doors ee>aeou�e- _ pia IL �,o . k � a w 4 - 1 a' tll C _______ _____ _ II w0~ z _ II moOC= mow aFu crp P II m ae n �F�rr, Li QaaUM moj f $� OPEN TO BELOW j =V 4 fi I '�'E�III��I➢'I ® AS t p�j=W dog m co 9D } ° eeov OT s r - II II , II �I 4 1,L_:3 C=JJ r F SECOND FLOOR PLAN - w< Q z Z K°o IL....°•a.1°•..1P— °°,., u O a 3 >- N OU C)Z W j anw LLImW 00 woow • rATlo 000ra ...+oou 3w z O N ,+oowe iaiow o use a 2 6 0 OF �wO a ¢ �a a �,o Town of Barnstable .�W"0 .� Regulatory Services Richard V. Scali, Interim Director * BARNgrABM • MASS. �0 Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Sewage Permit# Ass ors �P rcel 0 d 6-7 Designer: •Fp L_KoyT1-� Installe Address: t-7 &Cq•� r:1w� "rJ. Address: f=r4l vv%.c V ,V1.p� O 55 On was issued a permit to install a (date) (installer) septic system at l nj_ 1 � 1 �S�,nQ,-�{,.�- based.on a design drawn,by . _(address) _ p F L1M o� (designer)C-�I►`lC-ZZAJa dated ►1� . -- 5 �C-�jIS�b I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater,than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed ' fiance with the terms of IAA app oval letters (if applicable) N OF MAs s9 o� MICHAEL J. �y BORSELLI cGn lle s Signature)&fjtw� CIVIL m ( � ) 9 No.35054 O .� /STEP'��tQ S�ONAL ENS (Designer's Signatur (Affix Designer's tamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc No. C / Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es 4plitation for Nspo8al .6pstem Construction Permit Application for a Permit to Construct(ejT Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No./0/ //VO 516Uv21 Owner's Name,Address,and Tel.No. /T7 (-2%-34 P 0Srf-4-eiiG AA V10 ✓�i�i22F_c?: li Assessor'sMap/Parcel 0&-7 . /000 05OX 4&3 "� iWr9 02636 Ins ller's,Name, dresl Tel ` Designer's Name Address,and Tel.No. (f©8) +'S=7? 3- 11ta7 l r v 'S )E OL ' O ll e k~ CA/ Type of Building: . sS rAL/ltGvi�rv2Sp Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �3.30 gpd Design flow provided gpd Plan Date /D j2-1/S Number of sheets 7 Revision Date Title S'&P77C 5),+577-071 /X 0P/-!Ls /U j Size of Septic Tank /<T?C7 Type of S.A.S. '��' >7� � —C��512F� Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 nme t e an o o place th ystem in operation until a Certificate of Compliance has been issued by this o d of He Si Date Application Approved by Date Application Disapproved byCj Date for the following reasons Permit No. 3:7 7 Date Issued o �- Ka 4,( ... No. 'rs. �� Fee t computer: THE COMMONWEALTH OF MASSACHUSETTS Entered ih i 7 r, _.' 'PUBLIC WEALTH DIVISION -PrOWN'OF BARNSTABLE, MASSACHUSETTS JtJYiLatlOii for disposal 6pstent Construction Permit �r Application fora Permit to Construct(_�j. Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No./e/ #cy,41/V4 Swoa774 Owner's Name,Address,and Tel.No. e"7'7 4) 9-2/-38 9 9 0stfk(4c.44 A/iVI0 A^ef2C.Ct ,q Assessor's Map/Parcel O(D-7 ' D /3uX Q&3 61WV5 ,1j*(_,E nfll 0263 Installer dame,�,ddres acid Tel o` Designer's Name Address,and Tel.No. l-1 ('ate_5 e �/v �1 �"Fx� /F 4 -i�-�1 u�c t e fc U115 F GG /7 fl e,"f- rt 4ti Type of Building: 9 e-/rr*77'07S-tp j Dwelling No.of Bedrooms ...j Lot Size -2-4 7 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) %330 gpd Design flow provided gpd ` Plan Date /,4/Z�/,1�_ Number of sheets 7i Revision Date --� Title S_fPTiC DF;3y,1_s Size of Septic Tank _ wy!w p _ /�UZ� Type of S.A.S.S:A.S. /zZ71 Description of Soil 2.!5" Y k Nature of Repairs or Alterations(Answer when applicable) i Date last inspected: Agreement: 1 +��\��' YThe undersigned agrees to ensure the construction and maijtenanc%f the"afore descr bed on-site sewage disposal system in �. `accordance with the provisions`of Title 5 otthe Enui onme to odeand not to place the system in operation until a Certificate of Compliance has been issued by this Board of He Si Date t= t Application Approved byr Date e Application Disapproved by , $(�''�L Date ^ for the following reasons ,r Permit No.7 v� _"� ? ' Date Issued --------------------- -'-------------------------- --- --- ------------------------------------------------------------------------- THE COMMONWEALTH OF-MASSACHUSETTS BARNSTABLE,MASSACHUSETTS y Certificate of COmplidnre .;.«sue"'"✓ THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( Ar5 Repaired( ) - Upgraded( ) Abandoned( )by at /40/ k&1-U/t/S w o rt 77-/ DS 71 has been constructed in accordance ; with the provisions of Title 5 and the for Disposal System Construction'Permif No. :?o/ dated Installer Designer pifil/V7// #bedrooms .,� Approved design flow- 4 44- gpd The issuance o thi permit shall not be construed as a guarantee that the system will ~ design - Date Inspector tv (t/ No. G t - 7 ? Fee l�Z b / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposaf 6pstem Construction Veriiiit Permission is hereby granted to Construct(k) Repair( ) Upgrade( ) Abandon( ) System located at ,. . 09 l/1 iGL6_ and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction in be completed within three years of the date of this permit. Date p / Approved by v 'OeL TOWN OF B STABLE LOCATION Q S SEWAGE VILLAGE Qer✓i e ASS S R'S MAP&PARCEL O -D6 INSTALLER'S NAME&PHONE NO. k ' SEPTIC TANK CAPACITY ,SOCK 01 LEACHING FACILITY:(type) ��� size) J� NO.OF BEDROOMS (n� OWNER PERMIT DATE: ,� COMPLIANCE DATE: Separation Distance Between We: 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) t Feet Edge of Wetland and Leaching Facility(If an wetlands exist within I 300 feet of lea c ' aci i "" ;' Feet FURNISHED x IR-39-3 A •3 -5, I 15-d ro 3 n �iD Commonwealth of Massachusetts NOd� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 Hollingsworth Road `' Property Address Geoff Cottrill r Owner Owner's Name information is G 3 required for every Osterville Ma 02655 5-10-18 page. City/Town State Zip Code Date of Inspection { Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information ,1# 01�-- on the computer, use only the tab 1. Inspector: key to move your cursor-do not Brett Hickey use the return Name of Inspector key. B&B Excavation rzb Company Name 374 Route 130 Company Address Sandwich Ma. 02563 City/Town State Zip Code (508)477-0653 S113747 Telephone Number License Number B. Certification ` I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 5-10-18 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 I Commonwealth of Massachusetts Title 5- Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 Hollingsworth Road Property Address Geoff Cottrill Owner Owner's Name information is required for every Osterville Ma 02655 5-10-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system was in working order at time of inspection. B) System Conditionally Passes: ❑ 'One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"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): (Sins•M 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 101 Hollingsworth Road Property Address Geoff Cottrill Owner Owner's Name information is required for every Osterville Ma 02655 5-10-18 page. City/Town State .Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) .Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 Hollingsworth Road Property Address Geoff Cottrill Owner Owner's Name information is required for every Osterville Ma 02655 5-10-18 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. I 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 '/z day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection -Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 Hollingsworth Road Property Address Geoff Cottrill Owner Owner's Name information is required for every Osterville Ma 02655 5-10-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,.you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 101 Hollingsworth Road Property Address Geoff Cottrill Owner Owner's Name information is required for every Osterville Ma 02655 5-10-18 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)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (Actual) 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330/GPD t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 Hollingsworth Road Property Address Geoff Cottrill Owner Owner's Name information is required for every Osteryille Ma 02655 5-10-18 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2, Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d See below 9 ( Y 9 (gP ))� Detail: 2017-63,00bgallons 2016-64,000gallons Sump pump? ® Yes ❑ No Last date of occupancy: Week prior toinspection Commercial/Industrial Flow Conditions: Type of Establishment: NA 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: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 101 Hollingsworth Road Property Address Geoff Cottrill Owner Owner's Name information is required for every Osterville Ma 02655 5-10-18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner-date of last pump is unknown Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption'system Single cesspool g p ❑ 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). t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 101 Hollingsworth Road Property Address Geoff Cottrill Owner Owner's Name information is required for every Osteryille, Ma 02655 5-10-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1-19-16 per COC Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 2 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): — Distance from private water supply well or suction line: Town feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 1 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: 1500gallons 011 Sludge depth: t51ns•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 101 Hollingsworth Road Property Address Geoff Cottrill Owner Owner's Name information is required for every Osterville Ma 02655 5-10-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 36" 011 Scum thickness Distance from top of scum to top of outlet tee or baffle NS Distance from bottom of scum to bottom of outlet tee or baffle NS _ How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank was in working order at time of inspection with liquid level equal to outlet invert. Tank is not in need of pumping at this time but should be pumped every two years for maintenance. Grease Trap(locate on site plan): Depth below grade: NA 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 1 Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date (Sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° M0 101 Hollingsworth Road Property Address Geoff Cottrill Owner Owner's Name information is required for every Osterville _Ma 02655 5-10-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping.recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: NA Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 .Official 'Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 Hollingsworth Road Property Address Geoff Cottrill Owner Owner's Name information is required for every Osterville Ma 02655 5-10-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): 11 Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box is in working order at time of inspection with liquid level equal to outlet invert. D=box did not show signs of back up. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No Comments (note,condition of pump chamber, condition of.pumps and appurtenances, etc.): NA * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Forum Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 Hollingsworth Road Property Address Geoff Cottrill Owner Owner's Name information is required for every Osterville Ma 02655 .5-10-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: (3) 500 gallons ❑ 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 was in working order at time of inspection with no sign of hydraulic failure. Leaching was dry when viewed. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal S'+stem•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 101 Hollingsworth Road Property Address Geoff Cottrill Owner Owner's Name information is required for every Osteryille Ma 02655 5-10-18. page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: NA Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts R Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 101 Hollingsworth Road Property Address Geoff Cottrill Owner Owner's Name information is required for every Osterville Ma 02655 5-10-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells;within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below 0 drawing attached separately 1 B A 3 Al-39'3" 81-15'8" A2-417" 132-21'3" A3-23' 83-15' 0 A4-25`9" 134-22'6" A5- 147" 135-25'3" VEawy t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 i�r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 101 Hollingsworth Road _ Property Address Geoff Cottrill Owner Owner's Name information is required for every Osteryille. Ma 02655 5-10-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: No GW @ 120" 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: Oct-2-2015 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Plan on file with BOH. t Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 101 Hollingsworth Road _ Property Address Geoff Cottrill Owner Owner's Name - requir required is Osteryille Ma 02655 5-10-18 required for every page. City/Town State Zip Code Date of Inspection E. Deport Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage.Disposal System either drawn on page 15 or attached in separate file i t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Y Property Address: 101 Holt ingswnrf-h Rd OG Prville t Owner's Name: RrnPqt Shatz Owner's Address: ^97 Wi an no Ave. Date of Inspection: Name of Inspector: (please print) Wi 11 i am E_ • Robinson Sr. Company Name: William E. Robinson Septic Service Mailing Address: P O Box 1089, Centerville, MA Telephone Number: (508) 775-8776 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to SS 11on 15.340 of Title 5(310 CMR 15.000). The system: 1/passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority,. Fails ,. Inspector's Signature: A.,* ti 1(". Date: — —U ) - The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Heatth',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 time.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 I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 101 Hollingsworth Rd. Osterville Owner: Shatz Date of Inspection: tT— 55—d ! Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Sys m 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: B. yytem Conditionally Passes: One r more stem components as described in the"Conditional Pass"section need to be replaced or O o system P P repair d.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answe yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain e septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsoun ,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existin tank is replaced with a complying septic tank as approved by the Board of Health. *A in 1 septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indic�ing that the tank is less than 20 years old is available. A plain: Observation of sewage backup or break out or high static water level in the distribution box due to-broken or ted pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with al of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND ex lain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass ins ection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is rmnovod ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY-ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 101 Hollingsworth Rd. Osterville Owner• Shatz Date of Inspection: 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 fat ing 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 f< 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the sy tem is functioning in a manner that protects the public health,safety and environment: r The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a ' -su_rface watersupply 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 rivate water supply well**.Method used to determine distance *This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform� acteria and volatile organic compounds indicates that the well is free from pollution from that facility and e 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 Page 4 of I I ti OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 101 Hollingsworth Rd. Osterville Owner: Shatz Date of Inspection: a--7-0 7 D. System Failure Criteria applicable to all systems:. You ust 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''/2 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. 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 wa= 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. �arge Systems: To �e considered a large system the system must serve a facility with a design flow of 10 000 d to 15,000 0 g Y y y g � k;P gP Yoi must indicate either"yes"or"no"to each of the following: ( e following criteria apply to large systems in addition to the criteria above) jxes 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 u have answered"yes"to any question in Section E the system is considered a significant threat,or answered " '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 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 10,1 Hollingsworth Rd:' Ostervill ,n _ Owner: Shatz Date of Inspection: O l Check if the following have been done You must indicate"yes"or"no"as to each of the following: Yes No. _ umping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks? 1! 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? y ` Were all system components,`excluding.the SAS,located on site i/ 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 disposal maintenance of subsurface sew e a osal systems ystems . 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 III Page 6 of l 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 101 Hollingsworth Rd. OstervillP Owner: Shatz Date of Inspection: ,— F-0 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):46 Number of bedrooms(actual): o� DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):�L d Number of current residents: d Does residence have a garbage grinder(yes or no):A0 Is laundry on a separate sewage system(yes or no):`o [if yes separate inspection required] Laundry system inspected(yes or no):V Seasonal use: (yes or no): Water meter readings,if available(last 2 years usage(gpd)): 2000 80, 00 0 gal. Sump pump(yes or no):.4-0 1999 98,000 gaL. Last date of occupancy:. COM ERCIAIANDUSTRIAL Type o establishment: Design ow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease ap present(yes or no): Ind ustr' 1 waste holding tank present(yes or no):_ Non-s itary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last a of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: AA Was system pumped asp of the inspection(yes or no): ;4,d If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYP OF SYSTEM eptic 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 k9pwn) d source of information: lCa 81 ° 46 a Were sewage odors detected when arriving at the site(yes or no):iL-0 6 Page 7 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART C SYSTEM INFORMATION(continued) Property Address: 101 flo11_i nqc;wnrth Rd.' Ost ryi11P Owner: Shat-� Date of Inspection: BUI ING SEWER(locate on site plan) Depth low grade: Materi s of construction:_cast iron _40 PVC_other(explain): Distan a from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_(locate on site plan) Depth below grade: ' 4 Material of construction: /concrete metal_fiberglass__Soyethylene —other(explain) If tank is.metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) to Dimensions: / `a ae Sludge depth: ') /U Distance from top of sludge to bottom of outlet tee or baffle:,. J'O° Scum thickness: Distance from top of scum to top of outlet tee or baffle: 3 Distance from bottom of scum to bottom of outlet tee or baffle: L/ ' How were dimensions determined: J)Ai: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of.leakage,etc.): vvC> , 1 �zwv� /3.� 1✓�.1�� LL�� �� GR ASE.TRAP _(locate'onsite plan) Depth below grade: Materi 1 of construction:.., concrete metal fiberglass polyethylene_other xpla Dimens ons: Scum t ickness: Distan a from top of scum to top of outlet tee or baffle: Distan a from bottom of scum to bottom of outlet tee or baffle: Date f last pumping: Co ents(on pumping recommendations, inlet and outlet tee or baffle condition,_structural integrity,liquid levels a ate(d to outlet invert,evidence of leakage,etc.): 7 . Page 8 of l 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 101 Hollingsworth Rd.. Osterville Owner: Shatz Date of Inspection: TIGHT or OLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below ade: Material of co struction: concrete metal fiberglass_.polyethylene other(explain): Dimensions: Capacity: allons Design Fr(yes gallons/day Alarm pr no): Alarm leAlarm in working order(yes or no): Date of lCommen of alarm and float switches,etc.): DISTRIBUTION BOX: 1/ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: a Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUM HAMBER: (locate on site plan) Pumps in orking order(yes or no): Alarms in orking order(yes or no): Comments note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART C SYSTEM INFORMATION(continued) Property Address: 101 Hollingsworth Rd. Osterville Owner: Shatz Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)F If SAS not located explain why: VTyp leaching pits,number: leaching chambers,number: 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; F , etc.): _ f� t CESS)en LS: (cesspool must be pumped as part of inspect ion)(locate on site plan) ` _ is � ... • Numbd configuration: Depth of liquid to inlet invert: Depthlids layer: Depthum layer: Dimes of cesspool: terf construction: Indicaof groundwater inflow(yes or no):Comm (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): rs ` PR (locate on site plan) Materi Is of construction: Dimen ions: Depth f solids: Co nts(note condition of soil,signs of hydraulic failure,level of.ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 101 Hollingsworth rd. s erville Owner: Sh A g Date of Inspection:S —S` o 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. rne �,� - '" � ° >2 >, ��( 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART C SYSTEM INFORMATION(continued) Property Address: 101 " Hollingsworth Rd. Osterville Owner- - Shatz Date of Inspection: SITE EXAM Slope ' Surface.water Check cellar r Shallow wells m Estimated depth to ground water u 0 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans,on record-If checked,date'of design plan reviewed: V Observed site(abutting property/observation hole within 150 feet of SAS) flecked with local Board of Health-explain: Checked with,local excavators, installers-(attach documentation) Accessed USGS database-explain. h You must descri a how you established the high ground water elevation: bKJ I I LOT 6A N/F /. PETER & MARY ROCKq�, NG D/ST. BOX 3 - 500 6ALLaV BENCHMARK: � G \•� CV*9ERS W7112'aT IRON PIN ENOVSE I STGtVE aV SrUES AND EL. 34.04 35.1 4' S7 WVE aV ENOS N74'22'54"W IP o FOUND STOCKADE FENCE 88.12' 34.0t 34.0 �� PROJECT -' PP v 15" 1� LOCATION 413-5 LOT 9A OAK O 29 I NUL11 �010� 34.1 :�p��•.. HOLLINGSWORTH O TRUNK OAK �•••-_ , ROAD N/F 1300 O 1,500 LAWN N -O ESTATE OF SALLY FISH OAK GALLON --- ----T sync - -- -� ,-'�� 15 04 to TANK T.H.1 T.H 2 T .3 O`r� PO LA NOT OTO SCALE DOUBLE +35. O O O O t I o � LAWN +34.3 -10 Y TRUNK OAK �� 35.4 4 . . - . . GASH G SEamVtCE cv o LAWNG . . _ . . - . . _G >11 - O 35.5 GAS 35.2 e Y VALVE z � LOT 6A � . 35.5 ,yy•, � LAWN. 7,417t S.F. 11 � FL w W a LOT 8A sP CE 25' o a JOAQUIN R. TAVARES �35. A CEss N GAS ME GARAGE o 0 GREENED SLAB 21.5' 35.5 t�0i t�Gfi� W XISTI G BRI K WALK 0 OUSE #101 4.9 W _ 34.5 LEGEND ^ � 7.25 28 -- w .. E 'ANO MR)76' z rn Xft SYSTEM 70 BE W rn z PATIO Woo y w R`��.4No +35.5 EXISTING SPOT ELEVATION GE oMvvEa GA S�Af ( �p EL. 35.92 Y WATER o-- 'r w.0 PROPOSED SPOT ELEVATION p S , t1N 35.3 SERVICE \ o PROPOSE Q 34.1 o HOUSE LAWN PP �' EXISTING UTILITY POLE o PORC I 0 OAK p EXISTING TREE y EX�S�SE 10 8 1O 35.4 36L 6 eR 34.5 T.H.1 EXISTING TEST PIT NOU o PINE 219' w IP IRON PIN 36.0 �� Z FOUND C � NE EDGE a I` 3 .4 � DRIVE J O , I gZO Z pPp5E0 LAWN 34.5 RAGE E P DGE � cOee�E V) 2' 32. 034.7 U Z w 35.5 35. LAWN PINE I O 10 0 5 10 20 5' ti FLAG STONE WALK ; Y U_ LAWN `� I 18"0 OAK SCALE: 1 INCH = 10 FEET 35.9 EX/S)7N19 HOUSE TO O a¢. BE DEMOL/SHED S74'2 "E 34.2 34.2 10/12/15 ADD EXISTING SEPTIC SYSTEM AND NOTE TO REMOVE. IP' STOCKADE FENCE 67.7V IP FOUND 20"/14" I FOUND DATE REVISION E F "c DOUBLE LOT 7A TRUNK PINE PLOT PLAN s� cKPD N/F ( FOR #101 HOLLINGSWORTH ROAD JON W. & MARY L. MCKENZIE, SR. ( PREPARED FOR I 20' LINE BARNSTABLE HARBOR BUILDERS GENERAL NOTES. AS D DESCRIBB ESCED ON PB 103, PAGE 47) IN 1. HOUSE NUMBER: 101 OSTERVILLE MA 2. ASSESSOR'S NUMBER: MAP 140, PARCEL 067, LOT 6A I PLAN DATE: OCTOBER 2, 2015 PLAN SCALE: 1"=10' 3. ZONING DISTRICT: RC CIVIL ENGINEERING �� O U7, U T� WETLANDS PERMITTING 4. FLOOD HAZARD ZONE: X (FEMA MAP 25001CO757J) 5. TOPOGRAPHIC INFORMATION COMPILED FROM AN ON THE GROUND SURVEY. �p��H OF Njgss WASTEWATER DESIGN COASTAL ENGINEERING � 9 6. ELEVATIONS SHOWN ARE BASED ON NORTH AMERICAN VERTICAL DATUM (1988). o� MICHAELJ. �y � B CH ELLI can TITLE 5 PLOT PLANS (ter�,T PIERS AND DOCKS CD -r"-a, ��''! lY EER�� 7. LOT COVERAGE BY EXISTING STRUCTURES: 1,648 S.F./7,417 S.F. = 22.2% v 9 No.35054 LAND USE PLANNING COMMERCIAL/RESIDENTIAL O 8. LOT COVERAGE BY PROPOSED STRUCTURES: 1,615.8 S.F./7,417 S.F. = 21.8% �o� isTi- SerW9 CoPe Cod and SO4vt1i6wtein Massachusetts &FSSI 9. FLOOR AREA RATIO (FAR): 1ST FLOOR (1,170.3 S.F.) + 2ND FLOOR (1007.4 S.F.) 17 ACADEMY LANE, SUITE 200 - FALMOUTH, MA - 02540 - 508.495.1225 = 2,177.7/7,417 = 29.4% < 30% 0 PROJECT NUMBER: 15070 CAD FILE NAME: 15070SP DRAWN BY: L.M. SHEET 1 OF 2 1-7N/SH 6RADE SHALL BE 20 MINIMUM OY£R ALL .S£P770 SYSTEM COMPONENTS USE 4"DIA. SOYEDULE 40 PW OR CAST IROV PIPE 20'MINIMUM.SETBACK FRaW a7a-OF SA6NE A0 CELLAR WALL SOIL TEST ro'MINIMUM SE78ACIr Rf&011A9ZE COVERS SET TO X WIN REX10YABL£COWR'S SEr Date of soil test: SEPTEMBER 14, 2015 6-OF.,WlSH GRADE(TOTAL OF 9J ro Of77IIN ,3 0 OF FiNI-W Test taken by: MICHAEL BORSELLI, P.E. GRAOE�MJN. OF 2) EL. = 35.5 7R. _ .35.5 Results witnessed by: DAVE STANTON .�,.�,.�,,..� Percolation rate: < 5 MIN JIN. Ground water NOT ENCOUNTERED • = 3Bf hvWRT EZ£1! 'VAX 7-LAYER "1/8- 70 TEST HOLE #1 TEST HOLE #2 a • 1500 GALLON sETF/RST SLOPE VARIES 1 " WASHED S777YVE o" 35.5 0" 35.5 • 4 SEPTIC TANK 2'LEY£L S = .01 M/N. EL = .32.5 A A LOAMY SAND LOAMY SAND a' (H-10 LOADING) ®®®® 6" 10 YR 4/2 35.0 6" 10 YR 4/2 35.0 $ II D/ST. BOX £LEY = 2957 LOAMY SAND LOAMY SAND J p N 30" 2.5 YR 6/6 33.0 30" 2.5 YR 6/6 33.0 4► SET SEPT/O TANk' ANL7 DISTR/BU77ON BOX �' q /#STAY& ,fI4"IV t 1/2"bW&C C C K ON 6 A' LA YEf OF ORUSIIED STONE `` a XW-WED, OW-WED STONE ALL 41' COARSE SAND COARSE SAND t" AROUND CHAMBERS AND DOMW 2.5 Y 7/4 2.5 Y 7/4 TO TH£BOTTOM OF THE LYIAMBER SYSTEM. REFER 70 LAYOUT OF P1 Q�OFI LE SY57£M FOR ii/6WE/SETA/LS (9077Oi! Gl'c- TEST HfXE£L = 25.5 NOT TO SCALE 3 - REMOVABLE 24'"VIA. COkERS REMOVABLE 2W D/A. COW? 120" 125.5 120" 125.5 ; •• •, ,+. z • . •r• ..:: ;' ,•.. . K 2 - OUTLETS 1 3/4p �_TEE OPEN AT rOP SET •• 3"MIN. fwav TANK CON£R ' INLET XNO�KOUT a L/ /D LEY£L OUTLET KNOCIfOYJT ' ' OUTLET 00 INLET INLET TYPICAL OF 5 0 INLET 7FE SET OUTLET 7£E SET ;. TEST HOLE #3 TEST HOLE #4 8" it 10*MIN. B£L_OW 14 8ELOW LIOU/D LEY£L V" 35.5 o" 35.5 2 - OUTLETS ° , ."•• •. GAS BAFFLE i A A 19.5 4' I LOAMY SAND LOAMY SAND 19.5" 6" 10 YR 4/2 35.0 6" 10 YR 4/2 35.0 .I 1 B B PLAN VIEW CROSS--SECTION LOAMY SAND LOAMY SAND t 30" 2.5 YR 6/6 33.0 30" 2.5 YR 6/6 33.0 DB--5 DISTRMUMON BOX 1--10 LOADING C C NOT TO SCALE v COARSE SAND COARSE SAND 10' - O" 5'- 2" 2.5 Y 7/4 2.5 Y 7/4 ro'- s" 5' - 8" 11500 GALLON SEEP11C .TANK (H-10 LO , D NG) s' - 3 1/2" NOT TO SCALE 120" 25.5 120"1 25.5 6" BASIS FOR DESIGN: ��I" OF MICHAf1.1. 34 �s qog�0 " as TOTAL DA1LYR0W1SBASED LTV 3 8EDROL3iY.S� NO GARBAGEDISPQSAL '24" sal;s�tt� TOTAL DAZYFLOW= 1106-R,01$EDROGflYX,3B,CbW06WS = ,.U009D CIVIL No. BQTTOM AREA PRQPOSE0 = 295.8S.F. ©Fs sr�P SYDE AREA PROPOS420 = 169.2 S.F. CONSTRUCTION NOTES: $' _ 6„ k)-rOML LEACHING AREA PROPOSEO = 465 S.F.INSTALLA770N or NE PROPOSED SEPTIC SYSTEMSHALL BE IN ACCOWANCE Of/W .7771E 5 CROSS-S _CTI ON �✓ �' AND THE BOARD 6 F HEAL 711 REGIJLA77ONS 8' 6" APPZ10A;XW RATE = 0.74 - 2. 7tl£CON7RACr6R SMALL DETERMINE TH£L0 AAON OF TH£ WATER .SERVICE AND DfS/GW LEACHING CARWY7Y= J44 GPO > . JO GPD A-67 £IN ALL AREAS LESS 77IAN 10'FROIY 77IE PROPO-VT SEP17C SYSTEM. ° .. " 3. A CDPY OF THE PLANS SHALL 8E AVAILABLE 01i/ SITE F01?REFERENCE AT ALL TIMES 5" KNOCKOUT SEPTIC SYSTEM DETAILS DURING 7HEINSTALLA77ON ar 7HE,SEPTIC SYS" 21" DIAMETER COVER FOR #101 HOLLINGSWORTH ROAD 4NO 064NG£S TO THE DES/GW SHALL 8E PERFORMED Xf7,Va1T THE APPROVAL OF BTHO PREPARED FOR FALMOUTH£N(YN£ERING INC. ANO THE BOARD OF HEAL IH. BARNSTABLE HARBOR BUILDERS 1 5" KNOCKOUT 5" KNOCKOUT IN 5. THE SEPAL SYSTEM/S S7I8,E'CT TO W-WE071aV BY FALMOUTH ENGINEER/NG, INC AND IWE'9OARO 6F HEAL TH. OSIER VILLE MA ° 4 PLAN DATE: OCTOBER 2, 2015 PLAN SCALE: AS SHOWN 6. 7HE aWn AC7W -WA" N077FY FALM4UTH ZWNEFRING INC AND 7HE BOARD Or HEAL 7H 70 IN570ECT THE SEPTIC S)SF"PR/OR 70 BACKf7LL IN sawINSTANCESy MORE TNAN 6WF INSPEC77G1N MAY BE NaVERER IHE aW7RAC70R -WALL aW Y 8406AWL 7HE 06W)?OVS OF THE 5" KNOCKOUT CIVIL ENGINEERING �� � r x WETLANDS PERMITTING SYSTEM THAT HAYS BEEN INSPEOMO AND APPROWj9 BY FALMOU7H ENGINE�IN INC. ANO WASTEWATER DESIGN COASTAL ENGINEERING V THE BOARD OF HEAL)71 :° a • •'• : ''°,. • a • ' a' • 7. IF THE 6WXA0r0R ENCOUNTERS ANY VARATIONS IN SI7E C�VDlTMO SUCH AS DIFFERING PLAN VIEW TITLE 5 PLOT PLANS PIERS AND DOCKS SOYL.S T17POGRAPNY, 1fFnmos av OTHER CONDmms THAT MAY REQU/RE RE-EYALUAT/DN Or CaV7RA09W /� Ar//�� / {I NEE.. THE DESYQV, TH£ SHALL INW201ATEL Y CONTACT FALMOYJTH"aNEER/NG, INC. 500 GALLON LEACHING CHAMBER 2QLQA LAND USE PLANNING COMMERCIAL/RESIDENTIAL SCALE: 1' = 2' .Sev ving Cave Cod 07d Southoastem Mossodrusetts 17 ACADEMY LANE, SUITE 200 - FALMOUTH, MA - 02540 -- 508.495.1225 PROJECT NUMBER: 15070 CAD FILE NAME: 15070DT DRAWN BY: L.M. SHEET 2 OF 2