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HomeMy WebLinkAbout0218 ICE VALLEY ROAD - Health 2 1.8 ice Malley Road Gsterville A 096 o a t 0 f t 1 O y Q` TOWN PF BARNSTABLE LOCATION 1 O I SEWAGE # xT',.I,AGE OS�CUt�� ASSESSOR'S MAP& LOT '7V_ 0 ,t° INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) G(�I 14 PIJt rA 0--f (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leac ' g facility) Feet Furnished by S L/ _tbn T ro f 6 Ar L o � a 3(o y 3 3(0 ay T F B YTBLE va �. / r IOCATiON / SEWAGE # LAGE ASSESSOR'S MAP.& LOT ITZSTALLER'S NAME&PHONE NO.R'zy 6ev1kCouA. Con, -f EPTIC TANK CAPACITY LEACHING FACILITY: (type) ' So® O (size) J;�•q a c •� NO. OF BEDROOMS Y 7 BUILDER OR OWNER OIL Cq& t204" PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 3. 173 ' q 36 3 . 66 R �- soo NIA D133 t3 zee d P;Pe, r 41'0441e A r�o4 of 6odd in No Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZippYicaction for �Di5po5a[ fppftem Construction Permit Application for a Permit to Construct(1 ) 1 epai`rC( )2Uapgr de O Abandon O ❑ Complete System ❑Individual Components Locat'on Address or Lot No. ( Owner's.Name,Address,and Tel.No. �C�x`h X 1�qu� ��� rot oZg o��e��;►1� �I�- Z3-ISIs Assessor's Map/Parcel C In lle^s N e n I. S�D'�, X09 Designer's Name,Address and Tel.No. Type of Building: 1M C)24�w Dwelling No.of Bedrooms LA Lot Size JQS 072 sq.ft. Garbage Grinder ( ) Other Type of Building Si No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) %.7 gpd Design flow provided S " / gpd Plan Date L 2I IG O� Nu ber of sheets ��,pp Revision Date Title �r-nl eG� � c,,n Ivr 0Ide-e ) Pt,�i4brc, Size of Septic Tank i SOO C�1 r, Y�1Y� Type of S.A.S. 'S ' 02� 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 of t e Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board qf Health. S'gned Date Q� Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. _.( 0 (-� 7 0 � Date Issued �� No. ,. v i =� .; e Fee�� .e THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS YeS J �. ZIpprtcatton for migoza�C *pgtem Con5truettow permit Application for a Permit to Construct( ) ,Repair(.)_ Upgr`de O Abandon O ❑ Complete System Individual Components Location Address or Lot No.` 1 Owner's Name,Address,and Tel.No. 11' %,' Assessor's Map/Parcel In falle�s N� Addand Tel.N .,. �� Da• Designer's Name,Address and Tel.No. �G, �n �►n r,h �ca 9_6y bv�� �J�c )c �c O�6y�1 11SL4 S"W'I N "Type of Building: M 1A on,!�w Dwelling No.of Bedrooms Ll Lot Size .'sq.ft. Garbage Grinder ( ) 'M'l No.of Persons Showers( ) Cafeteria( Other Type of Building Si , ) Other Fixtures [� r Design Flow(min.required) J �� gpd Design flow provided ( S gpd Plan Date �G--a OS << Nu ber of sheets , J Revision Date Title _0, L7� 1 �'� jLn or }d 1.d e-Dox P,v�`cLr, Size of Septic Tank S Z� �i�' n I;Y 1)?rn Type of S.A.S. �J ' 7 y t A ��0'1 �2 • cl X � 3, 5— Description of Soil S r 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 of the Environmental Code.and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health.; ff � S'gned / Date 0 Application Approved by Date C�) 1p Application Disapproved by: Date _ for the following reasons V Permit No. ` Goo "'�"�' 49 Date Issued ------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS s Certificate of Compliance �1 THIS IS TO CERTIF(Y,,that the On-site Sewage Disposal System Constructed ( ) .Repaired (2 Upgraded ( ) Abandoned( )by 17Q J C,(Z v-"\ at cC- 10 G2 has been constred' ccordance AA with the pro v' ions of Ti e 5 and the or Disposal System Construction Permit No.�C>Q(9 dated Installer V`p `J'1 Designer C o'-p—K 1 #bedrooms Approved design flow LI a gpd The issuance of this permit shall not be construed as a guarantee that the system; will func ''o as esigned: Date �- C�"c 3 Inspector n ———————————-———— —— —————— No. D-C�(9 ^ � t Fee Q C� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS '. Migoml *p.5tem Cott!5tructton Permit .- Permission is hereby granted to Construct ( ) Re it (x) rade ( ) Abandon System located at C .1 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisionsaor special conditions. Provided: Construct i must be completed within three years of the date o this pe it. Date Approved by e Town of Barnstable Regulatory Services Thomas F.Geiler,Director ■ARNbTABLE. 3* Public Health Division 4� i6 ,� Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 2/Z3)0(p Designer: r- l� C1 �_ ,E'�2Z1�)(r rVL_ Installer: .. : Address: Address: V �2 2-'Z3 S F -r hi uJI 4 q- On — Q �. was issued a permit to install a (date) (insta lei) septic system at VALLEY 4A based on a design drawn by (address) r c��aiG �C dated 1 Z101CS- _ (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation'of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified-as-built by-designer-to-follow: __ _-----------.--_-_---.-.....-----.__.__...._...__----_. _---.____ JOHN L. �o CHURCHlLL `(Installer's Signature)-- -> JR• CIVIL No. 41 7 00, A65esigner's Signa - - - (Affix esigner' amp Here) EASE RETURN O BARNSTABLE PUBLIC HE TH 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:Health/Septic/Designer Certification Fonn `: 59 Al � l � j f TOWN OF BARNSTABLE LQC;�TION V=t VAII-CI41 Pod SEWAGE #Qq" � VILLAGE ®S u y.f`j ASSESSOR'S MAP & LOTO%-;Cjc� INSTALLER'S NAME & PHONE NO. og4 M,0 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) /-��}�� j; �f �' (si ) NO. OF BEDROOMS-PRIVATE WELL OR PUBLIC WATERpjjg;c., BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 4? VARIANCE GRANTED: Yes No �/ N�a I� v2 V1 , �� 3 Add y � d�S 356 tN i�h SY®y��' FBa..........�..??. .... THE COMMONWEALTH OF MASSAC'-U-S•E-fTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Ditiputittl Warkw Cnumitrttr#iun rrrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: n� / ocation-Address or Lot o. r -------------•------------------------.-...--•-••-- Owner Address W oR fJ a/r ce 1 tr 6( t Installer Address UType of Building Size Lot............................Sq. feet . ►, Dwelling—No. of Bedrooms---------�.---•.-.----.--_--._--_-__--Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------------ --------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow.............................-...•.---.-.---gallons. WSeptic Tank—Liquid capacityinelo-gallons Length---------------- Width.........------. Diameter.--------------_ Depth................ x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No------I............. Diameter.....C."-------- Depth below inlet---19.............. Total leaching area..................sq. ft. 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....------....-....---.. Li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ----------------------------------------------------•---•---------------------•-------•---•----••............................................................ 0 Description of Soil........................................................................................................................................................................ W W --------------- ----------------------------------------------------------------------------------------------------- x U Nature of Repairs or Al�ratio —Answer wthen applicable.---..�A�`�C�-_----.��.5-.-:/�i----------IC]f�. ----------------- = Pb' r -- , -----ice, c�'Fz � ..... 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 Compliance has been issued by the board of health. A Signed ......... ... 0-0/0Q/'�) l�lY+•;�?tam are Application Approved B .,,. ............... .... ................................ ............ ..... -....1..�-. ..... PP PP Y - - ...._.. Dace Application Disapproved for the following reasons- --------------------------------------- ------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------- ........................................ Da" Permit No- ----Yy.......5-.'?`--------------------- Issued .. . . .............................. . ------ Dace r is f r r, Y�/ice o I b� i 0 i v THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Di-ripniittl Works C omitrurtion Vrrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ZIXI......�..............ff -----------------------------------...••... ...........------••------••••......•-•--...-••-••••-••-•.......••-------•---•-••-..........---•-- 1 loration-Address - o•= o. Lot N ••...... ._.._.....----••... ------------•----•----•-•-•--••-----... Owner / Address ••---•-•-•----•----••--•--._...-•---....._. arZ ,vr�Qv� " - 1�=. rw I _ A--- .......................................... / t,S• 11�' '.� U Installer Address UType of Building / Size Lot............................Sq. feet Dwelling—No. of Bedrooms.___-__---------------------------/-----Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No."of persons----------------------------1 Showers ( ) — Cafeteria w - --------------- ---------_:_---------------------------------------- -----. d Design Flow-Other fixtures -- gallons per person per day. Total daily flow W ow--------------------------------------------gallons. WSeptic Tank—Liquid capacitv_lao©.gallons Length---_----------- Width-----.---------- Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. � �Seepage Pit No._____�_____________ Diameter_____.C__._._........ Depth below inlet--- ............. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed bY-------- -------------••------•-•---•---•---•----•----••--------•-••...... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ (%, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ P+ -----------------------------•------....-----•-----•-•-----•------•---....---•---•-••----•-•......•......................................................... 0 Description of Soil...............................................................................................................................--------------------------•••-•-•------- x w x •-•-------------------------•----...--••----------------------------••--......_.._....-•------•------ ----------------------- --------------. U Nature of Repairs or Alterations—Answer when applicable.______-,CA A?::I_......... ...................................................... ------------------ ---------1.62 .�7 - ------ i h S A0_ru `. 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 Compliance has been issued by the board of health. J f Signed ..... i!QA1---..C�^..... ...z" ,p S.................. ._�'/ .1.9t�+.:...... r ...'.� /mac e ---------------------------------------------------------------------- ----------- Due A ------- Application Approved B ��..... ..- PP PP Y U "� Application Disapproved for the following reasonf- ----------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------- ----------------------------------------- ------------------------------------------------------------------------ --------------------------------------- Dare Permit No. ......7.V..-....:57.7.7 ......... Issued .. .................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (Itlerlifi a e of QIontlaItttnre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) Ely �0Rd ------- .rn..�. __C.....------- ---------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ..f.� -------- ........ dated dated .........................................._. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION�SATISFACTORY.r InspectorDATE..._. ---------------------------------------- < � .. .'..... ---------,'r� --,-'----------= t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE FEE_._.q y `� intt1 irk Huairrrti�n Vrrntit Permission is hereby granted......U.cj&- ..................� ^ ii_ _....-------------------------- ................................. to Construct ( ) or Repair ( ) and Individual Sewage Disposal System �� at No.-R -�-.......�C ----•- Il�------ - � ' .. !�lc _ -------- Street / as shown on the application for Disposal Works Construction Permit No.:__t�:_�_.��Dated___��f yJ--�d��_..._---.-..---- - ------------ --------------------- (� V /� I � � Board of Health DATE.-----•--•----- / !- �. ................................. FORM 36508 HOBBS&WARREN.INC..PUBLISHERS G TOWN F BARNSSTABLE p� 0 Ce V�� C SEWAGE # 01OO 'OJ >�?ST10N II•- �,LAGE oS' fvy►��1. ASSESSOR'S MAP LOT /+ STALLER'S NAME&PHONE NO. r� V !' SEPTIC TANK CAPACITYW rr LEACHING FACIL=, : (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMPTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted.Groundwater Table to the Bottom of LeachingFacility .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 rf'Onl P a � 3 s yo �l3 No. -3 7) Fee •- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes ��L PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for Zi!5possar bpztem Construction permit Application for a Permit to Construct( . )Repair(VI Upgrade( )Abandon( ) O Complete System El Individual Components Location Address or Lot No. a 1 m VIA I I'Ll R Owner's Name,Address and Tel.No. Assessor's Map/Parcel 0j (V �.� / Installer's Name,Address,and Tel.No. C Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ( 13 d x (,L p A 1 T Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation u '1 a ertifi- cate of Compliance has been issued by this Board of Health. „7 Signed Sri Date Application Approved by _S Date Application Disapproved for the following reasons Permit No. Date Issued r o u S' --------------------------------------- y' No. DOS' Fee lUo THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ..... Wes f PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pprication for Migpozal *pMein Construction Permit Application for a Permit to Construct( )Repair(4upgrade( )Abandon( ) `El Complete System El Individual Components Location Address or Lot No. a 8 I c.e- V A 11 Cy R Owner's Name,Address and Tel.No. Assessor's Map/Parcel Q�e(V 11 e. -0/�0 � N G 6,A ram^ . r►�(6 Installer's Name;Address,and Tel.No. Designer's Name,Address and Tel.No. Ford — 3t,`I-B���- u 11 ; Gat8o,-% Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. . Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) ., Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) i J t30'X (f'p A t r Date last inspected: ` k 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 bf the Environmental Code and.not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. -7 /Q Signed �'• /�'S d Date f � e Application Approved by �w. f # Dit r �' Application Disapproved for the fo lowing reasons f, y~ Permit No. a u n S'- 3. 3 Date Issued u f THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( �ded( ) Abandoned( )by at 011$ Ice VA1 s'1 R d O STarv,IL,_ has been constructs in a cordance with the provisions of Title 5 and the ffpr Disposal System Construction Permit No. 2 oo S — 3 V 7 dated 712 o/a r Installer Goy6^ (3u P s / JAM rot d Designer The issuance of this permit shall-not be construed as a guarantee that the system will uncttonas�dyesigned. Date_.. ,+ Inspector.'+ �.----�!i•� No. US' 7 J Fee /Uo THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS - MiO ogar stem Con.5truction Permit � p Permission is hereby granted to Construct( )Repair(r parade( )Abandon System located at QL t VAlly- PT OS/1etV111i and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of th ''tl Date: �! zo/u S� Approved by �- i r i 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 Property Address: 218Ice Valley Road Osterville. MA 02655 Owner's Name: Ed Hobart Owner's Address: Date of Inspection: AN 20. 2005 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: (508)862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal systetn 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 Ne Further Evaluation by the Local Approving Authority Fai Inspector's Signature: Date: August 19, 2005 The systein inspector shall sub a copy oft 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 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 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE,DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 2181ce Valley Road Osterville. MA Owner: Ed Hobart Date of Inspection: July 20, 2005 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: 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 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: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 2181ce Valley Road Osterville, MA Owner: Ed Hobart Date of Inspection: July 20, 2605 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance **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 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 2181ce Valley Road Osterville. MA Owner: Ed Hobart Date of Inspection: July 20, 2005 D. System Failure Criteria applicable to all systems: You must indicate either"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 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.] No (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 detennine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design now 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 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. 4 Page 5 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 2181ce Valley Road Osterville. MA Owner: Ed Hobart Date of Inspection: July 20, 2005 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: 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)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 2181ce Valley Road Osterville, MA Owner: Ed Hobart Date of Inspection: July 20, 2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: I Does residence have a garbage grinder(yes or no): n1a Is laundry on a separate sewage system(yes or no): n1a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of infonnation: Unavailable Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from.system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Infiltrators were added in 1994-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM.INFORMATION(continued) Property Address: 2181ce Valley Road Osterville, MA Owner: Ed Hobart Date of Inspection: July 20, 2005' BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron._40 PVC _other(explain): Distance from private water supply well or suction line: Continents (on condition of joints,venting, evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 12" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1500 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc..): Tees were present. The liquid level was even with the outlet invert There did not appear to be any signs of leakage GREASE TRAP: None (locate on site plan) Depth below grade: 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: Comments (on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 218 Ice Valley Road Osterville MA Owner: Ed Hobart Date of Inspection: July 20, 2005 TIGHT or HOLDING TANK: None (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Commments(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.): The D-box was broken down structurall . A new D-box was installed Lfermit No. 2005-343 . PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Commments(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: 2181ce Valley Road Osterville, MA Owner: Ed Hobart Date of Inspection: July 20, 2005 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: I -6'x 6'(1000 gal.) ✓ leaching chambers,number: 4 infiltrators leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Connnents (note condition of soil,signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): The original pit had 3'of liquid on the bottom The infiltrators had 3"of liquid on the bottom There did not appear to be any signs offailure. CESSPOOLS: None (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 or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): PRIVY: None (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.): 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: _ 2181ce Valley Road Osterville MA Owner: Ed Hobart Date of Inspection: July 20, 2005 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. GAGA � �rpnT Q Y 3 3� ay 10 ' Page I 1 of I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 2181ce Valley Road Osterville. MA Owner: Ed Hobart Date of Inspection: July 20, 2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 25'+1- 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: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain:—topographic and water contours traps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps the maps were showing pproxiniately 25'+/ to ground water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied,relating to the system, the inspection and/or this report. 11 CAT10 SEWAGE PERMIT NO• VILLAGE �? I N S T A LLER'S NAME 6 ADDRESS B U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED _ . i �� � -.�. �, °• � � �� � 9 I p�+v a� 6 �/�'7 \ - � ,� .a '��,) ,�- �� /�� �� � No....B.l= Fizs...3 ................. THE C!?MMONWEALTH OF MASSACHUSETTS __. BOARD OF EA OF......... ........ Appliration for Disposal Marks C onstrurtion Vrrmit Application is hereby made for a Permit to Construct ( r Repair ( ) an Individual Sewage Disposal System a : s JL ti Address or Lot No. aaaallll r fh'l" ,C' O r Address a ........."----•-.. . .......o�...� --'-•"----'-'--------------- --..-.��). &law, Installer ,Address UType of Building Si ot... `__----------Sq. feet Dwelling—No. of Bedrooms ................Expansion Attic ��l Garbage Grinder (� `4 Other—Type of Building a g ._.. _ -________ No. of persons._..._.............. Showers ( ) — Cafeteria ( ) P4Other 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 ( ) aPercolation Test Results Performed by--------------------------------------------------------------------- •_.. Date---•-•------------------•----•--•------- ,� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water________.-__.________._. 0� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water____-.__.__--_._..._.___ 0 Description of Soil..................................................................................................................................................................... x W ----------------•-----------...-----------------------•-----•-••-•-----•---•--'------------------------•-•---------••----•------------------'---•---•-••--•--------------..._.......----------•-------. U Nature of Repairs or Alterations—Answer when applicable--------------------------------------------------------------------___________________________. --------•'---•------•---•--•--------------•------'-••---------•-----------------------...._...-••-•'•-----. Agreement: The undersigned agrees to install the aforedescribed .Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu d b t bo h Signed.......... ............ j /�e��tApplication Approved BY '/ ' �� � �� -------------- Date Application Disapproved for the following reasons:.............................................................................................................. Date PermitNo.'••-.................................---................ Issued-----...................................-............. Date THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^ACC DATA 4 No----A-1=. Kim 3.,a................_ THE COMMONWEALTH OF MASSACHUSETTS' -ur E®ARD ®F HEALTH ..� !1 --OF...........`' //...:....:.-l.:��....-/C Appliration for Disposal Works Tl ustrurtiott rrrntit Application is hereby made for a Permit to Construct (,_)or Repair ( ) an Individual Sewage Disposal System.at .J_C Z C/ v<, . / l Location-Address , or Lot No. I' Owner Address Installer Address Q Type of Building Size Lot---- .... ----Sq. feet U Dwelling—No. of ......Bedrooms________.-... ..........................Expansion Attic (_ )� Garbage Grinder p., Other—Type of Building -__,r .'.''?^. .......... No. of persons-------__________________ Showers ( ) — Cafeteria ( ) Q' Other 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 ( ) aPercolation Test Results Performed by.......................................................................... Date---------------------------------------- ,� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water---------------......... tz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water____-_______-_______-_-. a ------•----------•------•---.....-•-•-•----•------------------------------------•--....----•---•---........................................................... 0 Description of Soil.............................................................................................-------------------------------------------------------------------------- x c, W ------•--•-•-------------•--------------------------•---•-•....----•-----------------------•---•-------••----••-------------------••--•--•-•--•-=----•-••---•-••--•--...-----------•. ----------------- UNature of Repairs or Alterations—Answer when applicable.______________________________________________________________________________________________. ----------------------------------------------------------------------------------------------------•-•------••-----------------•-------------•-----•------•-•-••----------------------------•--••------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI 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. f Date Application Approved By.... �j`,�} ______________ j,Ff t-•----. - Lr/ � --•—..................... �� ! Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------•---•-•--------••---•-•----------------------------------------------------•----••-••-•----- Date PermitNo......................................................... Issued..................... .................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........../.. .s✓c 1.. ........OF....... � ,.. ......................................... Trdif irate of Tilutplitutrr THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed �/'j or Repaired ( ) bY------------------- .. ............A.".....-------------------------------•-- ...-•.--------------------------------------------•-------------•-------------....--------------•--- Installer 572 at------------------------ _ .: - ' ....... -----------------------------------------------------•-------:_------------------ has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.&..Z'._d d dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE �� --------------- ------ Inspector..._,,.5 .% ------------------------------- THE COMMONWEALTH OF MASSACHUSETTS ,•r� BOARD OF HEALTH .........................f6G� .....� .w.. +................OF.. �2. VJ ' I �' ..................................... o� N FE_,o................... Bigpagal Morks C��tt fr�tr i�tT frr�ti Permissionis hereby granted---- ---...-- ..b... :o` to Cons or Repair an Individual Sewage Dis osal stem S �� ( ) ( ) g P Y atNo.............................. C ........... •--•--•---�-&--------of��'--------------------------------------------------------------•-------- Street as shown on the application for Disposal Works Construction Permit No...............V... Dated___-___________----•___.__---•-•-----:._:_ .- /J . - jam. ®./ oard of Health DATE................ I f'v------U-------................................... s��- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS OVERLAY DISTRICT: < GP — Groundwater Protection Overlay District - Estuarine Watershed Overlay District _ .o. . RPOD — Resourse Protection Overlay District 0. 0 ZONE: - RF _ 06 Area (min.) 87,120 (RPOD) , er Fronts a (min) 150' Width min) --- Setbacks: N Front 30' `�' • a Side 15' r r Rear 15' X� ` lf -a rQ • . `... .4. - FLOOD ZONE: ► �N \ Zone C r Community Panel No. \ #250000; 018 D LOCATION MAP: July 2, 92 Scale: 1" = 2000'f \ ASSESSORS REF.: �� \ Map 96, Parcel.28��y� '6g�80�FY s8, b \ � � • Foss ox Q, Z LU Q J � i � Z o NA I Poo o PROi Z o Z- ADDITIONS h� zco ZU 48 175 1. PR.OPOS TERRA LLd - — - tx ❑ lsrrnic, ---- �-- ���y, - _ DWELLING 11 APPROX. 'LOCATION I OF EXISTING DRIVE ( 3 hN \ N J \ I L 'TC� EXISTING SEPTIC �Lv vV PER AS BUILT \ \ I I (#2006-049) \ J 41 S. ° � ' O L =300.0p, 1 ptw a+w =3�0 0 OHw �W Ice Valley Road `�w�«� �Qyw \SN OF Mgss9 0 OHN yGd, O'L m o (Im C 0. 6 FGISTE SSION ALE NG�� TIME. PREPARED BY., PREPARED FOR: NOTES., Site Plan 1.) The property line information shown was Proposed Additions Sullivan Engineering,Inc. 65 Scudder Lane, LLC compiled from available record information T po Box 659 218 Ice Valley Road 2.) The dwelling was located from an on At Osterville, MA 02655 the ground survey performed in t70°"26-""(50eN18-%"f- Osterville, MA 02655 September 2011. 218 Ice Valley Road Barnstable, (Osterville) Mass. Draft: — 40 a za '° DATE SCALE: Review: PS September 19, 2011 1" = 40' pro'ct : 27001 t Y._ 3G k+.h 37. z PfKc f ..p Fogy'-NDA,' - N t H +a. -A... v nib,+! N. c> ko wI DC t A� LID 3£s 5 Tc P OF a r♦ r G �1 -7 I t Rovtvc^,�v tOr+ �--� 3 G O j 6R/LV'Q4— 4 ? - c 1. (,A, 3l,L 3 � ^ INV. ` ( tN..� INS. !NV SG'T+C- e �, Doo ,, i � tnV_o •fry GhL a - 4 R A G d r� D >C U L 1 ,5 0 G G+A i.. S E T C_ "T'h N k; /\A I -T H ? ' STca ►.a i= � 0 � All 1 13 !� x 1 , o _ 4 ? '` �, '' ►' " S G A. �. AS WsT t PCt G O L A-C' ►v W o.,T o- '. 1 ' 1 N ►� + ly ^R E 5 pj �+ X `� ' k w �°_.,, R 1_G t STS VtL a ON A P P V_<J i<. M .S,i.- -- C) . 0 f'le , TOP OF FOUNDATION CONTRACTOR SHALL VERIFY SIZE AND FINISH GRADE OVER D-BOX= 37.7'± FINISH GRADE OVER CHAMBERS= 37,50' - 37.83' ELEV= 39.8' CONDITION OF EXISTING SEPTIC TANK @ SLOPE 2% MIN. OVER SYSTEM REMOVABLE COVER RISER TO ° GENERAL NOTES WITHIN 6 OF FINISHED GRADE 4��SCHEDULE 40 PVCMIN SLOPE 1 /° 3/4"TO 1-1/2" DOUBLE WASHED STONE TO CROWN OF PIPE FINISH GRADE @ FND. EL.= VARIES FINISH GRADE OVER TANK EL.= 39.0'± -5"DIA. OUTLET(S) 2"OF 1/8"TO 1/2" DOUBLE WASHED STONE 20" MIN. ACCESS COVER 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION METHODS (TYPICAL FOR 3) TOP OF SAS=34.83' PLACE RISERS ON ALL CHAMBERS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL CODE AND ANY 12" MIN. 12 MIN. TO 6"OF FINISHED GRADE APPLICABLE LOCAL RULES. 36"MAX. 34.00' 36 MAX. BREAKOUT EL =34.50' 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE e DESIGN ENGINEER. mit, 3" 3" 9" - PROVIDE WATERTIGHT 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL - JOINTS(TYP.) SYSTEM UNLESS OTHERWISE NOTED. 4" PVC IN FROM O o00 � O ao 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 14" 37.3'± SEPTIC TANK 4" PVC OUT TO ELEVATION = 34.50' FOR A DISTANCE OF 15 FEET AROUND THE PERIMETER OF THE CA -- LEACHING FACILITY o6 00 o = = = o S.A.S., UNLESS A 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST 5 FEET FROM S.A.S. 12" oo AND THE TOP OF THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. CONTRACTOR SHALL OUTLET TEE 34.57' MIN. 34.40' 2 0 0 0 0 0 0 0 00 0 o0 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. 48 VERIFY CONDITION OF � 0 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. EXISTING TEES 0 CRUSHED STONE o 0 0 0 0 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND REPLACE AS INSTALL NEW OVER MECHANICALLYL o0 0 0 NECESSARY 22"ZABEL FILTER COMPACTED BASE FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS MODEL#A1801-4x22 (GAS 4.0' 8.5' 4 0' 4.0' 4.9' 4.0' NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF BAFFLE ON BOTTOM) 5 OUTLET DISTRIBUTION BOX 33.5' (TYP.) HEALTH AND DESIGN ENGINEER. TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV.- < 10.00' * 8. ELEVATIONS BASED ON APPROXIMATE USGS DATUM OF 40.00'OBTAINED FROM A NAIL EXISTING 1500 GALLON CONCRETE SEPTIC TANK BASE. FIRST TWO FEET OF OUTLET 32.00 12 9� IN A PINE TREE AS SHOWN ON PLAN. PIPES TO BE LAID LEVEL. "Based on U 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION SEPTIC TANK PROFILE CROSS SECTION VIEW 3 - 500 GAL. CHAMBERS 5'MIN.SGS CHAMBER END VIEW THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT NOT TO SCALE FYPICAL CHAMBER PROFILE 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISTRIBUTION BOX DETAIL CHAMBER DETAILS DISCREPANCIES TO THE DESIGN ENGINEER. NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE STRUCTURES SHALL BE MADE WATERTIGHT. NOTE: ENTIRE PROPERTY IS LOCATED a Q TEST PIT DATA 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM WITHIN A D.E.P. APPROVED ZONE II. APPROPRIATE AUTHORITY. MAP 96 LOT 04-06 G AGENT: Donald Desmarais 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS ° 7" • EVALUATOR: Michael Pimentel, E.I.T. LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE THEY SHALL p WITHSTAND H-20 LOADING. �, 0° ,07" DATE: 11/23/05 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. ZO N E 11 TEST PIT#: 1 SWING TIES � ( 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND ELEV TOP = 38.00' UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING MAP 96 DESCRIPTION HC-1 HC-2 Q ° ELEV WATER= 28.00' FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE HC-2 V FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR LOT 28 - CORNER LEACHING (1) 50.4' 68.0' . \ '�' °. PERC RATE _ < 2 MIN/IN 15.255(3). 108,072± ° CORNER LEACHING (2) 68.1' 64.9' `� " 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN 2.48 Ac.± HC-1 0� �` DEPTH OF PERC= 64 -82 SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. CORNER LEACHING (3) 77.8' 77.7' . c+' .. �`� TEXTURAL CLASS: 1 16. PROPOSED PROJECT IS LOCATED WITHIN: ° CORNER LEACHING (4) 62.9' 80.3' Cq ASSESSORS MAP 96 PARCEL 28 i ko r Ire 0 38.00' #218 MAP 96 2) � • _• 'r' Litter � OWNER OF RECORD: JOY JONES HOBART _ LOT 27 - 2" 37.83 ADDRESS: PO BOX 418 o 3) a o r A Loamy Sand OSTERVILLE, MA 02655 (4 CU �1 _. • 8„ 10YR 3/3 37.33' FEMA FLOOD ZONE C AS SHOWN ON COMMUNITY PANEL# 250001 0018 D MAP 96 SWING TIES a` t t ` r • _ • Loamy Sand PLAN REFERENCE: LOT24 fR_613•00- - - _ - - - - SCALE: 1"=40' B 17. `�, .. .,,�.� " f-- 10YR 5/8 1. L.C. PLAN#5725-39 ROAp • ' i 46" 34.1 T 18. DEED REFERENCE: VIP-��EY , ' Coarse Sand 1. L.C.C. #85557 ICE fl r q C 1 2.5Y 6/6 V 10-20% Gravel 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. � -' � �� '� II ( o • ( ' �/ 64" 32.67 20. PROPERTY LINE INFORMATION IS APPROXIMATE, ONLY. THIS PLAN IS TO RF IJ- D ONLY `',;-- Perc FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY PROPERTY LOCUS - -- 82" 31.17' FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. SCALE: 1"=80' - LOCUS PLAN C2 2ed.5Y 6/6Sand \ CB/DH 36- (FND) SCALE: 1"= 1000' 120" 1 28.00' i GARAGE �� � \ DESIGN DATA TEST PIT DATA LEGEND #218 � \ � AGENT: Donald Desmarais EXISTING EVALUATOR: Michael Pimentel, E.I.T. - - 50 - - EXISTING CONTOUR 3-BEDROOM BM DWELLING Nail In Pine Tree \0, j NUMBER OF BEDROOMS (ASSESSORS) 3 DATE: 11/23/05 50 PROPOSED SPOT GRADES TOF =39.8'± x I Elev. =40.00' X� \ X NUMBER OF BEDROOMS (DESIGN) 4 TEST PIT#: 2 50 PROPOSED CONTOUR ` Approx. USGS yX DESIGN FLOW 110 GAUDAY/BEDROOM ELEV TOP= 38.25' EXISTING UNDERGROUND UTILITIES TOTAL DESIGN FLOW 440 GAUDAY APPROXIMATE LOCATION OF ELEV WATER= 28.25' -- - - -- W-- EXISTING WATERLINE VY EXISTING INFILTRATORS TO BE DESIGN FLOW X 200 % = 880 GAUDAY PERC RATE _ <2 MIN/IN ----- GAS EXISTING GAS LINE ABANDONED (SEE ASBUILT ON X USE EXISTING 1500 GALLON SEPTIC TANK _ ' DEPTH OF PERC= 66"-84" -X-X-X-X-X- EXISTING FENCE FILE WITH BOH\ U ) X ,- \ X, TEXTURAL CLASS: 1 TEST PIT LOCATION -9, O - n A, _ I INSTALL 3 - 500 GAL. CHAMBERS -38 I PROPOSED 4 SOLID SCHEDULE 40 PVC PIPE 0 38.25' EXISTING 1500 GALLON <� X O SIDEWALL CAPACITY 13 PROPOSED DISTRIBUTION BOX SEPTIC TANK - v 2� x 2" Litter 38.08' \ q O X \ r� EXISTING GRAVEL DRIVE (LENGTH +WIDTH)(2)(2 HIGH) (.74 GPD/S.F.) = GAUDAY A Loamy Sand U PROPOSED 500 GALLON LEACHING CHAMBER TP 2 O - (33.5'+ 12.9') (2)(2') (0.74 GPD/S.F.)= 137.3 GAUDAY 10YR 3/2 38x� o 10" 37.42' O O rJ EXISTING 1500 GALLON SEPTIC TANK PROPOSED 12.9'x 33.5' RESERVE AREA \ , 16 0' 38 �' 4 M N BOTTOM CAPACITY B Loamy Sand 0 TP 1 _: 10YR 5/8 38x 0 z - -::.x; "; ' ( LENGTH x WIDTH ) (.74 GPD/S.F.) = GAUDAY PROPOSED"D-BOX" s 0 _ 0 _ 1 \ (33.5'x 12.9') (.74 GPD/S.F.) = 319.8 GAUDAY 44' 34.58' - ` �•' ::. .�_;:� -' -•` 3 l Coarse Sand REV. DATE BY APP'D. DESCRIPTION PROPOSED 3-500 GALLON C1 LEACHING CHAMBERS 1 33.5 \ - _- - - 2.5Y 6/6 PROPOSED SITE PLAN I _ - TOTALS: 10-20% Gravel 1 N 66" 32.75' PREPARED FOR: `?' al oo - CB/H Perc OLDE CAPE BUILDERS 3g R_613• J 38� (FND) TOTAL NUMBER OF CHAMBERS: 3 84" 31.25' \ \� L=300 p0 - - - - - - TOTAL LEACHING AREA: 617.7 SQ.FT. cWr \ i __ _ ---- _ - TOTAL LEACHING CAPACITY: 457.1 GAL./DAY LOCATED AT �►� 12 Med. Sand C2 2 5Y 6/6 218 ICE VALLEY ROAD ?,ONO OSTERVILLE, MA 02655 36�- -�"pGE OF pAVEMEN AGE V At�PUg`1Cl 120" 28.25' E (40'W1DE SCALE: 1 INCH = 2�0 FT. 40 DATE: DECEMBER 19�, �005 RESERVED FOR BOARD OF HEALTH USE 5 EET / -� CHO --3 URCHILL � PREPARED BY: t JR. JC ENGINEERING, INC. ' - NIL 34-- c41 ' 2854 CRANBERRY HIGHWAY EAST WAREHAM, MA 02538 �- SITE PLAN ;Y 508.273.0377 SCALE: 1"=20' Drawn By: MCP Designed By: MCP Checked By:JLC JOB No.954