HomeMy WebLinkAbout0933 MAIN STREET (OST.) UNIT #F - Health 933 MAIN STREET, OSTERVILLE
._ _ A= 117181 ,� r CL ,,
- - �No. Z Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: .
Yes `
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
r,
01pplitation for ]Disposal *pstem Construction 3pPrmit
Application for a Permit to Construct( ) Repair X Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 9Y3 33F A4*10 5 f Owner's Name,Address, d Tel.No.
Assessor's Map/Parcel i, 11� s I i G�133�1Rt�A�5-r 0!97M_"� )
IInstaller's Name,Address,and Tel.No. 50 -471 v 9271 Designer's Name;Address,and Tel.No. 662-a73 3-17
9013e-T P� 0 00—Cc-
36-3
f.VEll r S' DU7y
Type of Building:< /liS !/ 4 3314 2� (0) toi 5a
g33C fa
Dwelling No.of Bedrooms Lot Size r) 4,011 sq.ft. Garbage Grinder( )
Other Type of Building E jflil�Cs No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) `ICJ gpd Design flow provided gpd
Plan Date 4-1 q-;w,1 Number of sheets � Revision Date
Title cl3 a R + c 33 `E' kAhQ !9T Q S 76"lLL
Size of Septic Tank Ir000(14 (,T(F) Type of S.A.S. ( ,�j 69(�C�
Description of Soil ICCA"6
Nature of Repairs or Alterations(Answer when applicable) use; G �'r/?j6-y t i 1 w
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction4mainten the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmenplacet� to in oper ion until a Certificate of
Compliance has been issued by this Board of Health.
Sigup _ ..�.� .. Date
Application Approved by Date
Application Disapproved bye f Date
for the following reasons
Permit No,�'� �i `� Date Issued
�+. "r�F 794-y. 'i V: ,� -7t:T 1. ` '�a, r'r s• {��.ti'. �"y r J .. r � -_ - {�
ell
F e No. A071 Z/ / ti 4 Fee
` Entered in computer: C..i
a THE COMMONWEALTH OF,MASSACHUSETTS
PUBLIC HEALTH DIVISION`=TOWN.OF BARNSTABLE, MASSACHUSETTS Yes
ftp
Yicatiorr for cs osar pstein 'Construction Permit �
Application fora Permit.to Construct( ) Repair( Upgrade.O Abandon( ) . ❑Complete„System ElIndividual'Components t
Location Address or Lot No" 93 Owner's Name,Address,and Tel.No. `"
`r. f �.,,�4 CY�t7tlte�eFost �K)
Assessor's Map/Parcel I � liV' 'Z' ocmwv td f.E
Installer s Name,Address,and Tel.No '3' Desi er's Name,Address,and.Tel.No.
' SO�s ? �S`r, t :o$-A 3-d-3'r7
Rv*3e�363 tt 31 0OI-CQ �G. Al >�z NG
Type of B0ding44W,_S' e6ffe �q) 415a
CU 3 G 2
q
)welling iNa.of Bedrooms Lot Size(P) 4!!I( sq.ft. Garbage Grinder
Other Type of Building
g 10f to, No.of Persons Showers(. )'Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided � gpd
Plan Date a+Q�+�) Number of sheets Revision Date
Title �3 a H + 9 �4 RAW! 09 74W�V/�'.c.+�/� f�
Size of Septic Tank �, MnF Type of S.A.S.
�]
Description of Soil G�oA�tS& 5 1,09 /659 nik, owJdt�;:,
to
4 Nature of Repairs or Alterations(Answer when applicable) L.)S E Go* b�L' d�/AJ6 1 .0
�..
Date last inspected: t
`Agreement: , t
• ' . _ - ^+'��.f J �_•��s yam. � ^.' '
The undersigned agrees to ensure the construction and m /,ce of the afore described on site sewage disposalasyslem utraccordance with the provisions of Title 5 of the Environmental eode and .W'placeetthe sy tem in oper tion until'a Certificate of'
t y . Compliance has been issued by this Board of Health. "' C �f/ 0-,
t Sign Date I
Application Approved by . Date 1X 2OZ-•
Application Disapproved by Date I
-for,the following reasons
Permit No.A fi b Date Issued 7�
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS _
Certificate of �Co�#Yiattc>e .
THIS IS TO CERTIFY,that the On-site Sewage Dispossal•system Co t cted.(•- ) Repaired(�) Upgraded( )
Abandoned( )by A bur— r it
-at 49 37ak l (b_ I✓ �tkl�U �T' Ds?_' r' . has been constructed in accordance r
with the provisions of Title Sand the for Disposal System Construction Permit No. dated
Installer . Dabecr N,, ff ouk CCU f ' Designer ITC 6me062� V& .0�
#bedrooms T ` Approved design flow q_4c) gpd
The issuance of this permitshall not be/c�'*nstrued as a guarantee that the system will functil n as'`design d.
Date "1 �I / 0"1 Inspector ,� I /� '
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Misposal 6psteta Construction Permit .
Permission is hereby granted to:Construct(_-) Repair( Upgrade( ) Abandon( )
System located at
and as described in the above Application for Disposal System Construction Permit` The applicant recognized his/her duty to comply with
i} Title 5 and the following local provisions or special conditions.
Provided:^C�o struction must be completed within three years of the date of this permit.
Date �iC'G Approved by
i-
I
Town of Barnstable t
"KE ,.� Regulatory Services
Richard V. Scali,Interim Director
• inRntsrner.e. • . G;:
Public Health Division
ee �s Thomas McKean, Director ;
200 Main Street,Hyannis,MA 02601 %t
Office: 508-862-4644 Fax: 508-790-6304
Installer& Designer Certification Form
Date: 9-15-21 Sewage Permit# ZOZI 'V15' Assessor's Map\Parcel 117/66& 117/181
Designer: JC Engineering, Inc. Installer: Robert B. Our Co.,Inc. (RBO)
Address: 2854 Cranberry Highway Address: 363 Whites Path
East Wareham, MA 02538 South Yarmouth,MA
On -I RBO was issued a permit to install a
(date) (installer)
sgptiL system at 933F&933H Main Street-based on_a_design drawn by
(address)
JC Engineering,Inc. dated 4-19-21 (last revised 6-24-21)
(designer)
X 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
I certify that the system referenced above was constructed i ' fiance with the terms
of the I\A approval letters(if applicable) 6 aF�+gSsgy b
c
Jr JOHtI L a� I
CHILL JR n
(Insta s nat re) CML
.41
(D ner's Signature (Affix.De 1 p Here)
PL SE RETURN TO ARNSTABLE PUBLIC HEALTH D V: SION. 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.
QASeptic\Designer Certification Form Rev 8-14-13.doc
1
Town of Barnstable
Board of Health
BAXNEMAI &
►ems. 200 Main Street, Hyannis MA 02601
asp a,
Office: 508-862-4644 John Norman,Chaimnan
FAX: 508-790-6304 Donald A.Guadagnoli,M.D.
F.P.(Thomas)Lee,P.E.
Daniel Luczkow,M.D.Alt.
March 7, 2022
Mr. Michael Pimental, EIT, CSE
2854 Cranberry Highway
E. Wareham, MA 02538
RE _933H Main''Street & 933E Mairi`:Street;Osterville A - 117=066jand`A117=181 F
Dear Mr. Pimental,
You are granted variances on behalf of your client, Cynthia Foster Trustee, to construct an
onsite sewage disposal system at 933H Main Street & 933F Main Street Osterville. The
variances granted are as follows.
310 CMR 15.211 Setbacks:: To install a soil absorption system two (2) feet away
from a property line, in lieu of the ten_(10) feet minimum separation distance required.
310 CMR 15.211 Setbacks:: To install a soil absorption system 10.6 feet away
from the house foundation at#933F, in lieu of the ten (10) feet minimum separation
distance required.
310 CMR 15.211:: To install a distribution box 3.5 feet below grade, in lieu of the.
maximum three feet of soil cover allowed
310 CMR 15.211:: To install a soil absorption system 4 feet below grade, in lieu of the
maximum three feet of soil cover allowed
These variances were granted with the following condition:
• The engineering plan shall be revised to show a clean-out between the two tanks, at the
outlet.
These variances are granted because the physical constraints at the site severely restrict the
location of the septic system components due to small size the two lots and the existing
dwellings' locations on these lots.
Sin re yours,
ohn Norman, Chairman
Q:\WPFILES\Pimental 933H&FMain Street0sterville SepticVariances June 2021.docx
y /
a THE 1tj DATE: � z
O —
;" ', t $95.00 FEE*:
• BARMABU&
1 39- Town of Barnstable REC.BY:
Board of Health SCHED.DATE: ��
2
� 200 Main atreet, Hyannis MA 02601
Office: 508-862-4644 / 1�✓Y�'-42� -/ U
John T.Norman
FAX: 508-790-6304 Donald A.Guadagnoli,M.D.
Paul J.Cannif,D.M.D.
F.P.(Thomas)Lee,Alternate
VARIANCE REQUEST FORM
LOCATION
Property Address: 933H Main Street(Map/Lot 1 17/66)&933F Main Street,Osterville,MA(Map/Lot 117/1811
y
Assessor's Map and Parcel Number: Map 117,Parcel 66 & Map 117, Parcel 181 Size of Lot 6,568 s.f._& 4.011 s.f._
Wetlands Within 300 Ft. Yes _ Business Name:
No X Subdivision Name:
APPLICANT'S NAME: Cynthia Foster 0 17/66) & Ma /Curley(117/181) Phone
Did the owner of the property authorize you to represent him or her? Yes X No
PROPERTY OWNER'S NAME CONTACT PERSON
Name:_Cynthia Foster,Trustee Name:_Michael Pimentel, EIT,CSE
Add`rss: 933H Main Street,Osterville,MA
Na rr _Mary Curley Address: 2854 Cranberry Highway,E. Wareham, MA 02538
Address: 933F Main Street,Osterville,MA
Phone: Phone: 508-273-0377
EMAIL: Jmpimentell@iceng.org
VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed)
_See attached Appendix A
NATURE OF WORK: House Addition House Renovation Volunteer Upgrade of Septic System X
Checklist (to be completed by office staff-person receiving variance request application)
Please submit first four on list as S collated packets.
Five(5)copies of the completed variance request form
Five(5)copies of engineered plan submitted(e.g.septic system plans)&one electronic version submitted to email:health@town.bamstable.ma.us.
Five(5)copies of MA DEP approval letter for Innovative/Alternative septic system(when proposing an I/A system,only).
Five(5)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans)and one(1)electronic version.
A completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian
Signed letter stating that the property or business owner authorized you to represent him/her for this request
Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for
Title V and/or local sewage regulation variances only).
Full menu—Five(5)copies of full menu submitted(for grease trap variance requests only).
*$95.00 for the following variances: 1.)New construction,2.)Septic repairs with increase in flows,and 3.)New owner/new lessee applying for
food, pool or body art variances. Exemptions from variance fee: 1.) Septic repair without an increase in flow and variances granted at the
counter,2.)Monitoring plans,and 3.)Temporary food(not a"variance").
Variance request submitted at least 15 days prior to meeting date
VARIANCE APPROVED John T.Norman
NOT APPROVED Donald A.Guadagnoli,M.D.
REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D.
[Type here]
.off JC ENGINEERING, Inc.
Civil & Environmental Engineering
0 4 2854 Cranberry Highway
* I East Wareham, Massachusetts 02538
' Ph. 508-273-0377—Fax 508-273-0367
APPENDIX A
Due to the physical constraints of the properties and soil conditions encountered during the
percolation test, the following Local Upgrade Approvals are being requested.
In accordance with 310 CMR 15.401 - 15.405, the following Local Upgrade Approvals are
requested from 310 CMR 15.211 & 15.221(7):
(L) An 8.0' waiver (10.0' - 2.0') for the setback from the SAS to property line.
(2.) A 9.4' waiver (20.0' - 10.6') for the setback from SAS to house foundation at#933F.
(3.) A 0.5 waiver(3.0 - 3.5) for the maximum cover over the H-20 distribution box.
(4.) A 1.0' waiver(3.0' - 4.0') for the maximum cover over the H-20 SAS.
T EXISTING FLOOR PLAN
. 933H MAIN STREET
SCALE: N.T.S.
ALI
tl '
FUTURE FLOOR PLAN
933H MAIN STREET
SCALE: N.T.S•
10
41
EXISTING FLOOR PLAN a _
933F MAIN STREET
SCALE: N.T.S.
S � f
i
h �Q
�.MEI Town of Barnstable PT 21-19
Department of Inspectional Services
B"NSMBM
. Public Health Division
QED 200 Main Street,Hyannis MA 02601
Office: 508-8624644
Date Scheduled 2/26/21 Time 10:00 AM
Soil Suitability Assessment for Sewage Disposal
Performed By: Brian Wallace, EIT, CSE Witnessed By: David W. Stanton (BOH)
LOCATION & GENERAL INFORMATION
Location Address: 933F & 933H Main Street Owner's Name: Mary Curly (933F)
Cynthia oster 3
Osterville, MA 02655 Owner's Address: 933F&933 H Main St., Osterville, MA
Assessor's Map/Parcel: 117/181 (933F) Certified Soil Evaluators Name: Brian Wallace
117/66 (933H)
Certified Soil Evaluators Email: mpimentel@jceng.org
New Construction or Repair: Repair Certified Soil Evaluators Telephone# (508) 273-0377
Land Use Single Family Dwellings Slopes(%) 1-3 Surface Stones NO
Distances from: Open Water Body >100 ft Possible Wet Area >1 00 ft Drinking Water Well N/A ft
Drainage Way >10 ft Property Line >10 ft Other ft
Parent material(geologic) Outwash Depth to Bedrock >156"
n n
Depth to Groundwater: Standing Water in Hole: >1 56 Weeping from Pit Face >
156
Estimated Seasonal High Groundwater >156"
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used: Direct Observation
Depth Observed standing in obs.hole: >156 in. Depth to soil mottles: >156 in.
Depth to weeping from side ofobs.hole: >156 in. Groundwater Adjustment N/A ft.
Index Well#{ Reading Date: Index Well level Adj.factor Adj.Groundwater Level
PERCOLATION TEST Date2/26/21 Time 10:00 AM .
Observation 1
Hole 4 Time at 9"
Depth of Perc Time at 6"
Start Pre-soak Time @ Time(9"-6")
End Pre-soak *Assumed pert rate based on sieve analysis
Rate Min./Inch <2. conducted in C soil on 3-4-21.
Site Suitability Assessment: Site Passed X Site Failed: Additional Testing Needed(Y/N) N
,t Deep Observation Hole Log Hole#: 1 & 2
Depth from Surface Soil Horizon I Soil Texture Soil Color Soil Mottling Other
(in) (USDA) (Munsell) (Structure,Stones,Boulders,
Consistency,%Gravel
0 - 76" Fill
76" - 84" A Loamy Sand 10Yr 3/1
84" - 108" B Loamy Sand 10Yr 4/6
108" - 156" C Coarse Sand 10Yr 5/3
Deep Observation Hole Log Hole#:
Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other
(in) (USDA) (Munsell) (Structure,Stones,Boulders,
Consistent %Gravel
I
Deep Observation Hole Log Hole#:
Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other
(in) (USDA) (Munsell) (Structure,Stones,Boulders,
Consistent %Gravel
Deep Observation Hole Log. Hole#:
Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other
(in) (USDA) (Munsell) (Structure,Stones,Boulders,
Consistent %Gravel
I
Flood Insurance Rate Map:
Above 500 year flood boundary No Yes X
Within 500 year boundary No X Yes
Within 100 year flood boundary No X Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the
soil absorption system? Yes
If not,what is the depth of naturally occurring pervious material? N/A
Certification
I certify that on 10-23-19 (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 310 CMR 15.017.
Signature ow" Date 3-7-21
SKETCH: (Or you can attach a separate sheet)
(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
SEE ATTACHED PROPOSED SEPTIC SYSTEM UPGRADE
DATED APRIL 19, 2021.
''t
BIKE Town of Barnstable PT 21-19
Department of Inspectional Services
• BnaNSTABM • Public Health Division
�63q.
�f0 MAt 200 Main Street,Hyannis MA 02601
Office: 508-862-4644
Date Scheduled 2/26/21 Time 10:00 AM
Soil Suitability Assessment for Sewage Disposal
Performed By: Brian Wallace, EIT, CSE Witnessed By: David W. Stanton (BOH)
LOCATION& GENERAL INFORMATION
Location Address: 933F & 933H Main Street owner's Name: Mary Curly (933F)
Cynthia Foster 3
Osterville, MA 02655 Owner's Address: 933F&933 H Main St., Osterville, MA
Assessor's Map/Parcel: 117/181 (933F) Certified Soil Evaluators Name: Brian Wallace
117/66 (933H)
Certified Soil Evaluators Email: mpimentel@jceng.org
New Construction or Repair: Repair Certified Soil Evaluators Telephone# (508) 273-0377
Land Use Single Family Dwellings slopes(%) 1-3 Surface Stones No
Distances from: Open Water Body >1 00 ft Possible Wet Area >100 ft Drinking Water Well N/A ft
Drainage Way >1 0 ft Property Line >1 0 ft Other ft
Parent material(geologic) OUtWBSh Depth to Bedrock 156n
n n
Depth to Groundwater: Standing Water in Hole: > Weeping from Pit Face > 5
Estimated Seasonal High Groundwater >156"
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used: Direct-Observation , ..a
Depth Observed standing in obs.hole: >156 in. Depth to soil mottles: >156 in.
Depth to weeping from side of obs.hole: >156 in. Groundwater Adjustment N/A ft.
Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level
PERCOLATION TEST Date2/26/21 Time 10:00 AM.
Observation
Hole# 1 Time at 9"
Depth of Perc Time at 6"
Start Pre-soak Time @ Time(9"-6")
End Pre-soak 'Assumed perc rate based on sieve analysis
Rate Min./Inch <2• conducted in C soil on 3-4-21.
Site Suitability Assessment: Site Passed X Site Failed: Additional Testing Needed(Y/N) N
Deep Observation Hole Log Hole#: 1 & 2
Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other
(in) (USDA) (Munsell) (Structure,Stones,Boulders,
Consistency,%Gravel
0 - 76" Fill
76" - 84" A Loamy Sand 10Yr 3/1
84" - 108" B Loamy Sand 10Yr 4/6
108" - 156" C Coarse Sand 10Yr 5/3
Deep Observation Hole Log Hole#:
Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other
(in) (USDA) (Munsell) (Structure,Stones,Boulders,
Consistency,%Gravel
Deep Observation Hole Log Hole#:
Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other
(in) (USDA) (Munsell) (Structure,Stones,Boulders,
Consistency,%Gravel
Deep Observation Hole Log Hole#:
Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other
(in) (USDA) (Munsell) (Structure,Stones,Boulders,
Consistency,%Gravel
r .
Flood Insurance Rate Map:
Above 500 year flood boundary No Yes X
Within 500 year boundary No X Yes
Within 100 year flood boundary No X Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the
soil absorption system? Yes
If not,what is the depth of naturally occurring pervious material? N/A
Certification
I certify that on 10-23-19 (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 310 CMR 15.017.
Date Signature 3-7-21
g
SKETCH: (Or you can attach a separate sheet)
(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes)
SEE ATTACHED PROPOSED SEPTIC SYSTEM UPGRADE
DATED MARCH 7, 2021
. r -
DATE:_1./3.4/96 -
PROPERTY ADDRESS: 8 Gallery Place �33, /nV�rlr
Os.terville ,Mass
02655 ,
4
On the above date, I Inspected the septic system at the above Address.
This system consists of the following:
1 . 2-1000 gallon septic tanks . #7 tied in with # 8
2. 1-Distribution box.
3 . 1 -4' leaching pit packed in 3 ' of stone.
Based bn my Ins.,*ctlon, IE certify the following conditions:
1 . This is a title five septic system. ' ( 78 Code' )
2. #708 share the same system.
. 3 . The-'septic system is in proper working
order at the present time . )
81GNATUR!-- : G`'1
Name: J. P .Macomber Jr•.
)1996
Company: J. P_ ----- - & So--- - . �-Address:_� _6�,-----_�___,__ �/ R�CCentervill.e LMass__0.2.632FEB,T-A TiR6AlOF'BPhone:---50-&_2 _5__3338-----__ '� egau►+t _
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
ffi
num
.pOSEPH P. M�L� A
& SON, INC.
Tanks-C �hflelds
Pumlled
Town ctions
P.O. Box 46• A 02632-0066
775-36412
U commonwealth of Massachusetts
Executive Office of Environmental Affairs
Department of
Environinental .Protection
Wiliam F.Weld
Oowmor •
Trudy Coxe •'
Seveiuy,EOEA
Davco 0..Struhs
SUBSURFACE SEWAGE DISPOSAL'SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: 8 Gallery Place Osterville Address of Owner.. 605 Salter P1aCe ,.
Date of Inspection: 1 /30/96 (If different). Westfield' .New •.Jers.ey
Name of Inspectur. Joseph P. Macomber Jr. 07090
som a Name,Address and Telephone Number:
J.�.�acomber & Son Inc.:` Box 66 Centerville.,Masb .. 02632
508-775-3338
CERTIFICATION STATEMENT
I certify that 1 have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate
and complete as of the time of inspection. The inspection was performed based on.my training and experience in the proper function and
maintenance of on-site
�sewage disposal systems. The system:
,j/ Passes V
_ Conditionally Passes
Needs Further Evaluatiow By the Local Ap roving Authority
Fails
Inspector's Signature. Date:
The System Inspector shall submit a copy of this.inspection report to the Approving Authority within thirty(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 ofthe Department of Environmental Protection. tl
The original should be sent to the system owner and copies sent to the buyer, if applicable and the'approving authority.
INSPECTION SUMMARY:
Check A, B,C,or D:
A) SYSTEM PASSES:
I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below,
81 SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,
passes inspection.
Indicate yo, or not determined (Y, N, or ND): Describe basis of determination in all instances. If"not determined", explain why notf
es n
The septic tank is metal, cracked, structurally unsound, shows substantial Infiltration or exfiltration, or tank failure is
imminent. The system will'pass Inspection if the existing septic tank is replaced with a conforming septic tank as
approved by the Board of Health.
(revised 8/15/95) 1
One Winter Street 9 Boston.Massachusetts 02108 • FAX(617)556-1049 9 Telephone(617)292.5500
�J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 8 Gallery Place Osterville ,Mass .
Owner: Joanne Sprague
Date of Inspection: 1 /3 0/9 6 .
61 SYSTEM CONDITIONALLY PASSES (continued) • ,
�0 Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed
pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the
Board of Health):
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
�b The system required pumping more than four 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
Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
/Ua Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
1, public health, safety and the environment.
1�1 J1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A,MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The system nas a septic tank anu suii absorption systen•,and is within 100 feet to a surface water supply or tributary to a
surface water supply.
The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well.
l� The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water
supply well, unless a well water analysis for colifdrm 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 Tess than 5
ppm.
D) SYSTEM FAILS:
11 M I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis
for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct
the failure.
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
A Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
�J
(revised SAS/M 2
Il '
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 8 Gallery Place Osterville ,Mass .
Owner: Joanne Sprague
Date of Inspections /30/96
D] SYSTEM FAILS (continued):
0
&)0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
t:64� Rr
Liquid depth in caccpoal is less than 6" below invert or available volume is less than 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
A:ry portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
LW Any portion of a cesspool or privy is within a Zone I of.a public well.
&L 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E] LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above:
The design-flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety
and the environment because one or more of the following conditions exist:
Q the system is within 400 feet of a surface drinking water supply
e
the system is within 200 feet of a tributary to a surface drinking water supply
to 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
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 8/15/95) 3
4Ki,
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 8 Gallery Place Ostervylle,Mass.
Owner: Joanne Sprague •
Date of Inspection: 1 /3 0/9 6
Check if the following have been done:
Pumping information was requested of the owner, occupant, and Board of Health.
None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates
during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
_V As built plans have been obtained and examined. Note if they are not available with N/A.
_V_/The facility or dwelling was inspected for signs of sewage back-up.
the system does not receive non-sanitary or industrial waste flow
2The site was inspected for signs of breakout:
ZAII system components,Wuding the Soil Absorption System, have been located on the site.
- The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or
tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
,/The size and location of the Soil Absorption System on the site.has been determined based on exi� g information r
approximated by non-intrusive methods.
,/The facility owne: tand occupants, if different from owner) were provided with.information on the proper maintenance of Sub-
Surface Disposal System.
/'.
(revised B/15/95) 4
U SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 8 Gallery Place 0sterville,Mass .
Owner: Jonne Sprague
Date of Inspection: 1 /3 0/9 6
FEOW CONDITIONS
RESIDENTIAL_: •
Design flow: ns
Number of bedrooms:
Number of current residents:,,
Garbage grinder(yes or no):_&Q
Laundry connected to system(yes or no):�
Seasonal use(yes or no):�j . �� c -40 �
Water meter readings, If available: r 1� per
' L
Last date of occupancy:ddA& A)
COMMERCIAUINDUSTRIAL:
Type of establishment:. 1A'
Design f1ow:,�Qgallons/day
Grease trap present: (yes or no)-Ll+
Industrial Waste Holding Tank present: (yes or no)-W,4-
q-sanitary waste discharged to the�tlg S system: (yes or no)�
�6ter meter readings, if available: y`r
Last date of occupancy:
OTHER: (Describe) u
Last date of occupancy:
GENERAL INFORMATION '•
PUMPING RECADS and source of information: . .
A6 k:6-�9 1 ?)97wzm t4j, AL
System pumped as pan of inspection: (yes or no)
If.yes, volume pumped; gallons
allons
Reason for pumping: NVJ
TYPE O SYSTEM
Septic tank/distribution box/soil absorption system.
VQ Single cesspool
, VQ Overflow cesspool
k16 Privy
Shared system (yes or no) (if yes,attach previous inspection records, if any)
AM Other(explain)
APPWXIMATE AGE of all components, date installed (if known� d Source of information: f [dr
f�,�i�Ga>•1 G�r� r 6o.r.Z.1•C. :;v O�r f� ��/
gage odors detected when arriving at the site: (yes or no)
(revised 8/15/9S) $
IY
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 8 Gallery Place Osterville ,Mass .
Owner: Joanne Sprague
Date of Inspectional /30/96 •
SEPTIC TANK:
(locate on site plan)
Depth below grade:i1r4Gt,
Material of construction: cone ete metal RP other(explain)
— DOD c A3—
Dimensions:
' " ttlah lil1h
Sludge depth: t
Distance from top o:sludge to bottom of outlet tee or baffler
Scum thickness.7TLI�°Li
Distance from top of scum to top of outlet tee or baffIe:.kjLCj
Distance from bottom of scum to bottom of outlet tee or baffle:
Comments:
f—ommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
,rity, evidence of leakage, etc.)
tees are in place ;l1quia level to out] ; s 5i1 tt ; •ThP
tanks are structurally sound ; The sP,=t; c t.an1cst shni ..sue;�;f l.e-ak.a.ge-.
No repairs are heedpd at th;gi- me
GREASE TRAP:
(locate on site plan)
Depth below grade:
Material of construction: oncrete _metal _FRP_other(explain)
Dimensions:
Scum thickness.
Distance from top of scum to top of outlet tee or baffle:_
Distance from botlon, criim v, button' oi outie! we or tame
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth-of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, elc.i
(revised 8/15/95) 6
II '
f
SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 8 Gallery Place Osterville ,Mass .
Owner: Joanne Sprague
Date of Inspection: 1 /3 0/9 6
TIGHT OR HOLDING TANK-JJW i e
(locate on site plan)
Depth below grader
Material of construction: concrete_metal _FRP—other(explain)
Dimensions: AM
Capacity: u gallons
Design flow: allons/day
Alarm level:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX:,
(locate on site plan)
Depth of liquid level above outlet invert: 66_ '
Comments:
(note if level and distribut,ui. i� equal, evidence of solids carryover, evidence of leaks a into or out of box, etc.)
Distribution box is level;Has equal flow; No signs of so i s carr7
over;No signs of leakage in or out of the box. No repairs are
needed at this time ,
PUMP CHAMBER: JbfZ
(locate on site plan)
Pumps in working order.(yes or no)-NA—
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
A244
(revised 8/15/95) 7
SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 8 Gallery Place
Owner: Joanne Sprague
Date of Inspection: 1 /3 0/9 6
SOIL ABSORPTION SYSTEM (SAS):z ;
(locate on site plan, if possible; excavation not required, buemay be approximated by non-intrusive methods)
If not determined to be present, explain:
Type:
leaching pits, number:
leaching chambers, number:
leaching galleries, number:
leaching trenches, number,length:
leaching fields, number, dim sions:-�—
overflow cesspool, number.
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.)NO signs of
Loam sand to medium nsigns
ol pon-ding: Ail Vegetation normal.
CL,,,OOLS:
(locate on site plan)
Number and configuration: AM
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 (cesspool must be pumped as part of inspection)
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
n lP
PRIVY:net
(locate on site plan)
Materials of constru 'on: AA Dimensions:
Depth of solids: NO
Comments: (note condition of soil signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
(revised 8/15/95) B
II •
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 8 Gallery Place Osterville,Mass .
Owner: Joanne Sptague
Date of Inspection: 1 /3 0/9 6
SKETCH OF SEWAGE DISPOSAL SYSTEM: •
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
Centerville Osterville Marstons Mills
Water Company
G p
y �
DEPTH TO GROUNDWATER
Depth to groundwater: 13; jeet
method of determination or approximation:
Struck wa ter _at-la t ' ���' )= --- -
,,-..... -1-ea,c hin - i-t--w- ---t- _of.- s- Fn .-.. ..all around. Installed October 18 1984 Bottom of pit 71 off TEe
water table ,
(revised,8/15/95) 9
r_
•••>•t•.1RT)T-Rt'1'SETT-I�R-..T.'TT�Tt-T'TT.T.T.:•.T:TiTi•J!'Pl"L��{'i1,-i'1'STTt<.��..� ........_. . .. .�.. .,.-. - .1.T.��.CT,"•'LZ}�LTTS"�S
I TOWN OF Barnstable BOARD OF HEALTH
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSIIFCTION FORM - PART D • CERTIFICATION 1
••• ••t�T••. ::T-T.ItS••�T�T�TfI'R:TT1�4.�If.T1":;•f1T.•.•T�:.'TT�JTTF'�RRT TTrS.'RJSTL i'CITt R'TRTTRSTt
• •� � i1TA'1'TT•.�ri.T•T•1r+.
-TYPE OR PRINT CI.EARLY-
PROPERTY INSPECTED
STREET ADDRESS _ R r:aj j Ary place ngter..; i e Ms g
ASSESSORS MAP , BLOCK AN1 PARCEL. #
OWNER' s NAME Joanne Sprague
PART' D CERTIFICATION .r
NAME OF INSPECTOR Joseph P. Macomber Jr. ,
COMPANY NAME J.P.Macomber & Son Inc.
COMPANY ADDRESS Box 66 Centerville ,Mass . 02632
Street Town or City State LIP
COMPANY TELEPHONE ( 1 - FAX ( ) -
.. p77r) 333E 5nR 79n 1578 _
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal, system at
this address and that the information reported is true , accurate, and
complete as of the time of :inspection . The inspection was performed and any
recommendations regarding upgrade , maintenance , 'and repair are consistent
with my training and experience in. the proper function and .maintenance of on-
site sewage disposal systems .
• _ n : �Ittn�,
Check one:
XXXXXXXXSysteoi PASSED
The inspection which I have conducted has not found any information
which indicates that the system fails to adequately protect public
health or the environment as defined in 310 CMR 15 . 303 . Any failure
criteria not evaluated are as stated in the FAILURE CRITERIA section of
this form.
System FAILED*
The inspection which I have conducted has found that th'e ' system fails to
Protect the public )health and the environment in accordance with Title
5 , 3.10 CMR 15 . 303 , and as specifically noted on PART C - FAILURE
CRITERIA of this inspection form ,
Inspector Sign4ceification
A1 Date 1 /31-/96
One copy of th must be provided to the OWNER, the BUYER
( where applicable ) and the DOARD OF HEALTii.
* If the inspection FAILED, the owner or"'operator shall u
pgrade ' the system
within one Year of the date of the inspection, unless allowed or required
otherwise as provided in 310 CMR 15 . 305 ,
{
THE CONMONWEALTH OF MASSACI- USETTS
DEPARTM ENT OF E . ONMENTAL "PROTECTION
BE IT KNOWN THAT
Joseph P. +Macomber, Jr.
-
;Has...satisfied'.the_:Department's qualifications as. required, and-is hereby ,
authorized ,to use the title
CERTIFIED TITLE 5 SYSTEM INSPECTOR
as provided..m" '310 CMR 15.340 and .Section 13 of Chapter 21A of the
General Laws Issued by The Department of Environmental Protection.
- r
June 8.1995
Acting Director of the ' ' ion of Water Pollution Control
z .
#(C133 r ?i.,50FOWNT OF BARNS -ABLE
<
L��A t iON °�te-'T �1�� ` SEWAGE #
VILLAG ASSESSOR'S MAP & LOT -7—
INSTALLER'S NAME&PHONE NO. T P/Mc-`�'ti "-
SEPTIC TANK CAPACITY /0 0 0
LEACHING FACILITY: (type) 44� °L G P' (size) 2 07
NO
. BEDROOM
S
BUILDER OR OWNER !!5®11Q C- V0113'*J I e-- 12�'f6 621 y
PERMTTDATE: G tee-01 5 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and 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
i
ti
G O
S-rTOWN OF BARNSTABLE
LOCATION 6�4 SEWAGE#
VILLAGE Dt°ri'U/��� _ ASSESSOR'S MAP&LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY Q ea
LEACHING FACILITY: (type) //l y1��(size)
NO.OF BEDROOMS 7
BUILDER OR OWNER
PERMITDATE: �" �11.7
COMPLIANCE DATE:
Separation Distance Between the: f
Maximum Adjusted Groundwater Table and 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 ' Feet
Furnished by
,A
r
i
i
i
ma
` LOCAT--I-O` SEWAGE PERMIT NO.
00
VILLAGE
o vs
c
INSTA LLER'S NAME i ADDRESS
B UILDER OR OWNER
DATE PERMIT ISSUED
DATE- COMPLIANCE ISSUED 5��/
Y
al
d
13
'� At
FEB
l THE COMMONWEALTH OF MASSACHUSETTS
� 33 BOAR® OF HEALTH
fA .-----.. <� ........oF......./����osFxa&.............................
7 ��1k6firation for Disposal Works Ton1rnrtion Frrmit
Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System at
.... '........................•-----•------•.. ....--•---------•---------.------..----•-•
..- Location-Address or Lot No.
q�� �/�'A�t �/� can e�r� Address
WW1 V.1 ....L.a.�iTleYlf:8.�"itie--'•• ^...............
Installer Address
dType of BuildingSize Lot...7........................Sq. feet
U Dwelling- //o. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
aOther 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 ( )
a, Percolation Test Results Performed by.......................................................................... Date----------- --......
•------------------
.
Test Pit No. 1................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........................
R+ ---------------f ----•-•• ------------.---
ODescription of Soil------'� -A4. _._... --....1�!f'��1�'�i...................................................................................................
W
VNature of Repairs o nswer whe pli le_. _= � �� __.._
-------
Agreement:
The undersigned agret;s fo install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TI 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been 'suedWbytb rd f healthSign,- ... ... ...... .. . ...WAI .............V.........
Date
ApplicationApproved By.................................. =- .�,�..� ................... . --•--------•------- ...........
Date
Application Disapproved for/the following reasons�•................................................................................................................
...................................................--•------ •---•-•--....•..------.....--•----------------- -----------------------------------------------....._..•.
'j_. Date
1 ` i
PermitNo..................I........................ .:... Issued.......................................................
Date
FEB
Ialo...e,e%`'�:/.l?t!r� vow~:"• x ... .... .............
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
......... ......... ______________
Apphration for Disposal Works Tontrnrtion Famit
Application is hereby made for a Permit to Construct ( ) or Repair (A�' an Individual Sewage Disposal
System at:
q ..
4 Location-Address or Lot No.
#6'l ✓r+.................... ................................................. ... ------............•.............. •-----..........._......._.............._..---
i .Owner f f r n Address
L>a �s} . /�a.E fB 1 �` i at1 v%
a ---------
Installer Address
EType of Building// Size Lot............................Sq. feet
V Dwelling ba•°T1o. of Bedrooms.................................. .Expansion Attic ( ) Garbage Grinder ( )
Other—Type, of Building ............................ No, of persons............................ Showers ( ) — Cafeteria ( )
P4 Other fixtures --------•--•--••----•--•-------- .. • . .
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
04 Septic Tank—Liquid capacity............gallons Length---------------- Width................ Diameter................ Depth................
W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
x
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... 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.........................
Test Pit No. 2.............. _minutes per inch Depth of Test Pit____________________ Depth to ground water-_____..__-_--_-----____
O Description of Soil - ------ '' ?`¢"-
V .....-•------••••-•----------••-------•-------•---------•--•---•-••-------------•--•.._........-•-•--•---------•------------•-••-----•-•----
W ••-•--•-••••-----------------• -----• -----• ---••-•-•-•------- ----------•------ . . - -----••--•••-•--•••-••-.....-••••:....
VNature of Repairs or Alterations when .Answer w pplic eble �r° jf f a ..,
` .n .......r.. ..............y..SiN.•-sy f=�^ 5'�� .�'.'".6 ______ c�. ..b_.�-(.f=•�t4.,; a Av..../' ' ----- ............. _.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 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 b9 rd of,health.
Signed:'= _ ' .' ' " y........... - ... ........ ........ -• ...•---- ..... .
ems,,..•-..•: _ Date
Application Approved BY _.:=== �y----.... ------------------ k Date
D
Application Disapproved for the following reasons-----------------------------------=-------•----......-------------•--•---------•---......_......-••--...---•----
•-----•----------•-•----•...-•--•-•-----------•-------••-----------------••---••-•-...---•--••----------•.__....-•----
Date
PermitNo......................................................... . Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
r .. . 0F........X........�f. +::' ..............
v.1rrtifiratr of tompliatta
.�X
T IS,T( CERTjIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )'
by.. y D............................................................f r . p o� } r
Installer r
at..._:X`. . z ........+e .............6 . r✓ ............................................................... .._......___..._..__.___. __._.__.. ._ .._._.. _._.
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No---- _°�'_ .%.'.. ........ dated________________________________________________
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATES ACTORY.
k
DATE... .. �>.. Inspector..... .......................................................•••--•-------•--.--•--
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH/ ,t
`vy ............... . ............
No..1...................
�i��o�ttltiork� �on��rion ruti�
Permission is hereby granted....,', ..._..' >e,. ,''� : �' ° ,%� -¢-!���.''"`,::
to Construct ( ) or,Repair y� ) n�Individual'Sewg=,e Disposal Syste
at No. :2 .... ..------ -�t-------
.r----
---------- .............. ............. .
Street
as shown on the application for Disposal Works Construction Permit No..................... Dated......................................
:...
............
-=..........................................................................
Board of Health
DATE...............................................................................
FORM 1255 A. M. SULKIN, INC.. BOSTON
T.O.F. EL.= 19.7't (#933H) FINISH GRADE OVER D-BOX= 18.2't FINISH GRADE OVER CHAMBERS= 18.1' - 18.3' PROP. VENT WITH CHARCOAL FILTER TO ABOVE GRADE GENERAL NOTES
PROVIDE EXTENSION RISER SLOPE @ 2%MIN. OVER SYSTEM 3/4"TO 1-1/2" DOUBLE WASHED
19.1 t #933F REMOVABLE WATER-TIGHT COVER OVER STONE TO CROWN OF PIPE
1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION
WITH COVER OVER INLET i� RISER TO WITHIN 6"OF FINISHED GRADE 4"SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS
OUTLET TO WITHIN 6"OF F.G. METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL
FINISH GRADE F5" DIA. OUTLETS) MIN SLOPE 1% BOX TO F.G. (SEE NOTE 21) 2"OF 1/8"TO 1/2'" DOUBLE WASHED I CODE AND ANY APPLICABLE LOCAL RULES.
FNp. EL.= VARIES F.G. OVER TANK EL. = 1$,7'fSTONE OR GEOTEXTILE FILTER FABRIC
2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE
TOP OF SAS= 14.30' PLACE RISERS ON ALL DESIGN ENGINEER.
PROPOSED 4 3.5 MAX. 3. 4 SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL
,----EXISTING 4" SCH. 40 PVC 4 0'MAX• CHAMBERS TO WITHIN
SEWER PIPE SEE NOTE 23 13.30' SEE NOTE 23 1 6"OF FINISHED GRADE
I BREAKOUT EL= 13.80 SYSTEM UNLESS OTHERWISE NOTED.
SEWER PIPE
L=36'± (A) AS SHOWN ON PLAN
66�""" 3" DROP MAX 3„ 9," L=31'±(B) 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN
2 DROP MIN 7�E
MINSLOPE@ t% PROVIDE WATERTIGHT ELEVATION = 13.80 FOR A DISTANCE OF 15 AROUND THE PERIMETER OF THE SAS. UNLESS A
13" 4" PVC IN FROM JOINTS (TYR) o �- 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF
14'" =16 0't* SEPTIC TANK 4" PVC OUT TO 0 0 O 0 0 °° 00O 0 o THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION.
CONTRACTOR TO PROVIDE .� LEACHING FACILITY oo °° 0 5. SLOPE ALL SOLID PIPE AT 1.0%MINIMUM.
SPECIFIED DROP BETWEEN -15,9 t „ „ ooINLET AND OUTLET CONTRACTOR CONTRACTOR SHALL , 12 o0 o° 1 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL.
SHALL VERIFY SIZE 48" VERIFY CONDITION OF \ TLET TEE 13.70 MIN. 13.53' 2 0 0 0 °° ao 0 o� I 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK
AND CONDITION OF EXISTING TEES GAS BAFFLE 6"CRUSHED STONE °o o oo FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS
EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY oo °° o NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH
TANK NECESSARY i COMPACTED BASE
I AND DESIGN ENGINEER.
8.5' TYP
2.0
,
OUTLET DISTRIBUTION BOX 3 -4.83' 3.0 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. BENCHMARK ELEVATION OF 20.00,
TO BE INSTALLED ON A LEVEL STABLE 38.0' (TYP.) ESTABLISHED ON A NAIL SET IN UTILITY POLE AS SHOWN ON PLAN.
BASE. FIRST TWO FEET OF OUTLET 11 .30' GROUND WATER ELEV= < 5.00' 10.83 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION
+. PIPES TO BE LAID LEVEL.
THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT
EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANKS 4 - 500 GALLON CHAMBERS 5' MIN. L;i-i/�MbLk EINU ViLVV 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES
SEPTIC TANK PROFILE 3 CROSS gS,,ECTION VIEW
ELEEVATION PRIOR TO ANY WORK & g I�- O D STRI lJ f ION L�V� ETAI TYPICAL CHAMBER PROFILE H-20 �Hi ", � ..., � TO THE DESIGN ENGINEER.
f�i I-1DETAILS 110. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT.
NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE
_-� - -_- -- 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING
TP ST PIT nATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM
✓' -- "� • > 1 APPROPRIATE AUTHORITY.
• , I PERC NO. Perc-21-19
EXISTING LEACHING . 08 INSPECTOR: David W. Stanton(BOH) 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED
PIT TO BE PUMPED, ". . { .� UNDER MORE THAN 3 FEET OF COVER OR LOCATED UNDER PAVEMENT, DRIVES, OR
\ FILLED wl CLEAN I EVALUATOR: Brian Wallace, EIT, CSE TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING.
SAND & ABANDONED - -- - ` C.S.E. APPROVAL DATE. Oct. 23, 2019
x - `�
' =�, 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES.
' • ` • February� DATE: 26, 2021
l�AP / -I - - � m ' # 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE
PRIVATE WAY \ H• is TEST PIT#: MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY.
16'WIDE LAYOUT) `� 'I'' a'� ' ems, ELEV TOP= 18.30' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY
( ) ,�LJ I�I� I I �
(A.K.A. GALLERY PLACE) ° " :i s+'• E `, FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3).
59.86' N89 43 55 E �8 + t + + + „ ELEV WATER= <5.30
S89°43' 55"W 59•�' ' : • • + ` ! 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN
j j _. .. .• • , s PERC RATE_
- ` 20 F� *•. « •• �• � * , � . ,� �y � SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK.
-- - �- -- '
- 20 t s , • ,• y ' r.• ! '� DEPTH OF PERC=
� � * 4� � ' 16. PROPOSED PROJECT IS LOCATED WITHIN:
C� I t ,' '`� . "• : ASSESSOR'S MAP 117
LOT 66 ASSESSOR'S MAP 117 LOT 181
-. a I , w ,� T k ,-"�, TEXTURAL CLASS- I - - - -
-
t - - - - _ _ w - EpGE PA
OWNER OF RECORD: CYNTHIA FOSTER TR. OWNER OF RECORD: MARY CURLEY
1> - - . `
u .---
> % ��''� AVEMENT m Y '$• / ADDRESS: #933H MAIN STREET ADDRESS: #933F MAIN STREET
_ • • s n
O w i a 8�:•"% • . i� •• ,�, • S T ' 0" 18.30' OSTERVILLE, MA 02651 OSTERVILLE, MA 02655
MAP 117 U l `y J' - l� +�•• �.:• •• .. FEMA FLOOD ZONE X
MAP 117 O / rn ° :} LOT 181 O i ? �- • , COMMUNITY PANEL# 25001CO544J
i� LOT 66 4�3r-�- o o 4 011±S.F. -' •�;ti�
• Fill
> o - •,__v____.0_v__-. } - -- -- , LOCUS17. DEED REFERENCES: 1.) BOOK 33518, PAGE 75(#933H) 2.)BOOK 11576, PAGE 120(#933F)
6,568±S.F. 4 PROPOSED q 3 ¢ \ .q� •
3 CLEAN-OUT TO m EXISTING i,uuu ut,�L,.AA Q \ _ • •i •• r t, •/ "� ! 18. PLAN REFERENCES: 1.) PLAN BOOK 552 PAGE 61 2.) PLAN BOOK 95, PAGE 135
GRADE cO Q fc- i .� •.; •;'C•.•'••� • 'f`r; • 76 11.97
o a I SEPTIC TANK 'B" TO BE \ . - I• �(/ �• 'J/ Loam Sand I
✓` 3 L ,- �; ,!� � ,j1� P � "�h,, • »� A Y 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION.
cn USED IN THIS DESIGN ,. • + �• \�+,• • + �� , • 10Yr 3/1 ,
w a 19 . ,,!. i„ , . yVl .tip •• + 84 11.30 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY
^'- --1 EXISTING LEACHING �, '-�\r' ' " �' ' '
S �' / ,:::� �• �} •.\ •'� • <• • FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY
CATCH BASIN w/ `' � �/ ` 1 '��••r s-' '. ' • Loam Sand
m ii//i f - - ' FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE.
�j OVERFLOW PIPE "= • • ri ; 1' • \•• • ( 10Yr4/6
PORCH ✓ - -- �� �) - • . �, •a •`� . \'
BUSH (TYP} / -19- s _, j+,� • •' �• � •� s `��• • • 108�' 9 30' 21. A 4" PERFORATED SCH. 40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A
#933H D f • %� �. • t1 • --' '• :\. I - DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A
EXISTING 1,000 .� EXISTING �// / "� ��' h �t " Publ IC , o � ;i ' f• • . ; , ' REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS.
GALLON SEPTIC FORMER z ZCY
,, ° I; Landing �f �, I 4 �� • 22. OWNER/APPLICANT/CONTRACTOR SHALL BE RESPONSIBLE TO OBTAIN ANY AND ALL
/ ov, met �_ �_ .. �
TANK "A" TO BE USED 2-BEDROOM �- �` #933F � if % � -' MAP 117
IN THIS DESIGN DWELLING - EXISTING i s u, Coarse Sand REQUIRED PERMITS AND APPROVALS FOR THIS PROJECT.
J 2-BEDROOM %, kr LOT 185 C 10Yr 513 23. IN ACCORDANCE WITH 310 CMR 15.401 -15.405,THE FOLLOWING LOCAL UPGRADE
4 D DWELLING rr9 m LOCUS PLAN
APPROVALS ARE REQUESTED FROM 310 CMR 15.211 815.221(7): ,
MAP 117 / HIM / 1 7 �i \ ' 1 (1.) A 8.0' WAIVER (10.0'-2.0') FOR THE SETBACK FROM THE SAS TO PROPERTY LINE.
qS 8x / SCALE. 1 - 1000 (2.) A 9.4 WAIVER(20.0 - 10.6) FOR THE SETBACK FROM SAS TO HOUSE FOUNDATION (#933F).
LOT 187 �. �� //.' q� 1`56" 5.30' (3.) A 0.5'WAIVER(3.0' -3.5') FOR THE MAXIMUM COVER OVER THE H-20 DISTRIBUTION BOX.
GqS HC-1 D TOF=19.1'± - CHIM % 18x6' ter° EXISTING 4" PLASTIC (4.) A 1.0'WAIVER (3.0'-4.0') FOR THE MAXIMUM COVER OVER THE H-20 SAS.
18x3' DRAINAGE PIPE TO _._ _-_ No Mottling, Standing or Weeping Observed
REMAIN IN PLACE
k;V�` --- - - DESIGN DATA - � LEGEND
TOF=19.7t GAS _ .lam _ }
\ WERE y W o PERC NO. Perc-21-19
18x7 UY �s O/y�W ______ o/H/'W _ 24•T NUMBER OF BEDROOMS (EX.)(#933H) 2 ISEE NOTE 5 ON SITE PLAN) INSPECTOR: David W. Stanton(BOH) 50xO' EXISTING SPOT GRADE
NUMBER OF BEDROOMS(EX.)(#933F) 2
°O `� 2} v�h s w _- �,, �,. EVALUATOR: Brian Wallace, EIT, CSE - - -- 50 -- - - EXISTING CONTOUR
NUMBER OF BEDROOMS EX. TOTAL 4
oM � / / 4�, p C'r'y%w -_- ( )( ) C.S.E. APPROVAL DATE: Oct. 23, 2019
S85°01' • 50 PROPOSED CONTOUR
° %// 18x2' 50 E �. DESIGN FLOW 110 GAUDAY/BEDROOM -�--
DATE: February 26, 2021
c 1 60.35' _ I TOTAL DESIGN FLOW 440 GAUDAY 50 PROPOSED SPOT GRADE
PROP. H-2.0 - 18x5' I PROPOSED TEST PIT#: 2
-�� �. -�' DESIGN FLOW x 200 % = 880 GAUDAY
\� D-BOX f .,, ki o INSPECTION PORT
ELEV TOP= 18.00' GAS EXISTING GAS LINE
ENERAC ` 4 USE EXISTING 1,000 GALLON SEPTIC TANK EACH DWELLING
\ ( } ELEV WATER= < 5.00'
° � G/H/N EXISTING OVERHEAD UTILITIES
# NLn
PERC RATE = See sieve results below
_ INSTALL 4 - 500 GAL. H-20 CHAMBERS W/ STONE W W - EXISTING WATER LINE
% °'- DEPTH OF PERC= N/A
to o -
�7 SIDEWALL CAPACITYii
3) m TEST PIT LOCATION
r 66.20'
RET. WALL ' -
>, . 17 -- � � � � TEXTURAL CLASS:
16 -
_ (LENGTH + WIDTH) (2 SIDES) (2' HIGH) (0.74 GPD/S.F.) = GAUDAY
Benchmark _ i - - - _ - - S85°44'43-E (38.0'+ 10.83') (2 ) (2' ) ( 0.74 GPD/S.F.) =144.5 GAUDAY EXISTING 1,000 GALLON SEPTIC TANK
Nail Set in U.P.#N3 -- - -- - 15- -- - -___ _
Elev. =20.00' "EXISTING SHED TO BE 14 ` , ` -16_ _ _ _ _ _ - BOTTOM CAPACITY 0" 18.00' PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE
Approx. MSL RELOCATED AWAY - - 15_ a
FROM NEW SAS �� (LENGTH x WIDTH) (0.74 GPD/S.F.) = GAUDAY PROPOSED H-20 DISTRIBUTION BOX
PROPOSED 4" - 13, (38.0 x 10.83) (0.74 GPD/S.F.) = 304.5 GAUDAY Fill
SCH 40 PVC VENT MAP 117
� \ � �� Q PROPOSED 500 GALLON H-20 LEACHING CHAMBER
MAP 117 \� � �
TREELINE LOT 42 TOTALS:
LOT 35 PROPOSED FOUR (4) 4 ! 76 Loamy Sand 11.6T 1 6-24-21 MCP JLC BOH comment: Add clean-out between both tanks
REMOVE ALL UNSUITABLE TOTAL NUMBER OF CHAMBERS A 10Yr 3/1 REV. DATE BY APP'D. DESCRIPTION
500-GALLON H-20 LEACHING MATERIAL DOWN TO"C"SOIL&
CHAMBERS w/STONE TOTAL LEACHING AREA 606.8 SQ.FT. 84 11.00
REPLACE w/CLEAN COARSE TOTAL LEACHING CAPACITY 449.0 GAL./DAY PROPOSED SEPTIC SYSTEM UPGRADE
SAND PER 310 CMR 255(3) B Loamy Sand
10Yr 4/6 SN OF M4,r I PREPARED FOR:
NOTES: 108" 9.00,
s° !
JOH L CYNTHIA FOSTER, TR. & MARY CURLEY
1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC SYSTEM o CHUR ILL JR.
__ c� VIL--1, N 48066
COMPONENT. I � LOCATED AT
2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE PROPOSED LEACHING SIEVE ANALYSIS RESULTS D Coarse Sand ,,
FACILITY TO ENSURE CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. REPORT TO ( 10Yr 5/3 933H & 933F MAIN STREET
ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. (Soil sample taken from "C"soil in TP2) OSTERVILLE, MA 02655
SAND 98.6%
3.) PROPERTY IS LOCATED WITHIN THE WELLHEAD PROTECTION OVERLAY DISTRICT, MASS DEP SWING-TIES SILT 1.2% SCALE: 1 INCH = 10 FT. DATE: APRIL 19, 2021
ZONE II AND THE ESTUARINE WATERSHEDS. CLAY 0.2% 156 5.00
0 5 10 20 40 FEET
4.) SWING TIES SHOWN ON THIS PLAN ARE PROVIDED ONLY AS A COURTESY FOR THE INSTALLER. DESCRIPTION HC-1 HC-2 No Mottling, Standing or Weeping Observed tN °F
PER TITLE 5 ALTERNATIVE TO PERCOLATION TESTING GUIDANCE
INSTALLER SHALL VERIFY SWING TIE MEASUREMENTS IN THE FIELD PRIOR TO INSTALLING THE I FOR SYSTEM UPGRADES (EFFECTIVE DATE: MAY 3 2006) UNDER "N ! ,� j PREPARED BY:
CORNER OF STONE(1) 16.5' 38.2' POLICY BRP/DWM/PeP-P00-4: o CHURC JR. JC ENGINEERING, INC.
SYSTEM. CONTRACTOR SHALL NOTIFY ENGINEER IF MEASUREMENTS APPEAR TO BE INCORRECT. � C H
CORNER OF STONE (2) 52.1' 11.4' � No. 1807 2854 CRANBERRY HIGHWAY i
7=I-
5.) EXISTING DWELLING LOCATED AT#933H MAIN STREET WAS FORMERLY A 2 BEDROOM HOME SOIL TYPE: UNCOMPACTED
AND WAS MODIFIED TO 1 BEDROOM IN THE EARLY 2000's. THE EXISTING SEPTIC SYSTEM WAS CORNER OF STONE (3) 55.2' 22.2' ! EFFLUENT LOADING RATE FOR EAST WAREHAM, MA 02538
BASED ON 2 BEDROOMS FOR#933H AND 2 BEDROOMS FOR#933F MAIN STREET(i.e. TOTAL OF 4 SITE PLAN CLASS 1, >85%SAND=0.74 GDP/SF 508.273.0377
BEDROOMS). DWELLING AT#933H WILL BE 2 BEDROOMS AGAIN AFTER ADDITION. CORNER OF STONE (4) 24.7' 42.7' ! ASSUMED PERC RATE <2 mpi
SCALE: 1"= 10' � Drawn By: MCP Designed By:MCP Checked By:JLC JOB No.5556