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HomeMy WebLinkAbout0656 MAIN STREET (OST.) - Health 65 5 Maiii Streetnow , Osterville A= 141 -- 039 - 003 I h r a Commonwealth of Massachusetts Executive Office of Enviromnental Affairs Dept. of Environmental Protection ad One.winter Street,Boston,Ma. 02108 Jitic septic ` D.1?.Y. 'Title V Septic inspector Y.O. Box 2119 Teaticket, MA 02536 WILLIAM F.WELD (508)564-6813 Governor ARGEO PAUL CELLUCCI Lt.Governor � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION � �`� --� � Property Address: 656 Main St.Osterville Address of Owner: .lq N 1 Inspection: 8197 (If different) �( TOW 998 Date of Insp 121 Name of Inspector: John Graci Bob Moran:135 Great Rd.Acton M)� SATH�NSiggt£ I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) £Fi Company Name,Address and Telephone Number: t•,y CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of 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: X Passes This Inspection Is based on criteria defined In This V code 310 CMR 16.303.My findings are of how the system is _ Conditionaly sses performing atthe time of the inspection.My Inspection does Needs Fu h Evaluation By the Local Approving Authority not imply any warranty or guarantee of the longevity of the septic system and any of Its components useful life. Fails Inspector's Signature: Date: 1219197 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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 Department of Environmental Protection. 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: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] 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 yes,no, or not determined(Y. N,or ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection, or the septic tank,whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04127)97) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 656 Main St osterville Owner: Bob Moran:135 Great Rd.Acton Ma. Date of Inspection:1218197 — Sew.aQe backup or,hreakout.or high.static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced —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 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 the public health, safety and the environment. \ 1) 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 has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. — The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. — 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 the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must Indicate either"Yes"or"No"as to each of the following: _ 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. Yes No Backup of sewage in facility or system component due to an 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 cesspool. — SAS is in hydraulic failure. rovlsad 04127)97 F r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 656 Main St.osterville Owner: Bob Moran:135 Great Rd.Acton Ma Date of Inspection:1218197 D]SYSTEM FAILS(continued) - Yes No _ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any 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. 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. 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: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply , 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) 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 04117)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 556 Main St Osterville Owner: Bob Moran:135 Great Rd.Acton Ma. Date of Inspection:1218197 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: ,t_ — Pumping information was requested of the owner,occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the 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. x As built plans have been obtained and examined. Note if they are not available with'N/A. x The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. _X_ — The site was inspected for signs of breakout. x All system components, excluding the Soil Absorption System,have been located on the site. x 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. x The size and location of the Soil Absorption System on the site has been determined based on The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is — — unacceptable)[15.302(3)(b)J (revised 04127)97) i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 556 Main St Ostervllle Owner: Bob Moran:135 Great Rd.Acton Ma. Date of Inspection:'12f8197 FLOW CONDITIONS RESIDENTIAL: Design flow: 6w g•p•d./bedroom for S.A.S. Number of bedrooms: 6 Number of current residents: 0 Garbage grinder(yes or no): Yea Laundry connected to system(yes or no): Yes Seasonal use(yes or no): Yea Water meter readings,if available:(last two(2)year usage(gpd): We Sump Pump(yes or no): No Last date of occupancy: nia. COMMERCIAL/INDUSTRIAL: Type of establishment: nla Design flow:0 gallons/day Grease trap present: (yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings,if available: No Last date of occupancy: nra OTHER:(Describe) rda Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System has been malntalned on a 2 year schedule System pumped as part of inspection: (yes or no)No If yes,volume pumped:0 gallons Reason for pumping: nla TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes,attach previous inspection records, if any) I/A Technology etc.Copy of up to date contract? Other: APPROXIMATE AGE of all components,date Installed(if known)and source information: 10 years Sewage odors detected when arriving at the site:(yes or no) No (revlsed 04rt7)97) f . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 656 Main St.Osterville Owner: Bob Moran:135 Great Rd.Acton Ma. Date of Inspection:1218197 SEPTIC TANK: x (locate on site plan) Depth below grade: 3" Material of construction:x concreate metal FRP Polyethylene_other(explain) If tank is metal, list age o . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: L10'6"H6'7"W5'8" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 26" Scum thickness:o Distance from top of scum to top of outlet tee or baffle:S" Distance form bottom of scum to bottom of outlet tee or baffle:0 How dimensions were determined: Measured 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,etc.) septic tank and all components are structurally sound.Recommend pumping system every two years. GREASE TRAP: (locate on site plan) I Depth below grade: rda Material of construction: _concrete_metal_FRp_Polyethylene_other(explain} Dimensions: rda Scum thickness:rda Distance from top of scum 10 top of outlet tee or baffle:rda Distance from bottom of scum to bottom of outlet tee or baffle: rda Date of last pumping;,, 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, etc.) nfa BUILDING SEWER: (Locate on site plan) Depth below grade: 9-- Material of construction:_cast iron x 40 PVC_other(explain) Distance from private water supply well or suction line<own Diameter: 4" Qmments: (conditions of joints,venting,evidence of leakage, etc.) (revised O4117)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 656 Main St Osterville Owner: Bob Moran:135 Great Rd.Acton Ma. Date of Inspection:1219197 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rya Material of construction:_concrete_metal_FRP_Polyethylene—other(explain) Dimensions: nra Capacity: nia gallons Design flow: rva gallonstday Alarm level:_nra Alarm in working order?_Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) nla DISTRIBUTION BOX: x (locate on site plan) Depth of liquid level above outlet invert: Liquid levelwith bottom of pipe. Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.) D4)ox Is structurally Bound. PUMP CHAMBER: (locate on site plan) Pumps in working order.(yes or no)No Alarms in working order(yes or no)_ve: Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) rda (revised 007197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 656 Main St Osterville Owner: Bob Moran:135 Great Rd.Acton Ma. Date'of Inspection:1218197 SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan, if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: rda Type: leaching pits,number: rya leaching chambers, number:411owd1Rusers(2setof2) leaching galleries, number: rya leaching trenches,number,length: rda leaching fields, number,dimensions:rya overflow cesspool, number:Na Alternate system:-rda Name of Technology:_rd Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) The flow difrusers are structurally sound and were empty at the time or the inspection;they have never had more than 4"In them. CESSPOOLS: (locate on site plan) Number and configuration: rya Depth-top of liquid to inlet invert: rya Depth of solids layer: rya Depth of scum layer: rya Dimensions of cesspool: rya Materials of construction: rya Indication of groundwater: rya inflow(cesspool must be pumped as part of inspection) n!a Comments: (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.) nfa PRIVY: (locate on site plan) Materials of construction: We Dimensions: rya Depth of solids: rya Comments:(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.) We (revised 04127)971 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 656 Main St Osterville Bob Moran:135 Great Rd.Acton Ma. 1219197 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) JA lY1U c d AG C Papa ! of 10 (rsvlo*d04f17197) i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 656 Main St.Osterville Bob Moran:135 Great Rd.Acton Ma. 1218197 Depth of groundwater o Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property,observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers x Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS Maps and Charts (rrvlaedG4r27197) Pape 10 o1 10 LOCATION " SEWAGE PERMIT NO. VILLAGE -4NST LL.ER';S„ NAME' i., A DRESS 8 -0 OWN ER s DATE PERMIT ISSUED }°"WAT E COMPLIANCE ISSUED � . i � . �� f -� . � 5� . s �`' �I �' �� i , L/ } _ Ne 1.WM... j r 1 E� •_ . ............ THE COMMONWEALTH OF MASSACHUSETTS ' 03�-0-03 BOARD OF HEALTH rVi ...............OF......... :� az.,E!E�......................... App iration for Uiipaaal Works Tong rnrtinn ramit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal (_, System at: V y� ...ssls...,a....a:ac'c�i L .L....�!�::. ..........•-••-•-•----•---•. 2•..-.....-•....._......----.....------•-----------•--- L cation Address or Lot No. Owner Address W Installer Address U Type of Building // Size Lot_____Z, 2_%.Sq. feet �. Dwelling—No. of Bedrooms.__._____(C ______________________________Expansion Attic ( ) Garbage Grinder (/►rb) Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures --------------••--•---••-•••••-- . •••- W Design Flow................. �l_.__................gallons per person per day. Total daily flow............��� _..................gallons. E r Sept'c Tank—Li uld capacit �'O _gallons Length '6_ _ Width...�_�8" Diameter---------------- Depth._C� $-'� M n.��L�/t(1 r T7iF /J SRC o. ...... Width......4.......... Total Length.......16.......Total leaching area.__ 2...sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (.X) Dosing tank ( ) '-' Percolation Test Results Performed by....... Date_._._. __. �__ � ._.. y-__._. 1 - `�� Test Pit No. ....minutes per inch Depth of Test Pit..........d______- Depth to ground water_-_-_-___I_�.._._.a_ Test Pit No. 2__.i5�;.2___minutes per inch Depth of Test Pit----1Q�B... Depth to ground water.......... � '/V>r���_�o-{��'al_.,�_._olae�7_�°Stl�3�a/�--��/��AB.�::�.�1�P:LJ.vr�-=�-'•`�+'y��----- �,Vd'�OFM�4 x��„De�dl .,tion of _�?¢ 9�^QPI.C,, ��` ��� ��E �!g"Jr� �Aj� -STEP Nss�'G HE U Uature of Repairs o lterations�Answer when'applicabl - � 'i Awn' J� --- �... � r � Agreement fAi,l . iA ��(� ��e '�aMALti The undersigned agreW to install the afo edescr bed In vidual Sewage Disposal System in a�cco the provisions of ii: 5 of the State Sanitar Code d rsigned further agrees not to p systilarit� Operation untilertifi of C s b is d t and of health. /t-J-p:s gned-X---- •-- • _.. .. _ - - -•-• ------------•----•----••-- Da App •cation Approved -••••-� --a:•- -•..... -•••-•--•---•-•-•-•--••-••---•-•----•-•--•-•-------- ---I:2-1.1G--1 Date Alication Disapproved for the following reasons---------------------------------------------------------------•---------------................................. ---•---_.._. Date PermitNo.---.--�_ . ----------------- Issued-....................................................... Date c; Ne -)ALCO... YE K. ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............OF......... c.. App iratiutt for Elispaiia1 Workii Totutruriiutt thrutit . Application is hereby made for a Permit to Construct (x) or Repair ( ) an Individual Sewage Disposal System at: i4✓! s� =....,,....449ff. ....-- i! . ............................'Lb -` ---------•--.......--------.........------. a L�cation-Address or Lot No. ... !�v71.�. .......: c!+'/4r{e/ ......... ,7..�r•- .F. ....... L!!.ac.. _a Owner Address W Installer Address U Type of Building Size Lot......17,y41 7Sq. feet ,.� Dwelling—No. of Bedrooms.........a........................:....Expansion Attic ( ) Garbage Grinder Other—Type of Building No. of persons............................ Showers — a YP g ---------------------------- P ( ) Cafeteria ( ) Otherfixtures ----------•-------------------------------------------------•------------------......._------------------/-�-------------- ........................... WDesign Flow................., ...............gallons per person per day. Total daily flow____-_______IC? _.....__...........gallons. WSept Tank Liquid capacitve—"' 4--�--gailons Length "'�___ Width-__ �,$'.. Diameter---------------- Depth_-.S"�''�. x To.___.._.> .._._... Width------er ......... Total Length.-•_ ..... Total leaching area----4fV ...sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area...._.............sq. ft. Z Other Distribution box (X) Dosing tank ( ) '-' Percolation Test Results Performed by........ ..._�.�,fy4 ............... Date....... e'4%7 Test Pit No. 1._4Z....minutes per inch . Depth of Test Pit______.lwee.._.._ Depth to ground water...._..__`7 IV _ G%4 Test Pit o. 2.--�"Z..minutes p _.per inch Depth of Test Pit__ �------�_.. Depth to ground water R4 r� s�Rl�`t1 OFl6tgs, D Description of Soils STEPHEN - rn ..._.-%1?A.-O- / "_'? AI. r�__r+ ".Glt, '._;�4M' ! ,1 .11 s�----..VILSON y ature of Re airs o Alterations—Answer when a licabl ._ `_ f1Vo.30216 U � . ,�.,,_/ P PP tAlr� - t-�C .. .. GIST t, J� cMa� I./1..... L Agreement. -� �f nr. �n 4�G �CC1 /A Zj�,. . ANAL E The undersigned agr@esJfo install the aforedescribed Individual Sewage Disposal.System in acco e the provisions of TITLE 5 of the State Sanita Code— Ae I ers gned further agrees not to p system 3`PS operation until ertificatt of Co nf-e-has n is ed th oa of health. 1 Date 'J Appl• tion Approved ]may.-9�� --- . . ........_....-•--•----•-•-•-•-•.................. ... e� -------- Date A lieation Disapproved for the following reasons-------------------------------------------------------------................................................. . ............................•----....----•--•------------------------------------•-----------------•--•-------•--------••--------------------------------•-----------------------------•--•-•---••...... r Date .__Permit No. 5_'l.�.G0 •--------•-------•------- Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS .'irjt � BOARD OF HEALTH 4r �pY(2NS7..... .....�:.L�..................... ..........................................OF......................................... .. Curdifiratr of Toutp.liattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by----------------------------------------=-- f +� In t ler has been 'installed in accordance with the provisions of T.ITL j of The State Sanitary Code as described in the application for Disposai Works Construction Permit \'o .-..!- _(L? .......... dated-------12-4/ .----._•__.•_.. THE ISSUANC OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL F PD ION SATISFACTORY. DATE. -------------------------------- Inspector THE r`- COMMONWEALTH OF MASSACH& TS� / BEARD OF HEALTH -`. V 1e t(dh . � -w CE. No......._ FEE........................ i���a��t1 ur�� �utt�firttirru rrutii Permission is hereby granted ' .................-................ to Construct( ) or Repair ( an I idual Sewage,Disposal System at No...........................-----.../.�/J T........ - �a1�•�-��1----- == Street as shown on the application for Disposal Works Construction Permit N :Ili .. Dated....j__2. . . ............ ................C'yam`Q�!ta Bard) Hear-------- DATE. �+g6 -. � . ` FORM 1255 HOBBS & WARREN. INC., PUBLISHERS' ^• i June 03, 1986 -BSL; Mr. Tom McKeon Barnstable Board of Health Town Hall Hyannis, MA 02601 Re: Subsurface Sewage Disposal System Lot 3, Main Street, Osterville Our File #3-1679.00 Dear Tom: This is to inform you that the subsurface sewage disposal system has been installed substantially as per plans prepared by this office for Moran/Souza, `Inc. Dated 11/06/85, revised to 05/13/86 . If there are any questions, please do not hesitate to call me. Very truly yours, BSC/CAPE COD SURVEY CONSULTANTS Stephen A. Haas, E.I.T. cc: Bill Souza Hy-Tech Building Corporation 9 Matawa Drive Assonet, MA 02702 SAH/mg lsah24 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) /SKETCH 56 Main St Osterville ob Moran:135 Great Rd.Acton Ma. 7J8r97 AGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks 11 locate all wells within 100'(Locate where public water supply comes into house) Y i tZ o e1 I Ab AC �6 C Pap• ! o! a0 (revised 04)27197) 41 039 L0. At1.ON 2 SfN1A0E P RUN N0. V I E.L A6'E Uvio r—n s �INST A LL.E*",S,' NAMfd ` Al9RESS 19 1 _*�"ls& 'k I't- I. ' ' . M . - OwN ER .o:d.E z 7- 0 A,T I. PERMIT ISSVEO :y �r `AATE COMPLIANCE ISSUED -i i E D E S I G N LOT 1 ENGINEERING & SURVEYING <v 12'.16 S 7). 7091, 2527„ www.bssdesign.com ry 8 BSS Design, Incorporated ^- 3.71 164 Katharine Lee Bates Rd trj Falmouth Massachusetts 02540 (0 a 508.540.8805 FAX 508.548.8313 �f 16.13 O) V 17,29 z F 0� 5.36 9 ���o�y �' LOT 2 a--- 27 W O U) 16.15 0; EXISTING TURNING EASEMENT SEE PLAN PROPOSED BOOK 450 PAGE 68 — Q W L 0 T 3 ADD17777ON --I- V) 19,501 SF `-{DUBS ® � 16.43 -- ' � � z 9 6,22 16.42 GAVEL 14 / w W U 0 SEPTICCn TANK ® 11, cq'Qgc� 14.9 — / DRIVEWAY O F v) 0 J OF �P�N 1 89 EASEMENT S 03*02'1 0" E ( L (n o o a Z a15,96 152.01 16.43 14.9 PAVED. DRIVEWAY o w PROPOSED (_n uJ FnC :2 LJ'r 1z73 N iCS FND ADDI7777ON � 338.13' 12.92 J PIPE �O N 03*02'10" W m > m-- PROPOSED REMO VE . 5 � � �11 Z W OU7DOOR EX/STING w� 0 �DO� �1 f- STORAGE DECK 0 00 Fo F P U) V0 o F_ O NOTES: - -J 1. - LOCUS IDENTIFICATION: LEGEND HOUSE No. 656 MAIN STREET ASSESSORS No. 141/039/003 PROPERTY LINE scale LOT 3 PLAN BOOK 450 PAGE 68 ce ® CONCRETE BOUND 1"= 30' 2. LOCUS IS WITHIN: date pHW OVERHEAD WIRES ZONING DISTRICT: RC JUNE 20, 2013 FLOOD ZONE: C WIND-BORNE DEBRIS REGION EDGE OF LAWN drawn BUILDING CODE WIND EXPOSURE CATEGORY: B ' AQUIFER PROTECTION OVERLAY DISTRICT • �� �<v (PROPOSED STRUCTURES EJP 3. LOCUS IS I�QI WITHIN: TI�C3 �S INCLUDED IN LOT COVERAGE x 105.03 SPOT ELEVATION ZONE II OF A PUBLIC WATER SUPPLY ^� i� CALCULATION checked ENDANGERED SPECIES HABITAT job number 4. LOT COVERAGE BY STRUCTURES: "`` "�' 'q �? vtl EXISTING 2,924 SF 14.99% (INCL STEPS) m 0 30 60 90 13052 PROPOSED 3,331 SF 17.0890 � - : low 5. ELEVATIONS ARE BASED ON BARNSTABLE GiS MAP title ? (NAVD'88) ADJUSTED TO NGVD'29. (EXISTING STRUCTURES 6. SEPTIC SYSTEM WAS DRAWN AS OUR INTERPRETATION INCLUDED IN LOT COVERAGE OF AS-BUILT SKETCH ON FILE WITH THE BARNSTABLE HEALTH DEPT. CALCULATION) REVISIONS drawing number ADDED FLOOD ZONE LINES TJB 6/26/2013 P21-33A 3 v AS PKEJ® F'TO BE VG FM • Ws C 1 w S, 1"3/4" L 15-4 VT' )0`-9 3/4" C, LU Z R4A'-0" - - Qobove 4 _ W C _ OISfITTX70R _ __ . Cq DUNG AREA 0 r 000 ,````` :- Ed_ 7-3" 3'-5" 6'� g•_B" 7-0..T_4.. R34-0 OOD SCREENWALL AT I•, O W 0 , N'iT3tlOR(X FHc4tY*OCNt r — — — — — — — — — — — — — — — � t- - Ca R' DETALS TO BE VE �RN /—Ra1N1m WOOD R-OM6 Q w DOOR INTO BATHROOMrl 4 , I _i�, VT' 6'-7 V2" DN SWING FWLACE TO RECENE FEW C D o OO - 7 STONE VENEER.VFY SIEM E _ < E)a9THKi�CLOSEf DOOR W/- - O ¢ ' SWING CHANCE INTO BATHROOM - U. \ --,' a 4-- ----- - Q_ BEDROOM#VOFRCF LIVING AREA O \ ® TACK R06M i \\ GARAGE 4_ FEW STEPS 1P OROM o \ )." ENTRY --- Lp - -- --- - p \ a WALL KEY.WAU TO BE MwOXM ravwe oalwcnw® z W W MAIN FLOOR PLAN n- 00 in in J Qa LL J J RED Aq C Ce _\E C \J�O G JO �� Q Q O N o 0 y 0 c0 CV I MA a CO O 2� PGA F9�TH OF N P LLJ LLJ 0 • w A-2 A-1 Q 0 0 C LLJ Vr VT K JN CL Lo � o ----- - -- v a/d 0 S ---- ---- � F as F o p. IF q c 'r" 3'-4 VT L .. XXJJ I O g r+ MASTERIB®ROOM y x o co ¢ LOF/ L -- —1-- —— --- - 5-6" 3-3 V7" 7-0 3-T 34" -O 3-3 V2- 5-e I 5-6" 7-6" WALL 13=Y: wm_uromtw I LJJ C � 3' \ w•ua ro ee aeo�m oals �LV wcnan® z W a. �n SECOND FLOOR PLAN OO In in U ww p cn cn J w w u J J ��RED AqC C C 5 h'i J tis T�C� � M c+� p� Z a_ _ a A 17 MOUTH of Lj 16 2� MA �J O O `c9l?y OF A4 PgS - ._..,. __.-._........-..- ... ....__...____._. -_..-.�..._. ...... ._._.._.".....-. .. _ .._-___ .. _— .. _ ..._ i _ .� - '- E � ... ^Y. .. rP'_. .. a .. .ne. n- r.. .,. . ._. -.0 p.♦'^_T.—..... ..�,...- .. T . -.... .. ....--. ._ ... +„w.._..y ,,... -. ..._r..�.._.—... � Y ,,. . ♦ ., I .r•. .p.. -�i:SSq�p: r • T' ,.. ..i .T. .r,yy. r, a.., .+.. ',5".""°T...a. .. t. X -' .. ...+r - � r ""'4 e ' 3. :k • , '3a 5 REVISIONS: SEPTIC TANK DETAIL: DISTRIBUTION BOX DETAIL: _i SOIL TEST PIT DATA. INDICATES INDICATES �' x / NO DATE _ NOT TO SCALE i I �'5$ pERC, �-- OBSERVED NOT TO SCALE l TEST GROUNDWATER NOTES: I. SEPTIC TANK SHALL BE STEEL 4. INLET AND OUTLET TEES TO BE CAST IRON OR r o NO. OF OUTLETS: ` # TP '''�2 TP REINFORCED CONCRETE. SCHEa 40 PVC. TEES TO BE CENTERED UNDER NOTES GRD. EL. 1 - GRID, EL. GRD. EL. � GRD. EL- _ 2. SEPTIC TANK TO WITHSTAND H-10 LOADING MANHOLE COVER. r__�_�___� PAVEMENT, DRIVES OR I I L DIET. BOX TO WITHSTAND H-10 LOADING UNLESS UNDERE I UNLESS UNDER PAVEMENT, DRIVES OR 3 ,8 `^Olt GW• EL, 9.10 GW, EL, GW. EL. I�• � GW• EL. TRAVELED WAYS,WHEREIN H-20 LOADING � PRECAST I_ TRAVELED WAYS WHEREIN H-20 LOADING z W000z-o L,M SHALL APPLY. DIST. I YVY�ppLDAM rw'�' I I I SHALL APPLY. Sf/B5O/L S(lBSOiL 3. ALL PIPE CONNECTIONS AND CONCRETE MAN O►IT CO FINISH GRADE "� BOX r` 2. PROVIDE INLET TEE OR BAFFLE WHERE SLOPE OF I- CONSTRUCTION TO BE WATERTIGHT. INLET PIPE EXCEEDS O.Oe FT./FT. OR IN 2.4' I I I PUMPED SYSTEM. MEaC?/UrVI WH/FA' L--- J +'�• -�- IIJL.E'� GENERAL NOTES: 12"MIN. '-�--- 3. FIRST TWO FEET OF PIPE OUT OF DIST. Q © ' i" S�VNE? MED/L/M WN/TE ;0 ` COVER BOX TO BE LAID LEVEL. 1 ( 1`' y I. THIS PLAN IS FOR DESIGN AND ... : " © C� `� CONSTRUCTION OF THE SEWAGE ¢8'r /f.E $AND I PLAN VIEW —ws-♦ cw. NORMAL WATER LEVEL REMOVEABLE-� DISPOSAL FACILITY ONLY. of 419 COVER J L„ r L MED1UHI _ A az lD,t'o r - - - - - - - - - - - - - - - - - -1 1. 0 2 MATERIALS ALL RSHALL NCONFORM STONMASS. ii FiF31151-1 �,ZAt�I /p1glK, SLGp TO - t�s,:_. I .:; PROVIDE ►. , ' � . . �:. � '•: :►:.� .: ►.,� _ D.E.O.E. TITLE 5 AND LOCAL BOARD f f �7�j"r�,d�i'- r OF HEALTH REGULATIONS. COARSE •�^r ,¢ ! � I INLET TEE � WATERTIGHT v..-•1�''f � '���=���' �' COARSEI JOINTSItyp) I (' 'I 10, tE'hiiAa, CllVECi QRAN4E I — — I 1. 3. ALL PIPES LOCATED UNDER PAVEMENT PRECAST 1,- 4'-O" MIN. OUTLET y f'1 SEE I. .� SANO .�NOTE 2 I OR TRAVELED WAY SHALL BE P .. 8¢ SANO %I 4 INLET I .,� I 1�.2 SEPTIC I� r, LIOUIO DEPTH TEE F/NE SANG � 1 i — TANK — i J 8 :` I ; �— � �� � � + eiI.. e' » � ,� ..,: .=}l)4J ) 4'°OUTLET `I � // I• � I� „�� SCHEDULE 40 OR EQUAL. �� 4 y� CLAY I I I I _.,,I I Z L� 4. PROPERTY LINES SHOWN WERE MfXEt? DENSE FNt(E 1 I I ___--- J ------ s' PG 49 WATER, SANd> �' (�AY -.. - - - - - - - - - - - - - -- L , . L "► .. -J: mr o ` r/ • t o: , i J. /, COMPILED FROM PL. BK. 371, !�Q•• S6 0:0� BOTTOr ON LEVEL !TABLE BASE O:�Du o o-o oo -_BOTTOM ON h%,4ti ,. ,_ AND DO NOT REPRESENT AN /20 �'� MIXES oy LEV'ELSTABIE b++�----4 ACTUAL SURVEY ON THE GROUND. 8p7Tbw� e3F D/T r WATER 5'4 �'� �Q CROSS-SECTION '�✓ / BASE !PB"' 4.9 PLAN VIEW �r'�� CROSS-SECTION VIEW � ��� ���� �� f'/T I 5. TOPOGRAPHIC SURVEY BY TRANSIT 9 STADIA METHOD. DATE: DATE: DATE: DATE: INS' PERT ELEVATIONS. CONSTRUCTION NOTES; �_!� - �� 71,���� . I. TOWN WATER AVAILABLE FOR 1 � THIS LOT. TEST BY: TEST BY: TEST BY: TEST BY: INVERT AT BUILDING INVERT AT SEPTIC TANK(in) WITNESSED BY: WITNESSED BY: WITNESSED BY: WITNESSED BY: r 1 n �//, J � INVERT AT SEPTIC TANK(out) PERC. RATE: PERC. RATE: PERC. RATE: PERC. RATE: 4 INVERT AT DIST. BOX(in) 77 MINJINCH MIN./INCH MIN./INCH MINJINCH �?> >I 13 /` INVERT AT DIST. BOX(out) INVERT AT LEACH CHAMBER � �' r ,+ ` +, 14 / 13 ,off BOTTOM OF LEACH CHAMBER DATUM. � � .�, •; , �► / 11+ q2 U.S.G.S. MAXIMUM GROUND 15 r i 1 ��� WATER ELEVATION VERTICAL DATUM: /V � V Q. i ,I l r� � r� / 15 �' � f � J6 A,c OBSERVED GROUNDWATER � 2rJ BENCH MARK USED: M28QU EL = /�./l3 `� 1 I F F9 ELEVATION 1 , I10 �J o I �� / � t -Ap ' 20 �i ,�� � 1, ����, �, � \�E, � �. 1�--f TrG�K /.' G .fir-v' - /`� . ;c'. r C�•�. - �� % - /` DESIGN CRITERIA: or DESIGN FLOW: ■r .�.���� ,, Mt BEDROOMS AT/16 G.P.B./D ( v� 100, FRANK WHIT c N _ . TOP OF C 8 V 8ND FND / ____%, l T4��o -, r �. crtl£5 . The BSC Group f' ° LOT r f�IJ s REQUIRED SEPTIC TANK: LEGEND f- �. �. .. , , . = GAL. / `` I9,4 9 9 t S.F. PROFESSIONAL LAND SURVEYOR DA lE 5�� �' - G yam; a SEPTIC TANK PROVIDED: C"Cod Survey Consultants ` \ \ � � / SIZE OF LEACHING FACILITY REQUIRED: EXISTING CONTOUR O ,� A � 3; 4) h _ , + _.,ts ete J /�/Y � '�•' 'r am - ,�,✓ �, RATE: --- -- J �,� '� �,�� � [� �� r � � ; DESIGN PERC. R�1 MINJINCH S p� 3261 Main Street —Idd PROPO ,QED CONTOUR `�, ,c� �.-. '�--�vw �- ,mod :© O , �, /h ' -- ._, _,,,_ r ALLYN Route 6A r ��. I- Barnstable Village A 02630 01 AT ���' 617 362 8133 a5" - ,,- PROJECT TITLE: PROFESSIONAL ENGINEER - C/V/L D TE SIZE OF LEACHING FACILITY PROVIDED: _� f �r 7 ,w; �. f { -• u ' �tr SEWAGE DISPOSAL All� � SYSTEM DESIGN Cf`L i GI.!' 7,� r' �1�v F a Measure depth to water tabu • to nearest 1/10 ft. »..............._................._........_...... ...._......_...... Date �"/ - S �• �' ! /O ' .'} T✓ N month/dav/y"r Using Watet-Level Range zone tK LOCUS PLAN: BARNSTA BL E , M A . and Index Well Map locate > T6) 8 - ' ""` ""' .-- -- N site and de:attrr►ine: SOh. � ; ( 0 S T E R V I L L E Appropriate index well.. (0 _ , �/ r /JoaMu� B Water-level ran zone - . . Q .».......................................__...... "�1 a 9e 1 �C"" " ,- � ... _ ���',��1i�=- �t' .� +f." � seAvu,r saK '-� HILLSIPW V I � � _ `W. - � o�/ -" Fbro�' car• rw r•-� r PREPARED FORS. ' M `i L Using monthly report"Current Water Resources Conditions" , �~ `` r Q�� ' WA J \ } r�NK c MORAN /SOUZA ' determine current depth to / ` ZONE- RC o Osbarvills water level f index well monthrysa SCALE: ! or .......».......... 7 � T r 9 $ �' ! -� ti•0P SETBACKSq' .• ` ' a FEET UsingTable of Water-level Adjustments l C3 `� ry r ' r' \ '�'� 0 � +/' t � ,r G' � �� FRONT 20 for index well(STEP 2A),current depth / V SIDE / O� B�'ocF �` DATE: to water level for index well (STEP 3). and water-level zone (STEP 28) / f REAR / O' �f I I /6/85 tS j / determine water-level adjustment _....................__........_.............................»........_.... �, a �' l.HECKDEJfhIV: �: _...... CHECK: k° 8. M. BAY DRAWN: Estimate depth to high water PLAN VIEW TOP OF C8/DH FND ��� r ,'HEM -� FIELD: R.E.G. L. H. G. O y,�o by subuacting the water- SCALE: 1" = 2 01 > �...,- � R.E.G. / J.V. B. UNDERGROUND UTILITIES WERE COMPILED FROM AVAILABLE EL = /0.80 (N.G.V.D-) : v FILE NO: level adjustment (STEP 4) RECORD PLANS OF UTILITY COMPANIES AND PUBLIC AGENCIES D1NIG NO: 10 3 0 SHEET from measured depth to water � �----- � SCALE =2083 r " level at site (STEP 1) AND ARE APPROXIMATE ONLY. BEFORE DESIGN AND CONSTRUC- ............................................................................................................ ' FEET !0B NO OF TION CALL ' DIG SAFE' 1 - 800 - 322 -4844 . o Io 20 40 60 03-1679-00 I !