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HomeMy WebLinkAbout0933 MAIN STREET (OST.) - Health 933 I''ilain Street -�- B & D Osterville ICJ a / Jul 01 2019 16:45 HP Fax page 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ran 933 B Main Street Property Address a X Richard Calaham y Owner Owner's Name information is required for every Osterville MA 02655 6-17-19 N." page, City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. ���\fit\pt1IQI F Nq�q�''' Important:When `���. •.• ��� filling out forms A. Inspector Information 67# R� �� •• �y on the computer, � JAMES use only the tab James D. Sears =a ; :m key to move your Name of Inspector ?v: t y cursor-do not use the return Ca ewide Enterprises •.c+Company Name o; key. 153 Commercial Street �'%u,F, s INSP�G`r````�. rm+lllltt4fl\\U �y Company Address Mashpee MA 02649 Cityrrown State Zip Code ICI 508-477-8877 S1623 Telephone Number License Number r, � B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CM 15.000); 1 have personally Inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® .Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority. 4. ❑ Fails ��►' 6-20-19 pector5 Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 151psp.doc•rev.V261,2015 _ Title 5 Official inspection Form;Subsurface Sewage Dispasai System•Page 1 of 18 Jul 01 2019 16:45 HP Fax page 2 Commonwealth of Massachusetts - , Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments V 933 B Main Street Property Address Richard Calsham Owner Owner's Name information is required for every Osterville MA 02655 6-17-19 page. cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary:Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes:. ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are Indicated below. Comments: The system is a 1500 Gal. Tank D Box and three chambers. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health, will pass. Check the box for"yes","no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank (whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound;not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑` NO (Explain below): I. t5insp.doc rev.V262018 Title 5 Official Inspedion Form Subsurface Sewage Disposal System•Page 2 of 18 Jul 01 2019 16:45 HP Fax page 3 Commonwealth of Massachusetts Title 5 Official Inspection Form Y Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 933 B Main Street Property Address Richard Calaham Owner Owner's Name information is required for every Osterville MA _ 02655 6-17-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): brokenpipe(s)are re laced ❑ Y ❑ N ❑ ND (Explain below): ❑ P ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): n or obstructed i e s . The ❑ The system required pumping more than 4 times a year due to broke p p ( ) system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: Mnsp.doc•rev.W2612018 Title 5 Official Inspection Form:Subsurface Sewage Olsposal System•Page 3 of 18 { r Jul 01 2019 16:45 HP Fax page 4 1 Commonwealth of Massachusetts Paz W Title 5 Official Inspection Form ii Subsurface Sewage Disposal System Form - Not for Voluntary Assessments goRtm 933 B Main Street W-w Properly Address Richard Calaham Owner Owner's Name information is Osterville MA 02655 6-17-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: *'This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and,nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or."No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ondin of effluent to the surface of the round or surface waters ❑ ® g P 9 g due to an overloaded or clogged SAS or cesspool t5insp.doc-rev.7/26/2018 _ Title 5 Official Inspection Forn Subsurface Sewage Disposal System•Page 4 of 18 7 Jul 01 2019 16:45 HP Fax page 5 Commonwealth of Massachusetts Title 5 Official Inspection Form �< Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 933 B Main Street Property Address Richard Calaham Owner Owner's Name information is required for every Osterville MA 02655 6-17-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in MRMM is less than 6"below invert or available volume is less than '/2 day flow rC-Elq G ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® . Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply'or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well, 0 ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and.nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ N The system falls. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems:.To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either'yes".or"no"to each of the following, in addition to the questions in Section CA. Yes No r ❑ ❑ 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 11 of a public water supply well t5insp.doc•rev.7l26f2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Jul 01 2019 16:45 HP Fax page 6 Commonwealth of Massachusetts Title 5 Official Inspection Form ` Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 933 B Main Street Property Address Richard Calaham Owner Owner's Name information is Osterville MA 02655 6-17-19 required for every page. Gty/Town State Tip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat,or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed h s in accordance with 310 CMR 15.304.The system owner under Section CA shall upgrade the stem y Y should contact the appropriate regional office of the Department. 6. You must indicate "yes"or"no" for each of the following for al!inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site Inspected for signs of break out? ® ❑' Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with 0 ® information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] t5in5 p.doc•rev.7126/2018 - Title 5 OfWal Inspection Form Subsurface Sewage Disposal System•Page 6 of 18 Jul 01 2019 16:45 HP Fax page 7 qC1-1\ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 933 B Main Street Properly Address Richard Calaham Owner Owner's Name Information Is required for every Osterville MA 02655 6-17-19 page. City/Town State Zip Code Date of Inspection D. System Information } 1. Residential Flow Conditions: Number of bedrooms(design): 1 Number of bedrooms (actual), 1 DESIGN flow based on 3.10 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Description: 1500 Gal. Tank D Box and three chamber's, . 1 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No 2017-40,000Gais Water meter readings, if available (last 2 years usage (gpd)): 2018-41,000Gal's Detail: Sump pump? ❑ Yes ® No Present Last date of occupancy: Date t5insp.dcc rev.7/282018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page T of 18 Jul 01 2019 16:46 HP Fax page 8 Commonwealth of Massachusetts Tithe 5 Official Inspection Form '- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 933 B Main Street `J Property Address Richard Calaham Owner Owner's Name information is O required for every sterville MA 02655 6-17-19 page, CitylTown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203), Gallons per day(gpd) Basis of design flow(seatslpersonslsq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water.treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancyluse: Date Other.(describe below): 3. Pumping Records: • Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: - gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.712612018 Title 5 Official hispection Fun Subsurface Sewage Disposal System•Page 8 of 18 Jul 01 2019 16:46 HP Fax page 9 Commonwealth of Massachusetts : Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 933 B Main Street Property Address Richard Calaham Owner Owner's Name Information is required for every Osterville MA 02655 6-17-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont,) 4. Type of System: ® Septic tank,distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ InnovativelAlternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I!A system by system operator under contract ❑ Tight tank.Attach a copy of the.DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 2016 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 26" Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH-40 t5insp.doc rev.1r26/2018 Title 5 Ol6cial Inspection Form:Subsurface Sewage Disposal System-Page got 18 Jul 01 2019 16:46 HP Fax page 10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 933 B Main Street Property Address Richard Calaham Owner Owner's Name information is Osterville MA 02655 6-17-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ -Yes ❑ No Dimensions: .1500 Gal. Precast H-10 3rr Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 27" 2" Scum thickness 8" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Asbuilt- Plan -Tape Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, e1c): Tank at working level_Tank at 16"below grade under block platio w/both covers at 3". In and outlet tee's No sign of leakage or over loading Note:Tank to be maint, Pumped afther inspection. t5insp doc•rev.7128=18 Title 5 018dal Inspection Form:Subwr►ace Sewage Disposal SYStam•Page 110 of 18 Jul 01 2019 16:46 HP Fax page 91 Commonwealth of Massachusetts ,o Title 5 Official Inspection Form ib Subsurface Sewage Disposal System Form -Not for Voluntary Assessments k 933 B Main Street Property Address Richard Calaham Owner Owner's Name information is Osterville MA 02655 6-17-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cost,) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle . Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day 15insp.doc•rev.7/20/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal Syslem•Page 11 of 18 Jul 01 2019 16:47 HP Fax page 12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewagep Y Disposal System Form Y I s rm -Not for Voluntary Assessments S s 933 B Main Street Property Address Richard Calaham Owner Owner's Name Information is required for every Osterville MA 02655 6-17-19 page. City/Town State Zip Code Date of Inspection D. System. Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover,any evidence of leakage into or out of box, etc.): D Box is 16'06"-33" below grade wlcover at 1'. Box is clean and solid w/two lines out. No sign of over loading or solid carry over. t5insp.doe•rev.7/2612018 Title 5 Official Inspec5on Form:Subsurface Sewage Disposal System•Pago 12 of 18 Jul 01 2019 16:47 HP Fax page 13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 933 S Main Street Property Address Richard Calaham owner Owner's Name Information is required for every Osterville MA 02655 6-17-19 page. City/Town State Zip Code Date of Inspection D. System Information (cant.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): I If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS)(locate on site plan,excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers- number:, 3 ❑ leaching galleries. number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovativelalternative system Typelname of technology: t5lnsp.doc•rev:7/26/2418 Tine 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Jul 01 2019 16:47 HP Fax page 14 c,off Commonwealth of Massachusetts Title 5 Official Inspection Form i� �6 Subsurface Sewage disposal System Form - Not for Voluntary Assessments q 933 B Main Street Property Address Richard Calaham Owner Owner's Name information is required for every Osterville MA 02655 6-17-19 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): Leaching is three 500 Gal, dry well chambers. Chamber's at 44" below grade w/cover at 10".Wet bottom w/clean like new wall's. 12. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): t Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.): I Lt51lnsp.dre•rev.7126/2018 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Jul 01 2019 16:47 HP Fax page 15 C� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 933 5 Main Street Property Address Richard Calaham Owner Owner's Name Information is Osterville MA 02655 6-17-19 required for every page. City/Town State Zip Code Date of.lnspectlon D. System information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): i . t5insp.doc-rev.712012018 Title 5 Official Vnspecdon Form:Subsurface Sewage Disposal System-Page 15 of 18 Jul 01 2019 16:47 HP Fax page 16 Commonwealth of Massachusetts Gil Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 933 B Main Street Property Address Richard Calaham Owner Owner's Name information is Osterville MA 02655 6-17-19 required for every State Zip Code Date of Inspection page. City/Town D. System Information (coat.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building_ Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately - A - - O t N rf—31 '7 I Ir c - a� - L/ t5insp.doc•rev.712612018 Tills 5 official Inspecdon Form:Subsurface Sewege Disposal System•Page 16 of 18 Jul 01 2019 16:47 HP Fax page 17 Commonwealth of Massachusetts Title 5 Official Inspection Form (/ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y` 933 B Main Street Property Address Richard Calaham Owner Owner's Name information Is required for every Osterville MA 02655 6-17-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam. ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to igh ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 12-14-15 g .Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health- explain: ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high groundwater elevation: T.H.on Design plan 12-14-15 10'no G.W.. Bottom of chambers at 6' below grade. Bottom of chambers at 4'above T.H. Depth Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5lnsp.doc•rev.71ZW2018 Title 5Otficial Inspection Form:Subsurface Sewage Disposal system-Page 17 of 18 Jul 01 2019 16:47 HP Fax page 18 Commonwealth of Massachusetts , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 933 8 Main Street Property Address Richard Calahaim Owner Owner's Name information is Osterville MA 02555 6-17-19 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1,2,3, or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed ® D. System Information: For&TightlHolding Tank—Pumping contract attached For 14:Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included �o170 G. w t5insp.doc•my.7/26/2018 Title 5 Mist Inspection'crrn:Subsurfare Sewage Disposal System•Page 18 of 10 t TOWN OF BARNSTABLE LOCATION eh-,-"3�-re•e' ` SEWAGE# Z0/4 VILLAGE QJ+e.'s' it ASSESSOR'S MAP&PARCEL — �o INSTALLER'S NAME&PHONE NO. /�s�i�i Cz���.'�t �. Sy 9 4,71'0!77 SEPTIC TANK CAPACITY 3 LEACHING FACILITY:(type) 3 L C�6 fC'1��•b1� (size) 14X 7AZ " NO.OF BEDROOMS " I J��t/ P�P�T!'•` (� _ OWNER PERMIT DATE: COMPLIANCE DATE: j h Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility /! Feet Private Water Supply Well and Leaching Facility(If any wells exist o � site or within 200 feet of leaching facility) ' � VP-kl Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching cility) f/f1 Feet FURNISHED BY 2 c � �`rf� YMNo. ©� ( Fee �C✓�THE CO NWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZippliLation for V 08at 6pstem Construction Vennit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) omplete System ❑Individual Components Location Address or Lot No. —rryVu A S I Owner's Name,Address, d Tel.No. Assessor's Map/Parcel 1p o&Tfd ltow; r's Name,Address,and Tel.No. (�'� ?Designer's Name,Address,, C�°a U rt > j GCS F)re5t 0 Type of Building: j i g Dwellin No.of Bedrooms r �� (fLot`Size sq.ft. Garbage Grinder( ) Other Type of Building f�6S f 't C41— No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 2- V gpd Plan Date Number of sheets Revision Dat Title Size of Septic Tank Type of S.A.S. t Description of Soil slot �(ja Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental de and not to pla he system in operation until a Certificate of Compliance has been issued by this Board o Signe DateLUO Application Approved by Date Application Disapproved by Date for the following reasons Permit No. C)-q/(o Date Issued { " ' o. /lf�' 04 Fee VVV - ,r�. st' Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS 'Yes $' PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS r Application for Misposal *pstem Construction Permit Application for a Permit to Construct( ) Repair(14upgrade( ) Abandon( ) omplete System ❑Individual Components Location Address or Lot No. — tIlICA Owner's Name,Address,and Tel.No. !M-� Assessor's Map/Parcel (P 0�,77 V 1 'c III Installer's Name,Address,and Tel.No. � G' L G�7 esigner''s Name,Address,and Tel.No. �7� 3 • �cir eSrlJ 1 e '- Type of Building: Dwelling No.of Bedrooms Lot Size J sq.ft. Garbage Grinder( ) Other Type of Building f�1 S ( W 0 fi No.of Persons Showers( ) Cafeteria( ) Other Fixtures If Design Flow(min.required) b gpd Design flow provided 2- gpd Plan Date Number of sheets Revision Dat i Title Size of Septic Tank Type of S.A.S. Description of Soil �70( La tl Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: 'The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental ode and not to placesthe system in operation until a Certificate of Compliance has been issued by this Board of H a t'h. / Signe Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. CT��� oW Date Issued ------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS �. Certificate of Compliante THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by �1�. X( L10 h G'G I/1 C at 67 3, has been constructed in accordance / f with the provisions of Title 5 and the for Disposal System Construction Permit No7/d —06 dated � /� Installer 2N,S�/ )( ('Q l} Uq t vIG vl el DesignerC�A l v< eefr I1 Gj (I S #bedrooms �—�J s(`c�Sty I(L l/ Approved design flow \ v gpd The issuance oft is ermit shall not be construed as a guarantee that the system will fun h,as design 6 !/ Date � � Inspector (1 L�,J I , -------------------------------------_-------------------------------------------------------------------------------------------------- No. 5; tb & T - _ Feed THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH�DIVISION -BARNSTABLE,MASSACHUSETTS fitsposAl 6pstem Construction Vermit Permission is hereby ranted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at ! e n l�✓i o ST•Poi U 0 e and as described in the above Application for Disposal'System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions., Provided:Construction must be compl teed/within three years of the date of this pe it. Date_ `��/7//� Approved by �r DEEQ REST'RICTI N. 1NHERAS, Richard P. Callahan, Trustee of Osterville Properties Realty.Trust III„ ` P.O. Box 346, Centerville,MA 02632; is the owner of 933B Main Street, Osterville; MA, and being shown as Lot 2 on.a plan entitled "Plan of Land:in Osterville-Barnstable; Mass., Property of Dana M. and Marion'M. Marston;"dated October 5, 1950, Bearse and Kellogg, C.E., duly recorded with the Barnstable County.Registry of Deeds in Plan Book 95, Page 135. WHEREAS; Richard P. Callahan as Trustee of said lot has agreed with the Town of Barnstable, Board of Health, to a restriction as to the number of bedrooms which can be included in any home built on said lot as a pre-condition of obtaining a disposal works ; construction permit in compliance with 310 CMR' 15.,000 State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage. WHEREAS, the Town of Barnstable, Board of Health, as a pre-condition to granting a Disposal Works Construction: Permit for. septic system in compliance with 310 CMR 15.000, State Environmental Code, Title'V. Minimum Requirements for the Subsurface Disposal of Sanitary Sewage is requiring that the agreement forthe restriction on the number of bedrooms in any,house constructed on said lot be put on record with the Barnstable County Registry of Deeds by,recording this document: NOW THEREFORE, Richard P. Callahan does hereby place,the following restriction on his above referenced land in accordance with her agreement with the Town'of Barnstable Board of Health which restriction shall run with the land and be binding upon all successors in title: 1. 933B Main Street, Osterville, MA may have constructed upon it a house containing no more than two (2) bedrooms. Richard P. Callahan agrees that this shall be'a permanent deed restriction affecting the dwelling located at 933B Main Street, Osterville, Wand being shown as Lot 2.on Plan Book 95, Page 135: Page 1 j For title of Richard P. Callahan, Trustee, of Osterville'Properties Realty Trust:Ill, see the following: Deed: Book 18890, Page 222 Executed as a sealed instrument his � 2 day of r Owner's signature i _�_COMt1A_MWEALTH_OF . rI , ss �`qi - Date Z 2016 Then personally appeared the above named :Ecjj M;*�, �'}LL,�� known to me to be the person/s.who executed the following instrument and acknowledged the same to be their free-act and deed, before me. e Notary Public My commission expires. 06 D 3'. l G ; (mate) �40ft&- Notary.Public State of riodda . .Adeie cosimano �+ My Commission EE 204301 off Expites 06103/2016 t GARNSTABLE REGISTRY F DEEDS; John F. Meade, Register Page 2 2 I Ttmn of Barnstable a� Is�ti Richard V.`cati,Interim Direcf r - nSAS6. 4 Patb;<ic Health.T.)Lvisi€;`n :63q. .y0 �oaax+� 'T'homas Wkean,,-Dir-eeto2' t I I nstaller c Tsesianer Cartification i o m {Tate: 11711 to S4�vYage i"umit#; Assessoa's'Map1Pnree9. I _ , Designer: ��n¢clrn�t/�u.�s �r^l ` installer:' Address: t L W.Cs_s��`�e�q��:.✓�J. Address; On ._ IZcan s iccsLSa o„ was issued a pertn'it to ins all a. (&Lle�) (installer) -- sc=laic.� i l;t at `�33_l3 h�rue� S t Q sl y►�I,t tined c,Tt a do.sign draw n by �ea-v Mc ewA-2k: dated t 15j� to I certify that the septic system referenced £i.bove was installed substantially accerdin- to the iesign, which rra.},'ill.Ckide minor appro-ved changes such its lateetl r6ocahol; Of the, distribution box.and or spat tank. Strip out (if i quiree-) tnspecAed and the soils; were.fottnd satisfactory. _—_ I cei�ti'fy,that lice sell is system zefere cea abo�r.was installefi witit;tn tjor changes i,i:u. =teaiter than 10 la terat relocation o1'the SAS_ l nny-ve rtical retcscatlp1 U{an}r oTrsponcjri Of the,septic system) bUt i'ra U—COTclV1rice iVi i State&L boll Regi:?ations., .k'la.n I=e.V tiicn c r certified as-F)aiIt .- designer t<t1,611ovv. Sitip out(ifrequiced) ,-iis i+lspected,anj fbe soil wei•ra found sall:isfaZ toyv. :l c-crd, that the system above )Fva!"conswacteil in (ornJliah-c.e vvil�7'tt7r, Ct'.C7P<� li of the hA al.prr letters(if appticabie), 'I PETER T r� 1 McCN kt nstatter s S:ignatu e) t' No. 05 Q� (DPSt T17�Y t SirrliatZirC s, } (Affix l7e,sl 'see }tI s i > PLEASE RETURN TO B sRNST'ABL E PUBLIC llIE„- LTH >13IV1810N. CERTIFICATE OF COMPLIANCE WILL N430 R4: I!w4I1fiI) IJN3'6I 93Q9TT5 F3tt`ti T4 I214I ANTI) .,A. BUILT CARD ARE RECEiVE;[} Y'7`HI BA 14'w'!'4AL,i't)ALICHEALTHT)fy����a�: THANK YOU. (3::Se��4 DiyiLt.icr t eniRcad.in T'Gr•nrR �ti €A-f;?.�ii`ri. t I Barnstable �t►+E tom, Town of Barnstable Cash MA�M Board of Health 039. �� Ar fo�A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,MR FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi February 22, 2016 Mr. Peter McEntee, P.E. 12 West Crossfield Road Forestdale, MA 02644 RE: 933, Unit B, Main Street,,Osterville A =117-186 Dear Mr. McEntee, You are granted variances, on behalf of your. client, Richard Callahan, to construct an onsite sewage disposal system at 933B Main Street, Osterville. The variances granted are as follows: 310 CMR 15.405: To install a septic tank six (6) feet away from the property line, in lieu of the ten feet minimum setback required. 310 CMR 15.405: To construct a soil absorption system five (5) feet away from a crawl space-type foundation, in lieu of the twenty feet minimum setback required. 310 CMR 15.405: To install a septic tank four (4) feet away from the crawl space in lieu of the ten feet minimum setback required. 310 CMR 15.405: To install a septic tank and construct a soil absorption system less than ten feet from the water service, in lieu of the ten feet minimum setback required. The variances are granted with the following conditions: (1) No more than two (2) bedrooms maximum are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. (2) The applicant shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds restricting the property to two (2) bedrooms maximum. A copy of the Q:\WPFILES\McEnteeCallahan 933-B MainStOst F62016.doc f recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction permit. (3) The septic s _ din strict accordance with the engineered plans date January 15, 2016. (4) The designin engineer shall supervise the construction of the.onsite sewage disposal system and shall certify in writing to the Board of Health that the s .m � aHed-M-sutr tial compliance with the submitted plans date �ua 15, 2016. This variance is granted because physical constraints at the site severely restrict the location of a soil absorption system due to the small size of the lot. The proposed system appears to be designed to meet the maximum feasible compliance standards contained within the State Environmental Code, Title V. Sincerely yours, Wayne Miller, M.D. Chairman QAWPFILESNcEnteeCallahan 933-B MainStOst F62016.doc TOWN OF BARNSTABLE LOCATION 3 �f'j)�,; �-f r � SEWAGE# VILLAGE c2Sfe�-�� 11 Q ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. �? aVA [` SEPTIC TANK CAPACITY l Do LEACHING FACILITY:(type) -!'c7;b (size) K/Z• X 2 NO.OF BEDROOMS �- d-eery N -Ir`.e�e OWNER ��2e �Letiro S / PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet `* Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) �w✓�L✓�'� Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 306 feet of leaching facility) Feet FURNISHED BY r A46 i fvn 7 -Za 6 y /9`9 4 4 �1 Eli 6 ' ': ' No. I '� v •p �(/� �/ �I Z 2 ` ��� ( Fee ()U/ THE K70MMONWEALTH OF MASSA HUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftpliLatlon for Misposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(grade( ) Abandon( ) L5eomplete System ❑Individual Components Location Address or Lot No. q38 b 01a I Owner's Name,Address,and Tel.No. <a v ,e ' L� i �� // Assessor's Map/Parcel 7 G2S'Tt/I/ g e- K eiirro5 Installer's Name,Address,and Tel.No. as h/�p� O Designer's Name,Address,and Tel.No.�ir�'f' Z0_ &� F ''n ��� " ZAo w K oar Iro &r ks Type of Building: hh )k. � ( ' /�Dwelling No.of Bedrooms o'er-- Lot Size `Z C� sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date 2- Title Size of Septic Tank / �(�d Type of S.A.S. Description of Soil - -, I Nature of Repairs or Alterations(Answer when applicable) -l� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environment ode and no o place the system in operation until a Certificate of Compliance has been issued by this Board o Ith. Sign Date '�'�/ Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 2 U Date Issued . Y-�� Fee PQ / THE/dOMMONWEALTH OF MASSA HUSETTS Entered in computer: ' PUBLIC HEALTH DIVISION - TOWN O BARNSTABLE, MASSACHUSETTS Yes F' f 21ppliLation for Disposal *pBtem Construction jhrmit t Application for a Permit to Construct( ) Repair(grade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. G13 (YI Gf SP N Add Owner's Name,Address,and Tel.N o. ,3f�t 1) 2 �G tM E o5`e Assessor's Map/Parcel 117— 9s T eiiTy-o5 Installer's Name,Address,and Tel.No. ,2S h/),p j'{�,t Designer's Name,Address,and Tel.No.Fpres* 4110 f 'n �nc ks Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Y Design Flow(min.required) gpd Design flow provided gpd Plan Date ) ���� Number of sheets Revision Date 2- Title Size of Septic Tank / �0 Type of S.A.S. Ti L r i Description of Soil a Nature of Repairs or Alterations(Answer when applicable) ' d�? � A Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environment %Code and no.to place the system in operation until a Certificate of` Compliance has been issued by this Board o 'falth. / Signed Date Application Approved by V y. Date Application Disapproved by Date for the following reasons t. Permit No. 2 0 4 ' U O Date Issued ---------------------------------z-------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) UpgradedEx ( ) Abandoned( )by C�11����" G IJ ► 4 -7kic at �/, � t r C21 4 5j t &5 t C Q has been constructed in accordance T / with the provisions of Title 5 and the for Disposal System Construction Permit No., 0I/b -G 70 dated Installer V1 ('01 U0 t n IJ1 G' Designer viG 1 P�► �OV K S #bedrooms cP— — dud r-?,4r L d' Approved design fl(dw �2 3 G gpd The issuance of this pe it shall not be construed as a guarantee that the system will cti,n as desig ed. Date Inspector �1/ -----------------------------------------------------------------------------------------------------------------------------7--------- No. O/b ` (�76 Fee d THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS 33isposal 6pstrm Construction 3pPrmit Permission is hereby granted to Construct( ) \ Repair( ) Upgrade( ) f Abandon( ) System located at 4�1 33 !►1 (N1� S� ®S tzoor V _- and as described in the above App ication for Dispos 1 Y-stem Construction Permit.'14he a plicant recognized his/her duty to comply with Title 5 and the following local provisions-or special conditions. Provided:Constructio must be completed within three years of the date of this permit. (� Date 3 �y/�(o Approved by Tawal'of Barnstable Re "ervices Richaas ct V.Scali,.Interim Director �1+13ARNR}ls.NA IM Public 13'ealth'Division �,� tCtitrerlas 1Vic C.eaae, Director 200 Main Street,,Hyannk,MA 426'01 Office: ;0S K6'2-4614 I tnistaller&Designer Certification Form. Date- �I `t 6 Sewage 1'erin", 20(�— Asses©s' 'tiaplat cet 11 Dcshyaer: .-^fit. CP-3.._......^ L(ls1D.44 (°�tti_. lxistalicr � Cc.vC_l Address: I Z. W-C/8s1 k"tla rw r4(Wress / ►�`S c4✓ate' On "j was l5slteci,c perm it.to;itsttall ,. — (date) — (installer} S-� 5 � ' septic system at �33 p �4��- �. based on;;tEr; ip dt W n (dei_�iter) Li certify that the septi ,.syst^,aria refercticed above wa,; inStalled SUb'4tartl;it;ll%' cacc)t-cliilj;i6 the design,which may include minor approved efa inges cuch as laterzal rcloeration of(fae distribution box And/or septic tank. Strip Out (if re�uired) was ,aspectLd and the tuila, were found;satlsfactOiv..- - - — 1, cert.ifv that tyre Septic sy'steni veferonced above vias insia{j�"tl with ll'jt,r !,bats£'s (t'0u greater than 10' lateril relocat c tt of th'ei SAS or an4 alical relo miola of aa61\ com,aonrnt of the sopt;c system) t7U in azcoldanc�V llh Sta.ie L,6cal Ceuta,;()1 5. 17t 1l a'cyls[1?I.L.E t;ertilieci as-built by desav per t:)tolla,:. 5trtp ot:t(ttxquared;l si.Fas.ansncct:;d ar1<fitnc soil Wea:e found satisfactlorv: I'ccrt.ify that the sys'tern rd..erctwcd abo'vc wris.ccn:lawt;ed in Qq han.ce% ath lho tcomi of the I\A approva Criers(il'4pplicablell / r E Tl•_Pi T utallef e s tDeslanel s Si6iwturel (Alf x Desat;a tl !e) PLEASE RE TURN TO BA 1 STABf E PUBLIC REALTH 6➢4 ISR)N. +CEis S IFI A f''l . F OF COMPLIANCE ILL 'cur i3F. t!a1;tiURT) UNTIL 3 OTIT THIS I:_D AS- BUILT CARD ARE RE:`'€?IVFD.'BY T14E"BARNS`d'ABLE P7,Ti;!AC f��'A3-;TH 79.IVIS-Ir N, a THANK YOU. Fn1 Q c Stiptia f)e ;;eilerCe.11iCu-,iti6 -�,:Ri1 4 i'R=nix:iliac - ' COMPLETE ® Complete items 1,2,and 3. Signature ® Print your name and address on the reverse \ ❑ gent ge so that we can return the card to you. X i.. Addressee Is Attach this card to the back of the mailpiece, B. Racal ved by(Printe Name) C. Date of Delivery or on the front if space permits. �...� 1. Artir!IA Ad lmmc Al tn- ~' D. Is delivery address different from item 1? ❑Yes If YES,enter delivery address below: ❑ No Lee Kentros 720 Highland Avenue NPPrlham. MA n2.d9d II I�III�I III I'I I I I I II IIIII II IIIiI I III 11111111 I I I I III 3. Service Type ❑Priority Mao Express® ❑Adult Signature ❑Registered MailrM ❑Adult Signature Restricted Delivery ❑Recllstered Mail Restricted 9590 9403 0232 5146 5388 00 ❑Certified Mail® Delivery ❑Certified Mail Restricted Delivery ❑Return Receipt for ❑Collect on Delivery Merchandise 2. Article Number(Transfer from service label) ❑Collect on Delivery Restricted Delivery ❑Signature Confinmation'r"^ fl Insured Mail El Signature Confirmation 7 014 1200 0001 0 3 5 8 5 814` ❑Insured Mail Restricted Delivery Restricted Delivery ' (over$5oo PS Form 3811,April 2015 PSN 7530-02-000-9053 Domestic Return Receipt tri'�7.L.11 w - V7 M Postage $ IO r9 Certified Fee Return Receipt Fee y 1yj&tmark C3 (Endorsement Required) Here Restricted Delivery Fee p (Endorsement Required) O ry Total Postage&Fees $ l�r r r rc Lee Kentros 1 720 Highland Avenue NPP/'ll�t ri m 1%/T A !lam A f%i • i,zY' Town of Barnstable Barnstable Regulatory Services Department " Public Health Division Q D 639 200 Main Street, Hyannis MA 02601' 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7014 1200 0001 0358 5814 September 22, 2015 Lee Kentros 720 Highland Avenue) , Needham, MA 02494 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5. • The septic system located at, 933 Main Street (Cotta ge D), Osterville, MA,was,last inspected on 8/25/2015 by James D. Sears, a certified septic inspector for the State of_ Massachusetts. 4 The inspection of the septic system showed that the system "Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Leaching pit or cesspool with hgh liquid level, <12" below inlet (per Town Code 360-9 j) You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. " Failure to repair/replace the septic system with in the deadline period will result in future enforcement action. PER ORDER OF T BOARD OF HEALTH homas McKean,R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\933.Main St Ost Sept 2015.doc �r Town of Barnstable p b 9 Regulatory Services Department Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 7/6/15 DEADLINES TO REPAIR FAILED SYSTEMS' (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑Any.portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover, relocation,of a pipe, relocation of a driveway due to H-10 components, etc) Leaching pit or cesspool with high liquid level, <12".below inlet(per Town Code §360-9.1) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc ep 10 1504:53p p,1 Commonwealth of Massachusetts Title 5 Official Inspection Form i- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - 933 Main Street Cottage D. Property Address e.y Lee Kentros Owner Owner's Name information is :r• required for every Osteryille _ MA 02655 8-25-15 F page. CitylTown State Zip Code Date of Inspection �,�•t Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms µ�autnrutunp on the computer, `````������`H.0Frt/,�S�����i, use onlythe tab ��ip.• ""' -,& 1. Inspector: 14tt / � . C �� key to move your a U • S y cursor-do not �: JAMES •'•emu' use the return James D_Sears _ _�; :m? =�. key. Name of Inspector =v; �R Q C, i _ *` CapewideEnterprises,LLC � A-. c a . —t1 Company Name 153 Commercial Street i���i''F 5 _ hunuurunta� Company Address - Mashpee MA __ _ 02649 Cityrrown State Zip Code 508-477-8877 S 1623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 9-9-15 spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or #'# has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the f report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. "*"*This report only describes conditions at the time of inspection and under the conditions of use I at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. i i I �(/ I t5ins•X13 �? Title E Official Inspect:or Form:Subsurface Sewage Oisp vsteir-Page 1 of 1? 3II I i Sep 10 15 04:53p p,2 I Commonwealth of Massachusetts - Title 5 Official Inspection Form W Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 933 Main Street Cottage D _ Property Address Lee Kentros _ Owner Owner's Name information is Osterville MA 02655 8-25-15 required forevery _ — page, City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E /always complete all of Section D A) System Passes. ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Failed system-leaching. The system is a block c pool and pit. Note:. System is shared w/cottage B. Note: Did further evaluation w/B.O.H.. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for "yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old`or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. j " A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): I i I i i t5ins-3/13 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 ce 17 t Sep 10 15 04:53p p.3 . Commonwealth of Massachusetts try _ - Title 5 Official Inspection Form of Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 933 Main Street Cottage D Property Address Lee Ke ntros Owner O -` — wner's Name -- - -- '------- information is Osterville required for every MA 02655 B-25-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y. ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below); ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: l ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment.. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water i ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh { t5ins•3/13 Title 5 Official Inspection Form:Sueaurtace Sewage Disposal System•Page 3 of 17 I I i Sep.10 15 04:54p p.4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ` 933 Main Street Cottage D Property Address Lee Kentros Owner Owner's Name information is Osterville MA 02655 8-25-15. required for every -._ --- - page_ Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other. D) System Failure Criteria Applicable to All Systems: 1 You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or 1, clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters { due to an overloaded or clogged SAS or cesspool �� ❑ ❑ Static liquid level in the distribution box above outlet invert due to an overloaded i or clogged SAS or cesspool ® ❑ Liquid depth in c is less than 6" below invert or available volume is less than '/day flow P,17— i i t5ins.•3n 3 Title 5 Official Insped,on Form Subsurface Sawage DlsDosai System•Page d of 17 i i i Sep 10 15 04:54p p.5 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments t 933 Main Street Cottage D Property Address Lee Kentros Owner Owner's Name information is Osterville MA 02655 8-25-15. required for every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ Required pumping more than 4 times in the last year MOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that.no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10.000g pd ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No i ❑ ❑ the system is within 400 feet of a surface drinking water supply i ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply the system.is located in a nitrogen sensitive area (Interim Wellhead Protection ❑ Area—IWPA) or a mapped Zone II of a public water supply well If you have answered"yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large i system considered a significant threat under'Section E or failed under Section D shall upgrade the system in accordance with 31 D CMR 15.304. The system owner should contact the appropriate regional office of the Department. j t5ins•3113 Title 5 Official Inspection Farm:Subsu..-face Sewage Disposal Syslem-Page 5 of 17 i I Sep 10 15 04:54p g p• Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 933 Main Street Cottle D Property Address Lee Kentros Owner .._ Ownerr`ss Name information is Osterville MA 02655 8-25-15 required for every _.......— _ _ _ _. page. CityfTown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ .® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ Were as built plans of the system obtained and examined? (If they were not available note as NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. 1 El ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information i Residential Flow Conditions: 4 i Number of bedrooms (design): NA-- 2 Per Unit Number of bedrooms (actual): Total DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 I I l5:ns-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 ; i i i Sep 1015 04:55p p ? Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary.Assessments 933 Main Street Co__ttage D Property Address Lee Kentros Owner Owner's Name -----.-__-_— information is required for every Osteryllle _ _ _ MA 02655 8-25-15 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: The system is a block c. pool and pit. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection [] Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage NA 9 � � Y 9 (gpd))� Detail: Sump pump? ❑ Yes ® No i Last date of occupancy: NA Date i Commercial/industrial Flow Conditions: i Type of Establishment: - Design flow(based on 310 CMR 15.203): Gallons per day(9pd) i Basis of design flow (seats/persons/sq.ft., etc.), Grease trap present? ❑ Yes ❑ No j i Industrial waste holding tank present? ❑ Yes ❑ No j Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available_ :sins•3/13 Title 5 Official Incpeclion Farm Subsurface Sawape Disposal Sysfwn•Papa 7 of 17 v i Sep 10 1504:55p p•g Commonwealth of Massachusetts i - Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form Not for Voluntary Assessments 933 Main Street Cottage D Property Address Lee Kentros Owner Owner's Name information is Osterville MA 02655 8-25-15 required for every —...-.�— page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons --- How was quantity pumped determined? Reason for pumping: - - ------ ----.. ---- - Type of System: ® soil absorption system ® S3W cesspool ❑ Overflow cesspool i i ❑ Privy ❑ Shared system (yes or no) (if yes, attach previo us inspection records if any ) i ❑ Innovative- Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. i ❑ Other(describe): I I i5ins•W13 Title 5 Official Inspection Fo-m:Suosurface Sewage Disposal System-Page 6 of 17 i { Sep 1015 04:55p p.g Commonwealth of Massachusetts _ R Title 5 official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments �. 933 Main Street Cottage D Property Address Lee Kentros Owner Owners Name information is required for every Osterville MA 02655 8-25-15 page. Cityffown State Zip Code Date of inspection D. System Information (cant.) Approximate age of all components, date installed (if known) and source of information: C.Pool NA-PIT 1989 Permit # 89 -497. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 18" Depth below grade: feet Material of construction: ® cast iron ®40 PVC ❑other(explain).- Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc-): Pipeing is cast iron and PVC. Septic Tank (locate on site plan): Depth below grade: feet --- Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: - 1 I Sludge depth: _....... ... [sine-3113 Title 5 Official lnspecCion roan:Subsurface Sewage Disposal System•Page 9 of 17 j 1 . 1! i Sep 10 15 04:56p p.10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 933 Main Street Cottage D Property Address Lee Kentros Owner Owner's Name - -- information is required for every Cisterville MA _ 02655 8-25-15 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle - - Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle -- How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, . liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ lene polyeth y El other(explain): Dimensions: _. Scum thickness Distance from top of scum to top of outlet tee or baffle - Distance from bottom of scum to bottom of outlet tee or baffle — — f Date of last pumping: Date I l5 ns•3113 Titio 5 Official Innpoetion Form:Subsurfaoo Gewage Disposal syslmn-Pau.10 of 17 ! i s i I , I Sep 10 15 04:56p p.11 Commonwealth of Massachusetts rl Title 5 Official Inspection Form Subsurtace Sewage Disposal System Form -Not for Voluntary Assessments 933 Main Street Cottage D Property Address Lee Kentros Owner Owner's Name r information is Osterville MA 02655 8-25-15 .required for every _. ..- _ page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: - — i Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: - - Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date , Comments (condition of alarm and float switches, etc.): l C "Attach copy of current pumping contract(required),Is copy attached? ❑ Yes ❑ No I i i tsie_-211a TAie 5 official mpectio-Form:SubWrace Sewage Disposal Svstem•Page 11 of 17 i. 'k i Sep 101504:56p p•12 Commonwealth of Massachusetts - - Title 5 Official Inspection Form _ - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 933 Main=� Property Address eet Cottage Lee Kentros _ Owner Owner's Name - information is Osterville required for every _ _ MA 02655 8-25-15 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order. ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): i a ` If pumps or alarms are not in working order, system is a conditional pass_ Soil Absorption System (SAS) (locate on site plan, excavation not required): } i If SAS not located, explain why: tins•3.r:3 Tile 5 Official Inspection Forr1 Subsurface Sewage Dispose Systerr.•Page.2 of 17 i i I Sep 10 15 04:57p p.13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 933 Main Street Cottage D Property Address -- Lee Kentros Owner Owner's Name -- information is required for every Osterville _ MA_ 02655 5-25715 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: — -- ❑ leaching trenches number, length: . ❑ leaching fields number, dimensions: ❑ overflow cesspool number: -- - ❑ innovative/alternative system Typetname of technology: ------- -- Comments (note condition of soil, signs of hydraulic failure, level of ponding,`da sAil, condition of vegetation, etc.): Leaching is a precast pit. Pit and cover at 22" below rade. Lever n it at 4" below inlet. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 4" Depth—top of liquid to inlet invert - -- Depth of solids layer 411 0„ Depth of scum layer "1-6 i Dimensions of cesspool 6 � Materials of construction Block__.. i Indication of groundwater inflow ❑ Yes Z No 15ins-3113 Title 5 Official,nsaedon Form:Slbsirlace Sewage Disposal System•Page 13 of 57 I. ' t i t Sep 10 15 04:57p p.14 Commonwealth of Massachusetts Title 5 Official Inspection Form r i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 933 Main Street Cottage D Property Address Lee Kentros Owner Owner's Name information is Osterville MA 02655 B-25-15 _ required for every _—_. .-._.-.....__.___—__......--__ page. Citylrown State Zip Code Date of Inspection D. System Information (cost.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation. etc.): Main pool block w/cement cover at grade. No inlet tee,outlet sweep. Note: See asbuilt Att: shared system. Privy (locate on site plan): Materials of construction: ----- Dimensions ------- ---- - Depth of solids -- - Comments(note condition of soil, signs of hydraulic failure, level of ponding; condition of vegetation, etc.): j I i 1 i l i it 1 i t5ins•3113 Title 5 Official I-speodon Form:Suksurtace Sewage Disposal System•Page 14 of 17 t i ' I S i i Sep 10 15 04:57p p.15 Commonwealth of Massachusetts Title 5 Official Inspection Form -,I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 933 Main Street Cottage D Property Address ^ Lee Kentros _ Owner Owner's Name information is required for every Osterville MA 02655 8-25-15 page. CityTrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately i r i j j. I i t5ins•5113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 (. } t i 1 i i Sep 10 15 04:58p - ,, p.16 -bencliimrks.Locate all wells witftln luv I—C. A. `J 6l2Cc _... fl U v ;T . V FF.1C.0-v 2 r.71.z L / _ OL---D GcS JFrX7� l 4 t � 3 rA i S 5 Ni. S Sep 10 15 04:58p p.17 Commonwealth of Massachusetts -- Title 5 Official Inspection Form i — of Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 933 Main Street Cottage D Property Address Lee Kentros Owner Owner's Name information is Osterville MA 02655 8-25-15 required for every .. ._..__ page. Chy/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: --- — -- Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Past Report Note: Failed system. _ I ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database- explain: I You must describe how you established the high ground water elevation: Past report 104 No G.W. I Before filing this Inspection Report, please see Report Completeness Checklist on next page. j I, t5ins•S113 Title 5 Cffic9al Inspe•-ion Form:Subsurface Sewage Disposal System•Page 16 of 17 f f P.M: : 294IP4 P:9.1; �a DEED. RESTRICTION WHEREAS, Lee Kentros of 720 Highland Avenue; Needham; MA, is the owner of 933D Main Street, Osterville, MA and being shown as follows:. First Parcel: Lot C, as shown on a plan entitled, "Plan of Land located'at#8 and.#9 Gallery Place,; Osterville, Mass., Owned-by and Prepar'ed.for Jessie A. MacQueen" dated September 15, 1999, drawn.by Yankee Survey Consultants,.Marstons Mills, MA, recorded in Barnstable County Registry of Deeds in Plan Book 552, Page 61. Second Parcel: Lot 3 on a plan entitled."Plan of Land in Osterville-Barnstable,:Mass., Property of Dana M. and Marion M. Marston," dated October 5, 1950, Bearse and Kellogg, C.E. duly recorded in the Barnstable County Registry of Deeds i.n Plan.Book 95, Page 135. WHEREAS, Lee Kentros as owner of said lot has agreed with the Town of Barnstable, Board of Health, to a restriction as to the number of bedrooms which can be included in any home built on said lot as a pre-condition of obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code,;Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage., I WHEREAS, the Town of Barnstable Board of Health, as a'pre-condition to granting a Disposal Works Construction Permit for aseptic system in compliance with 310 CMR 15.000, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on said lot be put on record with the Barnstable County Registry of Deeds by recording this document. NOW THEREFORE, Lee Kentros does,hereby place the following restriction on her above referenced land in.accordance with her agreement with the Town of Barnstable Board of Health which restriction shall run with the land anti be binding upon all successors in title: 1. 933D Main Street,Osterville, MA may have constructed upon it a house containing no more than two (2) bedrooms. Lee Kentros agrees that this shall be a permanent deed restriction affecting the I Page 1 1 dwelling located at 933D Main Street, Osterville, MA-and being shown as Lot C on Plan,Book 552, Pa9e 61 and Lot 3, on Plan Book 95, Page 135. For title of Lee Kentros, see the following: Deed: Book 23611, Page 263. Executed as a sealed instrument this day of , , 2016. Owner's signature COMMONWEALTH OF MASSACHUSETTS y�r o L ss Date-3cl. , 2016 Then personally appeared the above named fee ' J'� ��-r roS known to me to be the person/s who executed the following instrument and acknowledged the same to be their free act and deed, before me. . 4Notrvy PU 61iG� My'commission expires: o ' `' j(v (date) To sEuuURA!C.F s`30agi-V Pub!C a7ivoral?h6+,(aa 2 `�scc+tt� �4 t� Iuiyt�nMM43ionE BARNSTABLE REGISTRY OF DEEDS Page 2 John F. Meade,Register 2 Barnstable �1IHWE tq`, Town of Barnstable mCftv RMA MASS& Board of Health 9n 039. 1�$ L EDMA'1A 200 Main Street, Hyannis MA 02601 2007 Office: 508-8624644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. lunichi Sawayanagi February 22, 2016 Mr. Peter McEntee, P.E. 12 West Crossfield Road Forestdale, MA 02644 RE: 933, Unit D, Main Street, Osterville A = 117-186 Dear Mr. McEntee, You are granted variances, on behalf of your. client, Lee Kentros, to construct. an onsite sewage disposal system at 933-D Main Street, Osterville. The variances granted are as follows: 310 CMR 15.405: To construct a soil absorption system five (5) feet away from a crawl space-type foundation, in lieu of the twenty feet minimum setback required. 310 CMR 15.405: To install a septic tank six (6) feet away from the crawl space in lieu of the ten feet minimum setback required. 310 CMR 15.405: To install a septic tank and construct a soil absorption system less than ten feet from the water service, in lieu of the ten feet minimum setback required. 310 CMR 15.405: To install a soil absorption system eleven (11) feet away from a leaching catch basin, in lieu of the twenty-five feet minimum setback required. 310 CMR 15.405: To install a soil absorption system sixteen (16) feet away from a drainage field, in lieu of the twenty-five feet minimum setback required. The variances are granted with the following conditions: (1) No more than two (2) bedrooms maximum are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. QAWPFILES\McEnteeKentros 933-D MainStOst Feb2016.doc (2) The applicant shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds restricting the property to two (2) bedrooms maximum. A copy of the recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction permit. (3) A membrane barrier (e.g. 40 mil liner)) shall be installed in between the soil absorption system and the leaching catch basin. (4) The cesspools must be abandoned properly (pumped and filled with sand or removed). (5) The septic system shale ni st Iled in strict accordance with the engineered plans dated Januaf 15, 2016. i V64V,,J,��, J,U//6 f� /( (6) The designing engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system wps_..installed in substantial compliance with the submitted plans dated anuary Pf v;} This variance is granted because physical constraints at the site severely restrict the location of a soil absorption system due to the small size of the lot. ' The proposed system appears to be designed to meet the maximum feasible compliance standards contained within the State . Environmental Code, Title V. Sincerely yours, Wayne Miller, M.D. Chairman ` CUr,,( d QAWPFILESWIcEnteeKentros 933-D MainStOst F62016.doc Tk4E Barnstable Op T Town of Barnstable AgAmedcaCRY nARMASS. 04 E, _ Board of Health al fD MAt&' 200 Main Street,Hyanni.s'MA 02601 200� Office: 508-8624644 _ Y Wa ne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi February 22, 2016 Mr. Peter McEntee, P.E. 12 West Crossfield Road Forestdale, MA 02644 RE: 933, Unit D, Main Street, Osterville A = 117-186 Dear Mr. McEntee, You are granted variances, on behalf of your client, Lee Kentros, to construct an onsite sewage disposal system at 933-D Main Street, Osterville. The variances granted are as follows: 310 CMR 15.405: To .construct a soil absorption system five (5) feet away from a crawl space-type foundation, in lieu of the twenty feet minimum setback required. 310 CMR 15.405: To install a septic tank six (6) feet away from the crawl space in lieu of the ten feet minimum setback required. 310 CMR 15.405: To install a septic tank and construct a soil absorption system less than ten feet from the water service, in lieu of the ten feet minimum setback required. 310 CMR 15.405: To install a soil absorption ,system eleven (11) feet away from a leaching catch basin, in lieu of the twenty-five feet minimum setback required.' 310 CMR 15.405: To install a soil absorption system sixteen (16) feet away from a drainage field, in lieu of the twenty-five feet minimum setback-required. The variances are,granted with the following conditions: (1) No more than two (2) bedrooms maximum are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. Q:\WPFILES\McEnteeKentros 933-D MainStOst F62016.doc (2) The applicant shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds - restricting the property to two (2) bedrooms maximum. A copy of the recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction permit. (3) A membrane barrier (e.g. 40 mil liner)) shall be installed in between the soil absorption system and the leaching catch basin. (4) The cesspools must be abandoned properly (pumped and filled with sand or removed). (5) The septic system shall be installed in strict accordance with the engineered plans dated January 15, 2016. . 9 . (6) The designing engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the submitted plans dated January 15, 2016. This variance is granted because physical constraints at the site severely restrict the location of a soil absorption system due to the small size of the lot. The proposed system appears to be designed to meet the maximum feasible compliance standards contained within the State Environmental Code, Title V. SinAne y yours Wailler, M.D. Chairman QAWPFILESNcEnteeKentros 933-D MainStOst F62016.doc �4 1ME Tp� Kam' Llsl, :DATE FEE: ■ARNSTABLE, Imo' t�/ c 1 9. A��� $ L r�G��'1 itEC. BY U FD MAr v Town f Barnstable SCHED. DATE: Board of Health �,� ty 200 Main Street Hyannis MA 02601 .. y Office: 508-862-4644 CD Wayne A.Miller,M.D. FAX: 508-790-6304 Junichi Sawayanagi j Paul J.Canniff,D.M.D. I . 0!i VARIANCE REQUEST FORM LOCATION ` Property Address: : N1°`' " "i� .i- o YLv l E' Assessor's Map and Parcel Number: 1 1 - j �� Size of Lot: Ali 5 1 - S f-- i Weitlands Within 300 Ft. Yes Business Name: No '7Z Subdivision Name: APPLICANT'S NAME: PC.K.,-- M t-L� �- Pi Phone -5-u F f`i-?_5 313 Did the owner of the property authorize you to represent him or her? Yes ,,e No I i PROPERTY OWNER'S NAME CONTACT PERSON I Name: Name: n, of�t r'l rt�� i;.�<•, `,U� I c. Z I-i; C3 V\ 1 cl"d A--2 CASs- kA Address: �e Inc;raj . lt'1 iq O.2.1 9 Address: �,aa -r—,�ci� N1 W el �- Phone: 7 G 1 _ `�`1`l 4 I I �� Phone: S� —`i-7"7 "3 VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) .Sl`Ivy C 'i) 5T1�— i NATURE OF WORK: House Addition ❑ House Renovation Repair of Failed Septic System I i Checklist (to be completed by office staff-person receiving variance request application) _ Please submit copies in 4 separate completed sets. I- Four(4)copies of the completed variance request form _; Four(4)copies of engineered plan submitted(e.g.septic system plans) Completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) I Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) i Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/lessee only], outside dining variance renewals same owner/leasee only], i g [ y],and variances to repair failed sewage disposal systems[only if no expansion to the + building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D. C:\jUsers\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\BAJ9P9B7\VARIREQ.DOC i I Engineering Works, Inc. 12 West Crossfield Road, Forestdale, MA 02644 Tel/Fax (508) 477-5313 I January 22, 2016 Town of Barnstable Board of Health 20�0 Main Street Barnstable, MA 02601 Re: 933D Main Street, Osterville (Parcel ID: 117-185) Dear Members of the Board, On behalf of my client, Lee Kentros, the following request for variances related to a septic system upgrade, are being made. A complete septic system is being proposed to replace the failed septic system. Variance Requests are as follows: • 310 CMR 15.405(b)(f)&(g) — CONTENTS OF LOCAL UPGRADE APPROVAL 1 . A 15' variance, S.A.S. to crawl space, for a 5' setback. 2. A 4' variance, septic tank to crawl space wall, for a 6' setback. 3. A variance to the 10' setback requirement between sewer, septic tank or S.A.S. and water service, to allow a new sleeved water service to be installed within 10' of the septic tank and sewer. 4. A 14' variance, S.A.S. to leaching catch basin for an 11' setback. 5. A 9' variance, S.A.S. to drainage field (approx.), for a 16' setback. Variance requests are being made due to site constraints. S' e ly, Peter T. McEntee P.E. r From: PETER MCENTEE<peter.mcentee@gmail.com> Subject: Authorization Form Date: January 22, 2016 10:02:59 AM EST To: lee kentros<LEEFRANCES18@verizon.net> 1 Attachment, 12.5 KB Please sign and return to me via email or regular mail Peter T. McEntee PE - Principal Engineering Works, Inc. 12 West Crossfield Road Forestdale, MA 02644 Tel/fax (508) 477-5313 k Engineering Works, Inc. 12 West Crossfield Road,Forestdale, MA 02644 Tel/Fax(508)477-5313 January 21,2016 Barnstable Board of Health 200 Main Street Hyannis,MA 02601 Re:933D Main Street,Osterville,MA,Title 5 Septic System Upgrade Representation Authorization Dear Board members: I hereby authorize Peter McEntee PE to represent my interests for the subject project. tee Kentros—Property Owner • r i f 1/22/2016 AbutterReport Board of Health Abutter List for Map & Parcel(s): �'117185' ,2 �� J Direct abutters (no set distance) and the properties located across the street. / p Total Count: 9 j � Close �AllI- a,. WRIGHT,CATHRY •.- _._. _ _..:�..._. .._._.. ....,.-_r:_._._. ........ .._ __._._. ._,. ..,_____.. ___ ,.... .._•-: .._,,.,__.: N OSTERVILLE, 117042 22 BAY ST 18827/117 A MA 02655 � 117043 GRIFFIN,SHEILA E 16 HENDERSON WORCESTER, 9007/7.8 AVENUE MA 01603 117066 BRA DBURY JOHN GALLERY PLAC 933FI MAIN ST, OSfERVILLE 11107 84 C &YVONNE S MA 02655 / t 11.7067 LO WE,CANDANCE 992 MEMORIAL CAMBRIDGE, [ 6560/58 I S DR., #505 MA 02138 � I l 117181 CURLEY,MARY E ✓ 933E MAIN ST OSTERVILLE, 11576/120 MA 02655 117182 ADLER,HUI TING _ 26 COLEY ROAD WELLESLEY,MA 26806/320 LI &SAILING 02482 CALLAHAN, 117183 WILLIAM F III & C/O JUDY MCAfV/E PO BOX 346 CENTERVILI_E, 3318/282 RICHARD P MA 02632 �. j 720 HIGHLAND NEEDHAM,MA I 117185 KENTROS,LEE AVENUE 02494 #08P7.786EP 0STERVILLE' CALLAHAN, a/ CENTERVILLE, i 117186 RICHARD P TR PROPERTIES C/0 JUDY MCABEE PO BOX 346 MA 02632 18890/7.22 F {{ REALTY TRUST III This list by itself does NOT constitute a certified list of abutters and is provided only as an aid to the determination of abutters. If a certified list of abutters isrequired,contact the Assessing Division to have this list certified.The owner and addressdata on this list isfrom the Town of Barnstable Assessor's -database as of 1/22/2016., http://maps.townofbarnstable.us/arci ms/appg eoapp/AbutterReport.aspx?type=BOH 1/1 1/22/2016 AbutterReport Board of Health Abutter List for Map & ParcelQ): '117185' r( Direct abutters (no set distance) and the properties located across the street: Total Count: 9 (a Close Map&Parcel Owners Owner Addressi Address 2 Mailing Country Deed CityStateZip 117042 WRIGHT,CATHRYN 22 BAY ST OSTERVILLE, 18827/117 A MA 02655 117043 GRIFFIN,SHEILA E 16 HENDERSON WORCESTER, 9007/28 AVENUE MA 01603 117066 BRADBURY,JOHN GALLERY PLACE 933H MAIN ST OSTERVILLE, 11107/84 C &YVONNE S MA 02655 LOWE,CANDANCE 992 MEMORIAL CAMBRIDGE 117067 S DR.,#505 MA 02138 6560/58 117181 CURLEY,MARY E 933F MAIN ST OSTERVILLE, 11576/120 MA 02655 117182 ADLER,HUI TING 26 COLBY ROAD WELLESLEY,MA 26806/320 LI &SAILING 02482 CALLAHAN, CENTERVILLE, 117183 WILLIAM F III & C/O JUDY MCABEE PO BOX 346 MA 02632 3318/282 RICHARD P 117185 KENTROS,LEE 720 HIGHLAND NEEDHAM,MA #08P2786EP AVENUE 02494 OSTERVILLE CALLAHAN, CENTERVILLE, 117186 RICHARD P TR PROPERTIES C/O JUDY MCABEE PO BOX 346 MA 02632 18890/222 REALTY TRUST III This list by itself does NOT constitute a certified list of abutters and is provided only as an aid to the determination of abutters.If a certified list of abutters isrequired,contact the Assessing Division to have this list certified.The owner and addressdata on thislist isfrom the Town of Bamstable AssessDes database as of 1/22/2016 . http://maps.tavmofbarnsWe.us/arcims/appgeoapp/AbutterReportaspW ype=BOH 1/1 Town of Barnstable Geographic Information System January 2:2,2016 117046 #937 #945 117164 #23 117166 #33 #935 .117183 :• 117056CND 117028 ;i. _ `r'af933. ,':;': #920 #53 117182 ::::.' :: : ::;:;:':=:';, 117184 ?.'::.. #933'.,.**.-.:::,.-.,-,. 117067. - :.:.#933:::•:.:.;:;:, '.'•::'•::,::i;:::•;r:':'::.:... 117066 #933 -jij ::•:•.117181: •:;#933:;::.%=:.::. •.: #933:::;:;:::;.-••.::• Z to • �170"117187 117066 9 933 #933 . #908 117060 0 #911 117029 #69 0 117061 #896 117035 117041 #38 ' 9901 117034 #48 117168 0 #81 117036 #20 117040 n #891 1Y/167 Fee 117037 pow� Li DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map: 117 Parcel:185 Board of Health Selected Parcel boundary determination or regulatory interpretation. Enlargements beyond a scale of Abutter List Type-Direct abutters(no set distance)and the properties located 1"=100'may not meet established map accuracy standards. The parcel lines on this map E are only graphic representations of Assessor's tax parcels. They are not true property across the street. Abutters boundaries and do not represent accurate relationships to physical features on the map !•,�� such as building locations. Buffer .� Engineering Works, Inc. 12 West Crossfield Road, Forestdale, MA 02644 Tel/Fax (508) 477-5313 January 26, 2016 Re: 933D Main Street, Osterville, MA (Assessors Map 117, Parcel 185) Construction Title 5 Septic System Dear Sir/Mam: Please be advised that an application for variances from the Massachusetts Department of Environmental Protection, Title 5, and Local Regulations have been submitted to the Barnstable Health Department for approval. The following variances are being requested: • 310 CMR 15.405(b)(f)&(g) — CONTENTS OF LOCAL UPGRADE APPROVAL 'I . A 15' variance, S.A.S. to crawl space, for a 5' setback. 2. A 4' variance, septic tank to crawl space wall, for a 6' setback. 3. A variance to the 10' setback requirement between sewer, septic tank or S.A.S. and water service, to allow a new sleeved water service to be, installed within 10' of the septic tank and sewer. 4. A 14' variance, S.A.S. to leaching catch basin for an 11' setback. 5. A 9' variance, S.A.S. to drainage field (approx.), for a 16' setback. i The application and plans are available for review at the Barnstable Health Department, 20l0 Main Street, Hyannis, MA, Monday through Friday (excluding holidays) from 8:30 a.m. to 4:30 p.m. A public hearing will be held, to discuss the proposed work, on Tuesday, February 9, 20,16, at 3:00 p.m. The hearing will be held at the following location: Town Hall Hearing Room Second Floor 367 Main Street Hyannis, MA �iricerely, (JJ'!e �.__..._ Peter T, McEntee P.E. ENTRY cwn � BEDROOM u 9'X10' 90±SF BATHROOM KITCHEN LIVING ROOM BEDROOM 9'X10' 90±SF ENTRY FLOOR PLAN 933D MAIN STREET, OSTERVILLE, MA vim_ �10 Town of Barnstable P# Department of Regulatory Services + BARNSTABI,E, Public Health Division Date l _�� lS— y MASS. 1639. `�� 200 Main Street,Hyannis MA 02601 AIFD MO pv a Date Scheduled Time, � Fee Pd. d U0 Soil Suitability Assessment for Sewage Disposal Performed By: t i'�� 1`�C G✓1 �Q�'_ �G- j ��ta ljG1/4 `/I 1 1� Witnessed By: (fin �=r J� LOCATION cat GENERAL INFORMATION Location Address 933 1) �I C c� Owner's Name 1 ee �Z, (b S h- �-Q Address 7 ZO c5�lLlvl d. V`k nIV1ctv�,�l/l/ Assessor's Map/Parcel: ` ` 7 — i �S Engineer's Na e q wl- - , t✓✓lam ,p NEW CONSTRUCTION REPAIR Telephone# 37 ?G!F' Land Use (V`t(^7-j"C'1. Slopes(%) Surface Stones Distances from: Open Water Body / -/)� �..ft Possible Wet Area 5 L ft Drinking\',pater Well e Ft /"/Drainage Way A R Property Line Other ft SKETCH: (Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) ti �_ 3 t Parent material(geologic) y Depth to Bedrock Depth to Groundwater: Standing Water in Hole: ; Weeping from Pit Face Ivy"M' _ Estimated Seasonal High Groundwater _ -7( (;t �( D`LTERMIi'AT O -FO SEASt;NAL 141-' I WA"T'T_',-4-TABLE _-- Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: _in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST Date__ Time-- Observation Hole# --. - _Time at 9" . . —-- -- Depth of Perc Time at 6" Start Pre-soak Time rCi _ G �Z Time(9"-6") _ End Pre-soak I l U Rate Min./Inch IE� Site Suitability Assessment: Site Passed L -7— Site Failed: _ Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back - - -= ***If percolation test is to be conducted within 100' of wetland, you must first notify the ' Barnstable Conservation Division at least one (1) week prior to beginning. Q:\SEPTIC\PERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole#_� ;j Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure;Stones;Boulders. Consiltency.°b' rargl]_ ( Z_ A' Loct_►\^�� 1�G1 t� .i2�1 Z 2,- 01 DEEP OBSERVATION HOLE LOG Hole# Lepth-from Soil.t3orizon — Soil Texture Soil Color Soil Other Surface(in.) (USDA) (tvIuriseli) _ iviutding (-Structure,Stonm Boulders. Consiitency.%Gravel) 30 5/1 DEEP OBSERVATION HOLE LOG Hole# e Repth from Suit Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. n i?tenev.%Gravel) _ DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color °" -Soil , Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders, Flood Insurance Rate Man: Above 500 year flood boundary No Yes :., WiNn 500 year boundary No Yes `` Within 100 year flood boundary No�\ Yes Death of Naturally O.ccurrfnQ 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? If not, what is the depth of naturally occurring pervious material? Certification " I'certify that onO_(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 rain'ng,expertise and experience described in 310 CMR 15,017. Signature Date I Q:\.SEPTlCVERCPO R M.DOC Cv down cape engineering, inc. SIEVE SOILS ANALYSIS 933D Main Street Osterville, MA DATE OF REPORT: 1/16/16 .JOB : GRAIN SIZE ANALYSIS-SIEVE TEST SITE: 933D MAIN STREET, OSTERVILLE LOCATION: ENGINEERING WORKS TEST HOLE SIEVE ANALYSIS. Weight Sample(Grams): 164.2 SIZE :WEIGHT RETAINED € % RETAINED % PASSED € (sum ) -------------............... ....:........................ ...:::...---------------------...:...:.......:............. 0.0%' 100.0% 11/2" 0.0: 0.0%: 100.0% 3/8" 0.0; 0.0%; 100.0% -------------- ......................................................------------------o-----------------o- #4 0.0 i 0.0/o• 100.0/o --------------':......................................................>---------------------..................................... #10 4.9: 3.0%@ . 97.00 -------------........::.......:...:..::...:..:....:...::...........---------------------:................... #20 34.3: 20.9%: 79.1 --------------:......................................................,------------------44..................................... #40 82.4 50.2% 49.8% ------:.......................................................------------- - -. ........... . ` #50 110.4: 67.2%: 32.8% --------------:.....................................................>-------------------- ..................................... #80 141.3: 86.1% 13.90 -------------................... .......:.......:.:........:.......:.--------------------- ..._.:............ ............ #100 149.8: 91 2%: 8.80 ..:, ., --------------.......................................................>---------------------}---=-------------- #200 159.7; 97.3% 2.7% PAN: 162.3: 100.0% 0.0% --------------F--------------------------+---------------------------------------- SAMPLE: € 164.2 NOTE:TEST ON PASSING#4 ONLY, 0.40% RETAINED ON#4<45%O.K. RESULTS: SOIL CLASSIFIED AS AASHTO A-1-b(GRAVEL&SAND) (UNCOMPACTED) PERCENTAGE OF MATERIAL PASSING#4 SIEVE #4 100% (TEST ONLY MATERIAL PASSING#4) OK #5010%-100% OK #100 0%-20% OK #200 0%-5% OK SAMPLE MEETS TITLE 5 FILL SPECIFICATION >97%SAND RESULTS: PERMEABLE MATERIAL-CLASS 1 <2 MINAN. MATERIAL( is ) NONCOMPACTED tw°F Mgssgc SOIL DESCRIPTION: MEDIUM SAND - �o� DANIELA. yGs OJALA CIVIL.4 T� IST SSIONAL�a t i Barnstable OpIHE T Town of Barnstable RA 'FrAMASS.LE, : Board of Health 9 ASS. $ A 79 A TfD MAI 200 Main Street, Hyannis MA 02601 200� II Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi February 22, 2016 Mr. Peter McEntee, P.E. In 12 West Crossfield Road Forestdale, MA 02644 i r RE: 933, Unit B, Main Street, Osterville A = 117-186 Dear Mr. McEntee, You are granted variances, on behalf of your client, Richard Callahan, to construct an onsite sewage disposal system at 933B Main Street, Osterville. The variances granted are as follows: 310 CMR 15.405: To install a septic tank six (6) feet away from the property line, in lieu of the ten feet minimum setback required. ,, 310 CMR 15.405: To construct a soil absorption system five (5) feet away from a crawl space-type foundation,, in lieu of the twenty feet minimum setback required. 310 CMR 15.405: To install a septic tank four (4) 'feet away from ,the crawl space in lieu of the ten feet minimum setback required. 310 CMR 15.405: To install a septic .tank and construct a soil absorption system less than ten feet from the water service, in lieu,of the ten feet minimum setback required. The variances are granted with the following conditions: (1) No more than two (2) bedrooms maximum are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. (2) The applicant shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds restricting the property to two (2) bedrooms maximum. A copy of the Q:\WPFILES\McEnteeCallahan 933-B MainStOst F62016.doc recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction permit'.. (3) The septic system shall be installed in strict accordance with .the engineered plans dated January 15, 2016. (4) The designing engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the submitted plans dated January 15, 2016. This variance is ranted because physical constraints at the site severely restrict the location 9 pY Y of a soil absorption system due to the small size of the lot. The proposed system appears to be designed to meet the maximum feasible compliance standards contained within the State Environmental Code, Title V. Sin erely yours Wayn Miller, D. Chairman Q:\WPFILES\McEnteeCallahan 933-B MainStOst F62016.doc �` �tHE TQ,� �I�G•�y'�� �tiQ��J°k'cJ ��'� DATE:_ -7 �D � 'ter �. ' �► FEE: BM � ^ t� {`�/� �O/� �� a►��y t6 Aryl REC. BY s Town of Barnstable SCHED. DATE: Board of Healtho�� 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne A.Miller,M.D. FAX: 508-790-6304 Junichi Sawayanagi Paul J.Canniff,D.M.D. » VARIANCE REQUEST FORM LOCATION Property Address: s M c, h 5 t �� 5� �.r✓c I I{ Assessor's Map and Parcel Number: 1 1 ' 1 C(� Size of Lot: 6 Wetlands Within 300 Ft. Yes Business Name: No X Subdivision Name: -- APPLICANTS NAME: ► / Phone Did the owner of the property authorize you to represent him or her? Yes _K No _ I PROPERTY OWNER'S NAME CONTACT PERSON _ 1 7 Fe !t � mCc -i- IBC Name: `i/ ��:-� , P'icr-1 h e Name: .�lCTI t 1�I►! ZG z,Z. Address: Fl i-e s tt--C4G�t IMtA Q �?i" s`(y Address: .�, l�e�x �� c Phone: —") 7 Phone: S �4'7 VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) l j5 j LA OS L ci b T Jzr t Is, y0-,"' ( b� .5; - S/N-.s tv c:"nW eA f NATURE OF WORK: House Addition ❑ House Renovation ❑ Repair of Failed Septic System Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e.g.septic system plans) Completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title Vand/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) _ Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/lessee only], outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date --j a VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D. "T Internet �C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary (Files\Content.Outlook\BAJ9P9B7\VARIREQ.DOC to Complete items 1,2,and 3. A Signature ® Print your name and address on the reverse ❑Agent so that we can return the card to you. X , Y-vc�l., i ❑Addressee ® Attach this card to the back of the mailpiece, B• Received by{Printed N Date of Delivery or on the front if space permits. 1 R 1. Article Addressed to: d nt from item Yes f YES,en a ddress below: No spot F— 93J Iva 3. Service Type ❑Priority Mail Express®13 Adult d a II I IIII6I IIII III I I I I III'III II IIII III II I I III III ❑Adult Signature Restricted Delivery ❑Renature 0 gistered Mail Restricted .Q o z rtified Mail® Delivery d f 1 9590 9403 0215 5146 3097 00 ❑Certified Mail Restricted Delivery 13 Retum Receipt for 0 0 0 00 (\�) ❑Collect on Delivery Merchandise !, -� e.H m ti .++ rrrancfer from seryjcela6e() ❑Collect on Delivery Restricted Delivery ❑Signature Confirmatic �j =: +.=.ed Mail ❑Signature ConfirmationE 3 7 014 0150 0001 3 911 7 6 0 6 n ed Mail Restricted Delivery Restricted Delivery 9 Ps Form 3811,April 2015 PSN 7530-02-000-9053 Domestic Ro'm.Recelpt^ m a N m Zr r ■ Complete items 1,2,and 3. A. Sign ure w e ® Print your name and address on the reverse / ❑Agent O1 v} l C. so that we can return the card to you. X ` y cam" ❑Addressee 4 x m CS `. D Attach this card to the back of the mailpiece, ' ecely by(P nted Name) C. Date of Delivery r. or on the front if space permits. D. Is delivery address different from item 1? ❑Yes If YES,enter delivery address below: ❑No 4) c°'i Prop ID:117182 ADLER,HLn TING LI&SAILING 26 COLBY ROAD 'o E m WELLESLEY,MA 02482 N � IIIIIIIIIIIIIl01IIIIIIIIIIiII��II�IIIII�II�III kAjUK'ujr nature m ° ° E vervice T e o ag yp ❑Registered MaipT^+�® N ro" a� a)9590 9403 03915163 1602 77 Signature Restricted Delivery ❑Registered Mail Restricted cV'o � a8d MaNDelivery - p o A Wrtlfred-Mall Restricted Delivery ❑Return Receipt for y a w c a Z ❑Collect on Delivery Merchandise Q rl Collect on Delivery Restricted Delivery ❑Signature Confirmation'"' � � '015 0640 0007 . 9463 433 0 i Insured Mail ❑Signature Confirmation • 2 O m y w O x I Insured Mail Restricted Delivery Restricted Delivery . N 0 3 Y t Q (over$500) x �S Form 3811,April 2015 PSN 7530-02-000-9053 Domestic Return Receipt o o c w Co o W W o Complete items 1,2,and 3. o Print your name and address on the reverse A sign ure so that we can return the card to you. X ',� 12Mg-ant a Attach this card to the back of the mailpiece, 0 Addressee or on the front if space permits. B. ceived tinted Name) C. Date of Delivery — G� f L 0. Is deli ery address different from itri 1 C�,Y ,Prop ID:117184 If YES,enter delivery res��II CALLAHAN,WILLIAM F III& C/O JUDY MCABEE PO BOX.346 /, i-a CENTERVILLE,MA 02632 Y/ � J) ''_m 910z 0 E N yp �~. IIIOIIi�I IBII 1011l III OIIIII III IIIIIIIIII III III 3. Service Type ❑P: .. ..;...�\ 9590 9403 0391 5163 1602 22 ❑Adult Signature egist Mafl Express® ❑Adult Signature Restricted Delivery ❑Registered Mailrm rtified Mails �' ❑Regi istered Mail Restricted Dellery ❑Certified Mail Restricted Delivery ❑Return Receipt for _ ❑Collect on Delivery Merchandise 7 015 0 6 4 p 0 0 0 7 ` 11 ❑Collect on Delivery Restricted Delivery ❑Signature ConffrmationTm 9 4 6 3 4255 red Mai' ❑Signature Confirmation red Mail Restricted Delivery Restricted Delivery J PR G..... 4 Q ..__.. $5001 l 0. t. Engineering Works, Inc. 12 West Crossfield Road, Forestdale, MA 02644 Tel/Fax (5013) 477-5313 January 22, 2016 To ivn of Barnstable Board of Health 20 Main Street Ba nstable, MA 02601 Re: 933B Main Street, Osterville (Parcel ID: 117-186) Dear Members of the Board, On behalf of my client, Judy McAbee, the following request for variances related to a septic system upgrade, are being made. A complete septic system is being proposed to replace the failed septic system. Variance Requests are as follows: • 310 CMR 15.405(a)(b)&(g) — CONTENTS OF LOCAL UPGRADE APPROVAL 1. A 4' variance, septic tank to property line, for a 6'setback. 2. A 15' variance, S.A.S. to crawl space, for a 5' setback. 3. A 6' variance, septic tank to crawl space wall, for a 4' setback. 4. A variance to the 10' setback requirement between sewer, septic tank or S.A.S. and water service, to allow a new sleeved water service to be installed within 10' of the septic; tank and sewer. Variance requests are being made due to site constraints. c rely, ;L Pe er T. McEntee P.E. 2/1/2016 AbutterReport Board of Health Abutter List for Map & Parcel(s): '117186' Direct abutters (no set distance) and the properties located across the street. q�3 -10 Total Count: 7 (� �IW*," Close ts9 rl# ,�. 117043 GRIFFIN,SHEILA E 16 HENDERSON WORCESTER, 9007/28 AVENUE MA 01603 CH O l WEST 117044 DLN LLP BUILDERS NC✓ PO BOX 399 FALMOUTH,MA 10771/164 f 02574 ADLER HUI TING WELLESLEY MA 117182 26 COLBY ROAD 26806/320 LI &SAILING 02482 CALLAHAN, CENTERVILLE, ' # 117183 WILLIAM F III & C/O JUDY MCABEE PO BOX 346 MA 02632 3318/282 { RICHARD P CALLAHAN, CENTERVILLE, 117184 WILLIAM F III & C/O JUDY MCABE� PO BOX 346 3266/209 RICHARD P !! MA 02632 720 HIGHLAND NEEDHAM,MA ° 117185 KENTROS,LEE ✓ AVENUE 02494 #08P2786EP{ _ .._ _.. OSTERVILLE CALLAHAN, J CENTERVILLE, 117186 RICHARD P TR PROPERTIES C/O JUDY MCABEE PO BOX 346 MA 02632 18890/222 REALTY TRUST III ,_................_............. _.- ._ _.. _ ... .._..... This list by itself does NOT constitute a certified list of abutters and is provided only as an aid to the determination of abutters. If a certified list of abutters is required,contact the Assessing Division to have this list certified.The owner and address data on this list is from the Town of Barnstable Assessor's database as of 2/1/2016 . http://maps.townofbarnstable.us/arci ms/appg eoapp/Abutter Report.aspVtype=BOH 1/1 f � 2/1/2016 AbutterReport Board of Health Abutter List for Map & Parcel(s): '117186' Direct abutters (no set distance) and the properties located across the street. Total Count: 7 close I i 16 HENDERSON WO RC ESTER, 117043 GRIFFIN,SHEILA E AVENUE MA 01603 9007/28 WEST 117044 DLN LLP CH NEWTON PO BOX 399 FALMOUTH,MA 10771/264 BUILDERS INC' 02574 117182 ADLER,HUI TING 26 COLBY ROAD WELLESLEY,MA 2 6 8 0 6/3 20 LI &SAILING 02482 CALLAHAN, 117183 WILLIAM F III & C/O JUDY MCABEE PO BOX 346 CENTERVILLE, 3318/282 RICHARD P CALLAHAN, 117184 WILLIAM F III & C/O JUDY MCABEE PO BOX 346 CENTERVILLE, 3266/209 RICHARD P MA 02632 I117185 KENTROS,LEE 720 HIGHLAND NEEDHAM,MA #08P2786EP AVENUE 02494 OSTERVILLE CALLAHAN, CENTERVILLE, 117186 RICHARD P TR PROPERTIES, C/O JUDY MCABEE PO BOX 346 MA 02632 1.8890/222 REALTY TRUST III This list by itself does NOT constitute a certified list of abutters and is provided only as an aid to the determination of abutters.If a certified list of abutters is required,contact the Assessing Division to have this list certified.The owner and address data on this list isfrom the Town of Barnstable Assessor's database as of 2/1/2016. • a http://maps.tovvnofbarnstable.us/arcims/appgeoapp/AbutterReport.aspx?type=BOH 1/1 Town of Barnstable Geographic Information System February 1, 2016 / L 117163 117046 #945'~ #937 117164 #23 1 �^ #935 1170GGCND\ \ \ 9� I 1 TI 83 ✓✓„ #933 ^\ JI i 117165 �' ^�� � , IIT152 117101 #33 l�#933 #933 C117065 #933 117186 #933 117185 117181 � #933 ;- #933 117187 I "�— 117044 #933 4I 11706G (#,919 1✓ #908 V 117060 117043 #909 C117196 117035 117042 J #38 117034 `117061 #4$ 117041 #896 \ 117036 #901 `� \ 0 27 Feet DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:117 Parcel:186 Board of Health N boundary determination or regulatory interpretation. Enlargements beyond a scale of the properties located Selected Parcel 1"=100' ay not meet established map accuracy standards. The parcel lines on this map Abutter List Type-Direct abutters(no set distance)and e prope tY E m are only graphic representations of Assessor's tax parcels. They are not true property across the street. Abutters boundaries and do not represent accurate relationships to physical features on the map such as building locations. Buffer S Engineering Works, Inc. 12 West Crossfield Road, Forestdale, MA 02644 Tel/Fax (508) 477-5313 January 22, 2016 Town of Barnstable Board of Health 200 Main Street B rnstable, MA 02601 Re: 933B Main Street, Osterville (Parcel ID: 117-186) D (ar Members of the Board, I O n� behalf of my client, Judy McAbee, the following request for variances related to a septic system upgrade, are being made. A complete septic system is being proposed to re�lace the failed septic system. Variance Requests are as follows: • 310 CMR 15.405(a)(b)&(g) — CONTENTS OF LOCAL UPGRADE APPROVAL 1 . A 4' variance, septic tank to property line, for a 6'setback. 2. A 15' variance, S.A.S. to crawl space, for a 5' setback. 3. A 6' variance, septic tank to crawl space wall, for a 4' setback. 4. A variance to the 10' setback requirement between sewer, septic tank or S.A.S. and water service, to allow a new sleeved water service to be ` installed within 10' of the septic tank and sewer. I Variance requests are being made due to site constraints. Sind rely, Peter T. McEntee P.E. AMP(,l�i f Engineering Torks, .Irc, I 12 West Crossiield Road, Forestdale, MA 02644 i Tel/Fax'(508) 477-5313 i January 21, 2016 Barnstable Board of Health 200 Main Street Hyannis, MA 02601 Re: 933B Main Street, Qsterville, MA Title Septic System Upgrade Representation Authorization Dear Board members: f hereby authorize Peter Mccntee PE to represent my interests for the subject project. .l6dy McAbee-Property Manager l i l ENTRY BEDROOM BATHROOM 9'X 10' 90±SF - BEDROOM LIVING ROOM 9'X10' KITCHEN 90±SF ENTRY U FLOOR PLAN 933B MAIN STREET, OSTERVILLE, MA a i Town of Barnstable P# /'Y Department of Regulatory Services Y BARNSTABLE, Public Health Division Date i l yip 1639. ��� 200 Main Street,Hyannis MA 02601r-T ATBD MAC a , Date Scheduled Time b'� Fee Pd. _ I ob �U Soil Suitability Assessment for Sewa e Disposal �3 Performed By: ��d-e/ I" �t%V �l �L J� (�Vjft sled By: 10'(G� LOCATION cot GENERAL INFORMATION` I.ocrincn.address (Z�, ,G� ,-cA CC-_k ,�,ca ' 1// �`✓1�i•✓� S t— G/o ?"�sc�y Yvlc�c�b�e � Add)es5 3-t(, cve ,;I .f;1 L e e-i fA Assessor's Map/Parcel: 1 ' Engineer's Name �,_I� (j "-t - �p e✓ (`1 c n 1 mot' NEW CONSTRUCTION REPAIR Telephone# Land Use l s i ✓� ;-�ec Slopes(%) J+ Surface Stones /V Q�� Distances from: Open Water Body A Il.�- ft Possible Wet Area AJ A'' ft Drinking Water Well .?�SZ� ft Drainage Way_ �fl Property Line it Other ft SKETCH: (Street name;dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) I 0 C� i Z ��/K✓✓�d 1 vl vNP (WA _ Parent material(geologic) rn6t�l<:::: h Depth to Bedrock Depth to Groundwater: Standing Water in Hole: p,, A Weeping From Pit Face Estimated Seasonal High Groundwater J j DETERMINATION FOR SEASONAL, HIGH WATER TABLE ' Method Used: Depth-Observed standing in obs.hole: in. Depth to soil mottles: — -- - — - "' - _ Depth Co weepling fronSside of6bs.•hote n. Groundwater Adjustment f1. Index Well# Reading Date: Index Well level Adj.factor_— Adj.Groundwater Level_ PERCOLATION TEST Date—_ Time (ibscn'vaticn Hole# ' p Time at 9" Depth of Pere ��I \+ G _ Time at 6" Start Pre-soak Time @ C� Time(9"-V) C- 15 End Pre-soak on �7 - Rate Min./Inch Site Suitability Assessment:, Site Passed 1/` Site Failed: Additional Testing Needed(Y/N)-- Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland, you must first notify the Barnstable Conservation Division at least one (1) week prior to beginning, Q:\SEPTIC\PERCFORM.DOC DEEP.OBSERVATION HOLE LOG Bole Depth from Soil Horizon Soil Texture .Soil Color Soil Other 4 Surface(in.) (USDA) (Munsell) Mottling (Structure;Stonea,Boulders. i CoLLLiltency,%Gravel) C o c -- EP-OB.S--I R.V.A.TION HOLE LOG.-- Hole#�Depth from Soil Horizon Soil Texture Soil Color soil Uther - Surface(in.) (USDA) (Munsell) Mottling (Structure,.Stones,Boulders. Consistency.%Gravel) Z 3i (2) fsn S��a L LS!k DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(iu.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. n dstency.%Gravel)-^ Z. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones',Boulders. Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No Yes r Within 100 year flood boundary No Yes Death 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? -- If not,what is the depth of naturally occurring pervious material? Certification C qG� �r, I;certify that on l� (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. Sig nature Date Q:\.EvnC\PERCPORM.DOC oe T� Town of.Barnstable P# /� % 3 w r� ---_ _.—_ y,�p tio� Department of Regulatory Services BARNSrABLE, Public Health Division Date l l T h MASS.v '� 1639. .`�$ 200 Main Street,Hyannis MA 02601 AIfD MAC(v - _ Date Scheduled Titne, Fee Pd. ( ' 3 Z_-` Soil Suitability Assessment for Se wa e Disposal _ Performed By:• U �S—I i s led BY: LOCATION & GENERAL M INFORMATION t.�cati�n Ad tr��s c�..33 �•.� S ,— ��o �-�dly IMF/��.b-�� ® 5'!e�V.1lA ne Address !✓r0, Gc K. '3�l to l �h;t e M A Assessor's Map/Parcel: �.�'"j _- Engineer's Name ;�,�� Mcnh�� NEW CONSTRUCTION REPAIR Telephone# ,Ql F- -737— L 760F Land Use s\04 Vk+?e�� Slopes(%) I� �" Surface Stones /V �/ Distances from a/: Open Water Body A— ft Possible Wet Area A) A' ft Drinking Water Well .7/5V ft ('� Drainage Way �fl Property Liner/'ft Other ft SKETCH:(street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes) r�iltt�-t;�tea i . Z Parent material(geologic)_6�ca6�1��>l� Depth to Bedrock Depth to Groundwater: Standing Water in Hole: i\,J-( /.x Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEA SONAIL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: _in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment fl. Index Well# Reading Date: Index Well level Adj.Tactor Adj.Groundwater Level PERCOLATION TEST Date Time — (Ascrvaticn !— -- Hole# �`` Time at 9" Depth of Perc Time at 6" Start Pre-soak Time Time(9"-6") End Pre-soak S A, Rate Min./Inch L Sitc Suitability Assessment: Sire Passed L_.,' Site Failed:. Additional Tcsting Nccded(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back------------ ***If percolation test is to be conducted within 100' of wetland, you must first notify tine Barnstable Conservation Division at least one (1) week prior to beginning, Q:\SEPTIC\PERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole t)cptli from Soil Horizon Soil Texture .Sdil Color Soil Other Surface(in.) (USDA) ,(Munsell) Mottling (Structure;Stones;Boulders. Consistency,%Gravel) C l Z 15''Y G N - --- DEEP OBSER.VA.TION.HOLE LOG _ _ Hole_ _#_!^2- Depth from Soil Horizon Soil Texture Soil Color Soil Surface(in.) (USDA) (Munsell) Mottling (Structure,.Stones,Boulders. Consistency.%Gravel) 3i -iZU ----------------- DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. n si,5tencv.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. s',tenov.%Oravel) Flood Insurance Rate Man: Above 500 year flood boundary No— Yes Within 500 year boundary No Yes :. Within 100 year flood boundary No Yes Depth o_ f Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the ej area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? Certification 'r- I'certify that on �� q� ` (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 10 CMIt 15.017. Sign ature Date Q;\S EPnCTERCFORM.DOC Town of Barnstable P# j740 �Op INE - e� Department of Regulatory Services +.RARNSTABLE, Public Health Division Date y MASS. I t V i t l apA 1639• 200 Main Street,Hyannis MA 02601 � Date Scheduled .S 1 .� Time4ry -Fee Pd. 00 ; Soil Suitability Assessment for Sewage Disposal J� d114 104IS- Performed By: sC—QS Z_ Witnessed By: i • LOCATION & GENERAL INFORMATION Location Address Owner's<,n 5� Owner's Name AC ,,A :. -I� Lee LCe(4 Address fitee�(i tr► 0 2`t qt( 4 Assessor's Map/Parcel: "'" ( �S J t Engineer's Na • e ; 4 NEW CONSTRUCTION REPAIR s} t» L Telephone# j S— 73 J^(f76,F t ••.rra.F Land Use Slopes_(%) Surface Stones a f Distances from: Open Water Body / -/® A PossibleWet Area?cS 6 .^ft Drinking Water Well ~2f> "ft Drainage Way /"/ ` ft 'Property Line � Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&Pere tests,locate wetlands in proximity to holes) Parent material(geologic) orJ�� 0, Depth to Bedrock fll Una Depth to Groundwater: Standing Water in Hole: /`Q� Weeping from Pit Face fEstimated Seasonal High Groundwater 7(&5— 0 DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: _in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment n. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_ I PERCOLATION TEST. Date Time Observation x Hole-k- Time at 9 Depth of Pere �q Time at 6' I . jStart Pre-soak Time @ �Z Time(9"-6") i End Pre-soak Z II Rate Min./Inch Site Suitability Assessment: Site Passed L 'L Site Failed: Additional Testing Needed(Y/N)—_ ra, Original: Public Health,Division, Observation Hole Data To Be Completed on Back----------- ***If percolation^tesCis to'be conducted within 1'00' of wetland, you must first notify the Barnstable Conservation Division at least one(1) week priorAo.beginning' 'ti •,. � '� Q:\SEPTIC\PERCFORM.DOC '1 ) DEEP.OBSERVATION HOLE LOG Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. iteGravel) t-OCAP-1 eAILA to i'�-y I z- ,•z-�Z U- Lx I DEEP OBSERVATION HOLE LOG Hole# 61epth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) _ (USDA) (Munsell) ivlottling (Structure,Stosos,Bould^rs. Consistency,%Gravel) — 10 t wt Iola, /z 11 -1) D DEEP OBSERVATION HOLE LOG _ Hole# Depth from Soil Horizon Soil Texture Soil Color Soil, Other Surface(in.) (USDA) (Munsell). Mottling (Structure,Stones,Boulders. I iit,ency.%Gravel) r j DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones`,Boulders. o •'Itencv,96 Grnvell_ rq w j 11 i 1 , Flood Insurance Rate Mau: , Above 500 year flood boundary No_ Yes ,.. Within 500 year boundary No D Yes Within 100 year flood boundary No Yes ' Death of Naturally Occurring Pervious Ma terial Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? Certification I certify that on �T�—an' (date)I have passed the soilevaluator examination approved by the Department of Environtal Protection and that the above analysis was performed by me consistent with . the required ng,expertise and experience described in 10 CMR 15.017. --- i SI gnature - Date [ t � i f i Q;�SEPTICIPBRCPORM.DOC i y down cape engineering, inc. SIEVE SOILS ANALYSIS 933D Main Street Osterville, MA DATE OF REPORT: 1/15/16 .JOB : GRAIN SIZE ANALYSIS-SIEVE TEST SITE: 933D MAIN STREET, OSTERVILLE - LOCATION: ENGINEERING WORKS TEST HOLE SIEVE ANALYSIS Weight Sample(Grams): 164.2 SIZE WEIGHT RETAINED € % RETAINED € . % PASSED (sum 1" 0.0: 3/4" 0.0; 0.0% 100.0% -------------- ................................................---------------------------------------------- 1/2" 0.0€ 0.0%€ 100.0% -------`----__::.....:.:................::......::::.................}----=--------------'-r------------------ 3/8" 0.0; 0.0%? 100.0% -------------- ......................................................---------------------------------------- #4 0.0€ 0.0% 100.0% --------------.............................................••••.....}---------------------0..................................... #10 4.9 3.0% 97.0% -------------- ......:::::....:.....................:....:......:...:------------------o- .....:...::..:..... ... ............. . #20 € 34.3' 20.9/o: 79.1 /o --------------!---.--„--------------------------------------------}---------------------i..................................... #40 82.4; 50.2%' 49.8% --------------:...........................:.................. . -- ----------- -. ........... _ . ,... #50 _ _ _ 110A -_;_': 67.2% ... .32.8%_____- _p.. ..... .:... ...........} -----------------y.. --........... 141.3.: :. 86:1%@ 13.9% ------ .................................................. -... .. .... . ------- #100 149.8€ 91.2% -. 8.8% --------------......................................................}---------------------}------------------ #200 159.7' 97.3% 2.7% .................................... PAN: 162.3 100.0%•--- 0.0% ------------ ------- -- SAMPLE: 164.2 NOTE:TEST ON PASSING#4 ONLY, 0.4% RETAINED ON#4<45%O.K. RESULTS: SOIL CLASSIFIED AS AASHTO A-1-b(GRAVEL &SAND) (UNCOMPACTED) PERCENTAGE OF MATERIAL PASSING#4 SIEVE : #4 100% (TEST ONLY MATERIAL PASSING#4) OK #5010%-100% OK #100 0%-20% OK #200 0%-5% OK SAMPLE MEETS TITLE 5 FILL SPECIFICATION, >97%SAND RESULTS: PERMEABLE-MATERIAL-CLASS 1 <2 MINJIN. MATERIAL(0-7 0-MIS ) Z NONCOMPACTED NOFMAssq� SOIL DESCRIPTION: MEDIUM SAND Boa DANIELA. yes o OJALA a o CIVIL Cn 1 .o o, c IST �? �sS/ONAL��G FILE COPY COMMONWEALTH OF MASSACHUSETTS z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS i , a DEPARTMENT OF ENVIRONMENTAL PROTEMON �< PARCEL ;�1 $ p ' LOT To), X0D TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 133 MA1N �rm U `rr5 COTE i L 11,5 rVA .^r Owner's Name: _ANo j4btmMC, RECEIVED Owner's Address: SAME Date of Inspection: E5-29 o SEP 2 9 2003 Name of Inspector: (please print) Brad J White TOWN OF BARNSTABLE Company Name:Windriver Enviromental HEALTH DEPT. Mailing Address: 107 N.Main Street Carver,MA 02330 Telephone Number: (508)-866-2503 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). .The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. a Notes and Comments ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: S—k2c'zT Uts i i 5 OSiY.2U i t t , wti4 C2 01 s - Owner: HGOACAZC(_ Date of Inspection:t�-29 -0?) Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: V1 I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 T41A G T--.,+;- P -m 4/1 1;/100A Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:g1, :3 M A I N 61a-e-r--, (u a,,5 6,k D) Owner: Ndnn." Date of Inspection: C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _r The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: T41A s rn—,ft—V--4n r'11nnn 3 Rage 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUN TARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) -Property Address:Ci'-3^7 M A(N STn- v.v :S 6-3 3) 0'G'n=o-L:1 L L r 1AAA Owner Date of Inspection: a 7.9 -o'3 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool L Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6."below invert or available volume is less than''/z day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped V Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] ND (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no 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 t If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST - Property- Address:�(3) W1Aia N rS 8 D) Owner: Ht--)Mj►'1,� . Date of Inspection: pj-2ej Check if the following have been done.5(ou must indicate"yes"or"no"as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection'? Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up'? Was the site inspected for signs of break out? Were all system components,excluding the SAS,located on site? Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no Existing information.For example,a plan at the Board of.Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:C Q3 ytn.Ain} STD -; CUty Vr {� { Owner:}Awnm Date of Inspection: Pj-2ri-C 3 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): of bedrooms(actual): j DESIGN flow based on 310-CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: 1 Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no):NSo [if yes separate inspection required] Laundry system inspected(yes or no)•`1-, Seasonal use: (yes or no): Water meter readings,if available(last 2 years usage(gpd)): tJ va Sump pump(yes or no): Last date of occupancy:,t.�,;j ,.I T) COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: PC-2 Was system pumped as part of the inspection(yes or no): tic' If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓Septic tank,dutieuhax,soil absorption system Single cesspool _Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components, date installed(if known)and source of information: IQgP20.1C t ►a0 PC n As-ao j Were sewage odors detected when arriving at the site(yes or no):NO 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: A Its :�TQ-eZi (U0,3 1T 6'3 D� ( L•'YIA Owner: W6,MM Date of Inspection: 013 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:_castdron _40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting, evidence of leakage,etc.): SEPTIC TANK: ✓(locate on site plan) Depth below grade: Material of construction:,/concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: ] Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness:— �% Distance from top of scum to top of outlet tee or baffle: q Distance from bottom of scum to bottom of outlet tee or baffle: (1 How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels nas related to-outlet invert,evidence of leakage,etc.): 0 1�2A?T11- '1'A r3 1e-, U y 0 r (Z ��Tl Rt rC r S Nc, t�S•(`_[�SS - G�tM�g� �'2Gnn . n�65Pn:yc, -ram 't'.aNc GREASE TRAP:_(locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): T;AA c r­P,.r;, T7 . 411 7 Y, ..15age8of11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: M A l\1 S i(2, —r (U N rr S f3 3-Z� Csi o Owner: 00+V%nn c(_ Date of Inspection: Fj-21-1 -03 TIGHT or HOLDING TANK: -(:tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: NIA(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): T41A G Tnc., +it PA—4/1 v)nnn 8 'Page 9of11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: hA A o N Owner: LAC NLM z-t_ Date of Inspection: Z�l SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type .,r ,� leaching pits,number: 1 r.� �,'x C• leaching chambers,number: leaching galleries,number: leaching trenches,number,length: I leaching fields,number,dimensions: overflow cesspool,number: innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): SC:II �S nt?y Py[ ylF�(`rj [fir. ;4 y inn t_EAILL)2tt' t 5 tv in r ,wie-L d_ 0 G C b Qra n raC•r ram r C-7,g C'_ 1 N e P I-T 2- ra4m 10,PC TO S-An�Q iastf A-T-U—Z CESSPOOLS: ✓ (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: i I i A K of.A.C.-, Depth—top of liquid to inlet invert: F,v 'mod S�ftrt�i'bAlc- G�1la•r-z_=-� Depth of solids layer: 1" Depth of scum layer: C,-' Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): "n Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 3'D c (S f-)o--f No [31&6\3s n H-f,'Jrutuc.,t.c p n NoinrG- PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): r;*iA a Tn .,fi n,, ,,,Ail 9 i . Page 10 of 11 e OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: �!'?�?� 61AI1J 'S "xr (t�ry S 6 o> Owner: l 6MM -, L Date of Inspection:¢,r267_c r:� SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet. Locate where public water supply enters the building. AA A I 'y i d v • � FEwCr-�I 6 �J aFCX7c_ L T 3 31tx t,EaC►ti�rC T—ctic M tj T. V rj T - 5 T;+IA t r„.„A,.+;--F,,-F/1 10' Page 11 of 11' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 9`b,?5 bjA i j,.A Owner: y:y�nn Date of Inspection: -p'3 SITE EXAM Slope Surface water Check cellar Shallow wells y •1 9 Estimated depth to ground wafer feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: FO:�-CJ ti13iTU Aare 1-EC Jc�` A7r_) t?L'oJQQ,0ga3'Y� T;+1. TOWN OF BARNST LE 9 -QCATION / i4 I®✓ �`1� - SEWAGE#Jkai . VILLAGE 5TeR l//G1 R ASSESSOR'S MAP&LOT ' T111 - 4P INSTALLER'S NAME&PHONE NO.. T/F ./W A c C)itil /n ex t. O� SEPTIC TANK CAPACITY fn LEACHING FACILr Y: (type) Y"ZOD FLDW CPA—yPPhiKsize) T NO.OF BEDROOMS BUILDER OR OWNER -�L PERMTTDATE: 7 COMPLIANCE DATE: 0/°7 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 ✓�1Af s Noll, 1.2 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........OF ...RNA - .h --------------------------------------- � 1 � '� lirtt#iun for Disposal Works Tons#rur#iun Frrmi# Application is hereby made for a Permit to Construct ( ) or Repair. (than Individual Sewage Disposal System at: ....... ...t.�. �.6::e.� .. ..................................... ........ +D..........`fZ _?�..�� . --....•..... ......................._...... Location•Address or Lot No. -------------------- ...................%S_'A .................................................---.--- Own Ad�ess a .............G �p �..; - ?- --................ ......... �. ...... �-�!���----........... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms....s ....................... .Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers — Cafeteria a Other fixtures ........................ -------------------------------------------------------------------- --------------- ...:...... Q W Design Flow........ 7,'S:..........................gallons per person per day: Total daily flow........L3 j�-6)......................gallons. WSeptic Tank—Liquid capacity............gallons Length..............6.Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length............ Total leaching area....................sq. ft. 3 Seepage Pit No......I............. Diameter... .......... Depth below inlet..6.1_........... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) `" Percolation Test Results Performed by------=-------•...•--.......................... .......................... Date........................................ aTest 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........................ a --------------------•-----......._.............................----•-...._..........---------------.....-----........---------------------•-----•--.......--- 0 Description of Soil.........................•-••-••••••-•-•••--•----.................•---••--......----------------•---•-••-------•------...........--••----------...._.._.._.._-----.----- W --- . V ---------------------------------------- ---•------------------------------------------•........._--•....._..... --- •-------•-----------... -----------......--------------- W -••-•-------------------------------------------------------------------•-•------------------------------------------•---------------------------•..._-------- ............................--- U Nature of Repairs or Alterations—Answer when applicable.......1�'-im-------v �..-�!:� �..fakm--W ----.--- •-•••-.. Q`e - ............................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITL L 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 bo iealth ..... 1.r..�........9Signed '\ L Dat 0-- Application Approved By.............. ................................. -•---------�� j Date Application Disapproved for the following reasons:............•....__......._.__..________.__....................____._._.__._.._........._...._...........__._.- ........................................................................•-.........----•---._.......-----------------------------------------------------------------------......--------------......... Date PermitNo..... - . ... .... ............_ Issued..................................................... Date THE COMMONWEALTH OF MASSACHUSETTS 4 ,` BOARD OF HEALTH G �. / - � ' Appliratiun for UtsvnMl arks Tons#r dion rrrnttt -� Application is hereby made for a Permit to Construct ( ) or Repair (t..-),11an Individual Sewage Disposal ' !•t Systems, at: r ....... ..�.. . � ��., h. -----------••••---•-•--•--••......... .......................---....-.0.15isi?v. Location-Address or Lot No. ° yr a i 5� - •..•.......!........ ,............................................... .._..... Ow Address GA .Pr' y=n � _ .... t� ..1 ...... VLII ................. Installer Address Type of Building \� Size Lot............................Sq. feet Dwelli No. of Bdroo; s`S.A .............. ...... ." ...................Ex Expansion Attic� ng— •_-_--- pa r (' ) Garbage Grinder ( ) aOther—Type of Building ..............:............. No. of persons..........I.................. Showers ( ) — Cafeteria ( ) d Other fixtures ........................................................ -------------------------------=---':-::.•----------•--------.......:..---------- W Design Flow......-�.�.........................gallons per person per day: Total daily flow...... c3 ......................gallons. WSeptic Tank—Liquid capacity.............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench_—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No._A............. Diameter...1:O-+.......... Depth below inlet..�6. leaching area..................sq. ft: Z Other Distribution box ( ) Dosing tank ( ) r ., Percolation.Test Results Performed by................................ .................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... . Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water a water............_......._ �N { ® Description of Soil..................... �C , - U . • ..............•--•--•-•---...:------------•-............-----..............----------------.....-----------.....--•-•-.................---- ....:.......- +. ..... ........ . U. ;Nature of Repairs or Alterations,—Answer when applicable......A10 .......)1ti-�------ ... �T:usa7_....... ... ......"�K �` r t..... -:C-_ . n 1� .n :_ !. .........................................1........... Agreement: 1 pThe undersign d agrees to yinstall the afoedescribed Individual.Sewage Disposal System in accordance with the rovisions of :..>v.I. 5 of the State SanitaryCode— The undersigned further agrees not to lace the system in . ' .operation until-a Ceftificate•of Compliance has been issued by the boar health Signed �._.. Z -- D.10 -- .--••- ••. r ate D q, Application Approved By.............. k � - .. d ' Date, Application Disapproved for'the following reasons:.:.......::.....:............•-••••••••••-•-•-•-•-••••-•••-......--•------•-.........••--......---•-•......--- •--------•---•-•--•........--•--........••. 1.................................................... ... A +�, 1t1��. •' (.�7 . 1� ..............................................................Date Per�init No........ ,.. -..._- Issued...• ._........._s.............. Dater !. THE COMMONWEALTH OF MASSACHUSETTS { 1 BOARD OF HEALTH r , ......1.., 7.. H- '--........OF..,..11 .�5 .i4A .. ......................... t (9rdif irFt#r. ,af f9,antpliana .t THIS IS TO-CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by..................I-..,_ ..L�.!n-c.- '--!Os:N!� - ��-' � � -,...................:... .................................... ..r- ........._... Installer at--••................... ...... I�. . . ;n_l�: ._ .. = - • . . •-•--••-•-••.............••--•••-••--••- j has been installed in accordance with�the provisions of TITLP 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.... c---�.Z7...... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 5Y , DATE.......................•••-••-••-•............................................. Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH pp C��! .......OF....�.t.... � ..�T d'� _ �Isp asal Works (tunsfrnrtiutt rrrntit Permission is hereby granted............C 1A �_..1 16.1A TN'.... •.!7.....:........:.................................................. = •... rr to Construct ( ) or Repair ( L) anzIndividual Sewage Disposal System . at No.... .... ..... �n l G _ "' ......... ....... ...........••--•••••-•-•=.................•-••••......•-••................ . :: --....._ -..... � -� Street as shown on the application for Disposal Works Construction Permit No.�, �_ Dated.......................................... .................................... .- .............................................- r 7 — J Board of Health DATE................ �/•-----•--•----...------------- V O CATION S E E PERMIT NO. VILLAGE INSTALLER'S NAME & ADDRESS i1 �447Llls-a Z ztoj OR OWNER DATE PERMIT ISSUED r21 _ ���� 'DAT E COEIPLIANCE ISSUED 6 / 7 _ �v 4 a IT n 3 i ss��o 1 E No.......t1��f:........ Fes$.... .................... THE COMMONWEALTH OF MASSACHUSETTS <. l fe ? 1......- OF.......... ...... ...... .... - ----- .--...........---.------ Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Not-4,ddress or....-- dQ.. ---•--...... ate. ' .- - .. -Al �.................. W dres Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of.persons............................ Showers — Cafeteria Q' Other fixtures ............................ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width.............:__ Diameter__- __--__-_- Depth................ x Disposal Trench—No. .................... Width..................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) . Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest 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........................ P4 ----•--------------•------------•---•---...--------•-•-----•-----------.........-----------=---•••--......................................................... 0 Description of Soil........................................................................................................................................................................ ----- ------------------------------------------------------------------- ---......................... U Nature of Repairs or Alterations—Answer when applicable______ �' ....... -- ---- --------•--------------------•--...-----------------•------------...... ........ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of:T T L p S of the State Sanitary Code- The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i sued by the boa: of health. Si d---- = ------- ....... ---- ........' "... ................. -- -------------------- -...... ' Date Application Approved B � . � ' L! ' ate Application Disapproved for the following reasons------------------------------------------------•-- ............................................................. •-------------------••--------------•------------------•-•--...--•--------------•--.........------....•-•----------•---------------•--------------•---------------....-•------------•-------•---------- / Date Permit No......................................................... Issued....... .._...� -`--�--- Date l� �r No.--•�-.J p ....... Fmc...........''.......... THE COMMONWEALTH OF MASSACHUSETTS BOARD 1............0 F...................: Applira#ion for Disposal Works Tontrnrtion Vantit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal S stem at- ..... .... . _ .. .._... � �. :............... . -- y .: .e : / Locatio - •ddress c y"' or' r l ! ...... . ..�'� >__--••_•_^•_- ` -- ........................................ Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aa Other—T e of Building No. of ersons____________________________ Showers YP g --------------•------•-•---- P ( ) — Cafeteria ( ) Otherfixtures --------•---------------•---•--••--- --•••-----------------------------•-------------•-•-•-------- W Design Flow............................................gallons per person per day. Total daily flow.........................................___gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 4q Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ix --••-•--•--••••••----•••---•••-••••••-••---•-•-•-••--•----•...••--------------•------•••••-..._.__...-------._....._.........----------....-------..__....... 0 Description of Soil........................................................................................................................................................................ x c, UW1----- -----------�--- ------ ------------ a. Nature of Repairs or Alterations—Answer when ap I• able._..__ ,J �z ______ _ ______________ •--------------------------------•-••------•--------------------------------- '' -'- i - ....................................... Agreement: r The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'T`:L: p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i sued by the bog of health. Si .. -----•• _ _ ..................... Date Application Approved BY r l _ - '........................ .> A ..�_ _ d• Date Application Disapproved for the following reasons-.............................................................................................................. ----------------------•---•-----•------------------------------..-----•------------•--------------------------------------------------------------.-..------------------------------------------------ Date PermitNo...................................................... . Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH vo IS .. ./---tv'. N.........OF................ . ... (5rdifiratr of TontpliFatta Z11— .. TH I 0 CER IFY at the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ••�l`. c t 1.``1�... _ __f.�.... " �----------- ,rr ------ nst�l l 7­,7 er r i � � has been installed in accordance with the provisions of T r o, The State Sanitary �e As scribed in, _tl�?e application for Disposal Works Construction Permit N- ._.____ _________________ dated--- . f � -J''�--/ ---.fir..•-- •--•-•--••••- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. -- DATI:................................................................................ Inspector........................•........................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............. /...•�f...� ......OF.............Zav-g! ............_.._.._...._.._...._._............ �^a No......................... r FEE........................ Sartrwtion anti#Permi ion is hereby granted _.._ _�..... = to Cons u'Ct ( ) r ep i an In rvidual S .vcrage Dispo aY Sy tem �p g at No.'. !3C_. ..1t ----._..... ... •C� '!-: ....' � -- •. ~ / Street as shown on the application for Disposal Works Construction Perm t , o.....__._�Z�__ ated_..__2:._.............................. Board of Health (� DATE................................................................................ V FORM 1255 HOBBS & WARREN, INC., PUBLISHERS d LEGEND N -- 98 -- EXISTING CONTOUR ® MEADOWI- ARK LANE x 100.98 EXISTING SPOT GRADE BLOSSOM LN BENCHMARK W EXISTING WATER SERVICE MAGNETIC NAIL W PROPOSED WATER SERVICE EL.=10 1.99 Z 5 W PROPOSED WATER SERVICE 1 17-183 (SLEEVED) WATER METER PIT 8 G EXISTING GAS SERVICE RIV TE � --0•H•W. -OVERHEAD WIRES Z 1 17-182 \105.10 TEST PIT N \ 106.16 10' 4 PROPOSED 102.O1m \ 10 •54 \\ \\ \ BENCHMARK LOCUS 1 17-087 SEPTIC TANK _ \\ \ \k 933 D STRIPOUT BOUNDARY 100.22 \ \ 3 0 �� i LOCUS MAP SEE NOTE 11 \ \ 3105.45 f ,, NOT TO SCALE WATER SERVICES TO ALL PROROSED \\ ice ' I x 104.4,9 \ \ \\ a GENERAL NOTES: OTHER UNITS (APPROX.) SAS. (a prox.) W � GRW S�lSb4ND� �� \ 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. 99.11 W 6\2.81 (Opp 9x•) O W 10 \ PROPOSED 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS o `P z 39 FLAG OLE 105,30 \ S.A.S. OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE W \ LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW: ED�rA V \ -310 CMR 15.405(1)(b)(f)&(g): G P`Zj - OF p4v.TjBE \� p IVA I I \ 1) A 15' variance, S.A.S. to crawl space, for a 5' setback. 99,19 `99.77 _ _ _ R 101.37 - 1 ��]j/j ^ / \ 1 17-184 2) A 4' variance, septic tank to crawl space wall, for a 6' setback. 102.5 G X/ ,�j 3) A variance to the 10' setback requirement between sewer, septic CATCH BASIN 6 LAMP a 3 C�7 tank or S.A.S., to water service, to allow a new sleeved water service DRIVE WY. ,�� � x Pero OPEN BOTTOM :' . P :OR�E Fps / to be installed within 10' of the septic tank. RIM=98,00 F. F'r�; � �(/ .y / F 107.01 4) A 14' variance, S.A.S. to leaching catch basin, for on 11' setback. 03,20 A P OrA�/�' TO �A^/^/ 5) A 9' variance, S.A.S. to drainage field(approx.), for a 16' setback. \ N •- G.. \ RET. f"` :• ;: /V/r MAIN V STREET 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 1 17-181 91' � � 0 O WALL 104(�2i�p ';,.� \ lBFQ� / y TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE \ 3 -_ ;_J DESIGN ENGINEER. 99• 1 :. .. 9;O 5,23 71® x105.5 106.98 107,97 4• ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 933F EXISTING CE 05 0 I ENGINEER BEFORE CONSTRUCTION CONTINUES. F-~ IO \ HOUSE 933D I 5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM. I 1 I°' (# > 101 3 1 #9338 I 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF W IT. 100.45t 1 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF I III 1� SEWER INV.=98.45f � W W HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. I R,4PNOX. I C 23 Opp `_ 7. WATER SUPPLY PROVIDED BY TOWN WATER SUPPLY. FIELD I 98,6d P C PATIO G P T10 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED SEPTIC SYSTEM. H.I _0 H. 1 9-7 I x b HE ( 46 _-0; 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS 100,09 ---_ - G --- _ AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE H D 104.65 T- DIRECTED BY THE APPROVING AUTHORITIES. 99,95 100. y 1 17-186 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY INSTALL 40 MIL POLY LINER ` INSTALL l C THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING TOP OF LINER, EL.=97.5 �� CLEANOUT 1p14423.40 _------ ------- CONSTRUCTION. BOTTOM OF LINER, EL.=94.0 Z\ 3 W \ 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS io` \ PROPOSED IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND 97.87 OA m \ Ui9 \ SEPTIC TANK__ _ REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). x N - 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE �'\ 10L l 103_2� E9ISTING SEPTIC TANK INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. FENCE 44' \`, (PER INSPECTION ASBUIL,T) 13, THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMANTED EXISTING \� > -___ TO BE_REMB•VEa�;8'2-------- SEPTIC SYSTEM COMPONENTS NOT SHOWN ON THE PLAN. OF Mqs� IP FND x _ •7 2-- _ - - I 14. CONTRACTOR SHALL TAKE ALL NECESSARY PRECAUTIONS TO MAINTAIN THE 97.76 101.57 EXISTING CESSPOOLS THE STABILITY OF ADJACENT STRUCTURES AND RETAINING WALLS. o PETER T. ('� TO BE PUMPED, FILLED WITH 'SAND 15. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND McENTEE LOCUS AND ABANDONED OR REMOVED IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. `� EXISTING WATER SERVICES ' PROPOSED SEPTIC SYSTEM UPGRADE PLAN CIVIL PARCEL ID. 117-185 No. 35109 TO BE REPLACED WITH NEW �oFs�GISLER ��� 4988 fSF SLEEVED WATER TO EACH BUILDING 933D MAIN STREET, OSTERVILLE, MA Prepared for: Lee Kentros, 720 Highland Avenue, Needham, MA OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO. KENTROS, LEE EngineeringEngineeringWorks, Inc. 1"=20' P.T.M. 263-15 lQ 1C(o PLAN REVISION - 2/10/16 720 HIGHLAND AVENUE 12 West Crossfieldd Road, Forestdole, MA 02644 DATE CHECKED SHEET No. ADD POLY LINER NEEDHAM, MA 02494 (508) 477-5313 1/5/16 -P.T.M. 1 of 2 Ar NOTE: TO PREVENT BREAKOUT, FINAL GRADE SEPTIC TANK SHALL NOT BE AT, OR BELOW, E'=97.0 INSTALL RISERS' & COVERS OVER INLET & FOR A DISTANCE OF 15' FROM THE EDGE OUTLET AND SET TO 6" OF FINISH GRADE PROPOSED D-BOX OF THE PROPOSED S.A.S. CRAWL SPACE FLOOR INSTALL RISER & COVER PROPOSED S.A.S. EL.=97.7t SET TO 6" OF GRADE INSTALL RISER & COVER OVER EACH CHAMBER AND T.O.F=100.45%P SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT l­­16.5'_--1 F.G. EL.=100.2f F.G. EL.=100.1t F.G. EL.=100.1f F.G. EL.=100.O± 1 O� °° 1 L = 18'(MAX.) t S(max.) L = 6' ® S=1% (MIN.) ® S=1% (MIN.) ® L- 5, 1 6 ro 4"SCH40 PVC 4"SCH40 PVC 4"SCH40(PVCMIN.) 2" LAYER OF 1/8" TO 1/2" DOUBLE WASHED STONE �o"I as $ ea (OR APPROVED FILTER FABRIC) 14 s aaa sae EXISTING HOUSE(#9330) ®sasses ssaBSBa IT. F.=100.45t INV.=98.00 48" LIQUID �'-3/4" TO 1-1/2" DOUBLE LEVEL ADD INV.=97.32 P� V. PROPOSE 4' 5.2' 4' WASHED STONE SEWER IN =98.45t cas BASE INV.=97.15 INV.=97.75 D_BOX EFFECTIVE WIDTH 3 OUTLETS INV.=96.50 P C PROPOSED SEPTIC TANK 1-500 GALLON LEACHING CHAMBER SURROUNDED WITH STONE,AS SHOWN CONNECT TO EXISTING SUITABLE SEWER PIPES AT HOUSE, AT OR ABOVE, INV.=98.45 H-10 RATED TOP CONC. ELEV.=97.3t A BREAKOUT ELEV.=97.00 SEPTIC LAYOUT NOTES: INV. ELEV.=96.50 ea®Ba 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE a�aaeeaeaaa a aaaaaBaaa INVERTS, PRIOR TO INSTALLATION. BOTTOM ELEV.=94.50 2) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND 4' 8.5' 4' TRUE TO GRADE ON A MECHANICALLY COMPACTED 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH = 16.5' SIX INCH CRUSHED STONE BASE, AS SPECIFIED PERVIOUS MATERIAL IN CMR 15.2 5 (MIN.) ABOVE G.W. Ea®®Ea 0 3) INSTALL OUTLET INLET & OUTLET TEES AS REQUIRED. LEACHING SYSTEM SECTION.W., EL.=85.7 NO G =_ 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE I-- ®®®®®® ® ®®®® 33" AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. .4. W ®®®®®® ® SEPTIC SYSTEM PROFILE N Z ®L-ffE@ 102„ SOIL LOG DESIGN CRITERIA DATE: DECEMBER 14, 2015 (REF#14,908) 4" KNOCKOUT SOIL EVALUATOR: PETER McENTEE (SE#1542) 20" DIA. COVER NUMBER OF BEDROOMS: 2 BEDROOMS WITNESS: DAVID STANTON R.S. '- HEALTH AGENT SOIL TEXTURAL CLASS: CLASS I (EFFLUENT LOADING RATE=0.74 GPD/SF) Elev.. TP- Depth Elev. TP-Z Depth 4" KNOCKOUT / 4" KNOCKOUT 58" DESIGN PERCOLATION RATE: <2 MIN/IN 99.7 q 0" 99.5 q 0". ! DAILY FLOW: 220 GPD LOAMY SAND , LOAMY SAND DESIGN FLOW: 220 GPD 98.7 12"10YR 4/2 I987 10" 10YR 4/2 4" KNOCKOUT GARBAGE GRINDER: NO-not allowed with design B B LOAMY SAND LOAMY SAND LEACHING AREA REQUIRED: (220 GPD) = 297.3 SF 10YR 5/8 .10YR 5/8 500 GALLON CAPACITY, H-10 LOADING .74 GPD/SF 97.0 Cl 32" 97.0 Cl 30" CHAMBERS PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY SILT LOAM SILT LOAM PROPOSED D-BOX: 1 INLET, 3 OUTLET (MINIMUM), H-10 RATED 10YR 5/3 j 10YR 5/3 N.T.S. 90.4 111 90.3 110" USE 1-500 GALLON LEACHING CHAMBER SURROUNDED C2 CZ PROPOSED SEPTIC SYSTEM UPGRADE PLAN WITH 3/4 to 1-1/2" DOUBLE WASHED STONE-ALL SIDES (SAMPLED) 933D MAIN STREET, OSTERVILLE, MA SIDEWALL AREA: 2(12.8' + 16.5') x 2 = 117.2 SF MED. SAA ND � MED. SAND BOTTOM AREA: 12.8' x 16.5' = 211.2 SF 2.5Y 6/6 } 2.5Y 6/6 Prepared for: Lee Kentros, 720 Highland Avenue, Needham, MA TOTAL AREA:..............................................................328.4 SF Engineering by: SCALE DRAWN JOB. NO. 85.9 165" 85.7 165" Engineering Works, Inc. N.T.S. P.T.M. 263-15 DESIGN FLOW PROVIDED: 0.74 GPD/SF(328.4 SF) = 243.0 GPD NO GROUNDWATER ENCOUNTERED 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. PERC RATE: <2 MIN/IN PER SIEVE ANALYSIS) (508) 477-5313 1/5/1 6 P.T.M. 2 Of 2 f , r t` LEGEND N -- 98 -- EXISTING CONTOUR ® MEADOWLARK LANE x 100.98 EXISTING SPOT GRADE BLOSSOM LN BENCHMARK W EXISTING WATER SERVICE MAGNETIC NAIL W PROPOSED WATER SERVICE WATER SERVICES TO ALL EL.=101.99 W PROPOSED WATER SERVICE OTHER UNITS (APPROX.) 1 17-183 (SLEEVED) WATER METER PIT G EXISTING GAS SERVICE RIV TE WA y 1 17- 182 \105.10 _ H.W.-OVERHEAD WIRES Z\ \ 106.16 10'/ TEST PIT ' PROPOSED 10 •54 \� \ t BENCHMARK LOCUS SEPT TANK \102,01� \ 933 E \ gs h 100,22 \\ \\ � 105.45 \� LOCUS MAP 104.4�9 ��\ ,\\ � NOT TO SCALE P'R'OROSED GRASS�IS6AND GENERAL NOTES: 1 17-087 S.A\S. (a prax.) W ,\ \ e 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL 62.82 10 5 BOARD OF HEALTH AND THE DESIGN ENGINEER. \ \ (Opp � 0 W \ \ PROPOSED 2• ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 99.11 W \ 2 \ \LO�FLAG OLE 105.30 W\ \ S.A.S. OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW: W -310 CMR 15.405(1)(a)(b)&(g): Piz-S EDG�r OF P \ j i \ 1) A 4' variance, septic tank to property line(side), for a 6' setback. 99,19 x gVT�BER '� 101.37 I VA \ 1 17-184 2) A 15' variance, S.A.S. to crawl space, for a 5' setback. 99.77 �. 10 ,58 G 3 .C'1 •Y � 3) A 6' variance, septic tank to crawl space wall, for a 4' setback. LAMP °Ppro 4) A variance to the 10' setback requirement between sewer, septic �q "* o Ep /t tank or S.A.S., to water service, to allow a new sleeved water service �p .VE. �L CF OF n 107.01 to be installed between the S.A.S. and septic tank. �..�:...,.;;". "•`..` :1 O Y Imo--26 / 1 20 r: Aq9 TO lk�1AlN STREET 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR O •;I G. G� \ WALL 104�2.6�p BE Q n( TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE \ FENCE.;;...:`. }90\ -�" DESIGN ENGINEER. = Ate ' \ 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING + I E.,. ) 104• �5.23TP-2 105,5' FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 99• 1 4 10 ,0 TP-1 � x t J l 106.98 107,97 ENGINEER BEFORE CONSTRUCTION CONTINUES. CE O L I N 5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM. Q 41 S iEXISTING I 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF i #933D I HOUSE(#933B) THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 101 3 T.O.F.=106.0E I I HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. o W ` 6 / / i i / I 7. WATER SUPPLY PROVIDED BY TOWN WATER SUPPLY. fl 23 aPpro c W- SEWER INV.=104.0E , a D �i �'•-- 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED SEPTIC SYSTEM. 98.60 G I P TIO 4 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS PATlO 46 H W-. 97 7 . _- 11 --_ -_ AGREED UPON OWNER AND CONTRACTOR OR AS OTHERWISE -- O � 10009 � � .H• '�- --1-05=-- DIRECTED BY THE APPROVING AUTHORITIES. P H C 104,65 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY 99.95 100. THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. Q p14'�23.40 C��__ ---- --a 04-�---' 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND 11 1 \1 17-185 3 0 W \ PROPOSED LOCUS Q REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 97,87 ^� \ � Uri SEPTIC TANK_--•-G3- PARCEL-ID; 117-186 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE x 1 j\ ,\ lOCN 03_ 103.24_ -EXISTING SEPT/C TANK 4445 ±SF INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. \ (PER INSPECTION ASBUILT) _--_ 13. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMANTED EXISTING 4, FENCE �8-2 SEPTIC SYSTEM COMPONENTS NOT SHOWN ON THE PLAN. IP FND - _ .7 z� _ ___-TO B_E REMOVED 14. CONTRACTOR SHALL TAKE ALL NECESSARY PRECAUTIONS TO MAINTAIN THE x� _ THE STABILITY OF ADJACENT STRUCTURES AND RETAINING WALLS. OF M 97.76 10L5Z 0 EXISTINGFILLED POOSWITH SAND 15. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND Ass9 IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. AND ABANDONED OR REMOVED PETER T. McENTEE EXISTING WATER SERVICES PROPOSED SEPTIC SYSTEM UPGRADE PLAN _ . CIVIL `n TO BE REPLACED WITH NEW 933B MAIN STREET, OSTERVILLE, MA No. 35109 SLEEVED WATER TO EACH BUILDING Prepared for: Judy McAbee, 0.0. Box 346, Centerville, MA 02632 �'EGISZE� �Q OWNER OF RECORD SCALE DRAWN JOB. N0. 9�FS I N� 4 � CALLAHAN, RICHARD P TR Engineering by: 1"=20' P.T.M. 26 . NO. 15 C/O JUDY MCABEE Engineering Works, Inc. P.O. BOX 346 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. CENTERVILLE, MA 02632 (508) 477-5313 1/5/16 P.T.M. 1 of 2 �i NOTE: TO PREVENT BREAKOUT, THE PROPOSED SEPTIC TANK FINISH GRADE SHALL NOT BE < EL:102.5 INSTALL RISERS & COVERS OVER INLET & PROPOSED D-BO FOR A DISTANCE OF 15' AROUND THE X OUTLET AND SET TO 6" OF FINISH GRADE INSTALL RISER & COVER PERIMETER OF THE S.A.S. CRAWL SPACE FLOOR SET TO 6" OF GRADE PROPOSED S.A.S. EL.=103.2t INSTALL RISER & COVER OVER ONE• CHAMBER (MIN.) AND T.O.F.=106.0f SET TO 3' OF F.G. TO SERVE AS INSPECTION PORT ' F.G. EL.=105.1f F.G. EL.=105.1t —F.G. EL.=104.8t F.G. EL.=105.0t ---26'----� © S=1% (MIN.) ® S=1% (MIN.) Z�j'a' 4"SCH40 PVC 4"SCH40 PVC „ „ o..l E3 E3 TO 1/22 RDOUBLEB S q L /EXISTING 14" 6" INV.=102.15 WASHED STONE HOUSE(#933B) k4" C.I. 03.00 48" LIQUID INV.=102.75 24 (OR APPROVED FILTER FABRIC) T 0 F. 106.0f LEVEL GAS BAFFLE PROPOSED `�3/4"-1 1/2" SEWER INV=104.0t DOUBLE WASHED INV.=102.32 D BOX INV.=102.00 2' 3' 2 STONE EFFECTIVE WIDTH = 7' PROPOSED SEPTIC TANK LISP 3 LC-6 GALLON LEACHING CHAMBERS IN SERIES WITH 2' OF TO EXISTING SUITABLE DOUBLE WASHED STONE-ON SIDES 4' ON ENDS AND 1' BENEATH PE, INV.=104.0f(VERIFY) H-10 RATED TOP CONC. ELEV.=102.8 __ —BREAKOUT NOTES: INV. ELEV.=102.00 E3®®O®®® ELEV.=102.5 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE ®®E3 E3®a S.A.S. LAYOUT INVERTS, PRIOR TO INSTALLATION. a,2" 2) SEPTIC TANK & D—BOX SHALL BE SET LEVEL & BOTTOM ELEV.=100.00 TRUE TO GRADE ON A MECHANICALLY COMPACTED 4' 3 x 6 = 18,, 4' __ ___ _ 6" CRUSHED STONE BASE, AS SPECIFIED IN 310 4' OF NATURALLY OCCURRING r a" KNOCKOUT CMR 15.221(2). PERVIOUS MATERIAL EFFECTIVE LENGTH = 26 I 20' pip• COVER 3) INSTALL INLET & OUTLET TEES AS REQUIRED. 5' (MIN.) ABOVE G.W. I I LEACHING SYSTEM SECTION _ 4) CONTRACTOR SHALL INSTALL AN APPROVED GAS BOTT. OF TP, EL:=95.0 = (a• KNocKour a'KNoacourl BAFFLE ON THE OUTLET TEE. SEPTIC SYSTEM PROFILE L______ a_KNOCKOUT N.T.S. SOIL LOG r PLAN2VIEW , DESIGN CRITERIA DATE: DECEMBER 14, 2015 (REF#1 4,903) ____ ____ SOIL EVALUATOR: PETER McENTEE (SE#1542) WITNESS: DAVID STANTON R.S. - HEALTH AGENT ® E3 E30 E3 E3 ® z2" ® ® NUMBER OF BEDROOMS: 2 BEDROOM I l ® ® ® ® ® ® ® I I I SOIL TEXTURAL CLASS: CLASS I Elev. TP- 1 Depth EIeV. TP-2 Depth I",>2 i• DESIGN PERCOLATION RATE: <2 MIN/IN 105.1 A 0" 105.0 A 0 DAILY FLOW: 220 GPD LOAMY SAND LOAMY SAND r 72" r 36" 10YR 4/2 10YR 4/2 SIDE VIEW END VI DESIGN FLOW: 220 GPD 104.1 12" 104.0 12" B B GARBAGE GRINDER: NO LOAMY SAND t LOAMY SAND WIGGIN LC-6, H-10 OR H-20 LOADING PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY 10YR 5/6 10YR 5/6 LEACHING CHAMBER 102.6 30" 102.4 311, LEACHING AREA REQUIRED: (220 GPD) = 297.3 SF C PERC C .74 GPD/SF 30"/48" 1 N.T.S. USE 3 LC-6 GALLON LEACHING CHAMBERS IN SERIES WITH 2' OF PROPOSED SEPTIC SYSTEM UPGRADE PLAN DOUBLE WASHED STONE—ON SIDES, 4' ON ENDS AND 1' BENEATH 933B MAIN STREET, OSTERVILLE, MA MED. SAND I MED. SAND SIDEWALL AREA: 2(7.0' + 26.0') X 2 = 132.0 SF 2.5Y 6/6 2.5Y 6/6 Prepared for: Judy McAbee, 0.0. Box 346, Centerville, MA 02632 BOTTOM AREA: 7' x 26.0' = 182.0 SF i Engineering by: SCALE DRAWN JOB. NO. TOTAL AREA:........................................................... 314.0 SF 95.1 120' 95.0 120" Engineering Works, Inc. N.T.S. P.T.M. 264-15 NO GROUNDWATER ENCOUNTERED 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74 GPD/SF(314.0 SF) = 232.4 GPD PERC RATE: <2 MIN/IN (508) 477-5313 1/5/16 P.T.M. 2 Of 2 t • a� LEGEND N —— 98 —— EXISTING CONTOUR MEP.DOWLARK LANE x 100.98 EXISTING SPOT GRADE BLOSSOM LN BENCHMARK W EXISTING WATER SERVICE MAGNETIC NAIL W PROPOSED WATER SERVICE EL.=101.99 W PROPOSED WATER SERVICE WATER METER PIT 1 17- 183 ;' (SLEEVED) G EXISTING GAS SERVICE 1 17--182 } —�H OVERHEAD WIRES Riv rE \105,10 <-- TEST PIT N \ 106.16 10'/13\ PROPOSED 1021101 \ 10 .54 \ } _ BENCHMARK LOCUS 1 17-087 SEPTIC TANK \ `I\ \ \\ l� 933 D- STRIPOUT BOUNDARY 100.22 \ \\ 3 0 kI& LOCUS MAP SEE NOTE 11 \ \ 35 \1 , NOT TO SCALE ` A \ 104, 9 � \ m , WATER SERVICES TO ALL PROROSED \ �' 1 I \ �� \ a GENERAL NOTES: OTHER UNITS (APPROX.) S.A'S. 0 prox•) GRASS lSix4ND s. 11 W \ W f \ 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. W 6kL 81, v\ (app�) o W 10 \ �\ PROPOSED 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 99,11 \ \ �j FLAG ROLE 105.30 W\ \ S.A.S. LOCAL THE RULES AND ENVIRONMENTAL REGULATIONS CODE, EXCEPT AS REQUESTED BE APPLICABLE OW: ®• 0 ,[� �'�9 _��� �, _i_ -310 CMR 15.405(1)(b)(f)&(g); PK -SST G� OF pq�.TjBER \l + p 1 b7 \ 1) A 15' variance, S.A,S, to crawl space, for a 5' setback. 99,19 _ _ _ 101137 _ I VA I ,� A \ 1 17-184 a) A 4' variance, septic tank to crawl space wall, fora 6' setback. CATCH BASIN `99 77 _ (6 3) A variance to the 10' setback requirement between sewer, septic OPEN BOTTOM DRIVE WY, ( 6. LAMP 102.5 G appra 3 Q tank or S.A.S., to water service, to allow a new sleeved water service '" '� o to be installed within 10' of the septic tank. RIM=98.00 ` �^ iD�VE ' E'pCF 107.01 4 A 14' variance, S.A.S, to leaching catch basin, for an 11' setback. ��,k O s,• l 03,20 _ A P C` oq���.\ TO A/N 5) A 9' variance, S.A.S, to drainagefield(opprox,), for a 16' setback. 104(A26 Q' ��`,p / / STREET' 3, THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 1 17-181 i�1�; FENCE„ .:-LA� 0 � O f '..' - �p WALL :� dtf - —�._ TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE �-' DESIGN ENGINEER. + t' E9,�p 104, 5,23 J V 105.5 7' 4, ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING � •� 107,97 x 1Q6,98 FROM THOSE SHOWN HEREON -SHALL BE REPORTED TO THE DESIGN CE ENGINEER BEFORE CONSTRUCTION CONTINUES. #933F FF ~`� EXISTING (D5 0� - 5, ALL ELEVATIONS BASED ON AN ASSUMED DATUM. 1 HOUSE(#933D) 101 3 I #933B I 6, THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF T f� .O.F.=100.45f , THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF �APPR®XJ yy, EWER INV.=98.45t W appr W HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. DRAINAGE �W. C 23 06. 7, WATER SUPPLY PROVIDED BY TOWN WATER SUPPLY. FIELD 1 0� 96,6d P C PATIO G P TIO �. 8, THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED SEPTIC SYSTEM. H:Wr_ —0'H' I x E l p7 46 9, ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS � _® 100.09 "` `_�' _ _ AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE _ H 104,65 �! 1 17$1 C�6 e� DIRECTED BY THE APPROVING AUTHORITIES. 99.95 100. 10, IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY INSTALL l C THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING y , CLEANOUT 1�1 4�'423'40 _ _—————--t—+0.4 ——— ""' �" CONSTRUCTION. (N 4 p \ PROPOSED k, 11, WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S,A.S. AND 97•$7 O \\ to SEPTIC TANK———1$�-—A — _ _ REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). X 101� 103.2� EXISTING SEPTIC TANK ' • 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE \ ti INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. FENCE .44' (PER INSPECTION ASBUILT) 13, THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMANTED EXISTING \\� OF s IP FN x' __ _� 7 �-— - ___ TO BE REMOVE$11, SEPTIC SYSTEM COMPONENTS NOT SHOWN ON THE PLAN. Mq S 14, CONTRACTOR SHALL TAKE ALL NECESSARY PRECAUTIONS TO MAINTAIN THE 97.76 EXISTING CESSPOOLS THE STABILITY OF ADJACENT STRUCTURES AND RETAINING WALLS. 101,57 PETER T. �, TO BE PUMPED, FILLED WITH SAND 15. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND o� � McENTEE LOCUS AND ABANDONED OR REMOVED. IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. No CIVIL N PARCEL ID: 117-185 EXISTING WATER SERVICES PROPOSED SEPTIC SYSTEM UPGRADE PLAN , F RFC/SjER�� �� 4988 ±SF SLEEVED TO BE EWATER OTO WITH BUILDING 933D MAIN STREET, OSTERVILLE, MA ECG Prepared for: Lee Kentros, 720 Highland Avenue, Needham, MA OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO. KENTROS, LEE Engineering Works, Inc, 1"=20' P.T.M. 263-15 l 720 HIGHLAND AVENUE 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. NEEDHAM, MA 02494 (508) 477-5313 1/5/16 P.T.M. 1 of .2 t . 1r:1 NOTE: TO PREVENT BREAKOUT, FINAL GRADE SEPTIC TANK SHALL NOT BE AT, OR BELOW, E'=97.0 INSTALL RISERS & COVERS OVER INLET & FOR A DISTANCE OF 15' FROM THE EDGE OUTLET AND SET TO 6" OF FINISH GRADE PROPOSED D-BOX OF THE PROPOSED S.A.S. CRAWL SPACE FLOOR INSTALL RISER & COVER PROPOSED S.A.S. I EL.=97.7+ SET TO 6" OF GRADE INSTALL RISER & COVER OVER EACH CHAMBER AND 1-----16.5'�1 T.O.F=100.45%P SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT ____� F.G. EL.=100.2t F.G. EL.=100.1t F.G. EL.=100.1t F.G. EL.=100.0t7_0�0 �30 O I\ j a) ? L = 18'(MAX.) 3'(max.) r L = 6' 6 ® S=1% (MIN.) ® S=1% MIN. L - 8' 4"SCH40 PVC 4"SCH40(PVC) ® S=1% (MIN.) 2" LAYER OF 1/8" TO 1/2" 16 4'SCH40 PVC DOUBLE WASHED STONE EXISTING 10^I as $ 69 (OR APPROVED FILTER FABRIC) 14" s 3' 0 696 HOUSE(#93M) ®®®a®®® INV.=98.00 48" LIQUID ®sasses ---3/4" TO 1-1/2" DOUBLE LEVEL WASHED STONE T.0.F.=100.45E ADD INV.=97.32 PROPOSED 4' 5.2 4' SEWER INV.=98.45E GAS BAFFLE D-BOX INV.=97.15 EFFECTIVE WIDTH = 12.8' INV.=97,75 3 OUTLETS P C Nit anINV.=96.50 PROPOSED SEPTIC TANK 1-500 GALLON LEACHING CHAMBER SURROUNDED WITH STONE 'AS SHOWN CONNECT TO EXISTING SUITABLE SEWER PIPES IAT HOUSE, AT OR ABOVE, INV.=98.45 H-10 RATED I TOP CONC. ELEV.=97.3t I , BREAKOUT ELEV.=97.00 aaaa - SEPTIC LAYOUT NOTES: INV. ELEV.=96.50 a®®®® 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE 0000E ®ease INVERTS, PRIOR TO INSTALLATION. Baaaaaaa— BOTTOM ELEV.=94.50 2) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND 4' 8.5' 1 4' TRUE TO GRADE ON A MECHANICALLY COMPACTED 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH = 16.5' SIX INCH CRUSHED STONE BASE, AS SPECIFIED PERVIOUS MATERIAL IN 310 CMR 15.221(2). 5' (MIN.) ABOVE G.W. LEACHING SYSTEM SECTION ®®®® 0 3) INSTALL INLET & OUTLET TEES AS REQUIRED. NO G.W., EL.=85.7 = ®®®®®® ® ®®®® 33 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. ► �, w ®®®®®® ® ®®a N z ®�®®® ® ®®®® SEPTIC SYSTEM PROFILE 102" SOIL LOG DESIGN CRITERIA DATE: DECEMBER 14, 2015 (REF#14,908) 4" KNOCKOUT SOIL EVALUATOR: PETER McENTEE (SE#1542) 20" DIA. COVER .NUMBER OF BEDROOMS: 2 BEDROOMS WITNESS: DAVID STANTON R.S. - HEALTH AGENT SOIL TEXTURAL CLASS: CLASS I (EFFLUENT LOADING RATE=0.74 GPD/SF) Elev. TP— 1 Depth I'lev. TP-2 Depth 4" KNOCKOUT / 4" KNOCKOUT 58" DESIGN PERCOLATION RATE: <2 MIN/IN 99.7 q 0" 99.5 q O„ DAILY FLOW: 220 GPD LOAMY SAND LOAMY SAND DESIGN FLOW: 220 GPD 98.7 1OYR 4/2 12" i987 10YR 4/2 10" 4" KNOCKOUT GARBAGE GRINDER: NO-not allowed with design B B LOAMY SAND . LOAMY SAND LEACHING AREA REQUIRED: (220 GPD) = 297.3 SF 1OYR 5/8 1OYR 5/8 500 GALLON CAPACITY, H-10 LOADING .74 GPD/SF 97.0 32" 97.0 30"C1 Cl CHAMBERS PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY SILT LOAM SILT LOAM PROPOSED D-BOX: 1 INLET, 3 OUTLET (MINIMUM), H-10 RATED 1OYR 5/3 1OYR 5/3 N.T.S. 90.4 111" USE 1-500 GALLON LEACHING CHAMBER SURROUNDED C2 I C2 Ito" PROPOSED SEPTIC SYSTEM UPGRADE PLAN WITH 3/4" to 1-1/2" DOUBLE WASHED STONE—ALL SIDES (SAMPLED) I, 933D MAIN STREET, OSTERVILLE, MA SIDEWALL AREA: 2(12.8' + 16.5') x 2 = 117.2 SF MED. SAND MED. SAND Highland Avenue, Needham, MA BOTTOM AREA: 12.8' x 16.5' = 211.2 SF 2.5Y 6/6 2.5Y 6/6 Prepared for: Lee Kentros, 720 Hi g TOTAL AREA:.................. ,,,,.,•,,,,,,,,,,,,,,,,,,,328.4 SF Engineering by: SCALE DRAWN JOB. NO. 85.9 165" 85.7 165' Engineering Works, Inc. N.T.S. P.T.M. 263-15 DESIGN FLOW PROVIDED: 0.74 GPD/SF(328.4 SF) = 243.0 GPD NO GROUNDWATER ENCOUNTERED 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. PERC RATE: <2 MIN/IN (PER SIEVE ANALYSIS), (508) 477-5313 1/5/16 P.T.M. 2 0f 2 . ON,PN DEL11 ERY • ■ Complete items 1,2,and 3. A. Sygnature I a A.Si afore ' /,„ ❑Agent ❑Agent ■ Corn ms.1,2,and 3. (/(y Gz�p Addn ■ Print your name and address on the reverse.} X ❑Addressee.' And address on the reverse so that we can return the card to you * ■ Print yqur name. C.Date of De ■ Attach this card#o the back of the mailpfece; B Received b (Printed Name) 0. Da a of De' airy "so that we can return the card to You., Receive Y(Pn�tAe�1►�a"'e) - oron the.front,if space permits: 2l 6 ■ Attach this card to the back of the Mali piece = ❑Yes 4.cls delivery address different from item 1?. ; es or on the frontrfspace permits• D• Is delivery address drfferent from item 1? Tess below:_ No — :117042 If YES,enter delivery address below: ❑No If YES':enter delive add ID Prop ID:117181 ry` ❑ prop CURLEY,b,� l ' 3 1l1�! ' 2WRIGHT 2 AY S'T ATHRYN A r i,rU ..933F'MAl1�'S c .... OSTERVH.;LE'-M-NU 655 OSTERVILLE,MA 02655 �q Q ,.: ~ ❑Priority Mail Exp I�IIlalll�Ilh� �II I I II I I IIiII I ILIII 3.❑Adult Signatupree ' Registered McII ® 1 3: Service Type ❑Registered Mail' 0 Adult Signature Restrlcted.Delivery ❑.R istered Mail Restricted IIIII IIII IIIII I IIIIIII III IIIIIII IIIII»II O Adult Signature Restricted Delivery, ❑Delivery d Mail erCertited Mail® Dee rvery ❑Return Receipt* a 9590.9403 0391 51631602 60 • gCertifled Mall l ❑Cerflfled Mail Restricted Delive Return RecetPtfor 3'fJ39.1 5163 1602 Merchandise ry::, 95QQ 940 ❑Certified Mail Restrlcted:Delivery [3 Signature Conti ` Merchandise r ❑Collect on Delivery ❑Collector Delivery s?._oar. n�mnwr_Qr cfe`Jmm.senrlceJahell „_ fi_ ❑Collect on Dellvery Restricted Delivery',❑Signature Confirmation'"°' ❑_Collect on Delivery Restricted Delivery ❑Signature Dell, pred Mail O Signature Confirmation ._{ nsured Mail RestrictedDeB� 7 015 0640 0007 9463 4309 fired Mall Restricted Delivery Restricted Delivery 2_^AAjcleNwnher.jTrani fl°m'-ervr�IahaO 4 2.6 2 nsured Mail Restricted Delivery or$500) 7 015 0640 Q,007 9 4 6 3- ver$5oo Domestic Return '3S Form 3811 April 2015,PSN 7530-02-000-9053" .,, _ e ,,,: Domestic Return Receipt PS Form'3811'gpril20„ 15 PSN 753or02-000-90 . - . . . , r ■ Complete items 1,2,and 3.SENDER: COMPLETE THIS A. Signature SECTIONCOMPLETE ' • DELIVERY. ;. ■ Print your name and addressor the reverse X - 0 Again A Si re 3 A to that we can return the card to you Adds ■ Complete items 1,2,and 3. I" re your name and address onthe reverse qp gent �, ■ Attach this.card to the back of the mailpiece, $• Received by(Printed Name) C Date of De so that we can return the card to you. X ❑Addressee or on the front if space permits. B:' eived y(Printed N ate of.Delnre D. Is delivery address different from item.1? ❑Yes '■.Attach this card to the back of the mailpiece, -( ry" + If YES,enter delivery address below:. ❑No or,on the front if space permits, y c 1L' Prep ID:1 rocs ry Lur;ivaci vcv�c -" F' i D. Is delivery address m item 1?" es . GRIFFIN,SHEILA E ,,// If YESrenter deliv d low:: 0 16 HENDERSON AVENUE ' C"�(�';!k �J Prop ID:117183 I. WORCESTER,MA 01603 `` CAI,LAHAN,WILLIAM F III& a F C/O JUDY MCABEE 'CO} PO BOX 346 E MA 02632 „` �7" lA w CENTERVILL IJW� `. ( II I IIIIII IIII III I I I I I IIIIII II L I II I II I II I II I III p gun Signature o Priority ered MaipTM 9J� 94�3�39'� J �3 1 78 ❑.Adult Signature Restricted Delivery, ❑Registered Mail Re IIIIIIIIIIIIIIII11111111111111IILIIIIILIII IIII OAduINS9 aw oPriority�,IalMExpress® . ; �Cer�fledM�l® Delivery al ❑Certified'Mail Restricted Delivery• ❑Return Receipt for rn.9590 9408 0391',5163.,16Q2 15' y :'❑Adult Signature Restricted Delivery ❑Reeggistered Mail Restricted ❑Signature el Oontirme a comflad Mail® D•Iivery „ 2..Article Number(Transfer from service label) ❑Collect on Delivery ITM 13 Collect on Re livery.Restricted De 0_Insured Mail ❑Signature Confirne r ` ❑;Certified Mail Restricted Delive 0 Return Receipt 1or, 'Restricted Delivery ❑'Collect on Delivery Delivery Merchandise :f 7 015 0 6 4 0 . 0 0 07 9463 4293 0��`�s5o�1 Restricted°a'"airy ry r]-Collect on Delivery Restricted Delivery O Signature Confirmation'"" i y 7 015 0640 :0007 .l 4 316: insured Mail.- p signature Confirmation :`PS Form:3811,.April 2015 PSN 7530-o2-000- �.• •.Domestic Return Rey P.Insured.Mail'Restrioted Delivery Restricted Delivery. (over$500)` PS Fom7.3811;Ap012015 PSN 7530-02-000-9053.,t,; . - s; ; ,` ::^ DomestioRetum Receipt,°; -- - ------ _ . O -. ,( COMPLETE� a� ■ A. i. Complete items 1,2,and 3. S are • J e ■ V .Print our name r y and address on the reverse Age di, 9 `V Complete items 1,2,and 3, • so that we can return the card to,you. / ❑Adc A. ' nature ■ Attach this card to the back of the mailpie B R aid by rimed a C. Date of E ■ Print your name and address on the reverse ;_or.on the front if space permits._so that we can return the card'to you. X ❑Agent --- . ■ Attach this card-to the back of the mailpiece, B.'Received b ❑Addressee ` ,- D. Is delivery address different from item 1? ❑Yes ^"'f>a.fmntitsnace_Dsl mits. ' _ Y(Printed Name) C. Date of Dellvery a If YES,enter delivery address below- ❑No — n x Prop ID:117182 Pro D.,is delivery = ADLER,HUI TING LI&SAILING p ID:117 t 85 airy address different from item 1? ❑Yes if YES,enter delivery address below: 26 COLBY ROAD r a• <��" t KENTROS,LEE p No_: 720 HIGHLAND AVENUE WELLESLEY,MA 02482 NEEDHAM MA 02494Hl'—£ 3 0 . i II I IIIIII IIILIILI I I I i IIIIII I�I II II iII I III I III ❑Adult 9 ature . P Registered Mail- ' 'q;Priority Mail Expr III IIIIII IIII IIIII III IIIIII III IIIIIIIiIII II III 9�3 0391,5163 1602 39 Adult Signature Restricted Delivery ,�❑Registered Ma(lR edideil® Delivery 3 Service Type ❑Certified Mail Restricted Delivery, Return Receipt for ❑Adult Signature ❑Priority Mail ExPre ® ❑Collect on Deliv ❑Merchandise 9590 9403 0391 5163 1.602 ❑Reglatered Mall*^' " —�- <, �.f r,� ❑Collect on Delivery Restricted Delivery ❑Signature Confine ❑Adult Signature ResMcted Delivery ❑Registered Mail Restricted7015 - ed Malle 0 6 4 0 '0 0 0 7 9 4 6 3 4 2 4 8 "afed Mall ❑Signature Confirm ❑Cerllfled Mall Restricted Delive Delivery cured Mail Restricted Delivery Restricted Deliver) — ❑Collect on Delivery ry, E3 Meroh-Re Receipt for vain$500) _ n c i. PS Form 381.1.,Aoril 2015 PSN 7530-02-000-9053 Domestic,Return Re 7 015 0 6 4 0' 0 0 0 7 9463 4224 act°"Delivery.Restricted Delivery ❑❑Signaaturree ccoorniflflrmaattio�i°° fired Mail iced Mail Restricted Delivery: Restricted Delivery >, 5 Form 381,1.AP61.2015-PSN 7530-02-000-s053, Domestic Retum Receipt., LEGEND N -- 98 -- EXISTING CONTOUR MEADONI1-ARK LANE x 100,98 EXISTING SPOT GRADE BLOSSOM LN BENCHMARK w EXISTING WATER SERVICE MAGNETIC NAIL _ W PROPOSED WATER SERVICE WATER SERVICES TO ALL EL.=101.99 NI PROPOSED WATER SERVICE OTHER UNITS (APPROX.) WATER METER PIT 1 1 7- 1 83 (SLEEVED) G EXISTING GAS SERVICE RIv TE W 1 17- 182 \105.10 --G.H•W. -OVERHEAD WIRES Z \ 106.16 10'/134 TEST PIT W PROPOSED 102.01� 10 .54 �� �\ SEPTIC TANK \ ` \ -� BENCHMARK LOCUS a pp � 933 E \ \\ I 3 105,45 100.22 \ \ 3 LOCUS MAP \ x A104• 9 \ , NOT TO SCALE � 1 17-087 S.AOSED (a�prox) W `�' GRASS IS�4N0 \ 100, GENERAL NOTES: 62.$2 105 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL \ \ (aPp k w \ BOARD OF HEALTH AND THE DESIGN ENGINEER. 99,11 w \ O \ PROPOSED 2• ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 2 JO FLAG ROLE 105.30 w\ \ S.A.S. OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE 4� LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW: -310 CMR 15,405(1)(a)(b)&(g): Piz 97E-T x ' OF pyV,r/BER \j� I V � /J!7 !� \\ 117-184 1) A 4' variance, septic tank to property line(side), for a 6' setback. 99.77 101.37 21 ,� 2) A 15' variance, S,A.S. to crawl space, for a 5' setback. 10 ,58 �� Y � LAMP aP ro 3 ` � 3) A 6' variant®, septic tank to crawl space wall, fora 4' setback. ^* o D 4) A variance to the 10' setback requirement between sewer, septic '.,., • c : ;QfR'.V �Z F®G'F ��� 107.01 tank or S,A,S•, to water service, to allow a new sleeved water service , � � ••.: 1 ,20 I 6 ®'� Fg rO to be installed between the S.A.S. and septic tank. a...: 0 0 q lA%1AlN STREET 3, THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 0 O 3 G:• \ ALL 10 ��- �,: ; ^ �BF/i3y� /4 ____�_ TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE _ :•.. DESIGN ENGINEER, \ 99 1 + \ E.:.0 104, �5.23TP 2 10 5q 4, ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING ,•j 9• 10 ,0 TP-1 f J /106.98 107.97 - FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN -ENGINEER BEFORE CONSTRUCTION CONTINUES. 0 41 S iEXISTING I `" 5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM. \ 9330 I HOUSE( 93.3,9 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 101 3 , I THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 1 6 T.O.F.=106.0� HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. �I I 23 aPpro W SEWERlNVg104,0 .G - 7. WATER SUPPLY PROVIDED BY TOWN WATER SUPPLY. \ G P T/O �j B. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED SEPTIC SYSTEM. 98.6d PATIO 0� 6 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS W--97.7 100.09 HE ,.�-�- -- -_ AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE N H DIRECTED BY THE APPROVING AUTHORITIES. 99.95 100.0` -- 104.65 i 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCATION. OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING p14 23.40 J� __ _ 62.03' _. 1.04--'----_ CONSTRUCTION, 1 1, WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS z\1 17-185 3 C' W \ PROPOSED LOCUS IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND 97 87 r" o SEPTIC TANK REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). \ N "" -_1-03-- � A 44445 ±SF�_ �V 12, AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE x -�'\ 101• I _ 103_2 EXIST/NG SEPTIC TANK INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. FENCE \ \ (PER INSPECTION ASBUILT) 13. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMANTED EXISTING IP FN - 9 •7 ~ -2- ------TO BE REM9V€D""-10-2- --- --- SEPTIC SYSTEM COMPONENTS NOT SHOWN ON THE PLAN. x�_ 1 14. CONTRACTOR SHALL TAKE ALL NECESSARY PRECAUTIONS TO MAINTAIN THE 97.76 EXISTING CESSPOOLS THE STABILITY OF ADJACENT STRUCTURES AND RETAINING WALLS. OF Mgss9 101.57 TO BE PUMPED, FILLED WITH SAND 15, THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND �P Cy AND ABANDONED OR REMOVED „� IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. o� PETER T. G� MCENTEE EXISTING WATER SERVICES PROPOSED SEPTIC SYSTEM UPGRADE PLAN CIVIL TO BE REPLACED WITH NEW v No. 35109 SLEEVED WATER TO EACH BUILDING 933B MAIN STREET, OSTERVILLE, MA A�oFss G/STE � q OWNER OF RECORD Prepared for: Judy McAbee, 0.0. Box 346, Centerville, MA 02632 CALLAHAN, RICHARD P TR Engineering by: SCALE DRAWN JOB. NO. C/O JUDY MCABEE Engineering Works, Inc. 1"=20' P.T.M. 264-15 P.O. BOX 346 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. CENTERVILLE, MA 02632 (508) 477-5313 1/5/16 P.T.M. 1 of 2 J S If h ^^� SEPTIC TANK NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL:102.5 INSTALL RISERS & COVERS OVER INLET & PROPOSED D—BOX FOR A (DISTANCE OF 15' AROUND THE OUTLET AND SET TO 6" OF FINISH GRADE INSTALL RISER & COVER PERIMETER OF THE S.A.S. CRAWL SPACE FLOOR SET TO 6" OF 'GRADE PROPOSED S.A.S EL.=103.2t INSTALL RISER & COVER OVER ONE CHAMBER (MIN.) AND T.O.F.=106.0E SET TO 3' OF F.G. TO SERVE AS INSPECTION PORT F.G. EL.=105.1 t F.G. EL.=105.Ot F.G. EL.=105.1 f F.G. EL.=104.8f I '0 . $, 8, L 30 L = 15'(MAX.) f y O S=1% (MIN.) @ S=1% (MIN.) � 'ZrJ• 4"SCH40 PVC 4,SCH40 PVC s~ -•---2" LAYER OF 1/8" ' io~I ®�® TO 1/2 DOUBLE S HOUSE(#933B) 14" ? 6° INV.=102.15 WASHED STONE INV.=103.00 48" LIQUID 24 OR APPROVED FILTER FABRIC INV.=102.75 ( ) T.O.F.=106.0E LEVEL GAS BAFFLE PROPOSED `�3/4"-1 1/2" SEWER INV.=104.0t DOUBLE WASHED INV.=102.32 �� INV.=102.00 2' 3 2 STONE EFFECTIVE WIDTH 7' L. PROPOSED SEPTIC TANK USE 3 LC-6 GALLON LEACHING CHAMBERS IN SERIES WITH 2' OF CONNECT TO EXISTING SUITABLE DOUBLE WASHED STONE—ON SIDES. 4' ON ENDS AND 1' BENEATH 4" C.I. PIPE, INV.=104.0t(VERIFY) H-10 RATED TOP CONC. ELEV.=102.8 —— — —BREAKOUT NOTES: INV. ELEV.=102.00 ---®®®® ELEV.=102.5 S.A.S. LAYOUT 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE I Do a Do INVERTS, PRIOR TO INSTALLATION. 12„ 2) SEPTIC TANK & D—BOX SHALL BE SET LEVEL & BOTTOM ELEV.=100.00 TRUE TO GRADE ON A MECHANICALLY COMPACTED 4' 3 x 6' = 18' 4' 6" CRUSHED STONE BASE, AS SPECIFIED IN 310 4' OF NATURALLY OCCURRING r——a' KNOCKOUT CMR 15.221(2). PERVIOUS MATERIAL EFFECTIVE LENGTH _ 26 1 20° OW COVE 1 3) INSTALL INLET & OUTLET TEES AS REQUIRED. 5' (MIN.) ABOVE G.W. I I LEACHING SYSTEM SECTION 4) CONTRACTOR SHALL INSTALL AN APPROVED GAS BOTT. OF TP, EL:=95.0 _ — M BAFFLE ON THE OUTLET TEE. 14" KNOCKOUT a° KNOCKOUT I SEPTIC SYSTEM PROFILE 1 L- - 4° KNOCKOUT J N.T.S. 72" SOIL LOG PLAN VIEW DESIGN CRITERIA DATE: DECEMBER 14, 2015 (REF#14,903) 17-71 SOIL EVALUATOR: PETER McENTEE (SE#1542) — ——— ———NUMBER OF BEDROOMS: 1 BEDROOM — WITNESS: DAVID STANTON R!S. — HEALTH AGENT ® E3 E3 0 ® ® ® 22" Ea0 SOIL TEXTURAL CLASS: CLASS I Elev. TP- 1 Depth Elev. TP-2 Depth INVERT I ® � ® � ® ® ® I I I DESIGN PERCOLATION RATE: <2 MIN/IN 105.1 A 0" 105.0 A 0" DAILY FLOW: 110 GPD LOAMY SAND LOAMY SAND 72" 36" 10YR 4/2 1OYR 4/2 SIDE VIEW END VIEW DESIGN FLOW: 220 GPD 104.1 12" 104.0 12" GARBAGE GRINDER: NO B LOAMY SAND B LOAMY SAND 10YR 5/6 1OYR 5/6 WIGGIN LC-6, H-10 OR H-20 LOADING 102.E 30" 1 .4 31" PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY ! LEACHING CHAMBER 02 LEACHING AREA REQUIRED: (220 GPD) = 297.3 SF C PERC j C .74 GPD/SF 30"/48" N.T.S. USE 3 LC-6 GALLON LEACHING CHAMBERS IN SERIES WITH 2' OF PROPOSED SEPTIC SYSTEM UPGRADE PLAN DOUBLE WASHED STONE—ON SIDES, 4' ON ENDS AND 1' BENEATH MED. SAND MED. SAND 933B MAIN STREET, OSTERVILLE, MA SIDEWALL AREA: 2(7.0' + 26.0') X 2 = 132.0 SF 2.5Y 6/6 2.5Y 6/6 Prepared for: Judy McAbee, 0.0. Box 346, Centerville, MA 02632 BOTTOM AREA: 7' x 26.0' = 182.0 SF Engineering by: SCALE DRAWN JOB. NO. TOTAL AREA:........................................................... 314.0 SF 95.1 120" 95.0 120" Engineering Works, Inc. N.T.S. P.T.M. 264-15 NO GROUNDWATER ENCOUNTERED 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74 GPD/SF(314.0 SF) = 232.4 GPD PERC RATE: <2jMIN/IN (508) 477-5313 1/5/16 P.T.M. 2 Of 2