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HomeMy WebLinkAbout0010 NECK POND ROAD - Health •10 NECK POND A= 140- 191 bstetville • tiw �`" t J s ;j 3 a No. 4210 1/3 BGR r daffi 0&7a, I ESSELTE 10% a ® 0 0 I s N 0 C� TOWN OF BAR_NSTABLE LOCATION lb /l2[l-0--,a P�. . SEWAGE 20/7-- O 7 VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. j� SEPTIC TANK CAPACITY ISb® t� LEACHING FACILITY: (type) Chz-� $,a (size) f 2.1 X 33 NO.OF BEDROOMS OWNER 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) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY r b .. y r � n;:j= N N� N No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zippfitation for disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(!� Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 16 A)eCk fo; 2q• Owner's Name,Address,and Tel.No. � �yD / ire tee►-,p��►� R�_ �;�1� Assessor's Map/Parcel G*Y�� Installer's Name,Address,and Tel.No. F_letc STEv F 45 Designer's Name ddress,and Tel.No.�-(Ace) S CO.6w 11 Mars%m-.. m4 ds ►.a CX4�t �S" ;,�91 G�Ss w� Ns7 � �.�SIS Type of Building: L Dwelling No.of Bedrooms Lot Size /54 7 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided y S y, *_S gpd Plan Date �2/l Number of sheets Z Revision Date Title Size of Septic Tank /'S"OU Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of V.Compliance has been issued by this Boar eal� Si Date Application Approved by - Date ? Application Disapproved by Date for the following reasons Permit No. f — 20�? Date Issued r'7?,.1; ��rvr(t •,,v'yf, .,ter^..re...+tip.-.r�:".r/vi,e'�W':--a'ti"'nr'�t".s�" •h..+* ..:;.v ...r-.'fyL' .,.n•..'y.-.,..r �n.. .• .�` � w�.t� �'.�.S,�tt �, •-. itte. 6.n- . . • . . No. ) �� • Fee 16 o�THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppfitation for Misposal *pstem Construction Permit Application for a Permit to Construct,( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No, 16 kkC,.k forte Owner's Name,Address,and Tel.No. 1. - Gs�r.�i`� / 10 Aca.?On A R�. os�er�:11E Assessor's Map/Parcel Installer's Name,Address,and Tel.No.C:F-tc STEvf Ng Designer's Nam Address,and Tel.No.Entneer.\j WLS f.0,gj)-/ 11 Nars\oas. ^1 l►s ►Vw, OC414 r ,Z we <tdsS &SkCaZ e AAA,ws5, 1 pe of Building: / Dwelling No.of Bedrooms G/ Lot Size /S 7sA sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided y 5 y. gpd i Plan Date �n/2 -7 Number of sheets Revision Date Title ! Size of Septic Tank / !�"0U Type of S.A.S. f Description of Soil 1` Nature of Repairs or Alterations(Answer when applicable) Date last inspected: 'Agreement: a, µ The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of 1::: .Compliance has been issued by this Boar >eS ealt . Si a Date 6l3 Application Approved by Dat 61go 70 Application;Disapproved b� Date for the following reasons Permit No.17,00 - 20-;? Date Issued - -- ---- ----- --------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( )by at /D ti W t• ?ONO _.E.D - - has been constructed-in-accordance with the provisions of Title 5 and the for Disposal System Construction Permit No Q 4 -;?Oq dated 613o1-2,O► Installer E R%C. SSEof.► -S, Designer E h�R r N r,. tAGr le S #bedrooms Approved design flow y 0 gpd The issuance of this permit�shdal� gt be construed as a guarantee that the system will;Sot ion as d' signed. Date / /� Inspector - . N000 I I? - Zo 7�? Feellm - THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Misposal *pstem ConstrUction i3ermit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at 10 V e d, p pd h A fl& 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 completed within three years of the date of this pe it. Date 30/ZU( Approved by r Town of Barnstable Regulatory Services Richard V Seali,Interim Director eaxnrwsrns�;e. :, 9 MASS: �* Public Health Division Qp 1639. �0 Thomm..McKean,Direefor 200 Main Street,Hyannis,MA-02601 Office: 50M62-4644 Pax;: 5W790=6304 Installer Designer Certification Form ff t Date? ?1 1 Sewage Permit# ?l]-20 7 Asses sgr's Map�Parcel Designer: Installer'' `L� ;-iv_V-Q_itS CL•n$+"44dYA_; I V g �� G �a `7 Address. <12. U.�, Cass{-�e.l� -�'1 Address: �/►,, t o re S E`Oku e AA_ �6: it y. f 1 � �'�S � `` t 1 .S -2v-Q:�1 was issued a permit to install a (date) ,(installer)., r bascd`on a lG N.efi k.(o�c�i '1Cc� ;C3s <rjil;2 septicsystem at 'desien.drawn by f k 177y {address) zrjl�- ICYt(�1►'t2�.f �datCCl----- —--- - - - — I certify that the.sepri ystenI eicien_ced above was.'installed substantially according to the design, which inay include tnti�or ap oved changes such as'Iaterat relocation of the distribution box and/or sej�hc t<�1. Strip out (if required) was inspected and:the: soils were:found'satisfactory si I.-Certify! diai the aeptzc system referenced above was-installed,-with major changes (i.c. gr dater than, 0a iatetai,relocation:of tyre SAS or any vertical.relocation of any component; -`� of the septic:systent)but-:in accordance with State & Local Regulations. Plan revision or certifed.as=built by,designer to follow. Sirip out (if required)was;in"spected.and the soils �\ .wcre,fogpd.sat=sf'aetory 1 i r T certify that the systerri referenced above was eonstrucfe I nee:;with the terms: of the]1A.approva1aettcrs (if applicable) "OF F'El WT..' F CN11 7 (.1iist-51Ws.S gnatur-e) t r1 . - �Farstta+ esigner s Signature) (Aftix Designer tarrlp'Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISIO,4., CERTIFICATE OF COMPLIANCE. WILL .NOT BE ISSUED UNTIL BOTH THIS FORM AND AS--- BUILT CARD.ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. t Q:\S-cptic-lb.csigii.e.r-Ccrti-fi.cationf.bi-ffi.Rev 8 14-13.doc Town of Barnstable OF tHE Tp� Regulatory Services BARNSTABLE Richard V. Scali,Director &awMBIX.C�31F-AWt CQN .nY'A'IS f HAf3 i:N9 NW5.051FANLLE•1'ffSf 6UrvSfAE� STABLE, �� ' Public Health Division 9 � 1639-2014 039. ♦0 ��g Thomas McKean, Director 200 Main Street Hyannis,MA 02601 Office: 508-862-4644 Fax:. 508-790-6304 December 5, 201 4 Attoiney Albert Schulz Seven Parker Road Osterville, MA 02655 Re: 11 Neck Pond Road, Osterville Dear Attorney Schulz: The Health Division has no objection to an existing four(4) bedroom house at 11 Neck Pond Road, Osterville, based on the septic system inspection on October 29, 2014, performed by Robert Paolini. This inspection revealed that the system-can handle four bedrooms. Sincerely, omas A.•McKean, RS, CHO F Director of Public Health �?� C q:\wpfiles\l 1.neck.pond.road.osterville.112.5.14.doc { Town of Barnstable P Department of Regulatory Services aNu,arAara a Public Health Division Date MAM re3a 200 Main Street,Hyannis MA 02601 °{ " Date Scheduled_ � ���. " Time ` Fee Pd. Sail Suitability Assessment for Sewage Disposal Performed By: e,�-e N� Je S �� �— e 5� Witnessed By: LOC TON G RAL INFORMATION Locallon Address /� L Owner's Name lMof ka s v . Address Assessor's Map/Parcel: - Engineer's Name , NEW CONSTRUCTION REPAIR Telephone# 'j—j 7--S-3 to BQ. N/7A ' Lund Use• _1 •P.�c.G�(.�1�"fi"a � Slopes(96)`' �— Z' Surface Stones a , Distances from: Open Water Body IJ /A , ft Possible Wet Area�� Drinking Water Well `mil) ftu� Dralhage Way fil( I ft Property Line dam(=ff. Other {t SIKETCH:(Street name,dimensions of lot,exact locations of test hales&pero tests,locate wetlands In proximity to holes) —_ :-� o- �- d D CAJ . Par ant material(geologic) V 0 Depth to Hedroak /�Q Depth to Groundwater. Standing Water In Hole:_ A1a Weeping*0111 Pit Res Z1 Estimated Seasonal High Groundwater DETERMINATION FOR SEASONALUMM WATER TABLE Method Used: De lh Observed standing in obs,hole: In, ,, Depth to soll mottles: De�th to weeping from side of'obs.hole: In, •Groundwater Adjustment ft. Index Well•#1 Reading Data Index Wall level A�-,-hetor, , „_,,_ Adj.Groundwater••Leval,,,_ 'PERCOLATION TEST >vt# Thne Observation r Hole# eZ' Tlmn at 9"f '�• d: 0 Depth ofPero �:_ Tlmcat6"- ' rOU Start Pro-soak Time @. End Pro-soak f lIP. Time(4"•6") Rate Mtn./Inch Site Suitability Assessment: Site Passed_�� 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(i)week prior to beginning. Q:\SBPTICIPERCFORM.DOC 0 (/S DEEP.OBSERVATION HOLE LOG Hole# Depth from Soli Horizon Soil Texture Sdil Color Sall• Other Surface(In.) all (Munsell) Mottling (Structure,Stoned;Boulders. fl o rsistency, Ursval) Lti a t . DEEP OBSERVATION HOLE LOG Hole# 'ZI Depth from Sall Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. _ gonsistgricy, 2�S,`f i j kl DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sall Color Sail Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.. Consistency,%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sall Color Sall Other Surface(In.) (USDA) (Munsell) Mottling (Structure,S(apes;Boulders, Flood Insurance Rate Map: Above 500 food ood boundary No— Yes Y , Within 500 year boundary No Yes Within 100 year flood boundary No.-!�, Yes �.._ Death of MturallyOccurring Pervious Material Does at least four feet of naturally occurring pervious mtitorial 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?,.�.... .. Certi---�°;! I certify that on i k. k 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 traini , xpertise and experience described in�10 CMR 15.017. �— Datb 7/d /17 - Signature , Q;ISBPTICWEACPORM.DOC Commonwealth of Massachusetts 1.410--� 1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , n M '< 10 NECK POND RD N1 Property Address KERSHAW Owner Owner's Name information is u required for OSTERVILLE MA 5-22-17 rX every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out Slif a 3 9 forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not. Name of Inspector use the return key. D.A.BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE MA 02632 City/Town State Zip Code 5084204534 S14297 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 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 5-22-17 InsFectoA Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing,this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the,system will perform in the future under the same or different conditions of use. fs VS t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 10 NECK POND RD Property Address KERSHAW Owner owner's Name information is required for OSTERVILLE MA 5-22-17 every 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: Z 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: AT TIME OF INSPECTION SYSTEM MET ALL MINIMUM PASSING REQUIREMENTS. THE NEWEST LEACH PIT WAS OPENED AND WAS ALMOST EMPTY WITH A SMALL PUDDLE IN THE BOTTOM OF PIT THERE WAS A STAIN LINE AT THE SECOND ROW OF HOLES IN THE SIDE WALL WITH ABOUT 18 INCHES OF SPACE BETWEEN THA STAIN LINE AND PIPE INVERT. THIS REPORT CAN NOT PREDICT THE FUTURE PERFORMANCE UNDER THE SAME OR USE. 73 B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y` 10 NECK POND RD Property Address KERSHAW Owner Owner's Name information is required for OSTERVILLE MA 5-22-17 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y '❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 10 NECK POND RD Property Address KERSHAW Owner Owner's Name information is required for OSTERVILLE MA 5-22-17 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Healti (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: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 10 NECK POND RD Property Address KERSHAW Owner Owner's Name information is required for OSTERVILLE MA 5-22-17 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section.E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 NECK POND RD Property Address KERSHAW Owner Owner's Name information is required for OSTERVILLE MA 5-22-17 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ® Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the.baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage.Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,..�' 10 NECK POND RD Property Address KERSHAW Owner Owner's Name information is required for OSTERVILLE MA 5-22-17 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: ACCORDING TO AS-BUILT CARD SYSTEM CONSISTS OF A SEPTIC TANK D-BOX AND 2 PITS ONE EXISTING AND ONE NEWER. Number of current residents: 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 years usage(gpd)): Detail: WATER USAGE WAS NOT AVAILABLE AT TIME OF DOING THIS REPORT. SYSTEM NOT DESIGNED FOR USE WITH DISPOSAL. Sump pump? ❑ Yes ❑ No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 NECK POND RD Property Address KERSHAW Owner Owner's Name information is required for OSTERVILLE MA 5-22-17 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: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for—Voluntary Assessments �< 10 NECK POND RD Property Address KERSHAW Owner Owner's Name information is required for OSTERVILLE MA 5-22-17 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1996 NEWEST PIT PER ATTACHED CERTIFICATE. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 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.): Septic Tank(locate on site plan): Depth below grade: 1.75 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: 1000 PER PLAN Sludge depth: LIGHT TO MODERATE t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 NECK POND RD Property Address KERSHAW Owner Owner's Name information is required for OSTERVILLE MA 5-22-17 every page. Citylrown 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 0 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? WOODEN POLE Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): RECOMMEND PUMPING AT TIME OF TRANSFER AND EVERY 2-3 YRS THERE AFTER FOR MAINTENANCE. THE INSIDE OF THE TANK SHOWED SOME EXPOSED AGGREGATE AND STRUCTURAL WIRE BUT LOOKED TYPICAL FOR ITS AGE. 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 10 NECK POND RD Property Address KERSHAW Owner Owner's Name information is required for OSTERVILLE MA 5-22-17 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 10 NECK POND RD Property Address KERSHAW Owner Owner's Name information is required for OSTERVILLE MA 5-22-17 every page. City/Town 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 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.): 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.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 10 NECK POND RD Property Address KERSHAW Owner Owner's Name information is required for OSTERVILLE MA 5-22-17 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): THE NEWER PIT WAS OPENED AND WAS ALMOST DRY WITH A SMALL PUDDLE AND SOME SORT OF YELLOW PIPE LAYING IN THE BOTTOM. THERE WAS A DEFINATE STAIN LINE AT ABOUT 18 INCHES FROM THE PIPE INVERT AT TIME OF INSPECTION. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 10 NECK POND RD Property Address KERSHAW Owner Owner's Name information is OSTERVILLE MA 5-22-17 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments < 10 NECK POND RD Property Address KERSHAW Owner Owner's Name information is required for OSTERVILLE MA 5-22-17 every page. Cityfrown 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 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 10 NECK POND RD Property Address KERSHAW Owner Owner's Name information is required for OSTERVILLE MA 5-22-17 every page. Cityrrown State Zip Code Date of Inspection D. System Information (coot.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: NO WATER AT 12 FT 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: ATTACHED Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed.USGS database-explain: You must describe how you established the high ground water elevation: ATTACHED DESIGN PLAN. Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of(Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 10 NECK POND RD Property Address KERSHAW Owner Owner's Name information is required for OSTERVILLE MA 5-22-17 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE L gA WNi� �a�1, c � SEWAGE # �� VILLAGE ASSESSOR'S MAP & LOTz7- l INSTALLER'S NAME&PHONE NO. T a4 n AI lfy SEPTIC TANK CAPACITY LEACHING FACILITY: (type) Lei (size) NO.OF BEDROOMS 3 BUILDER OR OWNS PERMITDATE: LI t� 4/' COMPLIANCE DATE: T Separation Distance Between the: r Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Welland 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 Feet within 300 feet of leaching facility) Furnished by F � 33 l3 3 33 e Fee THE COMMONWEALTH OF MASS HVSETTS ` PUBLIC HEALTH DIVISION -TOWN OF BARNSTE, ll ASSACBU.3E�'TS ••r= �-�, ��, AppricatiolY fori0oga•Y � p�.terrY_��oi�gtru�ttor�µ �.ern�it • �• . . • A p cation is hereby made' a Perrriit to Construct( )or Repair( )an On-site Sewage Disposal System at: ' Location Address or Lot No. a /J Owner's Name,Address and Tel.No. F Ile Installer's Name,Address, and /Tel.No. P if,yQj�•y,t'q_r Designer's Name,A`dddross and Tel.No. Val wJ //� /7e¢l/p /�w/1✓+ys /"/���j l�X/�`4 A41, Type of Building: Dwelling No.of Bedrooms Garbage Grinder( ), Other Type of Building No. of Persons "Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 3�O gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations(Answer when applicable) g�J� �r� L Qce,c4 Adi,/ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued tr is oard of Health. Signed Date Application Approved by m Application Disapproved for the following yeas n Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certificate of Compliance - THIS IS TO C FVat(he On�S�wage Disposal System installed( )or repaired/replaced( )on - J �Ifor as h4qbg4a constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Use of this system is conditioned on corn liance with the provisions set forth below: \ J t ^ No.— f k9f A — — — -—/40 _ .1 � Fee �_ ...R► � THE COMMONWEALTH OF MASSAC�J HUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS T _ �erinttA_.� y-.-�•~ .~Permission is hereby granted to �v /V - �' i�• 1�) to construct( )re r- an to Sewer System located at o. and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. "All construc io must bF completed within two years of the date below. p 1/ � Date: Approved by i y i •�r _ i , CERTIFICATION OF SKETCH AND APPLICATION-FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANSI I "hereby certify that the application for disposal works construction permit signed by me dated . �l 3� —'1 , concerning the property located at o?f( d< 4o--4 ILI meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed . • There are no variances requested or needed. SIGNED: DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NOOER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. IAI:JGtC—. 'FAMI>L\( gGORAOM 6 Gp. BaGE 6Qit.IDE2. FLOW x 11ox 3s .. )3S PA OEPTIG TA�JK = 33ox15o'/• A9%G.P. :>05 'DbAL- PIT 'u,5 ►�06 GaL• I1 •s DG vfALL .-AV -A - y 5 5.0TTOM AREA- 50 5F• ,Lo f 9'J'S 5,o s.F x I• o 5 0 � 77 457 ' 99 •G -ToTA'1_ ES1GN * 4275'. G.P. D. , 'TOTAL- 'PA I►-Y PaEP_GOLATIoN RATES I IN 2MIN 0P.L1~�55 n,` " • of oF 4�r o� ALAN sacy� %o G / �.Sc �-�" ��• 99� fr; RICHARD' JUr�ES �Y A i. BAXTER H i\A w- 'S10o T/oa; P.r. fJo,240413O GIs rfL •^ ��,,,� � - � looms INS• ; _ , . .. Sur3sO�� �� P1ST. INS.' GATlG Z IGAL pO 9 TANK IO, LSA.0 9�3 Y.PIT INY. 97WA . s. 97.7 /�O�D. I�/3/q•I�i � � G 4 SW 6TvNG ''� �'�""• I 2TIFlGD PLOT j P1-Ah) :v L�/,a P R U'F I L .' f L o C A'T 1 o <ZEF E2EN GE' .1 CERTIFY T.NAT THE PP_oPGSc`� 1toIrYN KE2Eo1.1 GoMC'I_�5. YJITN SHE,S 1 oEL.IN . • .� T✓c y%G 1.71/7 ANC 5S-'T5A GK_ R.6Ru►sL>:N tiEN Tj OF 'TO W N o BARTA C-y r �— A N I S� f'• L.OGQT WlT I4J TNE.GL.O'Cl PL,¢•1N D ATE till cQ • R.EGIST�z6•"D LAW Dsu�vEY �. "TI115 P�Q.N i S Nord- (3�5f"p o!d AN "Y oSTEQ.vII.L.J✓ - MASs• w I�J•S-rZUM6lJ-r. 5u2vey -THE oI=F5E.T5 'SQOULT) hood it oI•IT' d -- .. .. ,.. _..... __. _,.. ___._._.... ........... - - ------ - --- - - __ P -- r 4.0 0 t* ------------ ..,..n..a..m LL Ld A _ A I I 1 l i i 1 I EXIST. - I a I I ,RAWLSPACE 1 1 A -- w �.uc uurrv". I - I - 1_�_�._l W _ !_.._i ► �.__� e w 0 o 1 � o 1 � z Q------------- li z GARAGE O Q a Q Y Ai ....�........, 4_ ,T— ,a.aa... w ,� U BA EMEN I -- MIN NTeda�� — .ne l n x°yxR?vvv x'Qa SCALE: 1/4'=1 0' o {� DATE: FOUNDATION PLAN 6/14/2017 DRAWING NO.: 10 NECK POND ROAD Ostervllle PRELIMINARY DRAWING A4 FOR DESIGN REVIEW --------- ---- -------..------- map/parcel140/190 Permit to finish game room,tv room and bath in basement. t : _ Z 'F m tm �yo9�'omamSrcz �; � ..ao cc_°� > `mo g�c'SLmozm�mo ---- --_= 1 n omm�iy ?�� o�m�m'o S _ m4 S > om`Sa£A a N <o�� c33 8 A m'g pg I p to i � L• ; Fri �n v n $ i�'� � 'ii Ae I r, xlg z Z P I I ' o imp � 'I&e� 7m o r Cn OTi y0 eom C soz I"m,a i"a, ign Ram mCq ul I Ia it o C IFS =S i Fr i�g z�YIz4FilVz ��; � I I � ,• c1!I �� y . �I a 1�+ i y� I I i I I x z �F 1888 8 8 8888 i _"8 el i8-- :8� n m A I� � te8'DS O o 10 NECK POND ROAD y m Osterville + i w- (2Dom e8 g gse8 8 ogE M, M o mapi4o/parce1190 za ioog oex m= Ie __ Perm for divider wall to make two rooms above.garage. �d I,pae a. . eon I g �oo) Each room to have 5ft entry. U NEW ADDITION/REMODELING FORS ■� o L,, COTUIT BAY DESIGN.LLC A aIDim^ 43 BREWSTER ROAD MASHPEE MA.02649 D z N�m n 1r I MARKOSKI RESIDENCE PH(S(F)1)41166 N o olm i a 10 NECK POND ROAD OSTERVILLE, MA I FAX(608)639-9402 r 7 Commonwealth of Massachusetts _ Title Official Inspection Form S surface ag Disposal System Form - Not for Voluntary Assessments (11 Neck Pond Rd.'JPI erty Address MCSH JOHW J JR& GAILE M Owner Owner's Name information is required for every Osterville MA 02655 10/29/14 page. City/Town State: Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information b 1 on the computer, use only the tab 1. Inspector: key to move your cursor-do not Robert Paolini use the return -- key. Name of Inspector Robert Paolini Septic Service Will re8 Company Name _ 17 Playground Lane Company Address Yarmouth_port MA 02675 City/Town State Zip Code 508 362-3555 S14454 Telephone Number License Number B. Certification MILO 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: µ ❑x Passes ❑ Conditionally Passes ❑ Fails s ❑ Needs F her Ev ation b he Local Approving Authority 10/29 14 Inspector's Signature V Date The system inspector shall submit a copy of this inspection report to the Approving Autho Ity(Board= of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection_and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 11 Neck Pond Rd. Property Address MCSHANE, JOHN J JR & GAILE M Owner Owner's Name information is required for Osterville MA 02655 1.0/29/14 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass".section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page.2 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �^M 11 Neck Pond Rd. Property Address MCSHANE, JOHN J JR & GAILE M Owner Owner's Name information is required for Osterville MA 02655 10/29/14 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below).: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 11 Neck Pond Rd. Property Address MCSHANE, JOHN J JR & GAILE M Owner Owner's Name information is required for Osterville MA 02655 10/29/14 every page. City/Town 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: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 11 Neck Pond Rd. Property Address MCSHANE, JOHN J JR & GAILE M Owner Owner's Name information is required for Osterville MA 02655 10/29/14 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary, to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be. necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El El Area system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone 11 of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 11 Neck Pond Rd. Property Address MCSHANE, JOHN J JR & GAILE M Owner Owner's Name information is required for Osterville MA 02655 10/29/14 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located'on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 11 Neck Pond Rd. Property Address MCSHANE, JOHN J JR & GAILE M Owner Owner's Name information is required for Osterville MA 02655 10/29/14 every page. CitylTown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes Z No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d na 9 ( Y 9 (gp ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): - Grease trap present? ❑ Yes ❑ No Industrial waste holding-tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 11 Neck Pond Rd. Property Address MCSHANE, JOHN J JR & GAILE M Owner Owner's Name information is required for Osterville MA 02655 10/29/14 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: Robert Paolini Septic Service Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest. inspection of the I/A system by system,operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑' Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 11 Neck Pond Rd. M Property Address MCSHANE, JOHN J JR & GAILE M Owner Owner's Name information is required for Osteryllle MA 02655 10/29/14 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line. 1 + fee et Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through house vents. Septic Tank(locate on site plan): Depth below grade: 1.5' 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: 1000 gl. 41' Sludge depth: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 11 Neck Pond Rd. M Property Address MCSHANE, JOHN J JR & GAILE M Owner Owner's Name information is required for Osterville MA 02655 10/29/14 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 32" Scum thickness 2 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 10.1 How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump tank every 2 years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears . structurally sound. 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 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 11 Neck Pond Rd. Property Address MCSHANE, JOHN J JR & GAILE M Owner Owner's Name information is Osterville MA 02655 10/29/14 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 11 Neck Pond Rd. Property Address MCSHANE, JOHN J JR & GAILE M Owner Owner's Name information is required for Osterville MA 02655 10/29/14 every page. City/Town State Zip Code Date of Inspection D. System Information Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No 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.): Box is Ievel.Box has two outlet Iaterals.No evidence of solids carryover.No evidence of leakage. 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.):. * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: M M t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page U of 17 I — Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 11 Neck Pond Rd. Property Address MCSHANE, JOHN J JR & GAILE M Owner Owner's Name information is required for Osterville MA 02655 10/29/14 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2/6'x6'with 2' stone ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy soil.No signs of hydraulic failure. LP 1 water to invert was 36" . LP 2 water to invert was 28" Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 11 Neck Pond Rd. Property Address MCSHANE, JOHN J JR & GAILE M Owner Owner's Name information is required for Osterville MA 02655 10/29/14 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Neck Pond Rd. Property Address Owner MCSHANE, JOHN J JR & GAILE M __..._. information is Owner's Name required for every Osterville MA 02655 10/29/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ ' hand-sketch in the area below 0 drawing attached separately I � /3 3 33S 33� A YY y 6x•�•hy tP a f l . t5ins-3113 TNe 5 Official Inspection Form:Subsurface Sevuage:Disposal System-Page 15 of 1.7 { Commonwealth of Massachusetts L. W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 11 Neck Pond Rd. Property Address MCSHANE, JOHN J JR & GAILE M Owner Owner's Name information is required for Osterville MA 02655 10/29/14 i every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of leaching 15' 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: As-Built ❑ Checked with local excavators, installers- (attach documentation) . ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: USED:USGS observation well data.USED:Technical bulletin 92-0001 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 11 Neck Pond Rd. Property Address MCSHANE, JOHN J JR & GAILE M Owner Owner's Name information is required for Osterville MA 02655 10/29/14 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file M t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE L�aN. t 1) n SEWAGE # VILLAGE O�P�r�,ll-t' - T ASSESSOR'S.MAP & LOT 6 e, F FrISTALLER'S NAME&:PHONE NO. ), �� lf� SEPTIC TANK CAPACITY _✓ ��� LEACHING FACILITY: (type) hi-/ (size)..Wew lt1 x G NO.OF BEDROOMS BUILDER OR OWNS f� a ✓► e` PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet j Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist - within 300 feet of leaching facility) Feet Furnished by I e t- 33 _1; f Crocker, Sharon To: Crocker, Sharon Subject: 11 Neck Pond Rd, Ost Tom, FYI - For Friday am. PROPERTY is not in any restrictions Owner John McShane, McShane Construction, 508-776-3945-will be in Friday, 12/5 am. A He said he discussed with you his house lot. He is trying to close on his house. He had septic inspector evaluate the system and it handles 440 gpd ---see inspection report. The original permit says they added a second pit and the as-built shows the two pits as does the septic inspection report. The permit says 330 flow and he would like you to make a notation on it that it qualifies for a 4 bedroom per your instructions to him to have inspector evaluate system. The buyer is working through Atty. Albert Schutz 508-428-0950. Thank you. Sharon 1 THE Town of Barnstable OF Tp� do Regulatory Services BARNSTABLE Richard V. Scali, Director BARNS TABLE- tREEALLE�COTVIT•,YANN IS • + KSSTCNSNWS•JS—UE•1'1W BkRBS7AEE ` MASS. ' Public Health Division 639-2019 9 '�"�' �' Apr i639. A`` Thomas McKean, Director 5775 ED MA'1 200 Main Street Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 December 5, 2014 Attorney Albert Schulz Seven Parker Road Osterville, MA 02655 Re: 11 Neck Pond Road, Osterville Dear Attorney Schulz: The Health Division has no objection to an existing four (4) bedroom house at 11 Neck Pond Road, Osterville, based on the septic system inspection on October 29, 2014, performed by Robert Paolini. This inspection revealed that the system can handle four bedrooms. Sincerely, omas A. McKean, RS, CHO Director of Public Health q:\wpfiles\l 1.neck.pond.road.ostervi I I e.112.5.14.doe C� �� ��' G TOWN OF BARNSTABLE L N Wde�L tall Al SEWAGE # VILLAGE— ASSESSOR'S MAP & LOT 114STALLER'S NAME&;PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) we-, 4 x G NO.OF BEDROOMS 3 B DER �OWNE //�� Sl a ✓I e PERMITDATE: �I 3f' COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by a 7, �, - 1 , a� a , - 33 F Ll _ O `►`� __Ja `D 49' geoaooM ��I�Y ��-ow :. ►lox 3 = 33o G•P'? , . • 5EPTtG, TAQK = 330x15o% = .49JG.Po U:5v, loon GAL: Di5Po5AL PIT "v5E [006.GAL-. , I� 5►pr.Y/ALI- 50TTOM AR.E.A s ''`F• j ,Lo'J'S / y/7 5O 5.F x 1. 0 r 5o G.Po� /f977 0— 99 'IOTA L. DESIGN * 427 G.P. D. I 'ZoTAI.. DA►�-Y Fti-ov�! 33oG.Po, zc--,� 9 $z� PE2Gol.ATIoN 2A'TE , 1--IN 2MIM oP.Ll~•.�S5 0 -r:u. F��• Q y9•g �w1%I OF AQ ALAN `yam i /DO G / 'S� �•ao- /a:l ; 1 / AICHARD y`� • u J01,ES H Lomas/ /ov Y� A. BAXTER H �\ o w� '5100 �Q• / �� No.24048 �° S T E l � FC�S iv Top FNo =10 I .o � ocu INS•oa.rl �' 1 GAL. ,SUt�Soi�-- ©�7 INS.. 56PTI( L 1.000 IN�l. ��79 TANK �a�.. y,23 ►o� LEAGII INY. IN - - 1-r S 97 7 w1ru 97 WASUGD 6Tv N B GE2TIFIGP PI-oT PLAtJ �17 -3 Np� SGALE .SCALE PLAN lzF= -eI I CEczT1FY -T.µp:r -TNE PP-o�GS �YN ��r� ///G y/� .}{E,R�oN GOM�PL•`(.5 YJITN"SHE..�,I o�LIN �7 AuP '51^-c5AC-K- F—F-Q0►RZEM�tJY� oF -tµ `. C ZCC� g 'TOWN O BARfi V-� ANC IS �Tr LOGQ.T -WIT )�I'�►J G -r1A'E \-ooD PLAIN DATE II 9 �C�CJ'�`�eQ C� 6AxTEcz e ti1YE INS• oes L REGI3z�Q6� t�uDSuevEY T1�►S PLo:r•► 15 NorT 4n5c p 0)d AN dSTEQ.VILL� • H�P.SS• 1 5-1-R,uMENT Sv�vE`( 'rNE ot=F E'r5 5uov CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANSI s, hereby certify that the application for disposal works ley construction permit signed by me dated �Y—3o - 1 t , concerning the property located at Ai meets all of the following criteria: There are no wetlands within 300 feet of the proposed septic system There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED: 06,11— DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. Y � THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS l� 0(ppiicatiou for Migpooal 6potem Congtructiou Permit Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. Plr�� N1CIC l�a�ad /�/ �f�t��✓7 �th /�aS� Installer's Name,Address,and Tel.No. ST6,9 `-VI;•)3'9.� Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow JD gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title / Description of Soil S•��e(,, Nature of Repairs or Alterations(Answer when applicable) _L?s 6 _44 L.,4,4 ,di'# Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued t is oard of Health. Signed Date Application Approved by ie Application Disapproved for the following reas Permit No. Date Issued i. {. lr >i J art_ , Y.C. r< e F e THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -_.TOWN OF BARNSTABLE, MASSACHUSETTS 4 0(pplicatt"On for Mi.5pq.5al *p5tem Construction Vermit Application is hereby made.for a Permit to Construct or Repair an On-site Sewage Disposal System at: Location Address or Lot No. lot jy///,7 Owner's Name,Address and Tel.No. /TV Installer's Name,Address,and Tel.No. 0 S 91 0-qrq.� Designer's Name,Address and Tel No. \J04 A�i --7 19 )0//, Type of Building: Dwelling No. of Bedrooms Garbage Grinder Other Type of Building No. of Persons Showers,( Cafeteria( Other Fixtures Design Flow 30 gallons per day. Calculated daily flow 30 gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations(AnsweirwUn"applicable) d; Date last inspected: Agreement: The undersigned,Agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued pyt ispoard of Health. Y100L_ 4 Signed(, Date Application Approved by Application Disapproved for the following reas n Permit No. Date Issued.- ——---—— --—— —————— ——————--- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE. MASSACHUSETTS Certificate of Compliance THIS IS TO C y TO he On ge�Disposal System installed or repaired/replaced on C _&wa b for as hg constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.(-/I,? �2 dated Use of this system is conditioned on com liance with the provisions set forth below: Vj No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION.- BARNSTABLE, MASSACHUSETTS Miqonl *pgtem Construction Vermit Permission is hereby granted to ge!) 0 Se� to construct( )re r� �-an - .n-&jte �a, gk System located at C AU1,113. KML) Mj= and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construc io must b com leted within two years of the date below. --2 Date: 4074177 Approved by / / t-- ---------------- T � I mood I I np9� 0 ®©O f=;r m a � mzm- D � p I ; mp m . 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'� \ S1 N O F m z WI MID-SPAN BLO�KINO i Zpmm�mo y�op00 'Fz91 z mmw b §ram 7 v of fya m D b. 3-P.T.2 x 12 BEAM 3-PT.2x 12 BEAM Oma I z28 I 7�11 0/ mFm I \ b I � b> 1010 X IF G FS m °z b I 00 Oc 'J o °Moo ZQaa 24'-W 16'-0' 0 G1 m 0 uo^OP O y 00 n°y0 DZ-Oz 2y1 m.Om O 60 .I D THE DESIGNER DRAWINGSSHALL PRIOR NOTIFIED IF ANY NEW ADDITION/REMODELING FOR-. a Q® COTUIT BAY DESIGN. LLC 'x� ERRORS OR OMISSIONS ARE FOUND ON O) Q \ y' COTHESECONSTRUCTION DRAWINGS PRIOR TO START OF (� CONSTRUCTION.THE BUILDING CONTRACTOR N D � WILL BE RESPONSIBLE FOR THE CONTENT 43 BREWSTER ROAD g o �}�I - D C MMEETHOUTNONSTRUCTION MARKOSKI RESIDENCE MASHPEE,MA. 02649 \ 111 II r C THESE DRAWINGS WITHOUT CONSTRUCTION NOTIFYING THE .I z N DESIGNER OF MY ERRORS OR OMISSIONS. PH.(508 274-1166 O ITI THESE DRAWINGS ARE SOLELY FOR THE USE FAX(50tf)539-9402 OF THE TOFTED NOTED. IGNER OTHER USE OF 10 NECK POND ROAD OSTERVILLE MA z V O THESE DRAWINGS REQUIRES THE WRITTEN Q _ CONSENT OF THE DESIGNER UNDER THE ARCHITECTURAL COPYRIGHT PROTECTION � ACT OF 1990. 0H o w m y 28'-0' $f mD m IV D2-1 314'x 9 12'LVL HEADER r m F D .$n o5 e0 pD r 6 9 ^m O O O9A; O >O z A �y �g � IA T i m 0 v 'm (K� A OO@ u g G�1v b 0 b, m� i{ 2-1 3/4'x11 718'LVLRIDGEBEAM a7 L M. e'o � n 6 A I °�` H Ow� I om A< NEW 3-13/4'x912'LVL BEAM y 1 Av— I , m °D C� $ _ ggm 0O N08 AO A D � 0 � �N m� 'A NpN mOy: wa m- o_y- znNF, mF _ 3 °mmayx� O��o- ® F �A ym Z�Uf A s °o4 Q`m 0 �t�m cmii� T a y °21 M,A-G 00 '1 o�A m1 2i y� O=A T 1 "N�° ° �p p p=�� D I a'I=i em N m. 0 Za mN D po we7m rnDD rnW O w < ;mm °c o 0. Z I In o n n w T A I c V N r z °i ,x 3-1 314'x 11 7I8'LVL RIDGESEAM I� 2 i.oo ON�y IA 020 CAA. °OF0 I y k 6" m '> b °O - Im � F 16'-W 1 I b I I I 24'-0' THE DESIGNER DRAWINGSSHALL PRIOR NOTIFIED IF ANY NEW ADDITION/REMODELING FORE Q® _ /n ERRORS OR OMISSIONS ARE FOUND ON COTUIT BAY DESIGN. LLC 0 v' THESE DRAWINGS THE BUILDING START OFCONTR 43 BREWSTER ROAD /� CONSTRUCTION.SIBLEFRTHCONTRACTOR N > 'A " WILL BE RESPONSIBLE FOR THE CONTENT O Z D IN THESE DRAWINGS IF CONSTRUCTION MASHPEE,MA. 02649 �I COMMENCES ANY OR THE MARKOSKI RESIDENCE PH.(508 274-1166 Z N m 'I r DESIGNER S ANY ERRORS Q L m THESE DRAWINGS ARE SOLELY FOR THE USE FAX(50ti)539-9402 OF THE OWNER NOTED.ANY OTHER USE OF Z y O COSE DRAWINGS NTOFTEDEIGNER UNDER THE cn 10 NECK POND ROAD OSTERVILLE, MA O ARC ITETOFTHE DESIGNER UNOTECTI ARCHITECTURPL COPYRIGHT PROTECTION ACT OF 1990. � °moma (MATCH EXISTING) Faomm� x mp F r00p fa OLl T�10 m Cy a ry°mmi �m 00' a a0 F a rnD �w \ n m€rDg wSw®F mu wN m 0 ca 00 n �mO � o 7-mZ O Z� 0 C � 0 n o Z W-T, m 3�iiF zpn o4ey nia DC N ogyyF m.> npz00 0 O Am O� Dm M. a o 0D pAC' �m"� mAxm '0 m 0 z z\ s co 0 z. 0 � m m K --I H m m z MME oo z O x x O a-1 ° mN nM,z mov i �(nz >0""bW; i Onm 92A 11 �o? 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PH.(SOS Z74-1166 I 1 1 THESE DRAWINGS ARE SOLELY FOR THE USE O ' OF THE OWNER NOTED.ANY OTHER USE OF FAX(50 )539-9402 Z V O THESE DRAWINGS WRITTEN 10 NECK POND ROAD OSTERVILLE, MA 0 CONSENT OF THEE DESIGNERIGNER UNDER THE ARCHITECTURAL COPYRIGHT PROTECTION ACT OF 1990. r • 14 f 14. N 0--rn, °od`Or d s �O,'0 E/T/C�pHW I pN£ 0_,, �i�o, R°od® E/T/C --aHw� x 33,9 I s �a 10 E/T/C oHtt�_ al F7: WIDE PR/VA TE W E/r/c _ � �a A Y � FENCE LINE �a 10 �1rc�e 67.96' AKq Meek'. L. Pon d R H -1 O pd B°r�°<d Rd q / S83 pg 3 moo\ E/r/C --OHw E � \•• :,. 137,0 37 0 0 E�..: �\ --•oHw LOCUS •PAVED `-.- LOCUS MAP O TBM \ `ORIVEWAY`;. ;' ��3 NOT TO SCALE [� Mog Nail set \ ^�I EL.=34.0 \ .>c•. 4,3 LAMP. \ o \ !z 140' of 1" PLASTIC WATER r 8' \ SERVICE TO NECK POND RD 1p' x (approximate location) x 34.6 ''� *� 33,6 3 1� GARAGE ,EX/STING a'1 t ° "OF MASK r 1 HOUSE#10) 17' / a 10' V 1 f SILL EL.=36.2 r o to -�� PETERT. ``1n McENTEE � 1 CIVIL' 1r bh 1�5 0 18' .35109 t1' / 1 SEPTIC 0 1¢ A GtS7ER�� 'q, 1 PROPOSED i 0 TANK g 1 COVERED PROPOSED z� x 33.8 I PORCH ADDITION It # 6 I PROPOSED 2 sfy w/f I o OWNER OF RECORD DwellingI PATIO': ° KEITH R. MARKOSKY PROPOSED ° TIFFANY SWAN MARKOSKY SHED . PROPOSED i 10 NECK POND ROAD IN GROUND ": ` .; .%. 3 OSTERVILLE, MA 02655 SWIM MIAdG'FQOL Concrete Drive �� ,,, PARCEL ID: 140-191 x 34,3 I_ PARCEL AREA U,�° � LEGEND GENERAL NOTES: ° 1 15,758±S.F. rj — EXISTING CONTOUR 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL 34 — =° ExisrrNc a° x 36.8 EXISTING SPOT GRADE BOARD OF HEALTH AND THE DESIGN ENGINEER. ���309;3p�E �- FENCE(REMOIrE� �/�/ _ PROPOSED WATER SVC. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS ° OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE "-i-__ 137.0�' _ °- _ LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: 9• ALL AREAS CLEARED FOR CONSTRUCTION SHALL' BE RESTORED AS ° �_° l -E/T/C OHW-OVERHEAD WIRES -310 CMR 15.405(1)(b): AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE EXISTING SEPTIC SYSTEM — TEST PIT 1) A 7' variance, S.A.S. to cellar wall (bulkhead), for a 13' setback. DIRECTED BY THE APPROVING AUTHORITIES. TO BE REMOVED 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY $ BENCHMARK TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING DESIGN ENGINEER. CONSTRUCTION. PROPOSED SEPTIC SYSTEM UPGRADE PLAN 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 1 1. WHERE REQUIRED, CONTRACTOR SHALL REMOVE BALL UNSUITABLE SOILS FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND 10 NECK POND ROAD, OSTERVILLE, MA ENGINEER BEFORE CONSTRUCTION CONTINUES. REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM (BARNSTABLE G.I.S.t). 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE Prepared for: COTUIT BAY DESIGN, 43 Brewster Road, Mashpee, MA 02649 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF INSPECTED BY DESIGN ENGINEER PRIOR .TO BACKFILL. Engineering by: SCALE DRAWN JOB. N0. THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY. 1"=20' P.T.M. 201-17 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. Engineering Works, Inc. 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 14. EXISTING BUILDING AND PROPOSED BUILDING IMPROVEMENTS ARE 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. TAKEN FROM PLAN ENTITLED PLAN SHOWING PROPOSED SITE CHANGES AT 10 NECK POND RD." BY CopeSurv, OSTERVILE, MA, DATED 6/12/17. (508) 477-5313 6/21/17 P.T.M. 1 Of 2 t „V NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL SEPTIC TAN K FOR A DISTANCE OF 1v5 T E 0 AROUNDTHE INSTALL RISERS & COVERS OVER INLET PERIMETER OF THE S.A.S. AND SET TO 6" OF FINISH GRADE. PROPOSED D-BOX PROPOSED S.A.S. PROVIDE ACCESS TO GRADE OVER OUTLET COVER PROVIDE ONE ACCESS MANHOLE TO WITHIN 3" �12.8'--1 INSTALL WATERTIGHT RISER & OF FINISH GRADE FOR INSPECTION PURPOSES SILL EL.=36.2 COVER SET TO 6' OF GRADE F.G. EL TING)6t F.G. EL.=33.9t F.G. EL.=34.0t F.G. EL.=34.0t (EXISTING) MAINTAIN 2% GRADE (MIN.) OVER S.A.S. � 1 mWim N 1!1 lal A,NIYJ � ® S=1%1(MIN.) L = 15' L = 23' try N1n 4"SCH40 PVC . ® S=1% (MIN.) ® S=1% (MIN.) lq 01 4"SCH40 PVC 4"SCH40 PVC LL " .„ Ba BB ,EXISTING �99, �1 14" 6 - MEMO Baa HOUSE(#10) 13�.3• al INV.=31.30 48" LIQUID OBaa113 SILL EL.=36.2 LEVEL ADD 4' 4.8' 4' GAS BAFFLE INV.=30.90 PROPOSED INV.=30.73 INV.=31.05 D-BOX EFFECTIVE WIDTH = 12.8' ,5Allml 0 • l • • k H-20 RATED INV.=30.50 PROPOSED SEPTIC TANK 3-500 GALLON LEACHING CHAMBERS H-20 RATED SURROUNDED WITH STONE AS SHOWN MODIFY INTERIOR PLUMBING FOR NEW SEWER H-20 RATED OUTLET SET AT, OR ABOVE, INV.=31.50 TOP CONC. ELEV.=31.6t BREAKOUT ELEV.=31.00 INV. ELEV.=30.50 Baas NOTES: Baaaa aaaBM 1) INVERTS, TRACTORIOR TO INSTALLATION.ERALL EXISTING PIPE as®a aaaBa SEPTIC LAYOUT BOTTOM ELEV.=28.50 4' 3 X 8.5'=25.5' 4' 2 SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND TRUE 4' MIN. OF NATURALLY OCCURRING TO GRADE ON A MECHANICALLY COMPACTED 6" CRUSHED PERVIOUS MATERIAL EFFECTIVE LENGTH = 33.5' STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 5' MIN. ABOVE GROUNDWATER LEACHING SYSTEM SECTION 3) INSTALL INLET & OUTLET TEES AS REQUIRED. BOTT. OF TP-2, EL.=22.9 - 4) CONTRACTOR SHALL INSPECT EFFLUENT FILTER ON 3/4" To 1-1/2" DOUBLE EO®®® 0 OUTLET TEE AND REPLACE IF NECESSARY. WASHED STONE _ ®®®EO®® ®®®®® 37" �t w ®®®®®® ® ®®®® 3" LAYER OF 1/8" TO 1/2' N Z ®�® SEPTIC SYSTEM PROFILE DOUBLE WASHED STONE - (OR APPROVED FILTER FABRIC) 102„ DESIGN CRITERIA SOIL LOG NUMBER OF BEDROOMS: 4 DATE: JUNE 20, 2Q17 (P#15,403) 4" KNOCKOUT SOIL EVALUATOR: PETER McENTEE SE-1542 20 DIA. COVER SOIL TEXTURAL CLASS: CLASS I WITNESS: DONALD DESMARAIS R.S. HEALTH AGENT DESIGN PERCOLATION RATE: <5 MIN/IN 4" KNOCKOUT / 4" KNOCKOUT 58" (0.74 GPD/SF LOADING RATE) ELEV. . TP-1 DEPTH ELEy. TP-2 DEPTH DAILY FLOW: 440 GPD 34.0 0" 33.9 0" DESIGN FLOW: 440 GPD FILL FILL 4" KNOCKOUT GARBAGE GRINDER: NO 32.8 Ab 14" 32.4 Ab 18 LEACHING AREA REQUIRED: (440 GPD) = 594.6 SF LOAMY SAND LOAMY SAND 500 GALLON CAPACITY, H-10 LOADING .74 GPD/SF 32.0 24" 31.9 24"10YR 4/2 10YR 4/2 CHAMBERS B PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY B PROPOSED DISTRIBUTION BOX: 1 INLET, 3 OUTLETS LOAMY SAND LOAMY SAND N.T.S. USE 3-500 GALLON LEACHING CHAMBERS IN SERIES 10YR 5/8 10YR 5/8 PROPOSED SEPTIC SYSTEM UPGRADE PLAN SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 30,8 38" 30.7 38" C C 10 NECK POND ROAD, OSTERVILLE, MA SIDEWALL AREA: 2 12.8' + 33.5' X 2 = 185.2 S.F. PERC ( ) M-c SAND M-c SAND 24"/42" Prepared for: COTUIT BAY DESIGN, 43 Brewster Road, Mashpee, MA 02649 BOTTOM AREA: 12.8' x 33.5' = 428.8 S.F. 2.5Y 6/4 .2.5Y 6/4 Engineering by: SCALE DRAWN JOB. NO. TOTAL AREA:..............................................................614.0 S.F. Engineering Works, Inc. N.T.S. P.T.M. 201-1 7 DESIGN FLOW PROVIDED: 0.74 GPD/SF(614.0 SF)=454.3 GPD 23.0 132" 22.9 132" 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. NO GROUNDWATER OBSERVED, PERC RATE 2 MIN, 26 SEC./INCH (508) 477-5313 6/21/17 P.T.M. 2 Of 2