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HomeMy WebLinkAbout0180 NORTH BAY ROAD - Health 180 NORTH BAV ROAD, OSTERVILLE A 0073 013 1 t j f i o � 1 Q 1 TOWN OF BARNSTABLE LOCATION _180 nioRrH 6R y 2C) SEWAGE# .2-006 -5�27 VILLAGE OSTCR Vi 14E ASSESSOR'S MAP&PARCEL 73 — D�3 INSTALLERS NAME&PHONE NO. h'QAAJ G'S Fh 1 6 4W 50 8-989-0056 SEPTIC TANK CAPACITY Z OO O �jAL LEACHING FACILITY:(type)15 W biFFySoR.5 (size) /6 X APZ'V S,=` NO. OF BEDROOMS OWNER AJ'TNo&/ .5=M 43 O L.— PERMIT DATE: moo COMPLIANCE DATE: J I 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 t P1 ISO CTi� MAs� Nose ot T I I 3 � y 59.z 37 .s, SoA 7o.5' y 3 No. 6 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ..PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pprtcation for �Bigo!gal �bpgtem Construction Vertu Application for a Permit to Construct(v< Repair O Upgrade(•�< Abandon O O Complete System ❑Individual Components Location Address or Lot No. f?o mAv\Z" f&,Lc( Owner's Name,Address,and Tel.No. � S r�Cu,'� ,4$� e� ryT,,,3t Assessor's Map/Parcel v 3 07 _© 75, czkTe q Q K 0 Installer's Name,Address,and Tel.No. a l�l y,iw�! Designer's Name,Address and Tel.No. �1,,-ti. 5u1C�v�� E t Ran�e;5 N 1 A4CC�G 4AJ SorS' 9Bf-oo v!° Type of Building: Dwelling No.of Bedrooms 7 Lot Size 1'5 s t.,&. ftrk. Garbage Grinder (0) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures pp Design Flow(min.required) 770 gpd Design flow provided gpd Plan Date DM g� ,7 Number of sheets \ Revision Date Title S( � 1�c6Qa`v2� 1���L�Dc�zmPJ�Qo rr Size of Septic Tank ?Lwo 0"Adn' Type of S.A.S. C—leo D*►+�,5'r5 iYl f[o 4 C—ACL4 Description of Soil 1RrL - 1l.411 0'�l1, 1°ILC- 8_ U rn a ® O Lti Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by2thi4sard of Health. ` Signed Date AA 7 Application Approved by Date / 0 Application Disapproved by: Date for the following reasons Permit No. o-oo co 7 Date Issued J CQ No. c� 6 J c n, ��^ .i.. Fee �S I Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpplication for Th5pont 9pp$tem Cow9truction Permit Application for a Permit to Construct(%,)o'Repair( ) Upgrade(,,< Abandon( ) [Complete System ❑Individual Components Location Address or Lot No. '�Q /ud�� ��r� Ow_�nieer``'s Name,Address,and jTel. yyNo. \ ,,, Us�er�\'� rnjT,l1A J �VJdM r 1b �t4 \v��Pe\,� 1rl5C Assessor's Map/Parcel O 1 3 w_.._ q4 6..T/i v1)/t O Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. rRa�.�ei5 N NAcc� .�� 5ob' ses-oa5ro ;F ;, ho( Scr Type of Building: Dwelling No.of Bedrooms Lot Size ;(,SS A& _sq:-ft. Garbage Grinder (�a) .i,sybN' Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) W(7 gpd Design flow provided gpd Plan Date `ecw,m�- r• 17_ Zop(o Number of sheets Revision Date Title S t1tti �u�D`ve o� SeP�L_ll(?crwer�Q ' lv Size of Septic Tank Type of S.A.S. IrJ C-lay b,(�,,jrS i �(n�(�,�( r,r1(� 4 Description of Soil - ill �� n- IL( Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Y i Date /A _Q 7 Application Approved by Date . s Application Disapproved by: , Date for the following reasons Permit No. a S / 1 '�� f, t Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,t at tE the On-site Sewage Disposal System Constructed (,.�) Repaired ( ) Upgraded ►� Abandoned( )by at NO A)Or\\_'R,) �4.j ru\ has been constructed in accordance with the provisions of Title-5_and the for Disposal System Construction Permit No. �� (D J�a' 7,dated /.3 Installer t4zk� Designers U #bedrooms �2 Approved design flow � gpd The issuance of this permit shall n-be construed as a guarantee that the system will,funati. n a s'in d. Date 1 Inspector No. o�Q5 C)— f Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS Migo!6al �&p!5tetn Construction Permit Permission is hereby granted to Construct Repair ( ) Upgrade (/) Abandon ( ) System located at Mo A rN, Frc_ 6c°� 0 "A, e and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction mu t beAe mpleted within three years of the date of tht p . Date l a Approved nY-- Town of Barnstable of T Regulatory Services . M` Thomas F. Geiler,Director • Ut.NsrasM Public Health Division TFc►urw�` Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Desizner Certification Form Date: er: J /1 �n Installer: F�An/Ci S 17���"��•c7 Design Sjm g� E brveer Address: PIA-ter- d A AL)0 Address: o Sc�"1� ilY�l d 21n — 1a/S/T� -�1A 42360 On F2pNr-ls b1 p LC1 craw was issued a permit to install a (d te) (installer) septic system at f�1y N�c�h �-tea '��►[[P� based on a design drawn by., (address) I dated 12 12 D L (des goer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical.relocation of any component of the septic system)but in accordance with State& Local Regulations. Plan revision or certified as-built by designer to follow. PkT��i (Installer's Signature) coma �n (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO B A INSTABLE PUBLIC_HEALTH DIVISION. CERTIFICATE OF COrIP`LLANCE NVILL NOT BE ISSUED UNTIL, BOTH THIS FORM' Ai�FD AS- BUILT CARD ARE RECEIVED BY THE B_ARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Desiper Cer i canon Form • Commonwealth Of Massachusetts Executive Office Of Environmental Affairs Department Of Environmental. Protection TITLE 5 Official Inspection Form -Not For Voluntary Assessments Subsurface Sewage Disposal System Form Part A . Certification Property Address:180 North Bay Rd.Osterville Ma.(System#2) � O Owners Name:Anthony C.Simboli Owners Address: 121 High St.Winchester Ma. Date of Inspection: 1/26/2006 Name of Inspector(please print)Sean M.Jones Company Name:S.M.Jones Title V Septic Inspectors Mailing Address:74 Beldan Ln. Centerville Ma.02632 Telephone Number:508-778-4597 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 pursuantto Section 15.340 of Title 5(310 CMR 15.000).The system: X Passes Conditionally Passes Needs further evaluation by the Local Approving Authority Fails Inspectors 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. Notes and Comments:Dwelling is served by two separate septic systems.This Inspection report reflects the condition of system#2.System#2 is used for a basement level bathroom only.., ****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. Page 1 i OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(corrTmm) Property Address: 180 North Bay Rd.Osterville Ma.(System A) Owner:Anthony C.Simboli a Date of Inspection:1/26/2006 Inspection Summary:Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _X_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: a 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 the 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 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: OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(cowmmD) Property Address: 180 North Bay Rd.Osterville Ma.(System a6) Owner:Anthony C.Simboli Date of Inspection:1/26/2006 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 310CMR 15.303(1)(b)that the, System functioning in a manner that protects the public health,safety and the environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a Surface water supplyor 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 less than 100 feet but 50 feet or more from a Private water supply well".Method used to determine distance "This 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: OFFICIAL.INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 180 North Bay Rd.Osterville Ma.(System 0) Owner:Anthony C.Simboli a Date of Inspection:1/26/2006 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ' _X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/z day flow _X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number . of times pumped _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. , X Any portion of cesspool or privy is within 100-feet of a surface water supply or tributary to a surface water supply. _X_ Any portion of cesspool or privy is within Zone 1 of a public well. _X_ Any portion of cesspool or privy is within 50 feet of a private water supply well. _X_ Any portion of 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 pp,provided that no other failure criteria ' are triggered.A copy of the analysis must be attached-to this form.] _X_ (Yes/No)The system fails.I have determined that one or more of the above 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:N/A - 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: t 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 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 CM15.304.The system owner should contact the appropriate regional office of the Department. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 180 North Bay Rd.Osterville Ma.(System#1) Owner:Anthony C.Simboli a Date of Inspection:1/26/2006 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health X_ Were any of system components pumped out in the previous two weeks? X Has the system received normal flows in the previous two week period? X_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X _ Were all system components,excluding'SAS,located on site? _X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tee,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _X _ 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 X Existing information.For example,a plan at the Board of Health. X_ _ 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)] OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 180 North Bay Rd.Osterville Ma.(System#1)` Owner:Anthony C.Simboli Date of Inspection:1/26/2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): *SYSTEM IS USED FOR BASEMENT LEVEL BATHROOM ONLY DESIGN flow based on 310 CMR 15.203(for.example): 110 gpd x#jof bedrooms): Number of current residents: 0 ; Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO_{if yes separate report required] Laundry system inspected(yes or no): N/A Seasonal use:(yes or no)_YES Water meter readings,if available(last 2 years usage(gpd): Sump pump(yes or no):—NO— Last date of occupancy/use:. 8/2005 COMMERCIAL/INDUSTRIAL N/A Type ofestablishment: YP _ -- Design flow(based on,3l0 CMR 15.203 d 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: Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: gallons--How was this 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 the 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: 10 YEARS+/- Were sewerage odors detected when arriving at the site(yes or no):—NO— OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 180 North Bay Rd.Osterville Ma.(System#I) Owner:Anthony C.Simboli a Date of Inspection:1/26/2006 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron 40 PVC other(explain): Unable to determine as plumbing run below basement floor Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_X_(locate on site plan) Depth below grade:_6"_ Material of construction:—X—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: 1000 141lons Sludge depth: 16" Distance from top of sludge to bottom of outlet tee or baffle: 24 Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle:_n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a 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.): I recommend cleaning septic tank because sludge depth is getting thick.Inlet and outlet baffles were intact and in good condition.Liquid levels were good.No evidenc of tank leaking. GREASE TRAP:_N/A_(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass Polyethylene other(explain) Dimensions: } 4. 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.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 180 North Bay Rd.Osterville Ma.(System#I) Owner:Anthony C.Simboli a Date of Inspection:1/26/2006 TIGHT or HOLDING TANK: N/A (tank must be pumped at time of.inspection)(locate on situ 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:_X_(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.): Box was level and in good condition,water level was at bottom of outlet pipe no evidence of solids carryover,box is not leakine. PUMP CHAMBER: N/A (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.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 180 North Bay Rd:Osterville Ma.(System#t) Owner:Anthony C.Simboli a Date of Inspection:1/26/2006 SOIL ABSORPTION SYSTEM(SAS)._X (locate on site plan,excavation not required) If SAS not located explain why: Type Leaching pits.Number: - _X_Leaching chambers,number: 2 Flowdiffusers Leaching galleries,number: Leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternitave system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Soil was dry,no sign of hydraulic failure,vegetation was normal. CESSPOOLS: N/A (cesspools must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no) Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: N/A_(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.): Permit Number. �.__.___Date: -- - ( Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location: ,qb AJaf"r�t= _OSke_r,���9 d1Aa Lot No. Owner: ArA,0A AW r✓vy o) Address:j Contractor: Address: Notes: rQQ___�_-- I i STEP 1 Measure depth to water table tonearest t/f 0 ft. .......... ................... ................. ................... Date nsunthOdeY/Y ®r STEP 2 Using Water-Level Range Zone f and Index Well Map locate site and determine: ® Appropriate index well...................... ... ......... ...... Nt►W �I Waterlevel range zone :.......................1....,..:.................... i STEP 3 Using monthly report"Current Water Resources Conditions" i determine current depth to p water level for Index well j a OS 7� i' Mont Ivee+ STEP 4 Using Table of Water•levei Adjustments for index well (STEP 2A),current depth to water level for index well (STEP 3), and water level none (STEP 26) ILi determine water-level adjustment .............:.................:...................................................... .... I I STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water b level at'site (STEP e) ............................... � ....................,.. ................. ........................... a' i 1 Figure 13,—Reproducklle computgon form, IS I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMZNTS SUBSURFACE SEWAGE IDISPOSA I,SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) i Property Address: 180 North Bay Rd.Osterville Ala.(System$Q) Owner:Anthony C.Simboll Date of Inspection:1/26/2006 SITE EXAM Slope ' Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)methods used to determine the high' ground water elevation: Obtained from system design plans on record-If chezked,date of design plan reviewed: Observed site(abutting property/observation hole wiihin 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach doc�mentation) Accessed USGS database-explain: _ You most describe how you established the high ground water elevation: . j k l�S'Ga.-mot' Lva� Wa.S G�etCtM1A[c� rat! �kn� i`�.uf Cf my (,�dWv '{�yj (s *7n 7 "►Q 1 r OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOS�,L SYSTEM INSPECTION FORM PART C SYSTEM INFORMATIOIN(continued) Property Address: 180 North Bay Rd.Osterville Ma.(system#1) Owner:Anthony C.Simboli Date of Inspection:1/26/2006 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent referencelandmarks or Benchmarks.Locate all wells within 100 feet. Locate where water supply enters the building . i i i j I { o i o ' t' � �' Iot�oCxlJugs O #a SANK O D IOrt, � Y Any IG 3 o j A- i 1y A-a C" SAS j ►3 3- S-Y I P)+ a f t Commonwealth Of Massachusetts Executive Office Of Environmental Affairs Department Of Environmental Protection TITLE 5 Official Inspection Form -Not For Voluntary Assessments Subsurface Sewage Disposal System Form Part A Certification Property Address: 180 North Bay Rd.Osterville Ma.(System#1) Owners Name:Anthony C.Simboli Owners Address: 121 High St.Winchester Ma.f Date of Inspection: 1/26/2006 Name of Inspector(please print)Sean M.Jones Company Name: S.M.Jones Title V Septic Inspectors Mailing Address:74 Beldan Ln. Centerville Ma.02632 ` Telephone Number: 508-7784597 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: X Passes Conditionally Passes Needs further evaluation by the Local Approving Authority Fails Inspectors 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. Notes and Comments:Dwelling is served by two separate septic systems.This Inspection report reflects the condition of system#I ****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: Page I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(cowpamm Property Address: 180 North Bay Rd.Osterville Ma.(System#1)' Owner:Anthony C.Simboli Date of Inspection:1/26/2006 Inspection Summary:Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _X_I have not found any information which indicates that any of the failure criteria described in 3 10 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 the 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 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: L I OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CON HUED) Property Address: 180 North Bay Rd.Osterville Ma.(System#1) Owner:Anthony C.Simboli Date of Inspection:1/26/2006 , 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 310CMR 15.303(1)(b)that the System functioning in a manner that protects the public health,safety and the:environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a Surface water supplyor 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 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: OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(Cowwum) Property Address:180-North Bay Rd.Osterville Ma.(System#1) Owner:Anthony C.Simboli Date of Inspection:1/26/2006 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. _X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ° T _X_ Liquid depth in cesspool:is less than 6"below invert or available volume is less than '72 day flow _X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s)..Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation. _X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface° water supply. _X_ Any portion of cesspool or privy is within Zone 1 of a public well. _X Any portion of cesspool or privy is within 50 feet of a private water supply well. _X_ Any portion of 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 pp,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] _X_ (Yes/No)The system fails.I have determined that one or more of the above 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:N/A 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: 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 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 ' CM15.304.The system owner should contact the appropriate regional office of the Department. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:-180 North Bay Rd.Osterville Ma.(System#1) Owner:Anthony C.Simboli Date of Inspection:1/26/2006 t Check if the following have been done.You must indicate"ves"or"no"as to each of the following Yes No X Pumping information was provided by the owner,occupant,or Board of Health X Were any of system components pumped out in the previous two weeks? . X Has the system received normal flows in the previous two week period? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X_ _ Was the facility or dwelling inspected for signs of sewage back up? X_ _ Was the site inspected for signs of break out? X _ Were all system components,excluding SAS,located on site? _X_ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tee,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _X _ 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 _X Existing information.For example,a plan at the Board of Health. _X_ _ 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)] OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 180 North Bay Rd.Osterville Ma.(System#1) Owner:Anthony C.Simboli Date of Inspection:1/26/2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):-6— Number of bedrooms(actual):_6_ DESIGN flow based on 310 CMR 15.203(for example): 110 gpd x#of bedrooms): 660GPD Number of current residents: 0 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate report required] Laundry system inspected(yes or no):_N/A Seasonal use:(yes or no)_YES Water meter readings,if available(last 2 years usage(gpd): Sump pump(yes or no): . NO Last date of occupancy/use: 8/2005 COMMERCIAL/INDUSTRIAL: N/A ' 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: Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: gallons--How was this quantity pumped determined?' Reason for pumping: TYPE OF SYSTEM _X 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 the 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: 10 YEARS+/- Were sewerage odors detected when arriving at the site(yes or no : NO OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 180 North Bay Rd.Osterville Ma.(System#1) Owner:Anthony C.Simboli f Date of Inspection:1/26/2006 BUILDING SEWER(locate on site plan) Depth below grade:_12"_ Materials of construction: cast iron_X_40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): Joints were in good condition no sign of leakage SEPTIC TANK:_X_(locate on site plan) Depth below grade:_6"_ Material of construction:_X_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: 1000 Gallons Sludge depth: 18 Distance from top of sludge to bottom of outlet tee or baffle: 2` Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle:— N/A-Distance from bottom of scum to bottom of outlet tee or baffle: N/A 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.): I would recommend cleaning of the tank as the sludge buildup is getting thick.Inlet Tee and outlet baffle were intact,tank was structurally sound,liquid levels were at the correct level. GREASE TRAP:_N/A_(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.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 180 North Bay Rd.Osterville Ma.(System#1) Owner:Anthony C.Simboli Date of Inspection:1/26/2006 TIGHT or HOLDING TANK: N/A_(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: X (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.): Box was level and in good condition,distribution was even between two outlets.No evidence of solids carryover, box is not leaking- PUMP CHAMBER: N/A (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.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 180 North Bay Rd.Osterville Ma.(System#1)' Owner:Anthony C. Simboli Date of Inspection:1/26/2006 SOIL ABSORPTION SYSTEM(SAS):_X (locate on site plan,excavation not required) If SAS not located explain why: Type _X_Leaching pits.Number:- 2-Leaching chambers,number: Leaching galleries,number: Leaching trenches,number,length: leaching fields,number,dimensions: ' overflow cesspool,number: innovative/alternitave system Type/name of technology:- Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): System has 2 leach pits,pit 1 is 1000 gallons surrounded by 2+feet of stone.Pit 2 is 500 gallons and is also surrounded by 2+feet of stone.Both pits were opened and at time of inspection no standing water was encountered. CESSPOOLS: N/A (cesspools must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,.condition of vegetation,etc.): PRIVY:- N/A (locate on site plan) T Materials of construction: Dimensions Depth of solids Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): f e - 4 Permit Number, Date: Completed by: NIGH CROUND-WAT'ER(LEVEL COMPUTATION Site Location: /Sb AJ,4-11 be R @U .1® M6 Lot No, Owner: AAA 111A Address: Contractor., Address: ... Notes J _� . STEP 1 Measure depth to water table to nearest 1f10 ft. .... . ..... .......... Oate , d Ufa 42 1/ month/do /year STEP 2 Using Water-Level flange con® and Index Well Map locate site and determine: GAppropriate index well i' ..+ µ \�J plater level range zone ....... ...... ! � .....1 f STEP 3 Using monthly report "Current Water Resources Conditions" I determine current depth to water level for Index well ............... ...:,. • month/Year S6 1 1 � � STEP 4 Using Table of Water-level Adjustments for Index well (STEP 2A), current depth to water level for index well (STEP 3)0 and water level zone (STEP 28) determine water-level adjustment ... . ............... .............................................:: j 5 STEP 5 Estimate depth to high water by subtracting the water level adjustment (STEP'4) from measured depth,to water /0�9 levelat site (STEP 1) ................... .........................,.................... ..................., .. ........... Nure 13,4 rods le conputagon form. i OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 180 North Bay Rd.Osterville Ma.(S�Uem#1) Owner:Anthony C.Sinmboli Date of Inspection:1/26/2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)methods used to determine the high ground water elevation: Obtained from system design plus 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: +i You:must describe how you established the high ground water elevation: - GYJ'N1�WA T:/ el US E'i2 ict OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 180 North Bay Rd.Osterville Ma.(System#l) Owner.-Anthony C.Sirnboli (Bate of Inspection:4/26/2006 SKETCH OF SEWAGE DISPOSAL SYSTEM { Provide a sketch of the sewage disposal system including ties to at least two permanent referencelandmarks or Benchmarks.Locate all wells within 100 feet.Locate where water supply enters the building { i I i O O � o a S 157eAA a -+ANK O A- 1 7' T a,.j tc A- I ILI' A•a ' �� �_ 1d 3� SAS 1 3= 73 , A- �3- 3�^ sy ' P;4 d l Townof]3arnstablc Ve.prfnlcul of Regulatory Scrvives Public IIcalth Division Mite CO% • RAPNArARV. I, MARK. ,d 200 N4:'lin S ccl,ifyannis MA 02601 Daft Schrtlule,lZ4 L_:2 I imc �� Fee Ild. Soil Su t(ll)Iht)1 4s'sesslll.oil Afgvy e�Di �Osf Performed By: Witnessed LOCATION & GENERAL INFORMATION L.ocnllon Address Mpr� Owncr's Name � cb�rfr,.)AQ, ink Address Assessor's Map/Pnrccl: U!6-0c,, 0 f;uginccr'sNnrne S\AV%0CX\ �nSi�eU'tn NEW CONSTRIJ1 1lON REPAIR _ Telephone++ S0 -4z!a LAW Use ;{� v1hi��� Slopcs(%)�_ Sorracestoncs , t Dlslallces rl"Ill: Qpcll Walrr Mdy f1 I'ussible Wct Area 17d tl Drinking Water Well Drninnge Way SCO, R Propclly Linc _R Olbcr MwA 4' R SKETCH:(Strrcl 11"Mc,dimrmlons of lot,exact for,nIiout of test holes&pert tests,locnie wcllnids in proximity to boles) t . aC E X, t� I s t a 76 C!i C11 CD . " Parent malcrinl(gcoingic) `S I)eplb Ill Ilcihock > Depth to Grtlmldwnlrc Standing Wnlcr in Ilute: - wCe.0ng from Pit "00 P E lhnntcd Scnsonnl lligh Grvundwnlcr EL 2.0Z. Dew� orN-_S ,Piave», Zoe F4 vfnaue ojkr �. DETERMINATION FOR SEASONATAUGII NVATER TA13LE Mclhod Used: /Owig— > Depth Clbscrved stniiiltiiP hr'tibs.hale in. Dcp1h In spll nlollles: Dcplll to weeping floral side urobs hole in. Groundwnlcr Adjuslmcnt R: - hld"Well I Reading Date: ludcx WCII level Adj.factor Adj.Groundwnlcr Lcvcl— PERCOLATION TEST Dxfew�k Time 10 Ubacivaogn... "L Time ht 9" „ Time alb" Depth of Pere __ Z$ (oRllol`'S I'inlc(9"-6") Slnrl Pre-stink Tillie 10 lr✓ r,:nd Pre-sunk 0 XL • llnlc A1in.11nclr � Z,��, t Y Site Suilelrilily Asscssnlcnl: Site Pncsrd �� _ Silt I'nilyd: MldilitinnF'I'csling Ncedcd(YIN) original: P,ttrl;c firm hll l,iolcsnn 0hrr.rvititln lltllc i),Ifa'I'o 11r•.Gm1111c1Cc1 on Back----------- ***If percol:ltion test is to Ile colldli led lvitllitl 10t)' of wetlanll.,you must first notify (Ile Ilat n,�ta171c Corlservitioll Division at Ic;1..st one(I) n•ccic prior to Iregintlit)g: n 11f:At'I I I I M V IVI'Ir('I'l I It WA - - � V EP OBSERVATM HOLE LOG Hole(F Ucplh fium Soil Ilutizun Suil'I'cxluro Svil Color Soil UUtcr $IIlI1sC0 (USDA) (Munsoll) Mottling (S(luclnro,Sltmcs,Iluuldcts. CGIS1SIUn DEEP OBSERVATION ROLE LOG 1101c 1t Depth from Soil Ilorimn Soil Texture Soil Color Soil Other Surfam(in.) (USDA) (Munsell), Mottling (Structure,Stones,Boulders. ' Cunsislatcy,%Grnvcll _ 0-113 (8- �" i3 n wne� 47^ CID L Z.SY 6/46 DEE,P OBSERVATION HOLE LOG II01c 11 tlntaA�Aeije Dcplh front Soil I loriwit Soil Texture Sell Color Soil Other Surface(in.) (USDA) (MunsclQ Mottling (Structure,Stoncs,Boulders. Co iRistcncy,°ig ;ly-cJ)— O 0 -L(d�, s r (()YK`t�(� DEEl1"OBSERVATION HOLE LOG 1101c It Depth from Soil Ilutiwn Soil Tcxturc Soil Color Soil Other Surface(111.) (USDA) (Mtntscll) Mottling (Shucttue,Slums,tlouldcrs. Cvttsis ate °.Glavc� Flood Insurance Rate Man: Above 500 yenr flood boundary No t� Yes Within 500 year boundary No— Ycs l Within IOU yenr flood boundnry No✓ Yes peulh of Naturally Occurring Pervious MRtcrittl Does at least four feet ofnaturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption systc)0 1E5 If not,what is the deplll of naturally occurring pervious malcrial7 Certification I certifyahat on A)W ?�(A�(date)I have passed the soil evaluator exmnination approved by the Department of Cuvirotunentril Protection and that the nbove mtalysis wits perforated by me consistent With the required training,cxpertiso rind experience described ire'310 CMR 1.5.017. Signature Datc Z 13 D(c) Q:11EALTIUMPU CFORM SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address of property � Owner ' s name M(� _S. qDRieN1t_ ��1�Anti {�2�21ip0 � Date of: Inspection WWILS5 L�01'� kwqRY PART A AUG 2 5 1995 CHECKLIST HEALTH DEPT. Check if the following have been done : TM OFBARNSTABLE Pumping information was requested of the owner, occupant , and Board of. Health . f None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period . Large volumes of water have not been introduced into the system recently or as part of this inspection . As built plans have been obtained and examined . Note if they are not available with N/A . • _L!/ ffrc C oci 1 i t7 or ci el l ing w;.1� i ri:;pected for kilns of sewage back-up . The site was inspected for s iyns of break.ouL . All system components, excluding the SAS , have been Located oil the site . The septic tan}, manholes were uncovered , opened , and the interior of the septic tank was inspected for condition of baffles or tees , milter-ial of con_ Lruction , dimensions , depth of liquid , depth of :. ludcte , d0j.-A.11 of scum. _ The size and location of the SAS on the site has been determined based on existing information or approximated by non-intrusive methods . ✓ The facility owner (and occupants , if different from owner) were provided with information on the proper maintenance of SSDS . 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential number of bedrooms number of current residents es garbage grinder,—yes or no tes laundry connected to system, yes or no o seasonal use, yes or no If nonresidential , calculated flow: Water meter readings, if available: o o' Last date of occupancy GENERAL INFORMATION Pumping records and source of information: NSA o_ System pumped as part of inspection, yes or no if yes, volume pumped Reason for pumping: Type of system: �".'o sY,Tcr+u �cr�o.;� 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) Other (explain) Approximate age of all components. Date installed, if known. Source of information: 00oNx ♦ \� C7U Sewage odors detected when arriving at the site, yes or no f 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B 'VW0 SYSTEM INFORMATION continued SEPTIC TANK: V11- (locate on site plan) depth below grade: 6) y�/ material of construction: t/concrete metal FRP other(explain) dimensions:_ e-710 = 86 X Z/ sludge depth s" distance from top-of sludge to bottom of outlet tee or baffle © scum thickness lVid distance from top of scum to top of outlet tee or baffle " -&jQ_ distance from bottom of scum to bottom of outlet tee or baffle Comments: (recommendation for um p ping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, recommendations for repairs, etc. ) !/20rre -- CVO Si�2-) o An-1 DISTRIBUTION BOX:_ (locate on site plan) Fvec C3o-<•1,> depth of liquid level above outlet invert Comments: (note if level and distribution is equal , evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc. ) Tu OA 6 vi cT c� crt r� rvb vn PUMP CHAMBER: (locate on site plan) pumps in working order, yes or no Comments: (note condition of pump chamber, condition of pumps and appurtenances, recommendations for maintenance or repairs, etc. ) 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued �wo S.��ern,5 SOIL ABSORPTION SYSTEM (SAS) : Z (locate on site plan, if possible ; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type leaching pits and number a-%fir-Pc'-)s% leaching chambers and number leaching galleries and number /- ys /ip�rOho leaching trenches, number, length leaching fields, number, dimensions overflow cesspool , number Comments: (note condition of soil , signs of hydraulic failure, level of ponding, condition of ve�e at ' on, recomm n t?o .lina� tenance or repairs, etc. ) i-2J ITC- CESSPOOLS ( 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 (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc. ) PRIVY : ( locate on site plan) materials of construction dimensions 6epth of solids Comments: il, signs of hydraulic failure, level of ponding, (note condition of so condition of vegetation, recommendations for maintenance or repairs, etc. ) f 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' - --- --- -- Y5e 71 hton4 NOQ CsArA,� DANK 9 00 �P S S_t�n�w�►1► J 3 Ip;54. rnx. 0 -�- 3 37 i(f 1 70 6 77' �,5t. Kok ss' �l r�� Pit It T) , DEPTH TO GROUNDWATER depth to groundwater method of determination or approximation: _ y l tv,T T 77m C of IA-54cch"'f - rvj ry\ 12 c SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances. If "not determined" , explain why not) Backup of sewage into //facility? Discharge or ponding of effluent to the surface of the ground or surface waters? - ff - `Y\.) /Vo obyw�� Pr�� ewes _ Static liquid level in the distribution box above outlet invert? c)%or•hc,4- ,S�Nc A LV Liquid depth in cesspool <6" below invert or available volume< 1/2 day flow? Required pumping 4 times or more in the last year? number of times pumped Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? Is any portion .of the SAS, cesspool or privy: below the high groundwater elevation? oi �erv�n►n c. W N \ A�J (fi e r ro .,}� ��o• �T c�A S, 1J within 50 feet of a surface water? X/ within 100 feet of a surface water supply or tributary to a surface water supply? V within a Zone I of a public well? Jy within 50 feet of .a bordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS) ? within 50 feet of a private water supply well? less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysi for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. 13 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector Company Name BRUC'E,P�9e�.%ALLIS+TER SHORELINIE CONSTRUOTiON Company Address 87 POND STREET OSTERVILLE, 10A 01555 Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and manitenance of on-site sewage disposal systems. Check one: y' I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15 . 303 . The basis for this determination is provided in the FAILURE CRITERIA section of this form. Inspector' s SignatureLyGC� Date Original to system owner Copies to: Buyer ( if applicable) Approving authority =: TOWN OF BARNSTABLE LOCATION � �6�1 SEWAGE # ��3Jf�FC'/�o�✓ VILLAGE 04 k e(MW e ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. -31 t-UQC SEPTIC TANK CAPACITY LEACHING FACILITY: (type) ''e"�� (size) NO.OF BEDROOMS BUILDER OR OWNER ADr`�e�n e ��Av►�,5 PERMITDATE: - 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) AYIA Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by2r",� Va c,01/, 2 67 1,/f 5 O ?,il Est � •Tq�h � i �:,i°fox 6� V y Los �y 6, 318 - � o THE COMMONWEALTH OF MASSACHUSETTS �v BOARD OF HEALTH ....................... _._.............O F..........................----...........------------------------------------............ Appliratiun for Ditipasal Works Toustrnrtinn Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .� ._..... ----------- ------ (,t • i atior�-Address or Lot No Owner Addr ss --------------------------------------------- ------------------------------------------------------------------------------------------- Installer Address UType of Building Size Lot--------------..............Sq. feet Dwelling—No. of Bedrooms------------ .............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 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. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area____---_--_-.._--_sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date---------------------------------- Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water-----_---_-__-_-___----. fT4 Test Pit No. 2............_---minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ P4 -------------------------------------------------------------------------------------------•-------------------...----------------•------ -------------- 0 Description of Soil........................................................................................................................................................................... x --------------------------------------------------------------------------------------------•----------------------------------------- ------ U N tur of Repairs or Alterations—Answer when..applicable.-- _ _ C" lei----------------------------------------- 1 -------------------------------------•-------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ................ _ ............. Application Approved B D to Date Application Disapproved for the following reasons:................................................................................................................ •---------•------------------------------------------------------------------------------•--•-------•----------•----•------------------------------------------------------------------------------.--- Date PermitNo......................................................... Issued-------................................................. Date may' No. .................... ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...... ._............OF....................................... - ...................... Appliration for 15iiiVos tf Works Toustrurtion V rrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: --------------------------•-----------------------------•----------------------------------------- ---------•-----•-•-•-•••-•-------------------.._.............---------•----•-••......----•------_. Location-Address or Lot No. ---•----------••---------------------------------------------------------------------------------- ----------••-•••-••-----------•-----------------------------•-------•---._..........•-----....---- Owner Address W Installer Address Type of Building Size Lot----------------_---__-__-Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther 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. 3 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------.-----_-------.--- LX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_-_.--------.-_--_---.-. --------------------------------------------------------------------------------------•--------•----......................................................... 0 Description of Soil.......................................................-----_-------------•-------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- W UNature of Repairs or Alterations—Answer when applicable--------------------------------------------------_-------------------------------------------_. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed...................................................................................... ................................ Dat Application Approved By.. r----Z. _ _..i r' , �r,P �________- Date Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------------•----- -----------------------------------------•------------------------------------------------------------------------------•-------------------------------------------------------------------------- Date PermitNo......................................................... Issued---------------------- ................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ .xv..............OF......... &IV............................................... %'Urrtifiratr jaf fW"Lautpliatta THIS IS TO CERTIFY,, That the,Individual Sewage Disposal System constructed ( ) or Repaired) /� �} ) y/� +y )� Installer /� /� at................ Q -_f.. d_ .......... ............-�- y -------•- Wit------0. �F 1�------_-11.4 -aeAf_.. has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.___'&2__>.'?............ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. y� DATE.................................. 1 30A Inspector --_l�l ---------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF..................................................-................................. � No.'TA )-_ FEE.., + .------......... Disposal Morks T.Ww trurtion famit Permission is hereby granted ----------- ----------------------------------------------------------------------------------- to Construct ( r Repair { .an Individual Sewage Disposal System atNo................................ ........ "-------------------------- --- Street as shown on the application for Disposal Works Construction Permit No.___-____-__-.----- Dated.......................................... a ---------------------------------------------------- V��� Board of Health DATE- FORM 1255 HOSES & WARREN, INC.. PUBLISHERS Page 73 Lot 13 PyO�TNETp�f TOWN OF BAR.NSTABLE • r S BAHBSTAME, i p Y BUILDING INSPECTOR �0 � pY a' APPLICATION FOR PERMIT To2...Add tlonsto •dwellingl 24I-O•• ••xx ............ TYPEOF CONSTRUCTION ................:.................................................................................................................... Septembor...l b.............19..� . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a,permit according to the following information: Location ....North• By•.Road. Oyster Harbor3, MA, Proposed Use living room, bath, add to kitchen . ......................................................................................................... Zoning District ..........R'.....1.................................................Fire District Centerville & Osterville Name of Owner4r j...Hobert W, Bo$ue Address 17 0 Pennsylvania Aver , WashingttonC. ...... ......................... Name of Builder .RMAZ ... MWAVY•t•••I ••••••••••••Address ...P.t...0,•••BS...�10...Osterville, MA ......................................... Nameof Architect ..................................................................Address ...............................:..:................................................. Number of Rooms Three Foundation Cement blocks & slab ............................................................ Exterior Clapbo�lyds Roofing vel . ............................................................. �'OX..�4...�I:........................................................... Floors 711e & carpet •••Interior Sheetroek ........................................... ................................................................................ Heating Hot Air-Oil................................. .. Plumbing 1 Bath 1 Sink ....................... .................................................................................. Fireplace ...................Approximate Cost ... 50,000. 00 ............................................................... . ............................. .. Difinitive Plan Approved by Planning Board .___--------- ___------- 19 L � Diagram of Lot and Building with Dimensions z ,J ¢ 2 S0 s U W C� LU > Z < �. <0 ix < _ - w i -p 0 w _yw, �0- W , O C. _j . t .Z v~i V) 1— W O w ®ta SeW qL ,qq if CL A _.r zi .. Z Q < I ereby agree to conform to all the Rules and Regulations of the Town 9f Barns le r a ing the above construction. C �j �, L G Name Bogue, Robert. -. 15501... Permit for .,, add to single N c� ............ ........................ fardly dwelling ............................................................................... b�0 North Bay Road Location ............................................................ Oyster Harbors.......................... Owner Robert W. Bogue ................................................................. Type of Construction frame .......................................... ................................................................................ Plot ............................ Lot ..... ..................... d , Permit Granted .........Setember1....�:. ........ .:...�.....19 . 72 , Date of Inspection Date Completed PERMIT REFUSED rC ..................................................... ...... 19 ........................................................f....................... Approved ........................................... 19 r a ■ 900L NRQW2AON OL 31 r O Snm4m=W VCUoa >aaAs, �1 - ■ ■ ■ Qd 1Y N M r tl O - 3,r.a a Sul aimangwy Sd3NI)]Vd +-n3NNO:)DW "N #1 — - — 3 l 1 1 1 1 a 3 H a S113SnH7VSSV41 InIA13M Gd011 AV8 HUVON 081 — `d 3:)N3aIS3d I108WIS 3H1 - - NY-1d NOO-1d 1SNU - - d0 NOISNVAC3 aNM NOLLVAON3a � .. � ■ me3L d8 �+Sjl _ NV1d 2100-Id 1Stlid U z-ac s z-a .e .L/1.8-A O room-awamci ON .L-M, R - :1 4 eovaaaL swum" EOWUNU ' 3rJr71r9 .CA e-.79 .7-.fl j. 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T S A � m-s In • -o ei ¢ a•-o a ? a •-r T L a ® d � � L a O r-a V 7 r-a yr _ m i 11-0• tam HALL bi m ® r-]va•' KY-1 Vr r-]Vr V" p I } a T s-o sie• Q j roves sem ® arT p s/r . r r-a n/ rc-c irr -i H sI VT Li } } a Y r ? '� eenRoon 4 ee°R°nn ^s a iu- r a•-r a•-Io air r-I• rd r e I• a Ir-r a•-�aie- a•-r 9•-O• •-s• s-t vs• V-r e-a• r-r 9•-0• a•i' a•-c.Vr Rn. I Ra Ro. Ra. I +T-0' Al A SECOND FLOOIE FLAN I/4' � I' — O' • ■ � �' _ RBdOVAT ION AND EXPANSION OF - - `•Me�o�� _ SECOND FLOOR PLAN THE SIMBOLI RESIDENCE _ A-2 IN NORTH BAY ROAD OSMVWF MASSACHUSETTS ■ S H e e T TITLE _ n, ■ McCONNELL+.PARTNERS Architecture Inc ■ a c A e ■ DRAWN BY PD ■ e�ris�oNs 1.0 Nw� LOOir — ■ ■ ,■ 164 Canal Sae oo So-eat Bosa MauadRaeas . ■ DATE 20 NOVEMBER 2006 ■ . I 41-4 Vr r-4 'V-1 Vrr a•-i 1/7 7-r l'-9 Vr b - ------------- ------------ --- '1 1 I 1 I 1 I 1 I 1 1 1 i 1 S €NTRYON s-s li 3 1 1 1 r 1 I . 3 -----4 ----- '---------------- ---- ---J 1 1 , -LLLLI ? 1 GARAGE ; I - °i h ---------- 1 1 1 1 } b 1 O 1 y 1 —L----------I I ' S 1 1 1 o 4 1 I I 7§ ! I T S Y 1 1 I 1 I S I b 1 1 I 1 1 ®® T 1 -L----------i. l 1 1 1 I I 1 1 1 I I 1 T © 7 1 1 1 1 a It, I I 1 1 1 1 I I I T T O O toI 1 —F'----------1 C�I/4 , I 1 1 I 1 I 1 1 1 I I i 1 1 I 1 I t 1 I t I 1 -4----------- --------------- " --------------1 I b ------------- 1 1 - h , 1 i. It a yr ss L a-a 1/7 }_- v y s r C-3•-4 W-e vr ---------- GARAGE ROOP PLAN GARAGE SECOND PLOOR PLAN GARAGE PIRST FLOOR PLAN I/4" O" OI/4O' I/4" TP - O' . RMOVAT ION AND ADDITION FOR j,• ,�_ — GARAGE FLOOR AND ROOF — I _ THE SIMBOU RESIDENCE - PLANS 180 NORTH 9AY ROAD OSTERV0.LE MASSACHUSEM ■ SHEET TITLE — • ■ SCALE ■ DRAWN SY HH - ■ REV 1 S I O N S i0 W. t.10` _ ■ McCONNELL+PARTNERS Architecture Inc ® ® ® 348 Congt�es Sweet 006COfl• Massachusetts ■ DATE 17 NOVEMBER 2000 ■ a vmrr 7 w. 11 '^;',� � r ��g Ex�wj ` O��4N>��� BONE• si it "l f "� ti r*ri s ;, �, �g QxiY • y O rn� M1�i� �y�' N Mafry J.Z2.1 aoNae4i41J ensL.,os RF-1 O M t t c 9 u zY,rihxr p 14, Area (min.) 87,120 (RPOD) :� ` Fronta e (min) 20, �.�.•„> Width (min) 125' "0910m - Setbacks: 'k kb' yti t r �7, r5rt%2 .,', 't}, ,r;• R_tic Flow niliaeb P6L reeELaz Front 30' •.,. « ,W �' { '� "�`+•e,� ��t`� �.a ea AsRaI Side 15 Ftowdifgifor r H•20 Rear 15 �,y r . s �•. z ,e as Per RmoveAtIUnmthNeSoib SeeNoks8&9 Within.ToMie0aserParimeler • ,eM+e.aae ( ) ofTbeSystee FLOOD ZONE. " w _ , • t RapYcmriaitffOlShauMeet lmnov®4aotaoob,vu, 310Ch9e15255(3). MooNtioeLYt2Y DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Zones A 13(el=12), NOT TO SCALE - All(el..=1 1), OG B Community Panel No. g #250001 0018 D *' July 2, 1992 •ox o •� � ° r i, H � r �, PERC TEST:11,499 t z rtououa®wsanrosetimr • �`L aULtrrAN.tODMUJM 4 3 •:Vs• k. r� ' WFI)nM Dw00NMDDR.4ARAAIL& Pion O•! DEQL®Ra.2006 lelr TBSTHOLB-f ILLS TEST HOLE-2 u TBSTHOLE-3 C01°•`°�° � LOCATION MAP: tw. Par. trwwm.•c® im•,n• a , IF OfU1rAR 7 1rADN41,n60a EII i,b. ►stow aLAriotrora4a uvr t� O t� 0 2nr.ttm wu0crtnLow.RniaAm DARRrWOW.RHRDWN 1T .W.a•6 Scale: 1 " = 2000'f 76• i.atMr LOAWILAM nLAr.t,erRaa euren2rraa u DAa,wuwsxSao" r DLNeYr9 WM 26 yu MY wsmc ,p Kr IN ASSESSORS REF : MEDI 4T ,NAN2,tvL c ur.i eras MEa IWD 40• n CROSS SECTION OF FLOW DIFFUSOR r OaWWWATIR ECO MOM 07 NOT TO SCALE Map 73, Parcel -= O t3 W , OVERLAY DISTRICT: / AP - Aquifer Protection District 1AIL Lr / iL// / �� • // DESIGN DATA SEPTIC NOTES Single Family-7Bedroom \ 1.Location*(Utilities Shown on This Plan An App m AtIAW 72Homn With NOOarbage(ldnda 0 / Prior to Any Excavation Per This Pr4oct the Contractor Shall Mdm Daily Flow-110 X 7-770 GPD do Required Notifiesdo°bDigSA(1418g3447213� Septic Tank 770GPD2:200%-1540GPD 2.The Cofactor is Required to SeLve Aypmpross Pe®ilsPramTown Use 2000 Gallon H•20 Septic Tank Agencies For Cons°nctioofkdloediyThiaPim S.The Proposed Water Line Shall be Caaanne0aa in ndoowith LEACHING AREA A 310 Water,and he a r Ane Shall b Withved Cbfit 1.00-70 Required 770 GPD 10.74-10404 SPRagaI &3lOChdR15.00.TheWeerLirroSha06e81eevedWbeieRetpmed 3tdewaR� I + / ( / / / 4.lestall Risers to within 6'of Finished GaI Require .IfRiman 2(6' 64)D-W-153A SF //•�� / ` / 0/ Y j/ Located Wilhla an Area to be Paved Rime gdl be ffiougbl1opkil 0wic AL Bottom ALea-(16 s 64��1024 SF / YYY S.Ali Structures BuriedThee Feet o 14oreorgubject 1177.6SPTotdAw[ded Recommendationththat all Compaeaou yabe LEACHING CHAMBER DESIGN i / n 6.Septic System to be Installed in Accordance Wb 310 CUR 15.00& • ,I/dW.// / l / /./��ji//��i\• Y ' J All Pipet to be Schad*40.We � !`• r / 248 CMR 1.00.7.00 Latex Revision a°dOie Taw ofBamruble iS Corierea lM1orclKmrae to �ftphe a S&z 16x64'Wished Stow FW&asShown. / f r S.Wet Tea Shall BxteedaMW=mnof 10" Apt, / / y, / / ZQ,. n Outletlow Flow with G. N 9.An Outlet Tx With stea Systemso a Abe Extend it oved the Flow Line / /• — / / // , / / 11.Loation�B► oflmahSamBxWmgRaildDgs tobeConSsmedPricroComtoc6m 01 143 4.\ CD AL i cr) / c �/ / \ 4P ve. / 00 / \ AL - i ,� j,,.- PD�w OwellingOn ta'0 i� /� 0. see / O+�� town US ao \ sit \ � � 10 r,a w0tor Shad Lawrt 06. CI R=197.34 r. 6-- '9 Of P ,_ _... _.... ,_. °"use» �. (40' Wide Private Way) end. \ \p` \ ov00R, �\ \ %!31, Deciduous Tree /------ 1 Coniferous Tree t \` ` 1 `� Light Post r NOTE: CB/DH O Water Gate (round) Fnd 0 C8/DH - Concrete Bound 1.) The topographic information was obtained from an on the ground survey performed on -0 Guy or between 191SEPT106 and 27/SEPT/06. -0- Utility Pole •"•••"-•••••• E .............. Underground Utility Line 2.) The datum used is NGVD '29, a fixed mean onw Overhead Wires - sea level datum. Title: PREPARED FOR: PREPARED BY. Site Plan j Anthony C. Simboli Tr. Sullivan En ineerin , Inc. CapeSurav Z31- Proposed Septic Upgrade PO Box 659 g Cb Cb The Franklin Realty Trust 7 Porker Road At y Osterville, MA 02655 Osterville MA 02655 80 ,Everett Ave, Suite 319 V O North Ba I !cad (508)428-3344 (508)428-3115 fax (508) 420-3994 (508)420-3995 fax j/ Chelsea, MA 02150 PSOPEOoo►.com capesurvOcapecod.net O Barnstable, (Oyster Horbors) Mass. Draft: JOD Field: WHK/Dss .y 30 0 15 30 60 90 ra : Scale: Review. PS Comp./Draft: WHK/Dss December 12, 2006 1 -30 Proj. # 98168 Drawing # C454_1g1