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0360 NORTH BAY ROAD - Health
360 North Bay Road Osterville F/R A = 072 003 II '1TOWN OF BARNSTABLE N LOCATION ��� dr ?2, SEWAGE # ,2a03 VILLAGE t _' STt'R U t LL Z ASSESSOR'S nMAP & LOT D 7Z"6� INSTALLER'S NAME&PHONE NO. a h A LI c) SEPTIC TANK CAPACITY Q D D0 (3►A,- LEACHING FACILITY: (type) 7151)o 6A L. O U+0t 12 (size)/c9.y3 o X 6S•t L x A•o 1 NO.OF BEDROOMS BUILDER OR OWNER t1 U t z iSV?S a PERMIT DATE: 63 COMPLIANCE DATE: 7 Lv 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 H es. Q, w 3 i V3 73 0 � . r... Commonwealth of Massachusetts v Title 5 official Inspection Form 11 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 360 North Bay Road Property Address p:7 Carol Castle1998 Family Trust Owner Owner's Name information is required for every Osterville MA 02655 11/5/2020 i 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. Impoetar►t:When A. Inspector Information 15o05 filling=:outaforms` onahe:eomputer, .n ; r,-I_ use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key. 52 Rivers End Road Company Address Teaticket Ma. 02536 City/Town State Zip Code ran 508-280-3356 S13938 Telephone Number License Number ' B. Certification } y, ` ) I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: i 1. ® Passes ;M 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority , __..�__.__._.- 4. ❑ Fails Inspector's Signature Date The system.inspector shall submit a copy of this inspection report to the Approving Authority (Board p.. ._ of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of ' 10,000 gpd.or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. t<' Please note: This report only describes conditions at the time of inspection and under the kk ., 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 cam, Commonwealth of Massachusetts w Title 5 Official Inspection Form <,M, .z. :.., tiii Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 360 North Bay Road Property Address -.., Carol Castle1998 Family Trust Owner Owner's Name information is required for every Osteryille MA 02655 11/5/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: a,, ,tr .-J eta 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 area indicated below. Comments: This 6 bedroom home has an H-20 2000 gallon septic with an H-20 D-Box feeding (7) 500 gallon chambers with stone. At the time of the inspection the leaching was dry and no visible failure criteria was found. 2) System Conditionally Passes: F 3r ❑ 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,. 5 Health. --- K# *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): W�p 4, tivl•' JC'. ,6W i'f . y Ifs f R C)f t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts ,p Title 5 Official Inspection Form is Subsurface Sewage Disposal System Form -Not for Voluntary Assessments. 360 North Bay Road Property Address Carol Castle1998 Family Trust Owner Owner's Name " information is required for every Osterville MA 02655 11/5/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if „rs- pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due s to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. Systerri 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 FIND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): _rH �M ❑ 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): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp doc.-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 30f,18... �� Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments - u— 360 North Bay Road Property Address Carol Castle1998 Family Trust Owner Owner's Name into.rmation is Osterville requlr'ed foPevery MA 02655 11/5/2020 k .. page: City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: w,a,;ir ❑ 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 publicwater 01 sfdii 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 agalysis-must i „Cirl3i, be attached to this form. , F I i J t {t c. Other: 1,6 on 7I .: .. 4) System Failure Criteria Applicable to All Systems: ` r��rxE'.r 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4�of�1& p4, LSr+ ; Commonwealth of Massachusetts , ,.. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V � 360 North Bay Road Property Address Carol Castle1998 Family Trust Owner Owner's Name information its required for every Osterville MA 02655 11/5/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) - 4) System Failure Criteria Applicable to All Systems: (cont.) = i « Yes No El ® 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 'h day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public water supply . ❑ ® well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP.certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] - ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure If, criteria exist as described in 310 CMR 15.303, therefore the system fails. The Y system owner should contact the Board of Health to determine what wi !?e necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply =r , 3 y r . : f , 1 Y' ❑ ❑ the system is within 2100 feet of a tributary to a surface drinking water spp1j ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection`s ` Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 I. Commonwealth of Massachusetts Title 5 Official Inspection Form r .I Subsurface Sewage Disposal System Form - Not-for Voluntary Assessments I G ,� � 360 North Bay Road v Property Address Carol Castle1998 Family Trust Owner; Owner's Name IlCnr'a Information is Osterville i MA 02655 11/5/2020 required for every page;. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question'in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no" for each of the following for all inspections: ;;. .�.•,. .- T>:r a ref 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? I I ® El available 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?#,; C)tra;�� i r+ ttb"aa " ® ❑ 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? ® 0 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. 17•xi 1 }k , ' � t .r'k u i 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)] II t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 ;. +t. l.p .+ ,,qyr,; ik Commonwealth of Massachusetts 4 C 0.;; Title 5 official Inspection Form € (!� YI Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u� 360 North Bay Road Property Address Carol Castle1998 Family Trust Owner Owner's Name information is required for every Osterville MA 02655 11/5/2020 page. City/Town State Zip Code Date of Inspection D. System Information - 1. Residential Flow Conditions: ' ' 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): 660"p1us=1-....._. GPD Description: = Number of current residents: Does residence have a garbage grinder? ❑ Yes No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes Z No Seasonal use? ❑ .Yes ® No .,': Water meter readings, if available (last 2 years usage (gpd)): town water Detail Sump pump? ❑ Yes ® No Last date of occupancy: seasonal'Gse Date n,a!(3T t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form Not for Voluntary Assessments 360 North Bay Road V� Property Address Carol Castle1998 Family Trust . (?, Owner.- Owner's Name '?'1 Information is required for every Osteryille MA 02655 11/5/2020 page. R City/Town 'State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: I Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): r Grease trap present? ❑ Yes ❑ No pli,F' Water treatment unit present? j ❑ Yes D ..No-- If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5I system? ❑ Yes ❑ No Water meter readings, if available: ,.>. Last date of occupancy/use: Date Other(describe below): i rJ i I I 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes No,, If yes, volume pumped: j gallons How was quantity pumped determined? Reason for pumping: j i t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 •.::I i v OfM c _ Commonwealth of Massachusetts tj,,;;1, �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments U— 360 North Bay Road Property Address Carol Castle1998 Family Trust Owner Owner's Name information is required for every Osterville MA 02655 11/5/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ 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 et i t'Si (� ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 2003 Were sewage odors detected when arriving at the site? ❑ Yes Zt6-No _ 5. Building Sewer(locate on site plan): ,,,c. Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): SP 7 40 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 360 North Bay Road Property Address Carol Castle1998Family Trust - - Owner Owner's Name rnforrnation is Osterville MA 02655 11/5/2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: 14"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑"ot;h°e'r(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes '❑ No v Dimensions: H-20 2000 gallon Sludge depth: _ f t Distance from top of sludge to bottom of outlet tee or baffle 33 Scum thickness 5„ Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? sludge judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I recommend the new owner put the septic tank on a maint. plan with a local septic pumo ng c-o - `'" ' based on the future use of the home. At the time of inspection the liquid level was at working level--p q 9 and the tee's were in place. t5insp.499-,rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page'10 of 18"`4'S +' ° rY-,ui�.r 0, Commonwealth of Massachusetts ' < o- Title 5 Official Inspection Form P , i , h Subsurface Sewage Disposal System Form -Not for Voluntary Assessments U— 360 North Bay Road Property Address Carol Castle1998 Family Trust Owner Owner's Name information is required for every Osteryille• MA 02655 11/5/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) n 7. Grease Trap (locate on site plan): } Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle t :'.r. Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): r4 t „1r� 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: t i I ro : Capacity: ._,.,. gallons Design Flow: gallons per day t5insp.doc-rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form Ala Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^ 360 North Bay Road Property Address Carol Castle1998 Family Trust - - - Owher,''' Owner's Name information i§ required for every Osterville MA 02655 11/5/2020 ----=- -- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: , ❑ Yes ❑ No Alarm level.' Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): t *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): ,41 0.1 "f Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At the time of the inspection the Liquid level was at working level and there were no visible signs of leakage or solids carryover. ntc,r " t5insp.d6c i rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12.of_18_- Commonwealth of Massachusetts Title 5 Official Inspection Form I, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 360 North Bay Road u� Property Address Carol Castle1998 Family Trust Owner Owner's Name information is required for every Osterville MA 02655 11/5/2020 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) j 10. Pump Chamber(locate on site plan): - _...._... Pumps in working order: ❑ Yes ❑ No - Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): is * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: Seven -500 gal ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: rq,€_ -, ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 c , Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u- 360 North Bay Road Property Address Carol Castle1998 Family Trust -- - - Owner;. ;. Owner's Name information is requi_r id for every Osteryille MA 02655 11/5/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection the leaching was dry and no visible failure criteria was found. 12. 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 Comments (note condition of,soil, signs of hydraulic failure, level of ponding, condition of vegetation, . etc.): t5insp.doc-rev:7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-page 14 of 18" S Commonwealth of Massachusetts Title 5 official Inspection Form �I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments - - 360 North Bay Road Property Address Carol Castle1998 Family Trust Owner Owner's Name information is required for every Osterville MA 02655 11/5/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) of i.8 a 13. Privy(locate on site plan): - -y Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): �jF:N 'IJ t5insp.doc•rev.7/26/2018 T:tle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts_ Title 5 Official Inspection Subsurface Sewage Disposal System Form -Not for n Form '.< Voluntary Assessments 360 North Bay Road Property Address Carol Castle1998 Family Trust Owner} is Owner's Name Information required for every Osterville MA 02655_ page City/Town 11/5/2020 State Zip Code pection .- D. System Information (cont.) Dateof ins 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enter; the building. Check one of the boxes below: sz .- ® hand-sketch in the area below f.. ❑ drawing attached separately 0 '/41 rcr`ns :.. 73 9 - y 90 y .r I `. { a .. , I— .. .. ..— ... — `V' _ _— .. .,.�� ,�''+�'I�;"r•'.�.[%€"',' �f. 0 C d�P CL t5inwd6c•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts } Title 5 Official Inspection Form <II Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 360 North Bay Road Property Address Carol Castle1998 Family Trust Owner Owner's Name information is required for every Osterville MA 02655 11/5/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) rn' 15. Site Exam: E-- == Check Slope i ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 12 plus feet feet Please indicate all methods used to determine the high ground water elevation: x ❑ Obtained from system design plans on record ` I If checked, date of design plan reviewed: i 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: 1e1 ra You must describe how you established the high ground water elevation: I augered a hole at a lower elevation and shot it with a transit to show 4 plus feet of separation id Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form " .I11 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 360 North Bay Road Property Address Carol Castle1998 Family Trust Owner Owner's Name information Is required for every Osterville MA 02655 11/5/2020 --- - - page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or checked ® C. Inspection Summary: =a 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System'drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.&o -rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) �AT�1 No. FEE COMMONWEALTH OF MASSACHUSETTS Board of Health,` 1 ��Ri•�, t% , MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) - 0 Complete System ❑Individual Components Location � uy�-,A Owner's Name Map/Parcel# `lZ Address Lot# � � � --L Telephone# Installer's Na G ® Designer's Name 42 CANTMURY LANE Address Address EAST FALMOUTH,MASSACHUSEtTS`025M 608/640-2534 Telephone# Telephone# Type of Building Lot Size 6'1, bQQ sq.ft. wel ' No.of Bedrooms IL Garbage grinder ( ) Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow(min.required) (06 0 gpd Calculated design flow G(00 Design flow provided $�0 gpd t x>� 1y. Plan: Date Number of sheets 1 Revision Date ` �7 n_ Title J\*`\'t- �►�P1,i D\r7 Toll. oD `l.ki�NT�► `��►.1 1�, V'�+s'�(��i�4..i� wY Description of Soils) sa%A— L-qGt C, Soil Evaluator Form No. Name of Soil Evaluator S : s psf i.lL Date of Evaluation \'L—��"`�q.`:r '! DESCRIPTION OF REPAIRS OR ALTERATIONS ~ L Y The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TIT 4 further agree/ no to place the system in eration until a Certificate of Compliance has been issued by the Board of Health. Signed ° Date '-,;? r' Ins ,tions Z' t,� .. .s.,..�Ga s .�s1 � ti 'e', , ,.. .h "s� ��-_� � �p ' �. r •'.x, .-at tr;n.• ..,� OU ' No. FEE COMMONWENLT14 OF MASSACHUSETTS Board of Health, 1 SA•rlia,5e1''sl,l , MA. APPLICAT FOP DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( Repair( Upgrade( Abandon( - ❑Complete System Ll Individual Components Lo,Afion' �-,Uc) Owner's Name'``-,!, Map/Parcel# �� ,�. �, �,J Address Lot# � "Z - Telephone# Installer's Nam L Designer's Name T E P 11 E N .i. 1)t l l LE AND:ASSOCIATES Address �I� DX J f � Address EAST FALMOUTH,MASSACHUSETTS 02536 Telephone# S� ��_ �►�` /,— Telephone# Type of Building Lot Size (o "f, laDD sq.ft. well' -No.of Bedrooms Garbage grinder ( ) Other-Type of Building No.of persons Showers ( ),Cafeteria( Other Fixtures k Design Flow (min.required) LPG O gpd Calculated design flow G(00 Design flow provided 8 b gpd r, .Plan: Date � Number of sheets Revision Date Title 4"-, —r—ru `5(.0 ` 40emJ. !&►.-L Q-►�, 't�'�� Description of Soil(s) S-mK= S rc--C. RAA-4 SP%L- 40EI C� Soil Evaluator Form No. Name of Soil Evaluator S -" Ps4 uc- Date of Evaluation %-7__be) V1 DESCRIPTION OF REPAIRS ORALTERATIONS H f Z ti;;17 Y The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agree no to place the system in o•eration until a Certificate of Compliance has been issued by the Board of Health,,.,, Signed Date i Ins e*tions .. ++°^. No. D ,; Q0'5 - -3 9 FEE COMMONWLAI OF MASSACI4USETTS Board of Health, _. CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) 0 Complete System The undersigne• he[lby certify that the Sewage Disposal System Constructed O Rep `t aired O Upgraded ( ),Abandoned ( ) =. m at too has been installed in ccordance with the pr ions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No.206 -Z3� dated (D ? Approved Design Flow (gpd) Installer Designer: Inspector: Date: . The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. FEE COMMONWEALTH OF MASSACHUSETTS Board of Health, MA. DISPOSAL SYS CONSTRUCTION PERMIT Permission is hereby granted to; Construct( 11 Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system at as described in the application for Disposal System Construction Permit No. dated Provided: Construction shall be completed /within Jthree years of the dat of�thhjs �it. All local conditions must be met. Form1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date �J/G7 /U 3 Board of Health �"� I omi of Barlista )le Delrartmeot of Ileallh,Safely, and IEnviroomenlal Services �1HE Public Health Division Dale olh lZ $ 367 Main Sircct,I lyannis MA 02601 uArorernm.�' t639, , Dale Schell Enlu. 0 Time rt hec I'd. .' 14 r SIJII SI[IlRIJ1ht)� fl1 SSL'SS/11L'/It f01' f,/JR EFIVED -UN 0 2 2003 I'crfiumcd BY: _Q\y�� )I ��1�-� \Vi(ncstcd Ily: \711 � a TOv,r, ARNSTABLE LOCAj"1ON & GI;NI,Itt1L INI�ORII ATION _^CH HDEPT. Location Address � 0`1 �1/�1 t/�'i� � G� Oxyncr's Name Address 1r\Stzvt�e) Assessor's Map/l'arccl:' •►..`-Z! ?� L'ngincer's Nalnc =+�"� a Nli\V CONSTRl1CTION Itla'AIR I'elcphonc ll � r e�'�p_ Z Lanrl llsc ���� Slr'�pcs(90) Z-e� j r' Surface Stones. Distances From: _Open Witter Body \l7 b Il jo tsible Wd Arch 4_tO R Drinking Wafer Well li Drainage Way II I'roperly Line L ZS Il •Other Il S ICETCI I: (Slice(name,dimensions 01,101,cxacl locations of lesl holes R perc tests,locale w0ruids in proximity to holes) �yL.j►�� 17M�1� I= L 0 I'arcnl nnatcrial(geologic) Depth(o Bedrock Depth to Groundwater: Standing Wafer in I tole: \Vecping from 111 Face _ lislimalcd Seasonal I ligh Groundwater 1 fieL, y p r 1)I�"1'r1ZNiINA`I'ION I"OlZ SI�ASONAL IIIGII �'VA`I'I�IZ.'1'AI3LL blelh011 DSCII:' ��fr'7�••G��. T . Dcplh Observed standing in obs.hole: in. Depth to soil mottles: Deplh to weeping from side of obs.hock: in. Groundwater Adjustment Il. Index WcILN _- .- Ireadinp Dille: _ _ Index Well level _ __ Ad.l. faclor.__ Arlj.Groundwater Level PrRCOLA'I'ION I'ES'I' i)rilc rine Obscrvrdiori I lute ll - finnc of 9" Dcplh of I'crc "r✓Al LA It Time>6"'Slarl I'rc-soak fim n c l7 \0 c 'time I-nd l're-soak 101i 1Q'_A13 Rule Min./Inch L -C LZ 4!,*pitila` no Site Suilabilily AssessnncN: Site Passed�� Sill:tailed: Addilional Testing Necded(1'/N) Original: Public Ileallh Division Observation hole Dahl 'I'o Ile Completed on Back j Copy: Applicant Oli,l[,I' O13S1�ItVt1'I'ION 40LE LOG hole It 1 Ucplh limn Soil Ilorizou Soil'1-cxlurc Soil Color Soil OIhcr Surface(in.) ((USDA) (t`lunscll) fouling (Slnrclurc,Stories,nouldcres. --- - �url� crlcy,1%a(`1lTvcl) v N. kill 1)I;I�1'.013rSL 07A'I'ION 1101;I- LOG 1Iolc !1 � I)cplh I'iom Soil Ilurizon Soil Tcxlurc Soil Color Soil OIhcr Surface(in.) (I ISDA) (Nlunscll) t lollling (Slruehuc,Slimes, Ilouldcres. pv�u — -- — g� loy2 �'Z ✓, LOJS�i Nlu I ENT OBSERVATION 1IOLIP, LOG Hole Il _ Depth floor Soil Ilurizon Soil*Icxlurc Soil Color Soil Oflier Surface(in.) (USDA) (I\lumsell) Ninlllin g (SUuclurc,Simms,lluuldcres. (lrwcl) -------- -- i llETW� 0MVIRVATION 1I0I,1�1 LOG Ilcile !! Ucplh floor Soil Ilurizon Soil Tcxhrc ,Soil Color Soil Olhcr Surface(in.) (USDA) (Monscll) Willing (Slruclurc.Sloncs, Ilouldcres. -- -- -- (_1115isLIl�Y.1�(il;ly51) hloaclln5nrslitcc 12a1e I11n[�: � _ _ Above 500 year Mond boundary No _ Yes Wilhin 500 year boundary No Ycs ✓ Wilh)n 100 year flood boundary No Yes 3)c.plll of N_if(linll Occurring_I'crvious f "gerial I)ocs at Icasl four feet of naturally occurring pervious material exist ill ;III areas ohsel ved throughout Ills area proposed for fhc soil absorption system'? A. S,i-( If nol, what is lllo depth of naturally occurring pervious Inaleliil? — -- Ccr(ificalion � ' i I cerlify Owl oil — � > ((lale) I have passed Illc soil evahlalo examination approval by the I)eparin)ail of[invironn)cnlal I'r Acclion and Ihat the above analysis was performed by Inc consislcnl will) . the rcrplircrl (raining, experli an experience described in 310 CM It 15.017. Signature I)alc . — ---- --- --- -- t l�a � V .. . e, r�u:.y t'YCI,,.,. :i+:F � ,.�), j• .' }'.�� � y c,';. n:-r.a y__.S 1 ..il't fi. arr .., _.r .:r - . ..1y �r Grs 'L_ *,./:.. . TOWN OF BARNSTABLE — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION OWNER AND INSTALLER INFORMATION }+ c�/ / `'"..�, a ,.•� i ..^ ADDRESS: .."1 lr�lr� /17.d 7`f J J 1/`', .`Y ^ - „_.._. MAP NO. PARCEL NO ie.y, mid' OWNER NAME: t"Ji ,�'l.l/� ._ �S Ci�fCl x.l VILLAGE:fi �`�"Y : 1 INSTALLATION DATE: t,i/�. ira, �( 1�l BY: Ak)i)..di ADDRESS: fivNr ( `�Jltil{�'I>f'c'L�j lrti�=�(r%l/ './�l�f CERT. NO! TANK/ INFORMATION _• LOCATION OF TANK: fc(,NA(,dz)l P`-,,4 D t 7!"1 V/1 L. J` C A P A C I TY.',),l r":1) TYPE :`tAGE �� FUEL/CHEMICAL 1 6 f L TESTING CERTIFICATION E.. ] PASS C ] FAIL DATE' LEAK DETECTION C ]\CH.ECK IF N/A ' TYPE/BRAND ZONE OF CONTRI BUT ION, C ] YES C ] NO ' DATE TO" @E REMOVED' FIRE. DEPT. PERMIT':, I'-SSUED C J YES• .j C ] NO.,:. DATE: A it t_ ;{ .� P CONSERVATION.• ,C I. .CHECK IF N/A DATE BOARD 'OF HEALTH ` TAG,:' NOe ]C ]C It ] DATE;. . l , PL'EASE. PROVIDE A SKETCH SHOWING THE TANK LOCATTON 'ON THE BACK OF THIS CARD 9'o� _� r TOWN OF BA �NSTABLE — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION OWNER AND INSTALLER INFORMATION ADDfiESS:1 NN )7) MAP NO. 0 / 2- PA' CECI N.0.4W 2 - OWNER NAME: ) , E... -- `�- VILLAGE: � 1` C INSTALLATION ATE: ' Y= -� � � �---� ADDRESS: CERT. NO. to 3#1 .- TANK INFORMATION • , /mo dLOCATION OF T NK: AGE Ju L., UCAPACITY - LE L TESTING CERTIFICATION C ] PASS C ] FAIL DATE LEAK DETECTION E% CHECK IF N/A TYPE/BRAND �Z®NE OP�,/ICONTR I BUT I ON C ] YES C NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED C ] YES . _.C�—]"NO'"—DATTE.,.,_ CUNSERVAIION C CH CK IF N/A DATE BOARD OF HEALTH? T G NO. ] ]C ]C ]C ] DATE PLEASE PROVID A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD ��� � . ���� g� �h� 1 �� ' D CENTERVILLE OSTERVILLE MARSTONS MILLS FIRE DISTRICT // ? UNDERGROUND TANK REGISTRY PROGRAM 1 Owner of Property: C I Date of Installation: 5 7 g Address: 3 -) p Description: S 4 e e Installer: Size: a O o U Certification: Location of Tank: INSPECTION INFORMATION DATE COMPLETED BY Site Inspection Air Test on Tank—Above Ground Air Test on Tank—Within Hole Test on Piping Cathodic Protection Test 'Continuous Monitoring System Type Backfill Operations Vent and Fill Pipes Other: oft A R98 Mass eel y re!•428,26 8,?0l8 M F 3, • ; a h 4 { k ` � i' L { T .�F i August 24 , 1988 Board of Health 367 Main Street Hyannis , Massachusetts Dear Madam/Sir : Our two oil tanks have been tagged . The monitoring wells 'have been dug by LCR Tank Services . I am enclosing a copy from the Fire Department st.ating the ages of the two tanks . I think this completes the work . Sincerely , g Robert B . Clarke , M.D . 370 North Bay Road P . O . Box 2011 Osterville , MA 02655 CENTERVILLE OSTERVILLE MARSTONS MILLS FIRE DISTRICT UNDERGROUND TANK REGISTRY PROGRAM Owner of Property: Date of Installation: Addres f 37() fvr27`� iS ay �� Description: S .f�� e Installer: Size: S D O Certification: r Location of Tank: INSPECTION INFORMATION DATE COMPLETED BY Site Inspection -- -- Air Test on Tank—Above Ground Air Test on Tank—Within Hole Test on Piping Cathodic Protection Test Continuous Monitoring System Type Backfill Operations Vent and Fill Pipes Other: AA 0 L > ° D� 80 X ao, M1. F, R x - �% M qRp M reiMWr �a'�SIM a?�ors ' . R • 4y TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION w- OWNER AND INSTALLER INFORMATION,..----- ADDRE g f. ,'; MAP NO'. (D-7 PARCEL NO. 0 0 7- OWNER NAME: -L C_.kc-)+K 4/. 7 VILLAGE: INSTALLATION DATE: - BY: ADDRESS: F CERT. NO. Nod6 a 41 j TANK INFOR ATTON LOCATION OF TANK: P R 7 f,,)_ _ #- i 1 N t Poo CAPACITY 1 0 TYPE ==' AGE FUEL/CHEMICAL 3 TESTING CERTIFICATION C I PASS C I FAI DATE ,y LEAK DETECTION' C CHECK IF N/A. TYPE/BRAND ZONE OF CONTRIBUTION C ] YES C,�(] NO DATE TO BE REMOVED FIRE DEPT. PERMITS ISSUED C I YES C I NO \DATE CONSERVATION C ] CHECK I � N/A DATE N` BOARD OF HEALTH TAG NO. ]C�. n ]C ] DATE U Ny PLEASE PROVIDE A SKETCH- SHOWING4;THE TANK LOCATION ON THE BACK OF THIS CARD �.�' ����� r TANKS] 31 FUEL STORAGE TANK RECORDS ] HELP [ ] FOR -PARCEL NBR: 0721 0021 ] ] MAIN ACTION C] Action Tank Nbr Tag Nbr Installed Location ----Notification Dates----- [ 4. [ '11 [ 5761 [0801771 [B ] Test 4931 Rem ] ---- Test --- --Abandoned-- -- R oved - -- Variance - [ ] [ ] [ ] [ ] [ ] , [0429911 [ ] [ ] Fuel Reason Capacity Constr St tus Lea et Cath-Det [D ] [H ] [ 5001 [SS] [NT [N] [N] Additional Details [REMOVED ] -------------------------------------------------------------------------------- Action Tank Nbr Tag Nbr Installed Location ----Notification Dates----- [ ] [ 21 [ 5771 [1107791 [B ] Test 193] Rem ] - Test --- --Abandoned-- -- Cus ed -- --. Variance - i [ ] [ ] [ ] [ ] [ ] 04951 [ ] [ ] Fuel Reason Capacity Constr StaLea et Cath-Det [FO] [H ] [ 20001 [SS] [N [N] [N] Additional Details [ ] ----------------------------------------------------------------------------J--- Cancel [ ] END OF DATA NEXT SCREEN [HMENU] ACTION [ ] PARCEL NBR [ ] [ ] [ ] ] TANK NBR [ ] [ ] �, II i 02-16-1999 04: 14PN CENT DST FIREDEPT 5087902385 P.02 MaKe appncation to local rire uepartmenL Ftre Department retains original application and issues dupliicate as Permit. ��✓Y�2/�}ZQ�I'GG��'+rz�/�f2 a� iZ�16� � S-�:.� APPLICATION and PERMIT Fee: 10.00 for storage tank remcv-cJ and transportation to approved tank disposal yard in accordance with the provisions of M.G.L. Chapter 148,Section 38A, 527 CMR 9.00, application is hereby mace by: Mark Burton Tank Owner Na�rte(please print) x O �gnaruro ap 9 rC/A6I711R Address North Bay Road, Osterville, MA Sneer city Snr• Iv Removal . t• `I • • • �� - Company Name Enviro-Safe Corp. t Co.or Individual_ Enviro-Safe Corp. Prirr - Ptsnr Address p•0- Box 810, E. Sandwich, MA Address Print _ Pion Signature (if applying fcr.er7nit) Signature (if ap ing f%rzermi IFCI Certifies Other IFCI Certified = 'S'-4 Other • r . Tank Location 360 North Bay Road, Osterville, MA ,,Tank Capacity(gallons: 500 Substance Last Storms #2 Fuel Oil Tank Dimensions(diarer=r x length) Remarks: IV�(� V �O i= • • • .u C�7 Enviro-Safe Corp. MA-329 w Firm transporting waste State Lic.# - Hazardous waste m T E.P.A. # rJ Approved tank di yard Turner Salvage 20101 � �. Tank ya d#. Type of inert gas Tank yard address Lynn, MA Centerville 01920 City or Town FDID# Permit# Date of issue February 16, 1999 Date of expiration March 2, 1999 Dig safe approval number- 19990701408 Di fe To( =-9 el, umber-800-322-4844 Signature/Title of Off--- Granting permit ji 4 , t—/1,I&P, After removal(s)send F=rt"F-290R signed by Local Fire Dept. to UST Regulatory.Compli.r,—._ Unit, One Ashburton Place, Room 1310, Boston, MA :2:0&1618. FP•292(revised 9/96) TOTAL P.02 r I y 05-22-1998 03:54PM CENT OST FIREDEPT 508?902385 P 02 . t-ire department retains original application and issues duplicate as Permit. 14*, APPLICATION and PERMIT Ee . 10-. �_ 00 for storage tank removal and transportation to approved tank disposal yard in accordance with the provisions Of M-G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereby made by: Tank Owner Nacre(please print) Harold G e n e e n X Address 360 .N N. 'Bay Road O s t ery i l l e, MA S&IW Its COY SWq AV Company Name EEnviro—Safe PAWCo.or Individual — h U rZ ew_op Address P•0•-BOX 810, E.Sandwich, MA Address Sign ure it • P""' "` 9 applying for permit) Signature if applying p d 9 ( pplyin for permit) IFCI Certified Other p IFCI Certified ❑ LSP# Other; Tank Location 360 North Bay Road CGsterville, MA aaaess Tank Capacity(gailo 2000 anyns) #2 0 i 1 Substance Last Stored Tank Dimensions( iameter x length) Remarks: AMG I��Y+cAIp�D lit/ Firm transporting waste Enviro=Safe 329 MA State Lic. # Hazardous waste manifest# `3AK140495 MAD985269323 ------------ Approved tank disposal yard Turner Salvage Tank yard# 002 r Type of inert gas Tank yard address 235 Commercial Street Lynn, MA City or Town Centerville FDIO# 01920 Permit# Date of issue Maq 20; 1998 June 3, 1998 Date of expiration Dig safe approval number.9 8 2 0 0 5 9 7 9 Dig Safe Toll Free Tel. Number-800-322-4844 Signature/Title of Officer granting permit After remova(s)send Fprm FP-29OR signed by Local Fire Dept.to UST Regulatory Comp ance Unit, One Ashburton Place, Room 1310,Boston,MA 02108-1618. W(revised 9NS) TOTAL P.02 ,��,� i TOWN OF BBA/RNSTABLE LOCATION G N a VK'+ SEWAGE # as o 3 VILLAGE . G Cq2 y 1 LE.E ASSESSOR'S MAP & LOT D rI2"Q30 INSTALLER'S NAME&PHONE NO. -1 a L % 1A A LTC3 Cif su ST. SEPTIC TANK CAPACITY -a 200 LEACHING FACU TFY: (type).7/Sy C u+'}ot la (size)/off.P3 X 6$•� o NO.OF BEDROOMS BUILDER OR OWNER u r t_ rz✓�S /J PERMTT 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.(1f any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(dany wetlands exist Feet within 300 feet of leaching facility) Furnished by 13 a,3Y� 56 , 7a 9 - 1 n O Tic _ 1l � <� T//V- ]\T, S 4" PVC Vent Pipe with Screened Ope1n'ng Gar/slab El, 16.91 1/9` to 1/2' 1lesbed stone o s' Thfex 36 GENERAL CONSTRUCTION NOTES Fin/Grade El. 16.5'a,�t�atw6: Ncwb} ' hers to withlB'o!1In/grado A venter and end nhambmw (&4YR) 1. All the workmanship and °materials shall conform to REP Title 5 MTNand the'\,Town of Barnstable rules and regulations for the subsurface` )MAL f'R,�i!E & coven' 9b OWN Fin. Grade R1 17.0'f ,'' �\ `� , Dla 1" V ., disposal of, eR�ge. L,,v ° IV seperetm One ohamner) 2. At least one access port over tank tees shall be accessible 15.00' El. 13.43' within. 6" of finish grade, . with anv remaining access ports brought ©ram cac�© to within 12" of finish .grade. p EL, WV EL, °°°'� n m ' ••Q•• ,x '. ' 3. All components of :the sanitary system shall -'be' capable of 10' 14` INV EL INV EL.. . . . . . . . 13.23 12.60 s/4- - 11%2' llasbed'Stone 10.60 withstanding H-10 ,loading unless 'the v are under or within 10 ft INV EL 13.98' 13.43P , . . . . . . •. 4' 4' .�, Ltquld Level 4e o1' drives or parking. "H 20 loading shall be used under. or within - -- 14•23' - , DI�S'TRIBMON BOX ens C, t. 10 A\of drives or parking unless noted. < Plastic equals may be j" used hZ lieu of all recast units 4. The exca va for contractor shall verify the location of all site PROPOSED LEACH TRENCH . . t utilities prior to any excavation, and shall be responsible for 2000 GALLON SEPTIC TANK - H2O LOADING ; + , all matters. relating.. to `electric easements.-, El 5.60' f , 5. Sewer pipes shall lie 4" Schedule 40 .1'IrC' laid at 0.02 slope. - .. » S �yr masonry units used to bring covers to grade shall be Adt Htgh Ground, ,24 = Ana ter <'Eb '5.0 (Coastal) 4 , mortared in place. Z600 GALLON REINFORCED CONCRETE SEPTIC TANK' 68» 7. Finish grade shall have a minimum slope of 0.02 ft per foot - -- t Minimum Construction Materials Per 310CMR 15.226(2) 8, Wherever .sewer' lines must cross water .supply lines both pipes Number of ?.Yenohes - 1 Tees shall be constructed ' of Schedule 40 PVC and shall extend a shall be constructed of class 150 pressure pipe or equiv. and shall be - �. _ _. Number of Chambers - 7 , minimum of 6 above the flow line of the septic tank and be on pressure, tested to assure watertightness the centerline of the Septic tank located directl under the clean--out manhole. PROPOSED LEACH TRENCH -- END V7E`N N.T.S. The inlet pipe elevation shall be no less than 2 nor morethan 3 above the invert elevation of the outlet pipe. Septic tank shall be installed level and true to grade on a level, �f stable base that has been mechanically compacted and on which 6 of crushed stone has been placed to ensure 'stability and Y.. �• to prevent settling: Septic tank shall have a minim um co ver of 9': Three 20" manholes w tlz readily removable impermeable covers of durable material shall be``provided with access ports beinglaced at the center and over the inlet and outlet tees ' Bx�. CB Fed The outlet tee shall be equipped truth gas baffle. /• - �% J Y Pump and FIII Bdsitng Cesspools 62 typ.) r��3 n. i# Ilk, aY f 10, / % o a► m ny �4 8;;,.. / / \ PRECAST REINFORCED CONCRETE' DISTRIF�UTION BOX 4 1 / 9 121 / . o \ Install on a level base. CL .' � . Minim um , wall 'thickness . ._.. Q Minimum inside dimension 12 i , Outlet inverts shall be equal to each other and at 2 minimum � � / / � -. , � � ,: , • : ,. . 'K / . O � , : �i,f9 °*�*�qy � ,, v,� Belo inlet � / _� _ cellos he istrlbutlon hnes from ` the distribution box shall all ha ve , sr T dIMP equal inverts determined b floodin the distribution box to � r�r - �.... ..d . . eq ,_ Y bo° / / / oQ yr / LAA4V S' 1 the height of the distribution line invert after all lines ha ie a,� / e h g / r � Xlstlri L��J C U. _M GRAPI SCALE • / / / �,. g . ` tone � ,, •. ,•- , `• been sealed in lace. , P /, / gall < . ► ,, Dwell�n -120 o I� .30 Invert adjustments shall be made b filhn h durable an __ , n ndeforma ble material ermanen l fastued to the line or Q P �:Y , 1 all i re is are of equal elevation.t can. ,��: � reconstructing the hnes until a ni ,� q i , 14 o , 1� e` i e� % `14 (,IN FEET .��' . 6 �� `ti �`i ` \ / 1 111Ch 30 ft t 18 % CB Pn LAi►iv r' • , 1B LOCUS ADDRESS.' / 360 North Bay .Road, Oster Me r j CTI Fh ASSESSORS MAP 72 PARCEL 3 96 P 30 ` . Soil Log Design Data: 1 1 1 1 f PARCELS 1 & 1 2 Test Date.- December 8, 1999 • Six Bedrooms = 6 X 110 d 660 d Required Flow with EXpa,17sion Potential to Eight 'Bedrooms Total Area 67,800 sq.ft. � w Soil Evalua tor.- Stephen Do le :.. �� �� 1.66 Acres P Y Use: Chamber Trench 68.51 x,12.83.'Jr x 2'-Eff/Depth °� \\ 1 i i ,�0$ Y F: 61 5 f 68 5 f 12.83 f i2.' 3 x 2.0 = 325 se wetland Area - 5,200 sq.ft. . 1 4� 00 h F a ,``�_Z ' P l r of . 'a Z2'C� HealM ;Agent: Donna Mora nd" � � J � Upland Area - 62,607 sq.f� 1 ��. �s �0• ' ,.. Yj, 68.5 x 12.83 = 878 c \ / / / / Prepared Foi.- r. ,20 Pere Ra te: �,� Min Inch 1,203 x 0 74 �-- 890 GPD Total Design Flow \ � � / 1B , �� z b / �36 0 aver th Bay' . c�' V`' t TP 1 - E'1. 16 TP 1 E'1. 16 . 0 Y�d1.0 � Ustervlle Massa ch use t t,s UVIERA 3 Scale: .1 30 Date:- may ,t2, ,c 003 SL 10yr 3/2 ,r »A„ SL 1Oyr 3/2 „ x�.;gin 9 -9 CB Fhd. Prepared By.'.,. 75 43 B 7.5 43 - , -B LS .Y�' ,� LS .T'1' � - _ � " ' Stephen J Do le and Associates 24 24 •a� 4, 'Canterbury: Lane, R IFal&outh, ,.MA 02536 - �� 9 Telephone 5081540--2534 X:e -v-i s i o L cy c FINE __ FINE I AND SAND A ,tr s+ S IOYR 518 10YR 518 » o+ aEc perc 24 / perc 24 ,+ STEPHEN J. S � • :. DOYLE �. _ •t` No. 3 9 n » fESS1 q 132 132 FEMA Data. The. existing dwelling lies in zone .B ,y sup .. El. 5. 0 E'l. 5 o _ as shown on FIRM `Panel 250001 0018 -D Na Water Encountered No Water Encountered _ , N0.; DATE DESCRIP770N BY x map rev: July 2, 1992) -��