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Home My WebLink About0390 NORTH BAY ROAD - Health 390 North Bay Road Osterville A= 072-001 TOWN O�F BARNSTABLE LOCATION 3qv NorlI�I� y lid. SEWAGE#oAD13-y09 VILLAGE C)6I eT U t l C ASSESSOR'S MAP&PARCEL 07oZ11o'o1 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY J000 G l LEACHING FACILITY- (type) SDOG I. CH sj /fa14size) 70? NO.OF BEDROOMS . 8 8 OWNER DOA/Al ()1 COAAC_11 PERMIT DATE: /6 /,3 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 3 S c�ego T 33' --1{— 6y" No. + Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ftpliLation for Disposal .pstem Construction Permit Application for a Permit to Construct(1-1--'Repair( ) Upgrade( ) Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. 3 9G �`t'rf '� 'Owner's Name,Add ess,and Tel.No. d s{e.��•+'�te �`* Dohh t '�ecn Assessor's Map/Parcel G? D%v/ Installer's Name dress Tel N ." Designer's N,an1� Addles and Tel.No. r�.. �c bG� Sv/(,'inn %hnn9 a8 y2S- 8 13- Si 5� Po 0"61 0SEPr v,/le -t,4 Type of Building: Dwelling No.of Bedrooms Lot Size 7�327 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 880 gpd Design flow provided T311. 7 gpd Plan Date C)C,4We—r Z620/3 Number of sheets I Revision Date Title S,'4e I'(aH n,e//fS Size of Septic Tank /5�04 G�l[�/Z Type of S.A.S. 8-7ce, Cq l n Description of Soil Z w,47 // ! S"'/z., O/ 4tZ ey .c Z, 6o,°" 10F'R IZ� CZ- f? Z.,,, (o?1e �84 `,!— i 39"' C_ l. 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 nd not to place the system in operation until a Certificate of Compliance has been issued by this Boar Heal Signed Date P 7 Application Approved by Date /0 Application Disapproved by Date for the following reasons Permit No. )-o 13 1 o Date Issued No. 0 f Fee �V Entered in computer: 1 THE�COMMONWEALTH O'F'MASSACHUSETTS Yes _ PUBLIC HEALTH DIVISION ;TOWN OF BARNSTABLE, MASSACHUSETTS 1 K ftplicatban for 0sposal 6pstem Construction-Vermit Application fora Permit to Construct(Repair( ) Upgrade( ) Abandon( ); Comple System ❑Individual Components Location Address or Lot No. 3 FG AAP/"4 !�� Rcx�o/ a ``)wriei's Name,Address,and Tel.No. Assessor's Map/Parcel 072 ea ' Installer's Name,,A�ddress,a�+n 77d Tel.No.' �� 1 �c Designer's Name,Address,and Tel.No. St,ilf,'vcrn Fns.hP�/.iiyr —�P,-fZ�^ Type of Building: i Dwelling No.of Bedrooms FU Lot Size?577 sq.ft. Garbage Grinder( ) r m Other Type of Building No.of Persons - Showers( ) Cafeteria( ) Other Fixtures ' Design Flow°(min.required) (�� gpd Design flow provided q3�i�f gpd Plan Date Z/,2o 13 Number of sheets I Revision Date Title /tOSP� MrGv,', c?i7f S r /� Size of Septic Tank"/, e0P Type of S.A.S.` "---_,,Description of Soil (� � l �< ,-r %r 'i f Nature of Repairs or Alterations(Answer when applicable) r Date 1 t inspected: Agreement: t 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 ope"ration until a Certificate ofa Compliance has been issued by this Board of Heald / F Signed Li�C _ ~ � Date Application Approved by IL- 5 t Date i Application Disapproved by Date for the following reasons - Permit No. )01 3 — 1-I 0 Date Issued V THE COMMONWEALTH OF MASSACHUSETTS r BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed Repaired g P Y ( p ( )_ .-'Upgraded Abandoned( )by S �`y�e Cc at Axo r l� &;X (:'co,j has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.a b 13 L10 o(dated _ Installer L,^v(:� �C'•C L._�I ,s (:. Designer #bedrooms Approved design flow J gpd The issuance of this permit shall of be co truledd as a guarantee that the system function s si ned. Date /6497J/Z 7` Ins- -------------*'--- -----=------------------------------- ---------------------------- No. o 13 Fee THE COMMONWEALTH OF MASSACHUSETTS,-' �> PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS 30ispoSaY•6pstem Construction 3permlt Permission is hereby granted to Construct( ) Repair( ) / Upgrade( ) Abandon(,,,-)^' J System located at X10 r-71Z �✓ G��o d` �� and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. ! Provided:Construction must be completed wiihin�three years~of the date of this permit.�-,` ! r Date _ Approved by Town of Barnstable Regulatory Services MAM Thomas F. Geiler,Director Public Health Division Thomas McKean, Director , 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer.& Designer Certification Form Date: 0 23 Sewage Permit# `/07 Assessor's Map\Parcel (372 0�'1' 3'� l'✓qh Gh dnq Installer: YLfle 417e- Designer: c . �l Address: 7 C Q k"o-v I ic- On 10 —'22—G LS '`' was issued'a permit to install a (date) (installer) , septic system at 3 90 Aar44 !2 based on a design drawn by (address ,f vrrAxs,ne�r?n S dated (designer) = 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. R 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 4 r Regulations. Plan r ems' n or certified as-built by designer to follow. N of nngs 90y s ��. (Installer's Signature) n J *1 c. ` 9 N o DE CIViL Cn No.48168 9 9F6/STERF� oFFSSIONALL4 signer's Signature) (Affix Designer's Stamp.Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION.CERTIFICATE OF . COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc S m mu,�vur. 9n"Aaan � ��jba¢3�SSSS� C� G" neaiea� t 0 Cx7 C 0 w F x U p.�te��e C7 = z cae I , 6 s s. g ,s.lr -�ea x - Himd1mEia-IJD UL d> J Z �i w N wr O K a I m ' W O Q _raid.----- ----- N aeoewae -- � F� Lo � m Q i e�§ 8 w.......... . ..:ar. O Qro ,h zzI N moot w.0 aro+. r @@,I raft d �s�iM��vepav I I f-----------. ---- IERR.; MR! U SiK;--17=77 Z d - Wo> 4-41 NQ� 8 oN�r w W>� J W N m 22 e RP Z G6 _- _ .. ❑GR Pov 1. 0 33 LLI gg 5 Z Lu - ... 0. oNW - Z Wad W F a .. .. W W z Q zpr . _ .. ego L 6 w Bathroom Bedroom #8 Bedroom #7 Living Room 2nd Floor Garage Sullivan Engineering, Inc. DONN & EILEEN R O'CONNELL' TRS PROPOSED GARAGE FLOOR PLANS_ . PO Box 659 AT-390 NORTH BAY ROAD Osterville,. MA 02655 OSTERVILLE MA OCTOBER 21, 2013 (508)428-3344 (508)428-9617 fax SULLIVAN ENGINEERING, INC. OSTERVILLE; MA f �. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal.System Form -Not for Voluntary Assessments 390 North Bay Rd. Property Address ' John Beatty III/Coral Gables trusy Company Owner Owner's Name information is required for every Osterville Ma. 02655 11/26/12 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, N' use only the tab key to move your 1. Inspector: _I{ IYJn Cp cursor-do not Robert Paolini use the return key. Name of Inspector Robert Paolini Septic Service Company Name 17 Playground Lane Company Address Yarmouthport Ma 02675 City/Town State Zip Code 508 362-3555 S 14454 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems, I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 16.000).The system: .0. Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further luation by the Local Approving Authority 11/26/12 Inspector's Signature I Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•11/10 Title 5 Official Inspection Form:Su Vcewae Disposal System•Page 1 of 17 � } o Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 390 North Bay Rd. Property Address John Beatty III/Coral Gables trusy Company Owner Owner's Name information is required for every Osterville Ma. 02655 11/26/12 page. CitylTown State Zip Code Date of Inspection B. Certification (cunt.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are . indicated below. Comments: The septic system is in proper working order at the present time. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health, *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form. Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 390 North Bay Rd. Property Address John Beatty III/Coral Gables trusy Company Owner owner's Name information is required for every Osterville Ma. 02655 11/26/12 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cunt.): ❑ Observation of sewage backup or break out or high_static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. .1. System will pass unless Board of Health determines in accordance with 310 CM 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 15irrs•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 390 North Bay Rd. Property Address John Beatty III/Coral Gables trusy Company Owner owner's Name information is required for every Osterville Ma. 02655 11/26/12 page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within -100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ FX1 Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ 0 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ 0 Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow t5ins-11/10 Tithe 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 390 North Bay Rd. Property Address John Beatty III/Coral Gables trusy Company Owner Owner's Name information is required for every Osterville Ma. 02655 11/26/12 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ❑x Any portion of the SAS, cesspool or privy is below high ground water elevation. El 0 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 a cesspool or privy is within a Zone 1 of a public well. ❑ ❑x 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.] ❑ 0 The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ 0 The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade-the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 1.7 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 390 North Bay Rd. Property Address John Beatty III/Coral Gables trusy Company Owner Owner's Name information is required for every, Osterville Ma. 02655 11/26/12 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No 0 ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ 0 Were any of the system components pumped out in the previous two weeks? ❑ 0 Has the system received normal flows in the previous two week period? ❑ 0 Have large volumes of water been introduced to the system,recently or as part of this inspection? ❑ Were as built plans of the system obtained and examined?(If they were not available note as.N/A) ❑x ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑x ❑ Was the site inspected for signs of break out? 0 ❑ Were all system components, excluding the SAS, located on site? 0 ❑ 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 El 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: ❑ 0 Existing information. For example, a plan at the Board of Health. ❑ F Determined in the.field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 7 Number of bedrooms (actual): 7 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 770 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 390 North Bay Rd. Property Address John Beatty III/Coral Gables trusy Company Owner Owner's Name information is Osterville Ma. 02655 11/26/12 required for every page. City/Town State• Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes 0 No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes 0 No Laundry system inspected? 0 Yes ❑ No Seasonaluse? 0 Yes ❑ No Water meter readings, if available last 2 ears usage d NA 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes 0 No Last date of occupancy: NA Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑. No Water meter readings, if available: t5ins•11/10 Title 5 OFficiat Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17, F Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 390 North Bay Rd. Property Address John Beatty III/Coral Gables trusy Company Owner Owner's Name information is required for every Osterville Ma. 02655 11/26/12 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Last date of occupancy/use: -Date Other(describe below): General Information Pumping Records: Source of information: Robert Paolini Septic Service Was system pumped as part of the inspection? ❑ Yes No If yes, volume pumped:' . gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool FX1 Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 390 North Bay Rd. Property Address John Beatty III/Coral Gables trusy Company Owner Owner's Name information is required for every Osterville Ma. 02655 . 11/26/12 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Approximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ❑x No Building Sewer(locate on site plan): Depth below grade: 1 feet Material of construction: ❑ cast iron ❑x 40 PVC ❑ other(explain): Distance from private water.supply well or suction line: 10'+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints.appear tight.No evidence of Ieakage.System vented through the Building vents. Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts A�. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 390 North Bay Rd. Property Address John Beatty III/Coral Gables trusy Company Owner Owner's Name information is required for every Osterville Ma. 02655 11/26/12 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 390 North Bay Rd. Property Address John Beatty III/Coral Gables trusy Company Owner Owner's'Name information is required for every Osterville Ma. 02655 11/26/12 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-11110 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 390 North Bay Rd. Property Address John Beatty III/Coral Gables trusy Company Owner Owner's Name information is required for every Osterville Ma. 02655 11/26/12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): 0 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 390 North Bay Rd. Property Address John Beatty III/Coral Gables trusy Company Owner Owner's Name information is required for every Osterville Ma. 02655 11/26/12 page. City/Town State Zip Code Date of Inspection D. System Information (cunt:) Type: ❑x stone leaching pits number: 'with 3' stone ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields. number, dimensions: ❑ overflow cesspool number: - ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy dry soil.No signs of hydraulic failure.Stone was dry at time of inspection.LP 1 stain line was 4' below invert.LP 2 has never seen water.Both were dry at time of inspection. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 1 Main with 2 overflow leaching pits. _ 1 Depth—top of liquid to inlet invert 6" Depth of solids layer Oil Depth of scum layer Dimensions of cesspool 61x6' Materials of construction Concrete Block Indication of groundwater inflow ❑ Yes 0 .No t5iris•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts luTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 390 North Bay Rd. Property Address John Beatty III/Coral Gables trusy Company Owner Owner's Name information is required for every Osterville Ma. 02655 11/26/12 page. Cityfrown State Zip Code Date of Inspection D. System Information (cunt.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5irs•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Map " http://66.203.95.236/arcims/appgeoapp/map.&W?pmpenyD=0720. Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size ❑ ❑ Zoom Out Q Q Q Q Q 0 Q 0 QIn r d 31 5q 5q 75 ti ,• 4 ~� N ` 20 Feet 't' Set Scale V = 20 ' Aerial Photos MAP DISCLAIMER 11/?(/ nl?k41: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments °r 390 North Bay Rd. Property Address John Beatty III/Coral Gables trusy Company Owner Owner's Name information is required for every Osterville Ma. 02655 11/26/12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: Check Slope Surface water Check cellar ❑ hallow S wells Estimated depth to high ground water: Bottom of Leaching 4' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) 0 Checked with local Board of Health-explain: As-Built ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 annual ranges of ground water elevations. Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts kiTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 390 North Bay Rd. Property Address John Beatty III/Coral Gables trusy Company Owner Owner's Name information is required for every Osterville Ma. 02655 11/26/12 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist FZ Inspection Summary: A, B, C, D, or E checked ❑x Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ❑x System Information—Estimated depth to high groundwater 0 Sketch of Sewage Disposal System either drawn on page 15 or attached in separate fife a t5ins-11/10 Title 5 Official Inspection Fond:Subsurface Sewage Disposal System•Page 17 of 17 DIRECTIONS: Vent - Final Locatation to be Determined at Time of Installation so From Hyannis - Take Route 28 into Osterville; At (yp.) g Y Y ASSESSORS REF.: F.F. EL. 24.08 See Note 6 t as to be as Inconspicuous as Possible the lights b White Hen Pantry take a left onto F.G. EL 22.00E F.G. EL. 22.00t F.G. EL. 21.5t F.G. EL. 20.5-22.25t Ostervllle West Barnstable Road and fallow to the r ,y end, Take a left onto Main Street; Take a right Map 72, Parcel 001 I yp � F, + Existing Main House gFt� zt }.. El 18.78 & 18.42 onto Parker Road; At the stop sign take aright Proposed Addition El 18.88 onto x West Bay Road, Bear left onto Bridge Street, Proposed Garage and follow to the Gate House; Take a right onto El 20.48 Oyster Way, a right onto Grand Island Drive, and a 4 Pt3x ,f � Right onto North Bay Road; OVERLAY DISTRICTr a za SEE NOTE 8 (TYP.) Site is on the left, #390 AP - Aquifer Protection District , EL. 17. Proposed r Tojo EL. 17.79 7 c gr 2000 Gallon EL. 1 - LONE. H-20 -20 7.63 EL. 17.24 Septic Tank Leaching RF-1 Chamber Flow E uilizers H-2087,1203C 7 q Area (min.) (RPOD) � '� Pe 1Y .� n° t ' •e p' 2 s Require o . . 14.79 Frontage min 20' Bedding,"T"s, & Baffels g (min) ......: w as Per Title 5 ' 10' aka fl s If Encountered Remove & Replace Width (min) 125 sui All Unsuitable Soils Within 5' of °Q 70' Min. - SlabSystemSetbaClCS: Min. Out Perimeter of The The er , FLOOD 20' Min. - Foundation EL. 9 TH-1 No Groundwater Front 30 * » r Side 15 REFRENCES: = s Rear 15' Zones A11(e1.=11), DEVELOPED PROFILE OF SYSTEM DEED CERTIFICATE #: C115957 B & c LAND COURT PLAN #: 15490G Community Panel No. ' NOT TO SCALE ENGINEER TO VERIFY #250001 0018 D SOIL CONDITIONS July 2, 1992 LOCATION MAP: Scale: 1" 2000'f PERC TEST: 14,145 OPERFORMED BY:CHARLES ROWLAND,EIT- SULLIVAN ENGINEERING SOIL EVALUATOR NO. 13586 WITNESSED BY:DONNA MIORANDI,R.S.-TOWN OF BARNSTABLE OCTOBER 3,2013 SITE PASSED a� TEST HOLE - 1 EL.21.0 N C ��W = := QD O 8, 20.3 LOAM �. �1 O/A 1.AR:19Y 3!2 O .... IDARK CsRAYISI-I BROWN SANDY.LOAM:.: 20 O Q LL 1 B...>AYEIt 10YR 3!£1 Proposed Vent DHCB FND / V-1 Final Location to _LO.AMY:3ANI3:::.::::::....:...:.... 18.4 R I ` \ 1 P YELLOWISH BROWN I �\ � be Determined in 31 ! j DHCB FND \ the Field C LAYER IOYR 7/6 DHCB FND 4' PICKET F CE .00, �` YELLOW I 1 W I t ! N 188 23'48" E V 7 \, E SAND `!f/� 31" PERC TEST 18.4 25 GALLONS MIN. 0 0. \ 2 6.2 _ _ _._ -. _- ... - C _ -_-_-- ?_' l 5 \ _1 4 - 138" PERC RATE<2 MINAN 1 TAR=0.74 9.5 Q t'` t I I i ' - �h ; `\ NO GROUNDWATER ENCOUNTERED J f (j7 i 50.0' �, O jr j %I i I \ t , r \ Q/a 12,83 y - E _ TEST HOLE 2 \ EL.2 0 20.00 TH \ \ �(} \ \ 6 t 4)ANr TH / \ 20 5 \ • O!�LAYIvR lOYR 3/2 46,17/ VLRY DARK GRAYISHBROWN __ 19.8 i Pine Tr4s i �, r .� 57,00' / \ \ ` \ B) AYER IOYR37$ r I td Remain i (� i' O \ ` ` \, \ 0YELLOWISH BROWN ............. Proposed Pier r i _ \.n 7 1 Cn 1 _ ! 32 LOAMY:SA i.: 18.3 J a, .0 >.. O See SE3-5106 i f ` \mo t ' {, t ` TOW In vert El YELLOW 1 .-E'> t__r- - •_._ \ \' - C LAYER l OYP.7/6 / r , 16 8' TIL Y PO / � 0 0 k Tree� __._ i t M.SAND t ti I 23' / 1 r j a d 1`ree' 138" NO GROUNDWATER ENCOUNTERED 9.5 uuter TO ' \to Re ain \ l 8.5' �, 10<83 % } I Prdp s d o t'o U f i ! Proposed / I ,� \ • \ F1 V. 1815' 1 vert Elev. 18.42' or Proposed Cleanop Q) \ j 1 Sher LAWN ' \ � t \ .. Proposed moved Pump Chamber \ y o - \ o , Sill nvert Elev. and Replaced,._ ith ropos d a io E1=24.0 18.88' or Ejector Pain':- El e v. 21.5*p: \ ti �a m�Dt� ` Higher \ \ \\ m rt,n I g Lot LIGHT F'OST \ I ` 10 Q t \ \ �\ n °+ I 4o osed 9 � S \ "N F 3 °� g\ \ 90 � Gar e 1 DESIGN DATA ` \ � , o { a� 1 sty W/F , Calculated t ML W) , 8 Bedrooms x 110 GPD=880 Gallons/Day l j i / t \ } \ ' y welling ' y \ / i Pr o eGI a t'o , n LAWN WATER PIT' SEPTIC TANK JI �, Trees-and \ \ \ I Eev, li&�' t _ _ �o . Total Daily Flow:8 Bedroom 880 GPD 1 I ' Understor� ,� �2 \ Tb�\� `` Trees to be f J, House&Garage ! ' CoosAMay 20131ogged ,1� to Remain \ a� \ �� ` \ \ T Proposed P do �. �/ Removed C' _. I 8 Bedroom x 110=880 x 200%=1760 ' ! \ 8 B. Hall \ \ \ , 3' Elev. 21.5 _ 30.8 UTILI POUE I y \ \ \\ \ Proposed -- 105.6 - 1. _ __ O a 2000 Gallon Tank Required VARIANCE l ? lr \ ` \ \ \ \ \ \ Spa / \\ Propos i f Over the Counter Variances i \ \ O \ \ TOW Addition Pro osed�ara e With 1 LEACHING AREA Required: 3'Deep f i \ \ \ \ \\ 5' -- Two Bedroom Above 880GPD/0.74(LTAR)=1,189.19 SF Required � 1 � �, ;'`1 � � \ � , Requesting:3.8E Deep t J \ \ \ \. Proposed Field As Shown DHCB FND Sidewall=2'(12.83+46.17+16.98+10.83+29.83+57) Septic Tank,D Box and 1 \ , \ \• r =347.3 SF SAS Greater Than 3'Deep, Deep Bottom Area=12.83'x57.0'+16.98x10.83=915.3 SF but less than 6' 1262.6 SF Total Provided SEPTIC NOTES ;` 1 t �i \ Oroposed D�nage ZPc I �--- p �P�IH Uk P4ss LEACHING CHAMBER DESIGN \ ` Pool Draw-Down Pit%lExis ing ISeptl _/ '' o� qc 1.Location of Utilities Shown on This Plan Are Approx.At Least 72 Hours €` t / 50.0 \ 'd 15.5 JO All Pipes to be Schedule 40. \ \ • Le chirdg Pit t \ �_ ---" _ s �, p Prior to An Excavation For This Pro Project the Contractor Shall Make 1 ` t ndohed Use 8-500 Gal.Chambers in a the Re Required Notification to Di Safe 1-888-344-7233 . \ \ \ Pro�osed Lawn _ --'' ND c� 9 g ( ) ^/ : o Re ovei ""20-- No.48168 Double Washed Stone Field as Shown. � �p -- __ _ _ _ i 2.The Contractor is Required to Secure Appropriate Permits From Town x Lbcoti `� ! `1 A 9 Agencies For Construction Defined by This Plan. \ \ / i + 1 1 �` \ - _ - -` �- --• '' - _ ' it rF FGISTE 3.Wherever Sewer Lines Must Cross Water Supply Lines Both Lines Shall IN. I / ) i --- _ , , _ - ' %-- _ _ _ 319.Od ss/ONAL ENG\ Be Constructed of Class 150 Pressure Pipe and Shall be Water Tested to , \ �.,. _ � � �"`- --- •- - _ -__. _ --- __ _ -- ___ _ .. - - ~" Assure Watertightness. In General,Water Lines Shall be Constructed in \ IN, Coordination With COMM Water,and Shall be in Accordance �3 With 248 CMR 1.00 7.00&310 CMR 15.00. \ 2 r N 810 -""- 4.A Minimum of 9"of Cover is Required for All Components. 1 -� Move two 500 gallon leaching chambers to allow room for 91312014 qu i 7-- _ 5.All Structures Buried Three Feet or More or Subject ✓ �� c : . '� _ Q 11 evision: as electric and water service. to Vehicular Traffic to be H-20 Loading.It is the Engineer's qJ g Legend: Recommendation that H-20 Always be Used. - Cedar Trees to Remar Revision: Remove tank / pump chamber and 3/31/2014 6.Install Watertight Risers and Covers to Grade in Driveway, replace with ejector pump Light Post or to Within 6"of Finished Grade In Lawn. Install 24"Cover to 4°- Hydrant Grade for Pump Chamber. Q V Reduce size of patio & change portion of 311912014 Hose Bib 7.Septic System to be Installed in Accordance With 310 CMR 15.00& Revision: patio to deck (113 to dune). 248 CMR 1.00-7.00 Latest Revision and the Town of Barnstable El CB/DH Board of Health Regulations. `; Revision: Approx. Location of Remaing and Removed Trees 1211012013 -4 Guy 8.All Piping to be Sch.40 PVC. NOTES: & Utility Pole 9.D-Box Shall Have a Minimum Inside Dimension of 12",and a Minimum PREPARED FOR: PREPARED BY. TI TLE: OHW- Overhead Wires Sumpof6 . Site Plan 25 Elevation Contour 10.The Separation Distance Between the Septic Tank Inlets and 1.) The property line information Shown was compiled SullivanS En ineerin Inc. iled from available record information. Outlets Shall be No Less than the Liquid Depth.Inlet Tees Shall Extend p Donn 0 Connell g, Proposed Im pro omen is Zz Holly Tree a Minimum of 10"Below the Flow Line.Outlet Tees Shall Extend 21" PO BOX 659 2.) The topographic information was obtained Osterville, MA 02655 At from an on the ground survey performed on or between MAY113 and FEB113. (508)428-3344 (508)428-9617 fax 390 North Bay Rd. Deciduous Tree 3.) The datum used is NGUD 29, a fixed mean Barnstable (Oyster Harbors) Mass. LU sea level datum. 20 0 10 20 40 80 Draft: CTR Field: MDH/WHL/MLL 7 UJ Coniferous Tree 16 JC 11Review: PS Comp./Review: MDH/RRL DATE: SCALE: Project: 330004_0'Connell cry October 21, 2013 1 = 20 Project: O'Connell