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0028 OLD EAST OSTERVILLE ROAD - Health
28 Old E �ast Osterville 6cd Osterville F -- A 145 009003 a o ' TOWN OF BARNSTABLE LC CATION $ C��� C .f�,rvvr'�� 10 SEWAGE #�0ffE lsJ� 'VILLAGE 1ZIle ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. o�r�+`r��i > � SEPTIC TANK CAPACITY LEACHING FACII.ITY: (type) S7eO (size) ii �s' NO.OF BEDROOMS BUILDER O WNE VaL PERMIT DATE: M--7,o•o r 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 D61w lab a�o7 6` F f 2 O k Fee • � ' �THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZIPP iratiOTT for Digoal 6pgtem COTtgtruction permit Application for a Permit to Construct Repair( , Upgrade OAbandon ❑ Complete System �Individual Components Location Address or Lot No. 7 g 01,e� 4 i Owner's Name,Address,and Tel.No. Assessor's Map/Parcel DS wI Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: 7 Dwelling No.of Bedrooms Lot Size 7�®3/ sq.ft. Garbage Grinder ( � Other Type of Building &J`•1 nlce No.of Persons Showers( ) Cafeteria( ) Other Fixtures Z Design Flow(min.required). .330 gpd Design flow provided j��/ gpd Plan Date / O Number of sheets / Revision Date TitleC7bt Size of Septic Tank P4! ,LEX1,67-Type of S.A.S. y'Q/ r✓' � l d�c Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board Hea h Signed ADate Application Approved by 11ADate ;Zo 0 Application Disapproved by: Date for the following reasons Permit No. a�Ua r'(p 3 e2 Date Issued 14Zd (� w No. fj 1r w , s, ? r v'� Of �o� a i t Fee �U "'. ,` t ^� ` Entered in compute THE COMMONWEALTH OF IVIAbSACHUSETTS 71 PUBLIC HEALTH DIVISION - TOWN/OF BARNSTABLE, MASSACHUSETTS Yes ZIppYication for �Dioail 6p5tem Construction permit Application for a Per i t.to Construct O Repair(V� Upgrade O Abandon O ❑ Complete System U Individual Components Location Address or Lot No. y t� O�aQ'�� Owner's Name;Address,and Tel.No. f�S�of.�83 Assessor's Map/parcel Installer's Name Address,and Tel.No. Designer's Name,Address and Tel.No. forell s. Type of Building: ° Dwelling No.of Bedrooms Lot Size 15, 03 sq. ft. Garbage Grinder ( � Other Type of Building PP.51 &WCe No.of Persons' Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) .330 gpd Design flow provided 3 e7/3 gpd Plan Date /1111a 57 Number of sheets / Revision Date Title c J`/-r s�tqx a fZ �� Ole �Q�s�' ��?/L// Size of Septic Tank /19/!V R41 Type of S.A.S. Description of Soil i 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 HeaI hh. Date Signed r �/t©,5. Application Approved by t d? Date a Z o A r Application Disapproved by: Date for the following reasons Permit No. a�Uu S `(p Date Issued 1 �u lo i THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage_ Disposal System Constructed ( ) Repaired ( I�Upgraded ( ) Abandoned( )by at 7� 61144 Gpc5� �✓"�/'l//Z/4f AAas been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 1 UO S- to 7 oZ dated 12 Installer AO/ f/�lO/T / Designer ©�/ CQ L� .��e , #bedrooms Approved design flow — 3 30 1 'gpd The issuance of this permit shall not a cons rued as a guaramee that the system wilhfunct'on a des'gned. Date J I S Inspector 0 ————————//—————————————————————————---————————— No. .�G15 '' (�! �� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS 1wi!5pont i§pgtemY Construction Permit Permission is hereby granted to Construct ( ) Repair ( �. Upgrade ( ) Abandon ( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this f er �it. (�oks— A roved b / 'yDate I � / Pp Y I LQCATI ON L.�ST' !L� , "" I 140. P-/Sa -7 VILLAGE DATE APPLICANT ( (^- af�`i ��.�`a �P" FEE ADDRESS TELEPHONE NO. „ ' _,,bj- Non-refundable ENGINEER TELEPHON NO. -i l S-1244 DATE SCHEDULED Applicant's signature • . •'• • • • • • • e • • • • • • • o . e • • • • • • • • e • • o • • • • • • • • o • • • • • • • e • • • • o • • • • • • . • • • o • • • • • • • • o • • • • • • SOIL LOG SUB-DIVISION NAME 6j 46 DATE 1q. ®1 s TIME EXPANSION AREA: YES ✓ NO _.� It .ALLA 45 ENGINEER TOWN WATER vlEA PRIVATE WE:.m, BOARD OF HEALTH KA b 4t%e_ L1. 61 Scg4 EXCAVATOR SKETCH: (Street naivie, etc. ,dimensions of lot, exact location of test holes and percolation tests , locate wetlands in proximity to test. holes ), NOTES: (2�/HEA_b LM LS H�I�E�ANT �2,O® -70., - I�pe"n 0v ►� 40. R -- -I:'1ERCOL�ATION RATE: ®. AA1I-i II-a . '.PEST HOLD, NO: ELEVATION: TEST HOLE NO ELEVATION: NO: s, 3sc3►k_ 2 3 3 . 4 �7 4 e� 6No Inspection Staff 7 r, AA 10 _. �/ 10 12 12 " 13 ti � � 13 14 14 15 15 ' 16 16•. SUITABLE FDR_ SUB-SURFACE SEWAGE: LEACHING .FIELD LEACHING 'P.ITS, iz ' LEACHING TRENCHES UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: NOTE: . ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON P1RC `I'1:ST. PLIChTION O12IGINAL: CO MPI FTP'D JN FNTTRF= Ry, P E . AND RT'TTJRNED TO BOARD 0P HEALTH (-nT v• uETAINr:D. BY APPLICANT FROM :down cape engineering inc FAX NO. :15oe3629880 Jan. 042006 02:04PM P3 =l Town of Barnstable Regulatory Services Thomas F. Geiler,Director r r 0B Public Health Division D03 row" Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Sewage Permit# ✓-i�37 Assessor's Map\Parcel ' LO0f do_?t� Designer: bo t�J✓1 _ 4ee' � Installer: 164�1 U �!/J e.6 Address: / 1, t/ V• Address: I'd* • on ` u�`d� ®/���2>-71&445;1>47 was issued a pennit to install a (date) D (installer) septic s stem at a V 0�rit ao D.J -. ��e 4 e 6��:. se p y _ � /fit ased on a design drawn by '(address) = - .C- -- dated (d igner) , 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. flan revision or certified as-built by designer to follow. r ` ARNE H.. Inst is Signature) U o JAIA ( g ) CIVIL' in No.30792 FSS�ONAL ENG\ (Designer's Signa re) (Affix Designer,s Stamp I Iere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUEI) UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE I21+,CEIVED BY THE BARNSTAUT E PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic0csiper Cenitication Farm 3-26-04.doc FAiLEDINSPECTION .) ATE : PROPERTY ADORE SS : 28 Old East Ostervil_le Road Oste rvi_i. le Ma 02655 On the above dale: i inspected the septic syVenyal the above �ARECEIVED 1, 1. 1000 gat ion zeptd c tank, NOV 13 2003 Z, 1—L7d.b1 2AA on. lot. A 1- 1000 gaiion pAeca& Nac.h-ing p! . TOWN OFBARNSTABLE HEALTH DEPT. 885? ? on my I(15n?(`,ic^,,(? r'iiily (ile i( ih�)YrInC'J C:( UII�CfIS G ihio C.h a f.t,X" es live Jai i ! c Sy1QM,Q8 C Od i pp�� J. / 0_ z e p i.d. s y l t e%m i- c.�. h ,i O t �! ,j r 1.1L 2 C. MAP ®O ti. newnewleaching yin r .! ,! C.CLh C.0 �.�_ !_iZ -` __a ( �GCL, PARCEL 7, Pumped comr/.et.__ %<laX_C'm at file 01 ia.^pecklon ,: Son , inc , r,!S uK87!'I iI ON DOE NO I. CONS] A � ;ARt ?,1r r oF1 Ar, R,�Ar, TY i T pooIS•l ld,Town stwqr i i r 0 BQ.t hit t.P(!I,ri Y!11, MA 0?63?,Q06 );13 318 !1 c�Jg•ti 2 c TOWN OF BARNST(A�BLE (! ' LOCATION 28 Oid Ea3.t 0. tfA.J4%-M$P�QT PgN10/23/03 PILLAGE 0,6.te2U-.i ee, 12a,6,6. ASSESSOR'S MAP& LOT MT11iU S(NAME&PHONE NO. .7ozeph P. N a c o l2 P z J 2. SEPTIC TANK CAPACITY 1000 gaLPon, Diztl iigatioa Sox LEACHING FACILITY: (type) 1-LP-1909 (size) 1500 ga P.Pon.6 NO.OF BEDROOMS 2- BUILDER OR OWNER /),e f o/tah lda Pkea ,pERMrM *M-10/23/03 �C�4 L(E DATE: 10/23/03 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of`Wedind and Leaching Facility(If any wetlands exist within 300 f``et of le hing fac- )' Feet Furnished �' „„,, ,, �_ �� r � \ � � o p � �., �6�® 4 \ 3\� O \o � � k COMMONWEALTH OF MASSACHUSET�`S EXECUTIVE O]FF'ICE OF EmIYP.Omm-EINTAL A-'FT.An-,;q DEPARTMENT OF EI+IV%Rf3N7VE�e'X°t��.. o I Jo" T!TILE 5 OFFICIAL INSPECTION FORM FOR VOLU�e''I'ARY ASSESSME: TS SIBSM"ACE SEWAGE DISPOSAL SYSTEIM FOPUNT PART CERTIFICA.`➢ ION .Property Address: 28 Old East Osterva-lie Rod Osterville Mr-i Owner's Name: Dehorah Owner's Address: Date of Inspection:' 10/77775 3 - Name of Inspector: (please print)J,P- macomber Jr. Company Name: Josepli P� macontbc.r =o n :Inc Mailing Address: Box_ 66 Cc t e rY° 1 7 c, i Telephone Number:5 CERTIFICATION STATEMENT I certify that I have personally inspected tine sewage disposal sys[(I—m at this address .and !hw ole• infom mion reN;:^ed below is true,accurate and cornpicte as of ti?e time Qf ti?K insperfiprl. i}?G InS�e:t10n was �crfOrtllCd D3S.'d on f 1Y iTai_, 'Jng' and experience in theproier function and mainicn?Af,C:e of on site sewage disposal systern`. I am a DEP appro}!,e{ system inspecto!-Narouant Ita SMior: 15.34 of 1-idt. S (310 CI'v;R i5.000). The system; i''aSSCS Conditionally P3S_Sc s Needs Funjicr `-t: ,ablation 1,y;hc I.,pcal Approving Authority. in5p.,clt®r 3 sflgYSa$-dr'2° �"x,�e. � �% e% '/`" r �1;r�',• .y^ Datf: T11e system inspector shaafstiu ;it a copy cf this inst-ect;on report to the Approving Autitoriry(Bow-d of Health or JEP)witllii? 30 days of corlpl tint t3?is inspectipr?. IfihP systcnn is a shared system or has a design flow of I0,0W d or gdeater, die ins pct>1or and t � p r'p IJ he s)ati,r? owner ,i?ail satNnhit ,r?e reppn to thg appropriate regional office of the DEP. I'le oligL'tsl sl?Cold ot;sP_y?f tv thesy.t n? p'-?'T?CT'and c0DicS SCn! to the buyer, If applicablc, at1Gt the approying aUt}lpritl': - Notes and Comments a'"!',This report only describes Coildidolls ut tilt t'it-T?i W'insneoiori and undo-r the condit;t?ri5 of use• lit that I Thk inspection does trot address hog; the syste.n, will perform in the finery unci,tr the ;ante or differed conditions of use. Title 5 Inspection Form 6/1512000 page 1 - Page 2 of I 1 OFFICIAL INSPECTION FORM.—NOT FOR VOLUNTA' RY ASSES,,1EN''1'S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 28 Old East Osterville Road _Osterville Ownenbeborah Walker Date of Inspection: 10/2: /p 3 Inspection Summary: Check A,B,C,D or E/AtW/ complete fill of Section B A. System Passes• I0d I have not found any information which indicates that any of the failure criteria 6escribed in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The iea,ehing pit iz in hydaauXic /7 n..e.:< as ea nee .6 To e .cnz . n e ---_ ---- _��_ B. System Conditionally Passes: L; One or more system components as described in the"CoaditiOnal PASS" sJction need to be repla.ce(i o' repaired.The system,upon completion of the replactment or repair,as approved by the Board of Health, will pass. Answer yes,no or not determined(Y,N,Nl))in the for the fcj',c,1 in staterncrus. ]f^'no; determined" clease explain. V The septic tank is metal and over 20 years old' or the..septic tank (Nvhether metal or not, is stnicrurally � unsound,exhibits substantial infiltration or exf inition or tank failure is imminent. System ;rill pass inspection if the existing.tank is replaced with a ccrriplying septic tank ::s approved by the Board of 1-lealth. YA metal septic tank will p,rss inspection if it is strucmraily sound, riot eak:ing and il'a Certificate of Compliance indicating that the tank is less than 20 years old is ND explain: , , A.Q;, Observation of sewage backup or break out or high stac'L tivater level to the. disc lbtitlon box dLI. to broken or obstructed pipe(s)or due to a brokers,settled or uni-v�,n disu- ?1tion box, System will pass inspection if(with approval of Board of Health)- broken ppe(s)are replaced obstniction is rernove i d15L ibutiort box is leveled or replaced ND explain: . The system required pumping more than 4 t11Ties e.,;r du, to brek:e11 or abstn cted pipt.rsj, ire system will Pass inspection if(with approval of the Board of 1 icalt.h): --- - broken pipe(s) are replaced obstruciiun is 1'GnlovcCl ND explain: 2 ragc.� 01 I! OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY , ASSESSMENTS SUBSURFACE SEWAGE 'DISPOSAL SYSTEM INSPECTION F0J Phi PART A CERTIFICATION(continued) Property Address: 2S 01 d East Osterville Road nst-Prville Owoer: Deborah waiver Date of InspectIODID -23/03 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of hcti!t}j Ji orcicr !, drier;line ii!; sys,;• is failing to protect public health, safety or the enviroruncnt. I. SN'stem will pass unless Board of Health determines in accordance with 310 C'i'+f1'< I�, l;;at the system is not functioning In a manner which will protect public health, safety and tnr cnvironrncnt: t/4 Cesspool or privy is within SO feet of a surface water Cesspool or privy is within So feet of a borderin- ve.,eu t , ! o t yediund or a s,t,t marsh 2. System will fail unless the Board of Health (rind Pubilr Wier Su, phcr, if any; determines ;liar the system is functioning in a manner that protects the public iie;�lth, s;;;ecr and environment: -, /6The system has a septic tank and soil absorption systerii (S-`,S) :Ul ! the SAS is ',S its?in surface water supply or tributary to a surface water supply. ,d The system has a septic tank and SAS and the SAS i5 y',k 111 [ ?f?C of it )I IJiIC ':5'BiCi iUpniv, /0 The system has a septic tank and SAS wid Yhr_ SA5: 59 (eFt of a pnva!r wa4er <,.!opli'v.c11. L%)The system has a septic tank and SAS ii,,d the SAS is less than I On feer but �. private Hater supply well° tvSc!hod tcet or more morn a.used to deter;-nine distance "This system passes ifthe well water anaNysis. perfJ iz'riCv at a !):.P ccn!(iccl laboratory, for colifor,� - bacteria and volatile organic r.ompounds indicates tit jt tale ,veil ,ec om poiiu!ion irUnl I ha! rjfor )'end the presence of ammonia nirrogen a d nitrite niu•oge, is cqua! !o or, Icss than S pprrl, provided that no other failure criteria are rriggrr�d. A copy U(117e iinitll'Si5 rnUSt bC aiuichcd tit ih15 f0t 71. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSPYIN'NTS SUBSURFACE SEWAGE DISPOSAL, SYSTEM INSPECTICI FojF_N1 PART A CERTIFICATION(continued) Property Address: 28 Old East Osterville Road 0steryill-e Owner:I].ehnrah Wa 1 kav- Date of Inspection: 1 0/ 3/0 3 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the; following for al! inspections: Yes No ' backup of sewage into facility or system componen clogged SAS or cesspool t due to overloaded or clogged SAS or cesspool !/Discharge or ponding of effluent to the surface of the ground or sur,ac€Wafers due eaten t;verloaded or Static liquid level in the distribution box above outlet invent du; lv itn overioaded or cloggeQ' c.,=,S or cesspool /_4 34p—1400 _ iquid depth in spoof is Icss than 6"below invert or aYaiiablt; volume is less than n day flow Required pw-nping more than 4 times in the Iasi year LfQ�r ,:lue to Cir ed or obstructed pipe(s). Number J of times pumped / . Fl Orly portion of the SAS,cesspool or privy is below I i jh ranl� �'at�Y Any portion of cesspool or privy is within 1Ct0 f ee Ora Surface 'w : su I }r, water supply. . {I , , ;.l-j': s :e o `iny portion of a cesspool or privy is within 1,1 Zone I of a public well. { l/Any portion of a cesspool or privy is Within 50 feet of a private water supply weli. Any portion of u cesspool or privy is less th;arl I OU fe.c! 1?,a.t &Te.attr than 50 feet from a ar':'alr. water supply well with no acceptable: water qua!iry anal;•sis. 1•i 1;is sysiem pusso if the well wa ter analysis, performed at a DEi'eertifled laboriiton' for coliforlr bacteria and v }ati! organle coal pounds indicates that the wt!j 1 frrc from pollution frorn That (facility and the presence:of ammonia nitrogen and uitrate nitrc)gen is equal to or less than, 5 pom, provided,thai 110 other failure criteria are triggered. A copy of the analysis must be attached to this torm,j (Yes/No)The systein f-?11s. I have dt;tCrITiincii that •ne p� J Ut'tl'll]r(' Of the above fa ll.r., criteria t:;;ist as described in 310 CMR 15.303. tlherefore the s)'Siei?i fails. The systern owner should COnt]CI the Board of Health to determine what will be thec'cssary to correct the failure. E. barge Systems: To be considered a large system the system must serve,a facility`vith a design no-e: of ':0,000 , pdi to 15,000 g pd. You must indicate either"yes"or"no"to e hch cf the f(?liovri;h�: ri i I• I ?a'•The tol;OWirs?c..ter. at)Q.ylO .i r�C systems L!h addition t0 the C'rileria above) Yes n0 _,Zile system is within 400 feet Oft s'urfa,.-u drini;!Pb water sljpply e system is within 200 feet of a ITibuttlry to a surf<Ice drinking wafer su-pply' tha sy stem is located i r. a y a nitrogen sensiti.: rea(i.n.crinl Wellhead Protection Area— JWPA) or a mapped Zone 1l Ofa public water supply w p!l If you have answered"yes"to any question in S,:Ction 1"' the syst(rii is collstderc:l a slpliflcan! t1':r�-at, or answered "vcs" in Section D above the large systenl hits f3ilrrl, f ii4 ("I'vner or operator of any lar Ye system :+.on.sidcred a si niflUnt threat under S"tion E or a1 u."der JYCtiOr: Il ;i tali, % s. a. i.p ade file ;,stem in accordance s'ith 310 CNM I 5.3[w. '1'he system owner should conuict lfle appropriate rgional office ol'the fJepaltrntm. 4 f Page S of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASS:u SUBSURFACE SEWAGE DISPO SAL SXS` 'E11 CHECKLIST Property Address: 28 Old East Ostervi1:le Road OsterVill� Owoert Dphorah r~ ° Date of Iospectloo; 10 23 03 ¢ ; Check if the following have been done.You must lndicate' s°'or .,no,,as toes chi of t'r c Yes ATo ® umping Information was provided by the owner,occupant, or Doayd of H wrz hh ®, v Were any of the system components pumped'out in the 4prcvious iwe :i v Has the system received normal !lows in the prGvi�)ul t-wo l t� Have large volumes oP water bzzrt.Gitroduccd to 01c system rucCiniy, or +.� ® F! Were as built plans of the system obu,intd L.nd exaaflbn,;d i (i('they �o Was the facility or dwelling inspected for.-Igns of si yc Lari=; ? .L/—/® Was the site inspected for signs bfbreak out'' !! Were all system components, ludtng the SAS% locatcd oil , . << _ Were the septic tank rnanthoks uncovcrzd,,opcne.d, tttd UIt t t^ri r t of the baffles or ices, material GrCUnSai rtirvl ci r _ Was the Iry a Gcet 4nt faci i o�+iscr(zn ,p s i!'ci�; rcni tro:n cr..;�crf :r maintcntnet of subsutrfa�e sewage dis�Gs�I syaknii ? � ` `' `'"• The size and loeatlon of the Soil Absorption S ystejjj (SAS) on the ;iie h�.s Yes no j irxistiltg information. For eX`?..trtplC, a riot?y of 01" ;3C�1,i �r;......... _ 1)ctetmined in the field(if L.,y of t!,,,- f,:i`;.!r�. cr'! E Page 6 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTA.,R"' SUBSURFACE SEWAGE DISPOSAL S'YSTrLm 'cNS? CT10N FOP-M PAR71 C SYSTEM INFORMATION Property Address:2f3 )l rl Rat O�S�t .ry 1 e Rc)ad 0sterv',T e Owoer: Deborah walker- Date or Inspcctl'on: R.ESIDENTtAL Number o(bedrooms (desip): Nu nber of bcdrooi t DESIGN now bued on 310 C,rYM 15.203 (for ex~rn 5k! 1 1 r `f Numbcr o(curnnt residents: —'- Does residence have a gubt;ve ..m�r)oCr (yzs or n;): : Is laundry on a sepuate sewar,e byste (yet n( nnl:77) (ii yes Sepir+iC inspeCIiOn r`C;uVcdj Laundry system inspected (yes or no):./,:`5 __._ Seasonal use: (yes or no):A�G _ Watcr meter readings, i(zvailabic (last ? 200�=49�_000 gaiion'6 34, 25 G%C� S'MP Pump(yes or not ,,z yr X „ 00 Lm; 22= 06, U gajJonz=290. 41 GPD CO^: MFRCL4LJL�!DUSTP.1?•.!_ 7r`pc c, sublislamen!: ,, rC}!�n I�ti'A {b szd ol) i n C•� r i JT, of dcsi'p �io'.'J ^:d_.,.Izl '.�zs!C hoidin t.aa. prescat {yes or f"v): i' y disci)t:6' + th 'Talc ; ( r y ' c: tc c syslcrn cs or no); • lbE .,a;i d trI C O t G r r'�r•`.n C y(U S t� _._.__-_k�.:�..Y~_ ....�..__.._. CI h'l kL 1,M"0P fATION p�tnpi�g i<ccords So cc of infnrn)a!ion; Pumped .tank 7130197 Vel p tr,sp< tlor {1cs car no) 5 pCd urn dClCrTnlnC'd ` ? T_ 4: t J'L (_)Y S r!J Septic e ..k, dis.ibutiGn box; soii absor01101-1 system S6n;IC cesspool d:•�%Over+.-iow c<SSrGiI , ^/ Shzr:d sys!crn (, , or ill") (ii"','cs, attach p;c,^'otr inspcc!ion records i(an i_' lr�n' t!iYPI, 1iCrT,F11Yr Itt.lL, ^I( y..At1;:Cft a c9CV C(llr: current O cration Y) G?;ai_ � r_r c•.,;;.•� � p V1C'l mdln,cna.7Ct contYct (tp be ct7()y of lilc Ifn-,F,' IH''roYa1 A��fQr;rl:BiC a4e c:(?l1 i.Orilp(•rit'lis; dale installcci (ifino�'.t)) and source ortnfor7nation: �v:R S' :13 is odpiS r C C.i!:! `•i'IiC,n A rl'ill;t 8t .1T :li" (i"} of r10 (•%4 }: 6 Page 7 of I I OFFICIAL, INSPECTION FORM - NOT FOR VOI IUNT"kR):' y S5 ;5S, n., ;Ni'S SUBSURFACE SEWAGE DISPOSAL S)'S"<'I?; Y'� 1?N:��'EC':'ZO;N0_ r�i r ri R= Ci SYSTEM ! NPOjrvyL;.'r[O;N (continued) Property Add ress:28 Old East Osterviille R"au Osterville__ _ Owoer: Deborah Walker Date of inspection: joJ2.3Y1 --- --- t. BUILDING SEWER (locate on site plan) ! Depth below glade: Materials of Construction: cast iron / J�Q(1 PVC ✓ thr'ir:{;_!�Vl),} C2oL yl,, oiL l i2�' } e./1, Distance From private water supply will Or suction linc:-^ _--- Comments (or) condition of join!<, Yentim,• e,,,; .^,C of Ita,Y.E ?, C(C.): OL/1.Zb Q_/711QQ/ 1 ( CI'i.t—ill0 ?1 LC!r fl,C= f+ �L rzkcz.ge. UP_R h--- SEPTIC_ TANK: ✓'(locate on s!!C D�ptn bclou' g>•adc: - i 1,121r(lai Of COnS ruCUi�n: COf:CrCtefJ!' n!etal:s_' ll�;r'j;l iSi.,r'•;;pOIyCC�I}'Ienc fTlr,t.dl IIIt dg".;' __.. la age cOnfu`!11Cd by it :.CrtIIIC.aIC of(„p!"iipiia.11CG ()'eS Of nO);1 ji(ai,aCh a Cop,of i)is; r!re 'om !ohU�gc�bot;Or,) Of 0u(let ter.. o p of i r baffle:Scunn ' fJlSlanCF F'OI'^ (,)r C'f SCUr to t0- O! outicr tcc Qr bafflC' U S ':C CGrI. 0O1017 of ;turn tc OOCtortl of outlet t?c or oaf le: 7` i 0`1, '•'v;.: Oiril:il'>IonS d,-tcrr!lincd' U_trZ;.'F t� /i:< T:.I'mo C? .I.IZ S�C.C'C.0O2. d-bons, -',t and oulict lct or Elio) condition, Stnictwral in le piny, t!(' 'd ti oCi,^,t !:;1' t, ^.'.'!d?nCC of 1C...;a co,C CtC.): '(-,nf.: '(il. %?1L;Il ? T:; o e p C'1:CzI .5 5 0 1.1 id C/ R.(< 5 1 J i 2.0 C.1 d.:`t F?1Z C e 0 p C?cl 4.Q V fl, .ASE TR'AI'',• �;(lo:a(c on tits plat) �.�rfaierl?I CfC.0'lst?"uC.fi�0[l:; '�CO[iCI'isicf'J'-+I'1Ci�1.(,a bCrglBSSri ypol}'Ctf,ylCnC�_ Othrr iOnl top of sCum to top Of out1cl (c'c br'baffle":' r�j§ DIS trlCC 7Cunl cO botl0(Tt Of OUtI<'t tee Or bale: i f ijl Joffe Of I,'..S( pi 'npiAg: Corrumeni5 (Oil purnp;!g reconlrnendvions, inlet turd outlet tee or 1N.Mc condition, structual tllte'piry, ((^find levels AS (,idled 10 Oullcl !I 1'e( , C1'IC'cncc of I'9F:$gl, etc:): 7 ! Page 8 of 1 1 OFFICIAL INSPECTION FORM —NOT FOR 1/t;IL-U it`4TA 1-?Y AS`ES SN'1EN7'S SUBSURFACE. SEWAGE, DISPOSAL SYS'fEM 3NSPEC0001 FOB'Ol1 PART C SYSTEM INFO ON(continued) PropertyAddress:28 Old East Osterv.i_ile Road Owner: Enhorah Walker Date of inspection: TIGHT or HOLDING TANI ,Jt'_,(tank must be ;n:ml?ed at tine of inspection)amate on site plan) Depth below grade: X.0 Material of construction:,54 concrete:;/r','-__mrta Will buglaSsr •� ncilvet!1Vlene �'i� Ulhe-(explain): Dimensions: �— Capacity: _ ;;---- -{;!'ions Design Flovr: %ri ga!1 , d Alarm present (yes or Alarm iF.!'el Alar n !n "irking or her Qms or AW: M Date of last pumping: ter_;%�' - CO(i'.??MES(CO ndi ion ofalar`rll and float ;whelies, etc:.): l_ DISTRIBUTION BOAn (ifl>resen' must tie• opened)(locate on she plan) D?f!:,h ,)i I i q u i d I:.re! ;'_,o!'e z)u c--t invert: ' it/ COrnanenlS (flog it box 5 level and d!suibudon tU Outlets upal, any evWence,o1 solids can ,over, any evidence Of leakage into Or out Of box, m): !:'-r."I X -h a 5 O/?P. ' 7(:!'.%Z.C.!( /� ! ! ! l Q i _ -_ _ _—_ Lf L/ L JlCiIFItC!'. C/. �<.> 1C<.h Pt>'�IP CH M13Fi4Ir'.1'C' (lO(-at( on, Site pla!i) Pumps in %vor'kin.g order f '7S Or no): %: ..y A!arrns in v"Orking oi-der(yes ur r.o): l f t 4 C 1n11T;e.n'.: (.lU�% ( 1d `':OL.,,LOn O, pUl,'Sp C:ili3!-lief!',yUni11t101i of 1)Uill}>S and c'1ppUI`iCllailCe$; C(('.): ' 8 t I Page 9 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTA-RY ASSESSMEN F.S SUBSURFACE SEWAGE DISPOSAL SVSTEN PART C SYSTEM INFORMATION(continued') Property Add ress:28 Old East Osterville Road Osterville _' - Owner:Deborah Walker Date of Inspection: 1 0/2 3/_0 3 SOIL ABSORPTION SYSTEM(SAS): a/ (locx�te ol�site plaL9 dxcavafion nit 7 eclitii e.l} 1-1000 gateonpaecaA -eeach.inq R-it> If SAS not located explain why: Type ' leaching pits,number: leaching chambers,number: 2> leaching galleries,number: ei leaching trenches,number, length: leaching fields,number,dimensions: ;VeT overflow cesspool,number: / i �_innovative/alternative SJSLern "f�/Ue!!1FilTtF: Of lCClln0�t,4�}'; %r;•�• �/ �� �,—�__..5�_' -!� C0I11rnenlS(note condition of soil, slglls of hydr8Ulic failure, level of ponding, damp soil, condition of N-getation etc.): L.oamu nand to goney /-.ine Sand, l r7 cclz i z, ;>> •t -L<s t:n hug!%a1, ( 1 c ann._4 nnt,i_ r.�ir.l�in � ^.. 2NrL ?1r>_0C/ fv (? darrt/2, vege.ta.z<iort -ice n.o/L:na-L CESSPOOLS,4,2011'(cesspool must be pumped as part of inspe:(ion)(locate on site plan) Number and configuration: Depth.—too of liquid to Ltilet nverr. Depth of solids layer: Dgtll ofscum laver: — ------ ,'yt Ditn't isions of cesspool ':iateri::is o`coil struction: Indication of.goundwater inflow �s or no): f/�f---------- Cornmenis(note condition of soli, signs of hvdi-aulic failure, level of ponding, condition of vegetation, etc.): nfvy--A,A2��(locate on site'ph n) Mat,Yrials of construction``: l,olnments(note condition of soil, signs of hydNulic CIil'•re, iev?i of oonfling„ Condition oI vegetation, eic.): 9 r ' t • Page 10 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLU-N"'."*A Y ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SY'S`><TEM PART C SYSTEM INFORMATION (continued) Property Address:28 Old East Osterville Ostervi e Owner:Deborah Walker Date of Inspection:i 0 23 03 { SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at leasi two rjcrmsnm re,rcr�rncs iandima;ks or benchmarks. Locate all welEs within loo feet, o ocate where public watcr supply crater: !hc building, FN i 10 I . l •Page I 1 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUR'TA•RY ASSE SSMENrS SUBSURFACE SEWAGE DISPOSAL, SYSTEM INSPECTION F011:�,� PART C SYSTEM INFORMATION (continu?c) Property Address:28 Old East Osterville Roar! ostervllle Owoer: Deborah Walker Date of Inspeetioo:1_0123 T SITE EXAM Slope Surface water Check cellar Shallow wells A Estimated depth to ground water feet 0 Please indicate(check)all methods used to deterriiinc the hi�ia ,:,.roui;d wa;cr cicva(;on; NO Obtained 6'om system design plans on record • ifche Acd, &'I; „ldcsigl' plan reviewed: N,'! AL, Ctbserved site(aburting propervylobscrvation Brit wj[! IUI 150 feet of SAS) N Checked with local Board of Healin•r.xplain; N,,? .(Checked with local excavbtors, installers- (at?ach d;xurnr ra:;on)�"_ I ccessed USGS databasc•explain: h.C_iL �;.i ot�-r i.rr_ n_ .i !l , rna, U16 You must describe how you established the high groundeicvntio n: redo G¢lZnefri R lrli00on Modf�-P l2116194__C �cptiit�L rc �v r c__L-� u r 0 1.6 r0.. e ecz ieUe.6. ,3ed: 1lSG�_n!� snnun� nn r,�nPP rla.r.a. „!r c J )`i>-�--- _� _ ded. Tee r r , f)7 f r , FLc aaLcachinE I Pit 1 Jr. "cc{ ! Groundwa(cr: r erI Below Bottom of Pit • - .'fUl:fl(1w31e(:..r? UcI;T!Gr Pc f rlft?p((f (`;IC(ItOQ r ':'CIOfC, G�( YeftlCdi Y,;t�! ;r0l diS(dfKC Z•t;w(cn t11C 0{irrn of U,c 1(z1Qh1r1g pit and ;he i(ljusicG voundwa;.:r (able is i J >•'•.:>�e,.—n:r�.•n���►rwovnnr��+wt+��nwoww►nw�www�wen,ei�a avp ,-3;�„_,. 7'QdN OF BARNSTABLE IYJARD OF 1ll:ALT11 SUI)SU11FACE SEHACE DISPOSAL SYSTEM F NSP%CT1 Ht7m 0 C I;p; Fi CAT D Oir I _•..,-T••.•: .—.�:it-.•n..,..A,r.,0,4„S,.Q,.A.�RT.-•�,r,V..Rtl VrM,C,.•- -�ew.rso:nre,+w x-rr�r-N:-Y,-.•.>..,y,-.�� ,-��..,,..,..-,.r.r,.",�.,,:�.�.,,>•.•.,��r,-•.�.�. _. � -TYPE 09 P818Y CU AALY- PI?OPERTY INSPECTED STREET ADDRESS 28 Old East Osterville Road ASSESSORS MAP, BLOCK AND PARCEL �q 1 `,5- 000` _003 OWNER Is NAME Deborha Walker 1 ------------------ NAME OF INSPECTOR Joseph _P 01Macomber Jr . b e COMPANY. NAME J.P,Macomber Soia Inc COMPANY ADDRESS Box 66 Centerv$_l le�Ma,s s . 0 2 613 2 ' trtvt Town 9r — Slcs ;!p COMPANY 'TELEPHONE ( 508 ) 775 3338 FAA 508 ) 790 ---! 5?8 CERTIFICATION STa°!°EHEN'1' 1 certify that 1 have per:;ot?F�1..1>' irisPected the sewage dispos '-I system% .n ;. this address and that the infor!nation reported is true , accurate , and 4= > > c a F 1 I a �x ornpl� tc a r of the "ime of . inspection , The inspeotlon was performed and any .. ' 'recoinri!endations re,,arding up VlAd'e , rnaintenan,f , and repair abe :onsistent with my training and cxpericnrce { 11 thi; proper fllnctioj-j d maintenance q (" pp- s ! re, scwr_ Ye disposa' systems . T Chec1< o l.c , Systeci PASSED , 1'1! a inspection which i have; coridlrc. ted has not found an 'i! ich indicates that tl"!c sv te;n [r i ' Y infgrmation ss Ito adequately prote,c ;=.; c i!ealLh or thi, environmeNt. as derined in J10 CHR 15 , 300 , Any fail,!re teri lk ;rtrd in t �e . � �ZLU,ti 1cr l r ; TvER1A section of this for!!! : System FAILP0 �\ P ['11e. inslpectior! tidy h i h,yYC' Coll �l( tGci ' as founQ t'rlat the system friil5 to nrotcct the E-,ublic° he(%Ith rind t1he environnent in t6ccordance with Title 1 0 r f`Dt t 15 . 31 !:3 , a; (1 as SpeCl t lcal ly noted or `A.R'1` C - r"A T! R Ct; i1'1:(trA of this insp'ec G .i. ,r! fore, , j ✓ S i %' I n s p e c t o r n r�t o r e T. _-ram r �� 'r✓/.0 .. �2 Date .._.�... . �._.._.�:.. `. LL.+vytss.r:ra :;Nrtr�.moo-„-r-�i':r.—..•r�r.-:,uv�„irixa"":s�.�n:�s��.s:m5e..�:v-.rw+:.os•v.��r.. .. � � �/�7 \ ^rcT.++.aser:xsca�cc,rr mG sz :'msarrsx.-wr�.,a.wCrGzr„xu.�crs�.c��y,",arcr� n copy OL this C3: t.1 (iC;iit:c?r: lnUsst ''-i '0'J � C1@ i � rh , i-7 .ro c a o iltutis n _ d t� , t)WNHER1 the !ljf,E..r� }%� ) s,.tt c+ C.11 v I3 Q,�,Fl U O F' :t is,;.i,'a'i i : inspectlot! YAlUXI), th't, ovine; or pc)��� rator si�r� ii upP t t;ci ' r,r� ;,'ut, tr,Qne Ye OC t1)fi ( (ti:e o he• �in.itect.io > �t.:•, , � n , unless allowed, cr -required-required`• 5t? 3 r o /ided , r; 3.1 C, C H1% 11) 130F) >av td , doc MAP 1A S VKax e— 9-3 COMMONWEALTH OF MASSACHUSETTS • EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PR ION , CT , <c ONE WINTER STREET, BOSTON, MA 02.108 617-292 co i® UDY CORE WILLIAM F.WELD T S Secretary GovernorB.oFB j•99 UHS ARGEO PAUL CELLUCCI PECTIO M �a�lyo prT , t�V commissioner onerr Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM IN S PART A ` CERTIFICATION Property Address: 2R) o� ' C�s�ev�Lc Address of Owner: ZSr C ` Date of Inspection: 6V Lv 301 1997 (If different) Name of Inspector: �E � S uLt_t Vt,t A �t am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: r — Mailing Address: 0\2'MA1" T 11E:r_J1 Telephone Number: -QZc�,-91� OF CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and t> e "I �'at rtre orted below is true, accurate c o 70er in the proper function and and complete as of the time of inspection. The inspection was performed based on �a nir5�s�r�c��,;�c�i e�' P P maintenance of on-site sewage disposal systems. The system: N0.29733 CIVIL ?C Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority 3J Date: U L�3C" 1997 Inspector's Signature: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared' system or has a design flow of i0,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Chec 0A, B, C, of D: A) SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: SYSTEM CONDITIONALLY PASSES: One or mor components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replace r repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined (Y, N, or ND). Descri e f determination°in all instances. If"not determined", explain why not. _ The septic tank is metal, unless the owner or operator vided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within 20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows su al infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced w nforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the World Wide Web: http:ltwww.magnet.state.ma.us/dep ZJ Printed on Recycled Paper z SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A a CERTIFICATION (continued) Property Address: 2¢� t� t� OS t�QV► t_t_I Owner: -L> \� I At_\GC-2 Date of Inspection: �Vt_�(,30, �997 B YSTEM CONDITIONALLY PASSES (continued) oLl~ sn'�; Sewage\backup or,breakout or high static water level observed in the distribution box is due to broken or obstrude "p pe(s)%, due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ The stem required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspects if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed CJ FURTHER EVALUATION IS REQUIR BY THE BOARD OF HEALTH: Conditions exist which require furthe evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environme t. 1) SYSTEM WILL PASS UNLESS BOARD OF LTH DETERMINES THAT AND SAFETY AND THE SYSTEM IS ENVIRONMENT: FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEAL7 _ Cesspool or privy is within 50 feet of a su ce water _ Cesspool or privy is within 50 feet of a bord ing vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (A PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PRO CTS.THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system (SA and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and the S is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SA is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and the SAS less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bast is and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of am is nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approxi ation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A • CERTIFICATION (continued) Property Address: ZB IF_" L C— A, e0 Owner. �, VJ t_1GE� Date of Inspection: 30, t 9 197 ] SYSTEM FAILS: Y must indicate eit,;er "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below: The Board of Health should be contacted to determine what will be necessary to correct e failure. Yes No <.:. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Di harge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cess ol. Static liqui level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth i cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping ore than 4 times in the last year NOT due to clogged or obstructed pipe(s).. Number of times pu ed _. Any portion of the Soil A orption System, cesspool or privy is below the high groundwater elevation. _ Any portion of a cesspool or p vy is within 100 feet of a surface water supply or tributary to a surface water supply.' Any portion of a cesspool or privy within a Zone I of a public well. . Any portion of a cesspool or privy is wi in 50 feet of a private water supply well. han feet m a vate water pply l wit _ — Any portion of a cesspool orprivy the tha wellh10 been but greater analyzed totbe acceptable, attach ttachrlcopy of well anlalys shforo acceptable water quality analysis. lysis. If he coliform bacteria, volatile organic compounds,.a onia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either "Yes" or"No" as to each of the following: The following criteria apply to large systems in addition to the criteria ove: The system.serves a facility with a design flow of 10,000 gpd or greater (La e System) and the system is a significant threat to public health and safety and the environment because one or more of the foll ing conditions exist: 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- I A) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the group ater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further info ation. (revised 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 2 0 E. Ds-%-c- LLL' EoA,O Owner: \k/a u--tGG—e Date of.Inspection: SO, 199-7 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No y _ Pumping information was provided by the owner, occupant, or Board of Health. 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. k As built plans have been obtained and examined. Note if they are not available with N/A. of _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. k The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: DC The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System`. _ Existing information: Ex. Plan at B.O.H. Determined in the field (if any of the failure criteria related to Part C is at'issue, approximation"of distance is unacceptable) [15.302(3)(b)] (revised 04/25/97) Page 4 of 10 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 2 01-0 C OS I t_-L C ?-oX0 Owner: Z7, \( �A Lk ✓ram Date of Inspection: JUL`C 30, 199-7 FLOW CONDITIONS RESIDENTIAL: Design flow: Dg.p.d./bedroorn for S.A.S. Number of bedrooms: 3 a7Es»rv�2.Co!�sc vc� O 4%2 ('APAc ti`( 1VES16k3 Number of current residents: Garbage grinder (yes or no): L1 0 Laundry connected to system (yes or no): Yes Seasonal use (yes or no): 0a Water meter readings, if available (last two (2)year usage (gpd): Sump Pump (yes or no): LLD 95 Last date of occupancy: Fe 651✓k-1 N t—Y O Cc v P t E o COMM ERCIAUINDUSTRIAL: Type of establishment: Design flow: gallons/day 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: OTHER: (Describe) Last date of occupancy: • GENERAL INFORMATION PUMPING RECORDS and source or. information: E?1 0w(v— sYST�,tit [AA-, pv System pumped as part of inspection: (yes or no) E S If yes, volume pumped: l oov >;allons Reason for pumping: 7 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) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: $I l G J83 Sewage odors detected when arriving at the site: (yes or no)!alb (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: L i7 1 F2V I t_:-(_ Owner: \�R t_�C e Date of Inspection: Ou L-`( 30 t i99� BUILDING SEWER: N A (Locate on site plan) Depth below grade: �~ ca st iron .— 40 PVC_other (explain) Material of construction: _ Distance from private water supply well or suction I' e• p6� Diameter Comments: (condition of joints,v -ting, evidence of leakage, etc.) SEPTIC TANK: (locate on site plan) Depth below grade: 20 Material of construction: x concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) - Dimensions: LO Sludge depth:__ _Distance from top of sludge to bottom of outlet tee or baffle: 5 E C '• E(:._©-, 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 dimensions were determined: Comments: (recommendation for pumping, condition of inlet and outlets or baffles, depthq�uid0 level o�latiNat outlet invert, structural integrity, evidence of leakage, etc.) I A fUVt ' L OCaX SAS tkA IT A OF' = GREASE TRAP: .F (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene other(explain) Dimensions Scum thicknew, 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: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence,-of-leakage, etc.) (revised 04/25/97) Peg* 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 2 a Ot-fl DT-6 w I LL C C OA D Owner: Date of Inspection: Vl9L-( SO, 199-7 TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection)' N (locate on site plan) Depth below grade: Material of construction: —concrete _metal _Fiberglass _Polyethylene ,_other(ex n) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Alarm in working ord Yes; _ No Date of previous pumping: Comments: (condition of inlet tee, condi of alarm and float.switches, etc.) DISTRIBUTION BOX:X (locate on site plan) Depth of liquid level above outlet invert: Comments: leakE\)1vSoC6 (note if level and distribution is equal, evidence of solids carryover, evidence a�g�e�(o or out boxet N�O T NnA27 - OI i OF G H E� i ti ��6L c L( IDS Eco uc,.k PUMP CHAMBER:_ (locate on site plan) . Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments: (note condition of pump cha er, condition of pumps and appurtenances, etc.) (revised 04/15/97) Page 7 of 10 SUB SURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION (continued) Property Address: 20 0 w Owner: 1� V-(A L-tG(: Date of Inspection: JU(-�-( 3C)i 199-7 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavatio6 not required, but may be approximated,by non intrusive methods) I:not determined to be present, explain: Type: leaching pits, number: I — ( O� GA��o ry L. �� � —IA- 10 LbgO r^�Es , 'b�'StC' (v 92Aw 1N� leaching chambers, number:_ st{c leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: el of ponding, condition of vegetation, etc.) (note condition of soil, signs of hydraulic failure; lev GAO L«�icE'p t:�_cc� Loops - - N CO�E� 30.r Bit ow f�2c�,�� YZ E o�^'t t (assx�t_t_� ►v6 eI��2 • L� o��o LTV EC I N PtT 5t_1 6N-TL%- LESSI44-A0 1 CAPACf APPQ —E-2 t P►T t U►J®ram mot 02T1p�U Fie\V� (t+- 12 c7�. ou 2 �2clt -� rV1 as �tot�i- rt6ov� �i tS t+- (o '��(LY t. i S �✓H�U l,7 6J Cam' '8 r' CESSPOOLS: (locate on site plan) Number and configuration: Depth-top'of liquid to inlet invert: i Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must pumped as part of inspection) Comments: (note conditi of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:_ (locate on site plan) Dimensions: Materials of construction: Depth of solids: Comments: (note condition of soil, s of hydraulic failure, level of ponding, condition of vegetation, etc.) (revimed 04/25/97) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:" Owner: �N sot I—ter—E—�2. Date of Inspection: 3Ut_Y 30) )957 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) nn DA.) to ± M gc=2 1C � a 31 zz '� �9•s zg.S' (revised 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 2 8 OL D 615T,EE'.\./ L Z. eD Owner. -P \ J'4t-KE'� Date of Inspection: Depth to Groundwater Feet Please indicate all the methods used to determine High.Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers X Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) OP IZ FOO i P A,Lam.-\ A, �jc S a� l k Tie Is - ' (revised 04/25/97) Psq• 10 of 10 i . , - G, 1 J r t• :I. : o ,C FN_ r`r , - ors.. •R �i";. : A _.... ..:..... .. . .(... . LtirO'�� lam 7 i . _a e^�F71 �. .� TL - ,�...:r�L�4Mti�� �,•''�!,,. r'G �. �,. r.Etc ,,, , .rt•C, '.. ..: .�J � �'j;. E. tM L 174 , , - _ :. a:r I,::-. ia c-rDc.+vw'o.:L.,n,�� ,'-. ,JE,t�r�[..:leJ,:.1',: u,,�3G,..S�' -�M1i.,�...,.:"' r• � I!'r , i t'c o or CERTR:F}ED P, :' : "... PLAN::: , XIST s�,,aT` i. Are rt oxo �,�� M,s :i. .: .. .. .. 'n . .:' CONTOOR �_:;^ ;}`� rt.';'• tMrsWa' sp'o'T^ t �caTloN 4� A =M � ' IN13HE:p: C0N`OUR. o: ____�.��_._.: MORSE p,r.:D :A D OF, P wa�4. ,.-.,.,. R-O II.E 4 R ..HEALTH ': ;:: r: „ AT- ►�~.LDh� OGE ENGINEERING CO IN CLIENt T lAT:",FHA:.ARtli?.OS,ED . go.ISTERE REt31ST REp JOB-NO. z -LA N D ;o G'.O N.FO..fZ',11R,S `''.Yd fi: • - A I A:R.N:S:T'A E F::.,:'. S 5...: : .: W ENGfN :ER SURVEYOR _ DR.8Y {. 712 WA 1 N" STREET .- . .CH. BY . HYA,WNA, ,. MASS,.. A 'SHEET:-:�. OF G. hAND SUR..-.VErQf " - .. �. :, 7,� a r•.�ii=h1LL=, '9'+ u_�,_:h n_1� 8,t, :rT. L66T./87/L0 sa ` T:v i `YIIC :7"A1l.. Ali - �. �'.�,:4C,i•�itvG :PST ,4,t�: r"I�i?E :T_s•,►A�'J 12�.BFL_ 'v ;. JD rY /MI.V .� SOY _ T r CONUtrTd 4 P!!C PJ1aC S -ALL. �F �Rd�Gf�7` TG:.CiR,.4I�E �i•;i/ Xt ?.4- iHJN'P/7CJti' hl�A S/y C.1-.S T C_ Y E.L !oo.a caYEjots r• L �x : A CCNCZZ7:i ak �.�CiCFIL� rr� G. 2 J.tY��? MA `•` :���� `R fF,. - s 1 i: s • .s a s.•_r A :y�1` 57L 'YE. =, a LT. Ba ty -► is -a* • .- :• ..-s� r' � s . -; ar + s r + D77++ 1.E s o Ste[✓.'S7'�.Y E T seas r' IJ�f3!�R7r l"LFYr47rI11X : n 1NYFR7r AT 17. PI AM. - /IwE ` _=07,1C T.4A/lr. 9b- FT. E D FT, Dli4Jy1. 3FF 7- JULA7)CX�> 4�1TLE7r'S�PTlC T/E f� -A-AZr 1k i , 4tlT1�TD/3TRIarI�jDN '`r5.�' : s'�CTiO gF I1Y1 Fr t 1'�tCX7h+Yr PtT: Yt s:4 .SEWAGE`-Dl>3',PLtiSA L SYST lr!: - �k rr Ti 8UL�4�I0� r; [ �. ,eL- ss.a - &FAC,4YJ JI�� AFT � � , o DfS16lYhCRlTE�1.+! : 'SCA Ir %'. = t'_.a' . Di Fwsraw. 3. xrPit N1JMdFR OFd�'DR4�15 �, , . - � - DJa►?t7Y51aN :G 4 FT�='_�.1-' �; (;ARZ.Ad. .PISPOSr4L.UNIT ..W0 AI-6 - SEEEt TCTIFL Zrjr'r'$'fret? FJ-0*oV Z .aAL 1.AAY SQI L 7'eS-r*l.. :.SOlL TF.S-r,* XUMBfR QF lft,CXt�+G°p/T3 / - � OF SSIDE 1 -ACN7vG PLR FtlT ,� rT L4 T. 0✓G _TEST - :,��•. c r� 19�1L BOTTOM CN,NG PER.PJT 7� J � _ RFSLlLTS lYlTNZ'�;EO. 3Y �-��:' _��E3 t - SQ. FT z +: TOTAL LE4C14/NG .AREA �, t,- S ice' L r.} t C01/tTln�v RA-re 1 R�XCQL/►7lON.RATp2 MlN�IlV[ti_' RE3FRYE E�CRlN_6 A�F�A► 2 = SO :?. 5✓��:S s OF , w G - ADEPT Xn �f#r:7lp�E.C . f �,A F w �., L D REDGF°FNGf NF.f�TI.SYG CO;I NC F. Tr�! 1vCaun�7�E,���. C] :G11CO U)V0 � t ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Tom Barnstable ....................0 F.........`.............. O.� Ii tin;Wf Dhipniittl ork,i &ngtrurfinrt JIrrmit gU44 ApplicaFion is hereby ma a for a Permit to Construct (X or Repair ( ) an Individual Sewage Disposal System at: — Lot 16 Rte�-28� V i ................_... - -------------••- -•---- = :._.__.......---•-----------...---------------•-------------...._..-----•--•...-•--- Capricorn Read°�ydrust 765 Falmouth Roa� N°H annis ........ .............- -------------------------------•-------------------------------------- -••------••-----•---••-------------•---•---••-------= Steve Leb21 Owner Address W Installer Address UType of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms-_3___________________ ____....._Expansion Attic ( ) Garbage Grinder ( ) _____________ No. of ersons_________._________.___. Showers 2 — Cafeteria a Other—Type of Building ranch p ( ) ( ) a' Other fixtures _______________________________ ___ gallons per person per day. Total daily flow_________3.3k. W Design Flow g P P � �� • ------------------------ auto W SiPtic osal Trench Tank—Liquidocapacityl00Wadl�ons Lengt118ota1Len4tlhidth�'._--1�----Totalleachin r -_ Depth ___$_..__.. Disposal area __ _____________s ft. Seepage Pit Nol................... Diameter......_.__..____._: Depth below inlet.................... Total leaching area sq. fi. Z Other Distribution box ( 't Dosin tank ( ) Hdred e En ineerin 11-2 81 Percolation Test Results Performed by......................_._..--_-_-_ --________________..g-----_•----_ Date________....___5 _________-....___.. Test Pit No. 1.2rr._0..._-.minutes per inch Depth of Test Pit--- 2............ Depth to ground waternOn! ---encounte Test Pit No. iinutes per inch Depth of Test Pit111A_----------- Depth to ground water._ A............. e ..................................................•-••------•--•-•------•---•---•--•----------------......................................................... 0 Description of Soil.........�_�____--._2_�_________loam & _to-psol--_-: ------------------------------------------------------------------------------------ x 2 ' — 10 ' Medium. yellow sand ........... --•--•------------•---•-------------•----•----•----------- - __ - 10• - 12' med. -white sandlt_races---of Eravellno water at 12 ' UNature of Repairs or Alterations—Answer when applicable_____ ____ _____ _____ ____ ________ _----------______________ _________ _______________ LApplication •--------•--••--•---•-----••-------_---•--•---------•-----------••------------------•------••----------------------------------------•----•----._.._..._..._...---•------------•-........ Agreement:: e undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with isions of T-LTLZ, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in n until a Certificate of Compliance as n�issued by the boa health_ e _ .� Pres 6�20 8 tion Approved B ----------•----•--------------- ---•------------- Date tionDisapproved t f ollowing reasons----------------------------------------------------------- ------------------------------------------------------ ---- - ---------------•------------------------------•------------------------------------------•---------•------------------- ---------------_------- Date*No. -•--•----------------•-- -- _ Issued r - Y No................-.....-- F>cs........................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Tovm ....OF...Barnstable ....................................... ............................................................. Appliration. fur Dhip sal lftrkii Tomuurtiurt "[amit Application is. hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at 6 -Rte'- 28' . Centery 11 mot .`" ........�......_. -1- -..... •............. ..........---•- '.r...............-•--• .......................................... Lo o -Ad ss or Lot No. Capricorn ReLa°Tty gust 76 Falmouth Road.,...Hyannis ..._._•.-__._. .........................--....r-----------------------•---••--•-•------•• ...............................--- W Steve L e b el Owner Address Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms...3......................................Expansion Attic ( } Garbage Grinder ( ) pa., Other—Type of Building raUQh............. No. of persons............................ Showers (2 ) — Cafeteria ( ) a' Other fixtures -----: ............................................................................................................................................... d W Design Flow.........r? ..............................gallons per person per day. Total daily flow.........33.Q.........................._gallons. WSeptic Tank—Liquid*capacity100 gallons Length$�6......... Widt>... Diameter---------:...... Depth.}...$....... Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit Nol.................. Diameter.....6........... Depth below inlet....6'........... Total leaching area...2.........sq. ft. Z Other Distribution box ( ) Dosin tank ( ) Hdred e Engineer'n 11-2 81-._------•---. Percolation Test Results Performed by........................_........................__]DR............. Date-__----.---_.__5-__... Test Pit No. 12 e.0_.__..minutes per inch Depth of Test Pit--12........... Depth to ground wateinone....enc.ounte - (i Test Pit No. P�A_....__._minutes per inch Depth of Test Pidi/A............ Depth to ground water--N/A............. e .....------.•----•--------•.......................................•-----------...._......---------=......................................................... 0 Description of Soil.......... !....-...2...........],o3It]--8e..tQpc.-j. .......................................................................................... x 2' - 10' Medium xellow sand..................................------------------------------------------- W z� _ med...white• sand`traces... f. ravelfno...Ywa � .. ._ 12' VNature 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 TITS- 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has,bee isskued by the board of,12alth. gned- Application Approved =__ G Date Application Disapprove or e following reasons____________________________________________________________________________ _.............. .........._ ..............•-------------•--•----•---------------------------------------------------------------•----._.....-------------------------------------••------------•--•-......-------•---•-----------.--- Date PermitNo---------------------------------------------------------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........Toffy?Z................ _OF.........arr :Viable............................................... (9rdifiratr of Tantliftanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (K ) or Repaired by......................•..--•-----------•--.......5.te ve-..L e bel.----------•-------------•-------------..................---•- I Installer Lot L 16 Rte 28: ;;_a- - Cente:r--v-rll at. =.__ -• - = •-------------------------------------------- ,.. ,. a h�---•••-- -•---- - -------- --- has been installed in accordance with the provisions of '" , :P /5aof The State Sanitary td s scribed in the application for Disposal Works Construction Permit No:........................................ dated_...--/-�_ ................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION S ISFACTORY. DATE...--••---------------•----.._.................. -- 9 y .... Inspector---� 1'J THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...Toyvn..........................OF...Barnstable.................................................. v No......................... FEE. ..._....-•--.--- Uiapnfial Works OpUana#r ion prnttt Permission is hereby granted................St.esje..J ahe1---•---••••---------------------------- ......................................... to Construct ) or Repair ( ) an Individual Sewage Dis osal System pp r <` T k �6 - Rye ;28e�-_ -................0 ent e ry it �� utA at No.---�.Q - �. Street / as shown on the application for Disposal Works Construction Permit No.................. 951-d� � 1 ................. � and of Health iDATE......................................................... ... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS _ u Tam @ srk �ytN OF M 2. G QQntb p i GOI, wArcPuaE a I ro SW4 FA�aTBa��' 4St s MD .SVRv�y c Ib P�IbsED 3 "PIA 8 � 15,o00 -s.F-. ` roao•� I \ Icl=' w10T11. 77 b h 2n ' f ai ,OKT.eoA 1 10, PIT 17* V �eese e cX t 017� /2. EXcA.rA�E�.�. 4 sex Pzctow �-r--nA c� F2�r✓oy, J.S- LFAct4-iuL, PIT ( 1•E. CL=. B5.4�) itl 3 Z " INSUkE IF-O GPoi-wD WA i�-2 Paci— .l �E FOL'C rf I SI A( L I rSLs S1t>TG0.1 _�--'/1 '•p�' / oe / -7 LEGEND CERTIFIED PLOT PLAN EXISTING SPOT ELEVATION Ox0 ���NOFM,s EXISTING CONTOUR --- O - -- �� FINISHED SPOT" ELEVATION o A R . G 4-0l v7 � 7 P FINISHED CONTOUR -- O . Gt: �C'!� ✓/ MORSE N IN APPROVED , BOARD OF HEALTH F�� T�P�� �t `' .` F�S�ONAI.EN� A ��1 SS* REvrse h 6• 1 1—83, DATE. -- AGENT SCALE: .. a� pATEIr�7 DREDGEENGINEER/NG CO. IN CLIENt --��---��-- I CERTIFY. .THAT THE PROPOSED EGISTERE REGISTERED � 2- JOB NO. BUILDING SHOWN. ON THIS PLAN CIVIL LAND CONFORMS TO THE ZONING LAWS ENGINEER SURVEYOR OF BARNSTA E , IASS. 712 MAIN STREET CH. BY �/, 7z•EF HYANNIS MASS ' SHEET_L OF . WE R G. LAND SURVEYOR a.. TNA--,t 7 AoF e SFoTIC .TAN�C OR LEACAe1,,VG Al/T APE MORE TH.qA-, /2 BELO/V W/Aol. SJ5AA OE,A 20",01A M E TER CONCRETE CO vEIP /ALL BF 9.?OUSNT TO GRA. Off.`-;,y EXT.4.q GONCI«T� q PV,A P/ /yERVY CAST IRON -COYFR S%Y.4LL. (3E USED A?/N. P/TtN /F IN DR/✓"=WA Y CO YER CL EAN SAN 10 E L1Q�/�D LEYEL �� 2"SAYER PIPE. - I v v o G/tt. , . o - • of �/8"-'/e" M.JN.PITIGM►. DIST. a• a• • • • , • • s .' WA SHEO SYVNC j %'PErt IT, "SEPTiC TA/VIC � � t a • • • • • � • • � ®aX i • t 8 • • • • • • .•• .. s r •��� t � •EFFECT/'biC •` • • �i J�d"- � �2~ '`. - • � • ► t• DEFT/+/ • • • • i � " 1V.4 S.NED STOGY E • - A • a • e s • • ae . m • .1,5-9-X Z.S r 47v • • • • t • • • 1Ial. �8 i s. • to • • • • • • • P; PRECASTSA.Z. AGE INYC�"r EtFvAT/oars n 1 T ���� y 4 B G,� /� r , ,. . . . . . a . • s •o P/7 OR E4r�/v. dew s sct.4- /A/YERT AT XIMPIA& `n.o Fr t fT IMAM. 9 G..S O/s4!►!. C�S�E .�7xiBlJL TION 'Orr � INLET .SiEPTitC' T.4NItt ONTCET S.&P,T/C TANS 9 INLET 01�TR/D!/T��M 80X 9TS B F GROUND P44 Z W rKMAr Tom. Df rsic- /ate off* , � t=4 0MErrOl J"45 /TYON 6Cld `t_5 6 Fa¢oPc ,e/NI FT tfAGyIAgG 954 S4WA.GE OtSPASA�G SY.ST�/�i Fir.. .4)&Aa, V400,-rTi181lLATIDII� �oDl/llENf/ONITTr2_3 DME`71/S/OltC . G,.R��.Fo/spvs�+�uAr/r .SOIL /-0& 4 TOTAL E.TT/I TED FLOIV 3 3 o G.4c/QA1� 60/L. TEST AtI S�]/L TAST E .�lt/MBER OF 4eACA/I/VG P/T3_L_ t�LCY. 9�. -c'LEY. D�4Tc OF SOIL TEST Dom. of i 9�fL. t S/D6 LrACH/Nd PER P/T _.SY� PT. _ RESLIteTS iV/TNt�SSED dY -� ���t + 9oTToM L�CNING PER P/T?SQ. FT: PERCO4AT/OJv RAT&,*/ LESS M/AI/NCH TOTAL LgACN//yG AREA b SAP. FT. AEJtCOL.yTION RATF2 TM�� MIN. INCH sv�3so�� / RESERVE LEACHlN6 AREA 2 'c 6 SO. FT. 2.o _ o ir�`SN O� 3�P\�H OF M� G' pfl 2.`r�/�� ✓�I 1 t�r 1 6 T<'v J?"G C 0� ��G ` �'/1....r,yi..� i f'.%�,J s•�'::�7 �%/..t'_.�. �� yN g A. a S j N 10 951 4�,;o EL DREDGE ENGINEERING co, NC. Ago FCts � • �L� &�'� 712 MA//y ST. ! .S/YRNNiS, ASJ. NAL \ ® su Q NO GROGJNt7 YY.4TEP ENCOUNTER�O CL/ENT: / 6 C DATE ; L' GRO llNO-LvA.TE.Q AT ELE✓. _ Z(, JOB No: gZ-z.z� Slr�gT?of 2• , :l � 0 � � T.ION. :. 77:- vtcCA.cE Y 1 IN; ST.A .LIIMR A E �' A DDRESS ;. S N M ,. , 8 � � �"DUR aR nwaE . u r k: T., p a M i T � 0 . D A"T: IS5U � d h.. - y , , , �C d. 4'. r f I rpl'::l1TI'= eh :hT L6hT.l$7,ILGt 'TOP FNDN. AT EL. 56.7' SYSTEM PROFILE TEST HOLE LOGS 0 NOT TO SCALE) . , ACCESS COVER TO WITHIN 6" OF FIN. GRADE � PROVIDE INSPECTION PORT WITHIN _ s" of FINISH GRADE ELDREDGE ENGINEERING ACCESS COVER (WATERTIGHT) TO ENGINEER: MINIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM JACOBI 54.0' WITNESS: ' sdE 12/1/82 2" DOUBLE WASHED PEASTO �- •` ELEV. 53.6' RUN PIPE LEVEL DATE: RTE 28 /—'FOR FIRST 2' , a t' EXISTING 1000 3' MAX. PERC. RATE _ < 2 MIN/INCH >. LOCUS GALLON SEPTIC 52.2' S2.33' CLASS I SOILS P# 1527 a AVALON TANK (H— 10 ) GAS \ y .:f, . :• RE-USE BAFFLE 52.0, a"�o 51.83 C,J CJ CI C] 0 C� L� Q og. . �o 0 w •<, . 0 51.5 C] CO O O E D O U CI E] AROUND �, Tb 6" CRUSHED STONE OR MECHANICAL go 1771 Q 4 ELEV. s COMPACTION. (15.221 [2]) $ 2 Q 0 0 CI 0 0 0 0 49.5' 0" 55.0' DEPTH OF FLOW 4 2 ( 5.5 y, SLOPE '� » o KING ARfE►UR DR. SLOPE) ( ) 3/4 TO 1 1/2 DOUBLE WASHED STONE TEE SIZES: »r INLET DEPTH = 10„ LOAM AND 14" SUBSOIL LOCATION MAP NTS OUTLET DEPTH = �, 18 , 53.5 LEACHING FOUNDATION EXIST. SEPTIC TANK 9 D BOX 8 FACILITY ASSESSORS MAP 145 PARCEL 9-3 r *THE INSTALLER SHALL VERIFY THE 6:5' LOCATIONS OF ALL UTILITIES AND ALL MED. 414 BUILDING SEWER OUTLETS AND ELEVATIONS --�-- - PRIOR TO INSTALLING ANY PORTION OF PERC SAND SEPTIC SYSTEM ae' THE INSTALLER SHALL CONFIRM MIN. SEPTIC TANK Q SIZE AT 1000 GALLONS AND ITS SUITABILITY FOR p RE—USE ROUTE 28 122.00' LEACHING FACILITY DIMENSIONS 144" 43.0' - NOTES: X 1 LOT 16 4 15,037 SFt APPROX. NGVD � 1. DATUM IS ! . <,. (GAREASE D;SPOSER _ EXISTING' DES GN FLOW: _3 BEDROOMS ( 110 GPD) _ 330 GPD 2. MUNICIPAL WATER IS �z TH Q USE A 330 GPD .DESIGN FLOW 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H— 10 SEP_IC TANK: 330 GPD ( 2 ) = 660 5. PIPE JOINTS TO BE MADE WATERTIGHT. CN' USE A lnnn GALLON SEPTIC TANK (RE--USE EXISTING) 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. LEACHING: ENVIRONMENTAL CODE TITLE V. 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT DWELLING EXISTING PERIME ER: 74' x 2 (.74) = 109 TO BE USED FOR ANY OTHER PURPOSE. DWELLING BENCHMARK TF=56.7' ' COR METAL BULKHEAD � _ 317 SF x 0.74 = 234 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. asn SOTTO h�: 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT TOTj\L: 463 S,F. 343 GPD INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED DECK FROM BOARD OF HEALTH. oc ,ms USE 2 500 GAL LEACHING CHAMBERS (ACME OR REMOVE ALL ' �--.� ;�� CONTAMINATED SOILS EQU AL' NITHIN STONE (SEE DIMENSION DETAIL) 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) EXISTING LEACH PIT �.n esee I WITHIN 5 OF NFIN SAS t AND REPLACE •°TH CLEAN I �O��l„9 , MED. SAND I S ST GRAVEL DRIVE ' LPI ' G LEGEND TITLE 5 SITE PLAN ' xn , _ . . PROPOSED SPOT ELEVATION OF dao: 1 .. 28 OLD EAST OSTERVILLE ROAD 10 EXISTING SPOT ELEVATION k , cr`a IN THE TOWN OF: °�''° 12 PROPOSED CONTOUR ( OSTERVILLE) BARNSTABLE E , � - w eN� k F 0 1 4 . ; �; ,._� • -�' 100 ,._......_ EXISTING CONTOUR -� PREPARED FOR: DEBORAH WALKER � DIRT i• .{, A 20 0 20 40 60 +DRIVE tr EASEMENT f. � BOARD OF HEALTH «o n APPROVED DATE MA SCALE: 1" = 20' DATE: NOVEMBER 11, 2005 I s I P F oS�R� off 508-362-4541 fax 508 362-9880 down cape engineering, inc: of CIVIL ENGINEERS as ARNE ���� ARNE H o OJALA LAND SURVEYORS 0 h 939 main st. yarmouth, ma 02675 0,5--2 F U DATE I