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HomeMy WebLinkAbout0088 OLD MILL ROAD - Health 88 Old Mill Road Osterville ° A= 141-052 ^ e Y" e : , , ° x e ° ° ^i 7 b ^ . a r �10 {� n ,4s e u a r ,N ° _ - . .e l.r 9' o � e � tl �'°'q aC1 °�P• ,a Q �p - x a 14 e u , ° Vol n ° ° 6 " 0 w � r e ° pa a F- e .. ,➢ �. ,:w - "! �,t. ., a npe n °o• sP� a e s•. " a � t U-• a d" " v. o�. 6 � > N .p ° ; d - NB ° ,a " a , r s .. a °, • - ,, ° ° , A^ 0 u o a s'TOWN OF pBAARNST"LE LOCATION 00 Mill SEWAGE# `v VILLAGE OS Ili ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ss n LEACHING FACILITY:(type) SIPOO (size) NO.OF BEDROOMS I OWNER M C.14,11M PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) ^ Feet FURNISHED BY C.G(^ .1 �anC" Q A L y so 33 s3 /TOWN OF BARNSTA.BLE T_OCAi1ON L o IGL 4i SEWAGE # VILLAGE �P/J�i d��� ASSESSOR'S MAP & LOT 1V16,1 z 204STALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR � Qi PERMITDATE: 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 _ t �L "1a �e`�� y TOWN OF BA STAB LOCATION ®C�J /rl// SEWAGE# O/) — 'VILLAGE DS kell /�� ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. J X4C)o z SEPTIC TANK CAPACITY / 1J LEACHING FACILITY.-...(type) &OS U11,1 S (size) NO.OF BEDROOMS �J PERMIT DATE: e'o/,t�� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well Leaching Facility(If any wells exist . on site or within 200,feet of leaching facility) r� ' Feet Edge of Wetland and Leaching Facility(If any wetlands exist 4 within 300 feet of leaching fa c' ' ) Feet FURNISHED BY ��� 3 Mou fie. 7 � � . ad Tows P No. vim Fee THE COMMONWf H OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - T F BARNSTABLE, MASSACHUSETTS Yes ftpliLAtion for Dispo stem Construction Permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon Complete System ❑Individup!Components Location A dress or I,ot No. � (�/►� �`J� Owner's Name,Address,and Tel.No. .ryJe Ce ,,�,7 p s V to _ a q Yr Assessor'sMap/Parcel q! /s �t� K,�l Vve Qvio+c 0,,¢ Q /`6 Installef�,'s Name, ddress,and Tel.NO:N. / Designer's Name,Address,and Tel.No. 8 ,�1 y 76� j e?/,�v4 Name, i s i � ffe it v t c e v4� Ehle e � Type of Building: 1- 04 C- Dwelling No.of Bedrooms 3 Lot Size /V / y?�" sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons . Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) J.�(� gpd Design flow provided �s�, gpd Plan Date /d- Number of sheets Revision Date r � Title ` Size of Septic Tank ��� Type of S.A.S. s7Pd1 Description of Soil rip Nature of Repairs or Alterations(Answer when applicable) /ti9 O�1 C zc.i Ia (DID Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si a ? Date Application Approved by ' Date Application Disapproved by Date for the following reasons ' Permit No. "t0 1°;�, �r � Date Issued ..,,_..,�.,.. ,,..� ».., tiR.'!n�,..r-. wrn -�.'�'M++F."'. •.... .� _.. .-. ..... ,r-. �,....-.. ,...,-. .... ,. -.-r^mow— ..r...,.�.•.:o .s.- -I.. .-.-..-.. - -. ... ... �1s I No. ;)j/ r� , o C7` J Fee y THE COMMONW OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -T F BARNSTABLE, MASSACHUSETTS Rp iratlon for D18po stem ConMrUctlon 3permit Application for a Permit to Construct( ) Repair(6�'Upgrade( ) Abandon( ) 19Conlioete System ❑IndividitA Components r Location Address /iot No. G/ j'��je.1 Owner's Name,Address,and Tel.No. AQ WE'-".,/y/rr�� Assessor's Map/Parcel C� �j f S f`L(t.► K/C�{ !fl//E' Qi,in y /�w O,P r�7 Installe ' Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Te �+durIs( .�7<SeOf11 C'f �cl // r Type of Building: /--G✓t -'s rG hI r, ff/"ri- Dwelling No fof Bedrooms Lot Size / ys sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) / �.�(�' gpd Design flow provided S gpd Plan- Date �l�o�G t /s2 Number of sheets Revision Date Title Size o/f Septic Tank Type of S.A.S. Fs? j (,�jt� ��q/� C ��26-4 Description`of Soil Nat re 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 'L Compliance has been issued by this Board of Health. Signed--, jJ�: � , Date Application Approved by Date � / Application Disapproved by Da te for the following reasons i Permit No' ;/h f3 i^'� C� 1 Date Issued-,._-.00*.64 - - -- --- - ---- -------------------------------------------------------------=------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ,�j Upgraded( ) Abandoned( )by at ,Q ' Q/n �� r,� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction-Permit No. dated 7Q l cj / L Installer C©N f Designer - 4 #bedrooms Approved design flow d gpd The issuance of this permit shall not be construed as a guarantee that the system will-function as,design((e}}d. Date r �(!i //� Inspector 1�. r--`"— --• Sf ---------------------------------------'----------------- No. 3 C.� / THE COMMONWEALTH OF MASSACHUSETTS Fee PUBLIC HEALTH DIVISION 4.4 BARNSTABLE,MASSACHUSETTS MiSposal Epstein Construction Permit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at 0/0 dry• // � /p f /A and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this Date '15/) Approved bye ` �' 02/06/2013 12:39 5084775313 ENGINEERING WORKS PAGE 01 Towle of Barnstable ' Regwla'tolry Services Thomas F.Geller Director Public Health Division Thoom McKean,Director 200 Main Street, Hyannis,MA 02601 ..' Office: 508-%24644 Fax: 508-790-6304 ' Date: 4 !3 Sewage Permit#Zo i Z 30 Assessor's Map/Pared� �'''� 1 U tier '?0t,—r rA .1;n,*Re �E. -37 Designer. 1 m ate'.rib wa r%Ay. Incl . Installers Address: j 2 W. C Address: Z.f MA- On 3,Fff—' kvlt�`Ja was issued apermit to install a'' (date) (installer) septic system at based Qn`$design drawn by ef Wp r-4, (- 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. Stsipout (if required) was inspected and the. soils were found satisfactory. I certify that the septic,system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of'the SAS or any vertical relocation of any component of the septic system) but in accordance with State& Local Regulations. 'Plan revision or certified as-built by designer to follow. Stripout(if required) ted'and the soils were found satisfactory. "OF IPCTER,r: WENTEE . er'9 ignature CIVIL cn No.sb,ae ow _ (Des lgner'sSignature), (A ix DeSlgn ) PLEASE RETURN TO BAt.NSTA.BLE PUBLIC HEALTH DM§112N. CEIRTIFI ATE OF COWLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND rrm.T reR ARE RECEIVED DY S LE PUBLIC 1[�AL'l'H DIVISION. TSANK You. - q.k*8w fD=WeMpmB rOG9tlon f&m.d4C Town-of 4arns qa. ble ' Department of Regulatory Services I Public Health Division Date t3 f 2 200 Main Street,Hyannis MA 02601 Date Scheduled t� Time _ Fee Pd. Soil Suitability Assessment or Se Dis osa �-e Performed By: �`1 "� f S 7 �Vitnessed By: LOCATION& GENERAL INFORMATION Location Address Owner's Name G /'/-Lo fin C Av-e- 7� Add ress /LI/I- .CJZf Assessor's Mapfl*cel: 5� Z Engineer's NameA4"- /Vic E, --ek . . NEW CONSTRUCTION REPAIR Telephone# 50,�f '- 7 3 7^Y76 Land Use Slopes(3'0) ?`I Surface Stones A)J�-- Distances-from: Open Water Body _ft Possible Wet Area.Z__ft Drinking Water Well7L ft Drainage Way ft Property Live © ft Other ft SKETCH:(Street name,-dimensions of lot,exact locations of test holes&perc tests,locate wetlands i'n proximity to holes) 8 t , ZE r�t 1.Parent material(geologic) Depth to Bedrock� � /[� k it1 Depth to Groundwater. Standing Water in Hole: I �t Tp—y Weeping from Pit Face Estimated Seasonal High Groundwater 1 • I 'FaL kc-") DETERMINATION FOR SEASONAL HIGH WATER TABLE .Method Used: C'd 4a✓h M Depth Observed standing in obs.hole: �_? _ Depth to soil mottles: ;n Depth to weeping from side of obs.hole: J':2 4 In. Groundwater Adjustment Index Well#A-j uj Zq Reading Date: =--je-J Index Well level �„ Adj,thctor Adj,Groundwater Level—.(O Z ?-i z PERCOLATION TEST Date . Time Observation Hole# 'u t Time at 9" Depth of Pere :„ 9 v7 6 Z� Sal,\ Time at 6" . Start Pre-soak Time® 4� �M� Time(9"•6") End Pre-soak .i Rate MinJInch Site Suitability Assessment: Site Passed y Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division, Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the, Barnstable Conservation Division at least one(1)week prior to beginning. Q:\S EPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling '(Structure,Stones;Boulders consis , . to v l Q— is loY� Y12 !o Q 1 `t' DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. . onsistency.%Gravel) 6 ALS -z y �►S LaY(2- S/� 2y —12c1 C ►'`'� SaKa �5`�` �l DEEP OBSERVATION HOLE LOG Hole# 3 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders: i to . e lo-YA y Z y c.S iaYR 36-r zv M 2-5-Y : DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texiure Soil Color Soil Other Surface(in.) (USDA) (Munsell)` Mottling .(Structure,.Stones;Boulders. 6_r G Ms Z* - ply Flood Insurance Rate Map: Above 500 year flood boundary No— Yes „ Within 500 year boundary No- Yes Within 100 year flood boundary No-X, Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervioumaterial exist in all areas observed throughout the area proposed for the soil absorption system? _'y______.� If not,what is the depth of naturally occurring pervious material? ..._ Certification _f�} :. . I certify that on.--1't `�`—(date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the'above analysis was performed by me consistent with .r the required'training,expertise and experience described in 310 CMR 15.017. Signature Date Q:\S.EpTlMERCFORM.DOC n� r. COMMONWEALTH OF MASSACHUSETTS k u EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a i' DEPARTMENT OF.ENVIRON MENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS -SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM' PART A -_ - CERTIFICATION Property Address: 88-Old Mill Road - Ostei ille MA 02655. . '. Owner's Name: Kay Mclellan 1 Owner's Address: 'A Date of Inspection August 10,2012 Name of Inspector: (Please Print) James M.Ford * , Company Name:: . James M. Ford Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 Telephone Number. (508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the`.`information reported below is,true,accurate and complete as of the time of the in The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 'I am a DEP,' approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15 000).-Jhe.system: N 1 t ✓ Passes Co . Tonally Passes Ne ds urther Evaluation by the Local Approving Authority Fai s, •• • Inspector's Signature." Date August'17, 2612 The system inspector shall sub i a copy of this inspection report to the.Approving Authority(Board ofFHealth or DEP)within 30 daysof complete this.inspection. If the system is a shared.system.or has a design flow of 10;000 gpd or greater,the inspector and the system owner.shall submit the report to the appropriate regional office of the DEP. The original should be sent to.the system owner and copies sent to the buyer,if applicable,and the approving - authority. Notes and Comments ****This report only describes conditions at the tithe inspection and under,the conditions of use at that - t.me This inspection does not address how he system will perform in the future.under the same or different conditioiis:of use.,' } cvd Title 5 Inspection Form '6/15/2000 page 1 _ `'. LA r Page 2 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM, PART A CERTIFICATION (continued) Property Address: 88 Old Mill Road Osterville,MA Owner: Kay Mclellaii Date of Inspection: August 10, 2012 4 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all.of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in'310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: w ' One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The.system,upon completion of the replacement or repair,as approved.by'the Board of Health,will pass.`` Answer yes,no or not determined(Y,N,ND)in the for the'following statements. If"not determined",please explain. The septic tank is metal and over,20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration.or,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. ND explain` Observation of sewage backup or break out or high static water level in.the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health) „ brokenpipe(s)are replaced obstruction iS removed distribution box is leveled or replaced NDexplain- The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the'Board.of Health): - broken pipe(s)are replaced obstruction is removed ND explain:. . 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION: (continued) Property Address: 88 Old Mill Road Oster-ville,MA Owner: Kay Mclellan Date of Inspection: August 10, 2012 C. Further Evaluation is Required by the Board of Health:.. Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303 (1)(b)that the system is not functioning in a manner which-will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated,wetland or a salt marsh 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 aseptic 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 ata.DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates'that the,well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other, failure criteria are triggered. A copy of the analysis must be attached to this form' 3. Other: _ 3 ' f Page 4 of 11 OFFICIAL INSPECTION FORM,-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 88 Old Mill Road Osterville,MA Owner: Kay McWlan Date of Inspection: August 10, 2012 D. System Failure Criteria applicable to all systems: You must indicate either`.`yes"or"no"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to,an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6".below invert or available.volume is less than'/z day flow, ✓ Required pumping more than 4 times in the last year.NOT due to clogged or obstructed pipe(s).'Number of times pumped ✓ Any-portion of the SAS,cesspool or privy is below high ground water elevation.. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.. Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy.is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,. . performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)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 System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd.to 15,000 gpd..-' You must indicate either"yes"or"no"to each of the following:' (The following criteria apply to large systems in addition.to the criteria above) 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 tlueat;..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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B :.CHECKLIST Property Address: 88.01d Mill Road Osterville,MA Owner: Kay Mclellan Date of Inspection: August 10, 2012 Check if the following have been done: You must indicate"yes"'or"no"as to each.of the following: Yes No ✓ Pumping information was provided by the owner,occupant;or Board of Health ✓ : Were any of the systein'components pumped out in the previous two weeks? Has the system received normal flows in the previous two.week period,? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ Were as built plans of the"system obtained and examined?.(If they were not available note as N/A): ✓ _ Was the facility or dwelling inspected for signs of sewage back up:? ✓ Was the site inspected for signs of break out.? ' ✓ Were all system components,excluding the SAS_,located on site ✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth-of sludge and depth of scum? ✓ Was the facility owner(and occupants if different from owner)provided with.information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No , ✓ Existing information:,For example,a plan at the Board of Health J ✓ Determined in the field(if any of the failure criteria related to Part C is at issue'approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. - 5 L Page 6.of 11 . OFFICIAL INSPECTION FORM-`NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION i Property Address: 88 Old Mill Road k Oster ville,MA Owner: Kay Mclellan Date of Inspection: August 10, 2012 FLOW CONDITIONS RESIDENTIAL , 'r Number of bedrooms(design): n/a. Number of bedrooms(actual): 2 i DESIGN flow based on 310 CMR'15.203 (for example: 110'gpd x#of bedrooms): 220' Number of current residents:: 0 Does residence have a garbage grinder(yes or no): n/a ' .4.., Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no); N_o Seasonal use(yes or no): No Water meter readings;if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCIAL/INDUSTRIAL ; Type of establishment: Design flow(based on 31.0 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no)Non-sanitary waste discharged to the Title 5 system(yes or no)`. Water meter readings,if available: if Last date of occupancy/use. .., . OTHER(describe): ' GENERAL INFORMATION Pumping Records , jSource of information: Unavailable a Was system pumped as part of the"inspection(yes or no):.. ' If yes;volume pumped: gallons--How was,quantity pumped determined i Reason for pumping:. j f 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, Innovative/Alternative technology.'Attach a copy of the current operation and maintenance contract(to be obtained from system owner) . Tight Tank Attach a copy of the DEP approval -Other(describe): Approximate age of all components,date installed(if known)and source of information: Date of installation unknown-orikinal'systeni Were.sewage odors detected when arriving at the site(yes or no): - No Page 7 of 11 ,..: OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 88 Old Mill Road ' Osterville.MA _ Owner: Kay Mclellan Date of Inspection: August 10, 2012 I ' BUILDING SEWER(locate on site plan) Depth below grade: r Materials of construction: _cast iron _40 PVC _other(explain) I Distance from private water supply well or suction line: ? ' Comments(on condition of joints,venting,evidence of leakage,etc.); " a' SEPTIC TANK: ✓ (locate on site plan) (Cesspool acting as a septic tank) Depth below grade: To grade Material of construction: concrete _metal _fiberglass =polyethylene e t "other(explain) _ If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes'or'no): (attach a copy of certificate) Dimensions: 4'W x 4'T x 6'bottom to grade Sludge depth; -- - Distance from top of sludge to bottom of outlet tee or baffle: -- Scum thickness: 2" 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: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels L, as related to outlet invert,evidence of leakage,etc.): The liquid level was up to the outlet vine.A steel cover'was to grade. GREASE TRAP: None (locate'on site plan) Depth below grade. r 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: s Comments(on pumping recommendations,in and'outlet tee or baffle condition,structural.integrity,.liquid,levels as related to outlet.invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM.-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C - SYSTEM INFORMATION (continued) Property Address: 88 Old Mill Road Osterville,MA Owner: Kay Mclellan Date of Inspection: August 10, 2012 TIGHT or HOLDING TANK: `None (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: eallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or_no) Date of last pumping: Comments(condition of alarm and float switches,etc.): +' DISTRIBUTION BOX: None (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.): t - —PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no) Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):, • Page 9 of 11 , OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY'ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' SYSTEM INFORMATION (continued) Property Address: 88 Old Mill Road Osterville,MA Owner: Kay Mclelian Date of Inspection: August 10, 2612 SOIL ABSORPTION SYSTEM (SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,.number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool;number: 1 - Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding;damp soil,condition of vegetation;etc.): The overflow cesspool was 4'W x 4'T x 6.'bottom to vrade. .There did not appear to be any signs of failure. A steel cover was to_Arade. CESSPOOLS: (cesspool must be'pumped as part of inspection) (locate on site plan): Number:and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer:' Dimensions of cesspool: _ry Materials of construction: Indication of groundwater,inflow(yes or no): e Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,'etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulie.failure,level of.pondi' condition of vegetation,etc.). 9 Page 10 of 11 ; OFFICIAL.INSPECTION,FORM- NOT FOR VOLUNTARYASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIONTORM PART C SYSTEM INFORMATI.ON (continued) 4 Property Address: 88 Old Mill Road Osterville:MA } Owner: Kay Mclellan Date of Inspection August 10, 2012, SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to:at least two permanent reference landmarks or benchmarks Locate all wells within 100 feet. Locate where public water supply.enters the building. . A Q s , 33 3` s. t Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM : PART C SYSTEM INFORMATION (continued) Property Address: 88 Old Mill Poad a. Osterville.MA Owner: Kay Mclellan Date of Inspection: August 10, 2012 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 15 +I- feet Please indicate (check) all methods used to determine the high ground water elevation: Obtained from system design plans on record -If checked, date of design plan reviewed: Observed site(abutting property/observation hole within,150 feet of SAS) . . ✓ Checked with local Board of Health-explain:_, topographic and water contours maps ' Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation Using Barnstable topographic and water-contours maps the mays were showing approximately 15''-% to around ivdter at this site. r This e ort has been re ored orhl or.the e n s c s stem and conh'oiheihts described herein. This p P p Y.f p Y p s se nc s stem was. p Y inspected and passed as of the date of inspection.-This report is not a warranty orguarantee that the system.will Anction properly in the fihture. There have been no warrawies orguarawees,either expressed, written or implied, relathig to the septic system, the impectiori, this report and/or any components of the septic system'which have riot- been located aril inspected. 1 11 W p „ <TCHEN C4 w .Qq p LIVING ROOM w � DINING a o r m o� ii z J W ❑ u) 10 AEXISTING IST FLOOR PLAN _ C14 EXISTING 2ND FLOOR PLAN � �► � Z = 0 0 SP 1!_ Q- w ZQ Cc r- 0 U p z 5EDROO I 01 IBEDROO 1 #2 W u o u z a QC4 � c� � z �nzm (L z x3 ; �, x a o dpo MICH ECLID --------• r., . . No. �34 a STRUCT AL LLJ O _9FGr� 13Q011 ; 8'-O° 3'-D" 6'-3" �'-�" 3'-8" 3'-8" ; 3'-O" 3'-O" SOON (L 1 l ' W R.O. 2'-b II x 4'-478" R.O. 2'-6 x 4'-4151' TW24,42 TW2442 Z Q p o Lu -- -------1------------------------------- ------------- ' -----• A p � . uj I FRENCH DOOR BEAM d �) W � Jul I ti( SEE SUPPORTING I ' z t- DOCUMENTATION N 8 R.O. 6-O II x 3'.5% R.O. 6,-3„ R.O. 2'-Z6" x 4,-476' B J 0 U O - C335 Cj)KtNG 12X80 FRENCH A 2 TW2042 W -� j CL '— N MASTER BEDROOM O F— II N LM FMQ u I ' ' ' I? O Lu 1 1 1 F-1'���_ Q - J W 3, _Q -1 MASTER BR BEAM KITCHEN o 0 6�E SUPPORTING � FOYER BEAM I , 1 � D CUMENTATION ZX ( ® SEESUPPORTING DOCUMENTATION FOYER (� r II / cl - I 1 I w w w w w w w w ---------- ----- HALLKyLATdD----- _ ._._-_-..- J • t FI I I I I I I 1 1 I I I--���� -_ TW2042 I I� ' R.O. 1'-2Lb" x 4'-47b' O O • KITCHEN SEAM ; i i ; ; ; ; i ; i i R.O. 2'-6i' \ R.O. 2,-6" R.O. 2'-6" "� SEE SUPPORTING 2y�" ' Z>t _ p IL 2'-4" ' DOCUMENTATION MASTER BATH � mL f )).31 1 "�v I w Q TW2442 TW2442 Q +�- a) DINING ROOM LIVING ROOM R.O. 2'-6 " � 4'-476" R.O. 2'-6 " x 4'-476" 1 � p 0 V' O 1 ; Vi/1 , y� . , J I I ; C/)ILU f— U mll Q ° :3 Q N I j cl to z N Q cl) QL I w � zc-qr) co 31-0" 31-0" Q N 0 LEGEND c' s N 38--EXISTING CONTOURCD o ` X 100.98 EXISTING SPOT GRADE K• 92 PG• 65 9756 PROPOSED SPOT PROPOSED GRADE a 0ok In n LOCUS PL. B W EXISTING WATER SERVICE Finger Ln a G EXISTING GAS SERVICE H.W OVERHEAD WIRES t9 TEST PIT r o BENCHMARK 3 �°- Main St m -o 0 CD Wipn0p Rd Ave - LOCUS MAP NOT TO SCALE v r co q Cb Mop 141 - 1v Parcel 334 F Approx. Area 46,433t S.F. r o N 1.07E AC. N Q (b Cb m __-- 109.29 - 108.69 - - _ edge x of • x 107.54 Brick /CW, -�'' ' -APotio ` ------- -- 107,53 PROPOSED ADDITIO , PROPOSED - 21 43' -A106.95 SEPTIC TANK /EXISTING - " -Z. HSE(#88) - ;�: ------ 104 OU 0 TOF=107.16' / rn DESIGN ENGINEER SHALL -- -----,1�6- ' 105.3 10598 26 �o I1o5.364j t VERIFY SUITABLE SOILS To TO EL.=102.3. OTHERWISE, _ - c0 fl3.99 j- ------ 102 SEE NOTE 11, SHEET 2. o r 43 �" : -._S.A.S_w_ x� ; x 1 l.ao EXISTING CESSPOOLS 39' 4 _ io4.o�_ - 103.90 TO BE PUMPED, FILLED 35' - • = �-=1-0 e4-.7� x 104.07 - -- - x �; W/ SAND & ABANDONED 106.18 ;184.30 104 TP-1 r , ry ----- to _: 100 OR REMOVED r------ - 103.16 1o1.30 RESERVE ---- -1 GL9 TP 3 TP-4, 101. v... .,. ,n,_2� 1 101.99 Benchmark Set - - ,-_AR€_A� -----I lolls /' Left Cor. Bottom Step 102.57 3T - 102-_----- _ EL.=105.72 (Assumed) STK/TCK/F �"--- ��--- . 98.44X 021 !S - 101.49 i 100 ---100- 9.31 97.92 %0 9$�3 'A100.20 q=113.31' 99.00 98. 4 4&68' x R— x 97,66 --- R=494.6T--------- m avement berm ° 4\ Concrete Retaining Wall 9 L=161 f edge of 9>S�p / q�' OLD MILL x ROA D UP'/99/8 r(C.> WARNER O F Mgs �P��� OF MgsTERRY o PETER T. FLOOD PLAIN DATA ANN MCENTEE _ NON HAZARD-ZONE C o CIVIL "' o No. 38721 ZONING CLASSIFICATION: ZONE RC o No. 35109 SETBACKS: FRONT YARD=20' RFGISTE ��� o R£^61-�O �� SIDE/REAR YARD=10' NG� OWNER OF RECORD' LOT AREA = 43,560 SF 88OLQED.MILL ROAD Mc KAT A MAXIMUM BUILDING HEIGHT = 30' / % 0\ 1 UJ I LKVILLE, MA 02655 WIND EXPOSURE CATAGORY: Exposure .B Engineering by: Surveying by: SCALE DRAWN JOB. NO. PROPOSED SEPTIC SYSTEM SITE PLAN Engineering works,Inc. WARNER SURVEYING 1"=30' P.T.M. 250-12 88 OLD MILL ROAD, OSTERVILLE MA 12 West Crossfield Road 22 Long Road Forestdole, MA 02644 Harwich, MA 02645 DATE CHECKED SHEET NO. (508) 477-5313 (508) 432-8309 9/26/12 P.T.M. 1 of 2 Prepared for: Cox Construction Co., 6 Winnies Way, E. Sandwich, MA 02537 NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL.=102.8 SEPTIC TANK FOR A DISTANCE OF 15' AROUND THE INSTALL RISERS & COVERS OVER INLET PROPOSED D-BOX PERIMETER OF THE S.A.S. AND SET TO 6" OF FINISH GRADE. INSTALL WATERTIGHT RISER & PROPOSED S.A.S, PROVIDE ACCESS TO GRADE OVER OUTLET COVER COVER SET TO 6" OF GRADE INSTALL INSPECTION, PORT OVER END UNIT T.O.F.=107.16 F.G. EL.=106.Of F.G. EL.=105.0t F.G. EL: 105.01 F.G. EL: 104.5t MAINTAIN 2% GRADE MIN. OVER S.A.S. INSPECTION L = 18'(mox.) L = 6' L = 6'(MAX.) PORT ® S=1% (MIN.) ® S=1% (MIN.) ® S=1% (MIN.) 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC to^I 6 7.13" TO 1a" - INVERT INV.=102.83- 48" LEVEL 2' 1 ROW OF 7 UNITS AT 5.0'/UNIT = 35.0' 2' 0as INV.=102.52 PROPOSED INV.=102.35 BAFFLE D-BOX EFFECTIVE LENGTH = 39.0' ... INV.=102.58 INV.=102.29 SOIL ABSORPTION SYSTEM (,PROFILE) PROPOSED 1500 GALLON (,H-10) SEPTIC TANK ESTABLISH VEGETATIVE COVER CONNECT TO SEWER OUTLET/S AT BACKFILL WITH CLEAN NAJIVE OR HOUSE, AT, OR ABOVE, INV.=103.63 PERC SAND TO TOP OF CHAMBERS (MODIFY PLUMBING IF REQUIRED) r urEB OF /e To,/r BREAKOUT=TOP TOP ELEV.=102.79 DOUBLEal FXT STONE NOTES: INV. ELEV.=102.29 cc"" DTO�T1FOUIn a 3/a^TO t-1/2'DOUBLE 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE "ASKED STONE INVERTS, PRIOR TO INSTALLATION. BOTTOM ELEV.=101.70- 2) SEPTIC TANK & D-BOX SHALL BE SET 'LEVEL AND TRUE TO 4' GRADE .ON A MECHANICALLY COMPACTED SIX INCH CRUSHED 5 MIN. SEPARATION STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 'TO HIGH GROUNDWATER .EFFECTIVE WIDTH=10.8' EXISTING SUITABLE 3) INSTALL INLET & OUTLET TEES AS REQUIRED: ADJUSTED G.W., EL=96.7 _ MATERIAL 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE USE.1 :ROW OF 7-ADS Aro 36 UNITS AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL.` WITH '4' OF STONE(SIDES) 2' (ENDS) SEPTIC SYSTEM PROFILE TYPICAL SECTION N.T.S. ' GENERAL NOTES: 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SOIL LOG BOARD OF HEALTH 'AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS DATE: 9/24/12, 2012 (REF# P-13,747) OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE SOIL 'EVALUATOR: PETER McENTEE SE 1542 LOCAL RULES AND, REGULATIONS. ( # ) 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR WITNESS: DAVID STANTON-HEALTH AGENT TO INSPECTION AND-APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. Elev. TP- 1. Depth Elev. TP-2 Depth Elev. TP-J Depth Elev. TP-4 Depth 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING*_ 103.4 A 0" 102.2 A 0" 101.8 A 0" 101.5 A 0" FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE, DESIGN.. LOAMY SAND LOAMY SAND LOAMY SAND LOAMY SAND ENGINEER BEFORE CONSTRUCTION CONTINUES.- 1OYR 4/2 10YR 4/2 10YR 4/2 10YR-4/2' 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 102.9 6" 101.7' 6 101.3 6" 101.0 6 B B B B 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF. MED. SAND MED. SAND LOAMY SAND LOAMY SAND THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 10YR 5/8 10YR 5/8 1OYR 5/8 10YR 5/8 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. ' 101.9 18" 100.2 24" 98.8 36" 98.5 36" C C C PERC C 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. PERC 36"/48" 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 36"/48" 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE F-M SAND F-M SAND MED. SAND MED. SAND DIRECTED BY THE APPROVING AUTHORITIES. 2.5Y 6/6 2.5Y 6/6 2.5Y 6/4 2.5Y 6/4 10. IT SHALL BE THE�RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 96.7 .ADJ.G.W. _ 96.7 ADJ:G.W. = 96.7 ADJ.G.W. = 96.7 ADJ.G.W. CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 .CMR 255(3). 93.4 120" 92.2 120" 91.8 120" 91.5 120" 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE NO G.W. NO G.W. NO G.W. STG. G.W. 120" INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. PERC RATE <2 MIN/IN. ("C" HORIZON) 15. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED OR INDEX WELL MIW-29, ZONE C UNPERMITTED SEPTIC SYSTEM COMPONENTS THAT MAY EXIST-ON WATER LEVEL=9.6 (AUGUST 2012) THE PROPERTY. REQUIRED ADJUSTMENT=5.2' 16. CONTRACTOR SHALL VERIFY THAT ALL SEWAGE EXITING THE HOUSE 1S CONNECTED TO THE PROPOSED SEPTIC SYSTEM. DESIGN CRITERIA NUMBER OF BEDROOMS: 2 EXISTING + 1 PROPOSED' = 3 TOTAL` SOIL TEXTURAL CLASS: CLASS 1 63.5" DESIGN PERCOLATION RATE: <2 MIN/IN DAILY FLOW: 330 GPD 13" DESIGN FLOW: 330 GPD GARBAGE GRINDER: NO 33.8^ PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY PROPOSED DISTRIBUTION BOX; 3 OUTLETS MINIMUM TOP VIEW LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF 60" .74 GPD/SF END CAP END CAP USE 1 ROW OF 7-ADS Arc 36 UNITS SURROUNDED WITH FRONT VIEW SIDE VIEW 4 FT. OF STONE(SIDES) AND 2 FT. OF STONE(ENDS) REAR/TOP vlEw BOTTOM AREA:................. .....................10.8' x 39.0' = 421.2 SF NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT SIDE VIEW SIDEWALL AREA: 2(10.8' + 39.0') x 0.6................. = 59.7 SF TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. TOTALAREA:.........................................................................480.9 SF 4640 TRUMAN BLVD DESIGN FLOW PROVIDED: 0.74 GPD/SF(480.9 SF) = 355.8 GPD now novu+ceo DRAINAGE SYSTEMS,INC. UNITS OHIO 43026 UNITS a 3 DETAIL STAMPED H-20 d Engineering by: Surveying by: SCALE DRAWN JOB. NO. PROPOSED SEPTIC SYSTEM SITE PLAN Engineering Works,Inc. WARNER SURVEYING N.T.S. P.T.M. 250-12 88 OLD MILL ROAD OSTERVILLE MA 12 West Crossfield Road 22 Long Road Forestdole, MA 02644 Harwich, MA 02645 DATE CHECKED SHEET NO. (508) 477-5313 (508) 432-8309 9/26/12 P.T.M. 2 of 2 Prepared for: Cox Construction Co., 6 Winnies Way, E. Sandwich, MA 02537 i