HomeMy WebLinkAbout0314 OLD MILL ROAD - Health 314"Old Mill Road ;,�, ;
r
"Osterville -P __ o
,142 063,
4
Ili
I
p
6r
l
TOWN OF BARNSTABLE
LOCATION OIcy MOJ &34 SEWAGE #
y VILLAGE ASSESSOR'S MAP & LOTI �` ��3
/A,SPfC1-aeS
IIiSTAtt:ER'S NAME&PHONE NO._ A 18 e--4,v r®
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS
BUILDER OR OWNER "lP�'/^/�
/N.S/0,XCT1oN Z401 O�
PERMIT DATE: C��1►9CE 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
0
"a
COMMONWEALTH`OF MASSACHLJSETTS .
EXECUTIVE`OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL. PROTECTION.
TITLE 5
OFFICIAL INSPECTION FORM'=NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGEDISPOSAL SYSTEM FORM
.• .:PART A P
CERTIFICATION-
Prop erty Address z .314 Old Mill Road:l
Osterville.MA'02655
Owner's Name: John Moraites
Owner's Address:
Da-'Of.Inspection. No enlbe�il;}2012'r.. r
Nanie of Inspector: (Please Priiit) Jaii es M,Fo�d
Co' tpany,Nante: James M. Fo1 d
Mailmg.Address: P O Boz 491 k'1hi`4;
Osterville,iMIA 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 thel nformation reported
below is true,:accurate and.complete as of the time of the inspections. 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 systentyinspeetot put suant to.Section 15.340 of Title 5 (310 CMR 15 000):.•The system:
Passes
QnditionallyPassesa •.
eeds Further Evaluatioaby the Local Approving Authority
ils .
Inspector's Signatut e Date Novernber..8 2012
The system ntspector'shall sub t> ;a of this:in report-to the.Approving Authority(Board of Health or
DEI') witliin30.days of coiitpletitig d _inspOption. If,the system'is a shared system or has a design flow;of 10,000
gpd orlgreater,t the<inspecto3 and the:system ow3ier.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:�,t*.}x._i { "�:;;:�r �'►i�il .'.,�`_".t( )...;rc+�,t
• �p'Q11n13 ttl"t'i1 lift#;:' ..�alt�,�:..�!�.�ti�"s._za__..
Notes and wConunents x �q
*i t*,;This report°only desc-.ibes'condit{.ons at t13_.e tone of inspection and under the conditions of'use at that
_.
time TlJ;is inspections does not addr wess ho the system will perform in_the future:wader the same:or different
coiidtttons'ofusey ' 1. '41, 1
s
1 3�Ci i. j,' l,;.hi i}�r (�3 l::f
1
t'LfJ111 1,9•:( (,i+t.if i«:Ialy
Title;5,Inspect(on Foi❑i '6/15/200Nll €: 1 page 1
47,
' qq
J
' Page 2 of 11
OFFICIAL INSPECTION'FORM-NOT FOR VOLUNTARY AS
}SUBSURFACE4 SEWAGE DISPOSAL SYSTEM INSPECTION FORM
1 PART A
CERTIFICATION (continued)
Property Address: 314 Old Mill Road.`
oyoville MA'
Owner: John Moraites;:
Date of Inspection: November 1 -2012.'
Inspection Summary: Clieck`A,B,C,D or E I.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 Condition{{allyl P
asses:
One or more system tcomponents4as described in the"Conditional Pass" section deed 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)m tliet 'y for the following statements..If"not determined",please
explain.
I' tit�tt �lcltsss: ,t;q (} tll .l sr.c,'i ,
The septic talk is metal and over'20 years old*or the septic'tank(whether metal or not) is'structurally
unsound',exhibits substantial_mfiltration_or.exflltration or tank failure is imminent. System will pass inspection if the
existiiigltailk>is.replaced with a coniplyiilg-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_
iiidic`ating'that tlleltank,is Tess than"201years oldfisr.available:
d.
ND explain;
_ ]11.trS?11 �; tI.3t1„r, L i>it�31r]�Uf'G'I.0 frill Ch'.Ir(�k .
.Observation of sewage_vackup or'bieak.out or.high static water level in the distribution
box due to broken or
obstructed pipe(s)or due to a broken',settledor'uneven distribution box. System will pass inspection if (with
dpprovaliof.Board of.He'alth)
-- - __ ;_brokeir pipe(s).:are replaced'. '
-; - _:._:,_bbstruction_is:removed '
distribution box is leveled or replaced-
l.,i.•. t t:t;jt (_undidolicl i�
r
ND explain:
iait flTlie}systeniliegnired punilingimore 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):
'1` brokeir.pi"pe(s)are replaced.
r 'obstruction.is removed
It€Ih'.t ill. -
t i
it drs d I:;SI G� <yd� it )!: l9t�l,1J J t
2
'its t
b`+ 31111 l`; !rill '„Ii.
Page 3 of l l
OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION:FORM
PART A
CERTIFICATION (continued)
Property Address: 314 Old Mill Road
Osterville,M.4i.
Owner: John Moraites .
Date of Inspection: November 1. 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 in],
is failing to protect public health;safet 'or the environment:
L. System will pass unless Boai7d of Health determines in accordance with 310 CMR 15.303(1)(b) that the
system is not functioning in.a mariner which will proteet'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 prot66 the public health,safety and environment:
r if r1_rll li',The system has!a sephc,tank and.soil absorption system(SAS)and the SAS is within:100 feet of aA
surface water supply o>,tributaiy to'a surface:water supply.
l.r irn t I fri!sc t.SriaThe system has;a septidtank'and SAS and the SAS is within,a Zone of a public water supply.
} IFt I t b }F ;.The 9yist6m!.h 4,septic#ank and{SAS and the SAS is within 50 feet of a private water supply well.
iivThe'systemllas a septic',Ank_iagd!;SAS and the.SAS is less than 100 feet but SO feet or more from a
:,i private,watersupplyawell*T-i 1Metliod usedao determine distance
1. k'Thisaystern.passeshftli`ezwell.water analysis,perfornied at a DEP certified laboratory, foi`coliforrii
bac. a'hn rvolatileforgan>cicorupounds.iridicates that the well is free from pollution from that facility and
the presence of anunonia.nitrogen and nitrate nitrogen is equal to or less.than 5 ppm,provided that no other
failure criteriaiareitrigge•eda.A copy of,the,analysis must be attached,to.this foriri.:
4 ti<il ,J%'1 k 1 rl -./IS 'iM tilr `✓( f
3: Other.
}
t .I.IS}is� 453{,�4: lUf1 :'i'd�fl lq 11ps1!�;i<I:i1 t Y�lzd•V:•f.61 4Btk1iCQ;y L} =
-If tic"
7f lct au"I P!F7�'
"r
i "l 11C. i:'�''.11 �La f �l liK-u •(#11.:(.l!�
3
F''
i11 .aa.L-r}i
Page 4 of.l 1
OFFICIAL INSPECTION.FORM'-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE,SEWAGE DISPOSAL.'SYSTElyI INSPECTION FORM
..PART A
CERTIFICATION, (continued)
Property Address: 314 Old Mill Road..
Osterville. A11 ,
Owner: John Moraites
Date of Inspection: November 1. 2D12
D. System Failure Criteria applicable fo all systems:
You must indicate either"yes"or`"no"to each of the following for MI inspections:
Yes No
✓ Backup ofsewage into facility or systein component due to overloaded or clogged SAS or cesspool
✓ Discliarge.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 iii 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
f_a,.. -1..+ ✓t Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number
of times pumped;—.
sr.i i-Any portion ofsthe,SAS,.cesspool or privy is below high ground water elevation
— ✓ Ar?ylport on�of gesspoolprol p{iv4y is within 100 feet of a surface water supply or tribufaiy to.a surface
water supply.
✓ A{iy portion of a cesspool o{ privy is within a Zone l of a public well.'
✓ An portion of a cesspool or r Y p p p vy rs within 50 feet of a private water supply Well.
_ ✓ Ariyportion of a cesspool or privy is'less,than 100 feet'but greater than 50 feet from.a private water
Fd t 1'! {. s',l!;r c='supply well witlino acceptable,_water quality analysis. [This system passes if the well water analysis,
performed a`t a(DE'P c'ei tifi. d laboratory,for coliform bacteria and volatile organic
indicates.-that; well'is free pollution from that facility and the presence of ammonia
iiitrogen.ar>d.iiitr ate;.nhogeii,,is equal to or less than Sppm,:provided that no other failure criteria
are triggered.-ed A copy of the analysis must be attached to this form:]
�'. `z4.ttl'Fit'ladCl(l;l +r:.31({tl.lCl t17dS r '�5911'fttl�i�l+ti -
No i(YesmTo)<The systein failsi Irhave deternuh6d that one or more of the above failure criteria.exist as s
described in 310 CMR 15 !03,therefore the system fails.;:The system owner should contact the Board of
' Health to determine wliat will be necessary to correct the failure.
E. Large Systedri l;; >> ; vi v ,.ter
To-be considered a lar gegsystein;�tlre system 4iiust'serve a facility with a design flow of 10,00.0 gpd.to 15,000'
gpd. xf1, tip
You_must,ind{cate.either yesl'on.`1noriEto:eachitof the fohowing:
(The following critena.apply tol,large system'g in addition to the criteria above)
ti. UIII 5!l tt 11
Yes No C o{.y i csl i; 5.1
theisystein rs 1witlim;-4001 feet ofa surface drinking water supply
ahe systein rs lWitlun 200 feet of a,tributaiy to a surface drinking water supply
thedsyster7iiis located.ip:a,nrtrogen sensitive area(Interim Wellhead Protection Area-.1WPA) or a mapped
Zone Ih.ofia:publiccwater suphly:well
({i�,,{
If you have answered:i yes'<<'tfo an}�„questioiilm Section E the systein is considered a Significant threat, or answered
yes"in Section Diaboveitlie'large system�has`failed6,The owner oi`
operator:of any large systein considered a
significant threat Lihder.�Se,:t{on L-.6.failed uftaer S.ectioii D shall upgrade the system in.accordance with310 CMR .
15.304. The system ownerishould contactithe gal propriate regional office of.the Department.
a� i{'lt_t�:rrC,{ .•::', d.rtdi;t"tel lLr:a{t.•�,{f
ttt 1 11a,, r~ld3 E' iis, t
_iL.Y'-11'att .
j , +lil, ftu,41t'c fat's `t lis t l I € p'
r
Page'S of 11
OFFICIAL,INSPECTION FORM- NOT,FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGEDISPOSAL SYSTEM INSPECTION FORM.
}' PART B
t CHECKLIST ;
Property Address:" 314 Old Rlill Road:
a Osteiville, MA
Owner: John Moraites
Date of Inspection:• `' Novernb6-1;'2'012
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 system components pumped.out in the previous two weeks?
✓ Has the system received normal flows in the previous two week period
r—+e r�'�✓:i Have large volumes of water been introduced to the system recently or as part of this inspection?
✓ Wei eyl as Uuilt lans,`of the�syste/mgobtained and examined? (If they w re not available note as N/A)
,�i,i l� p � '�-• l T,F{i � •.
✓ Was the facility"or dwelling inspected for signs of sewage backup
Was the site inspected for sighs of.break out?`
!✓ �1 I 1 :Were all system:components,excluding the SAS,located on site?
� 1 •
t✓ii 1r[it :_ Were the se ptrc tanksmaiiholes.uncoyered,.opened,and the interior of the tank inspected.for.the condition
of the baffles orifees,>iiatenal of constructrori;dimensions,depth of liquid;depth of,sludge and depth of scum
✓�cr !I i1 rloWas the;facrhty owner (and occupants if different from owner)provided with information onthe proper
maintenance of subsurface sewagedisposal systems ?
a
If!)•6 7lli:r'.Irl 9i11,v,t" n'17.nuff.The size and location of the Soil Absorption System(SAS)on_the site has been detennined based on: .
--- -- - ��`°lam n!;' toy l, '?�i(:11Y•-l( 1 i7r3Lt:}file.-.. .
Yes No
_✓.. Exist hg infoiinatron+ F6hex'ample;'a plan at the Board of Health.
✓..: Determined male field'(if(any.of tie failure criteria related to Part C-is at rssue`approxmatiori of distance
is unacceptable) [310 CMR 15:302(3)(b)].,
t..l. f 4P1 fllii{?
ttiF -
e'tylt ti,
5
lallll 191i{; l �` r rt4 t:.;�ri l rf.""! l Ll
l'tl (zs_;lanfii 1tf,Q.ktklCullI.111 tlsa : 9,a4{
c
Page 6 of 11
OFFICIAL INSPECTION'.FORIVI•-NOT FOR VOLUNTARY"ASSESSIVIENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 319.01d Mill Road
Osterville'MA
Owner: John Moraites
Date of Inspection: November 1 2012
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):,' 5 "Number of bedrooms(actual). S
DESIGN flow based on 31 O,CMR 15.203 (far exam ple:.I 10 gp,d x#of bedrooms) - SSO
Number of current residents: 0
Does residence have a garbage grinder(yes or no): N/d
Is laundry on a separate sewage system(yes of no): N/a [if yes separate inspection required]
Laundry system inspected(yes or"ilo): no
Seasonal use(yes or no) no
Water meter readings, if available(last 2 years usage(gpd)): ;'Unavailable
Sump.Pump(yes or no): No
Lastdate'of°occupancy: Urrkrrown
. W .
COMMERCIAV/rINDUS;TRIAis
Type of establlshnient: a' 7 f I.i+
Design flow(based on 310(MR 1.5.203): - gpd';
Basis of design flow(seats/persons/sq/ft etc.):
Grease trap present(yes or no).
Industrial waste holding tank% present(yes or no)
Noii'saiiitary�vaste'discharged to-tlie Title!5 systdin Eyes or no):
Water meter readings,if available._
Last date of occupancy/use:
I t v'.0,1 tl
OTHER(describe) 14
NAsGENERAL INFORMATION:''
P'til]iphig'1�Records'I r'I `)i o,l Tl'•`,' t tr,)',k14 (.,;;?1'll7
S'ounce.ofkiiffonnati"on�u jr-;U»civdi,l'able
Was:systeni ptiniped as part of(theinspection,(yes)or no);
If yes,rruoluiile pumped I <L` ' Ar .. >galloiisg How wasquantity pumped determined?.
Reasoiilfor,pumoing.I
TYPE OF,'SYSTEM 1 i E!!l thf i lij�t ._<
✓I i4 1 Selitic tank,dlstrlli...60 i Uox,soil absorption system
.,rl;"Siil`gle°cesspool.
Overflow cesspool
$haled system(yes of no) (!f yes,attach previous inspection records, if any)
I c:a«'u Innovative/,Altelnahve,teclinology.. Attach a copy of the current operation and maintenance contract(to be
olitaviied fuo it system bwner)I c .z k Jq/l,,wt
t ! Ti'g1itlTank' ,l. "1'Attach a copy of:the DEP approval
Appi`oxunafe age of all c'oiipotieilts,date in (if known)and,source of inforiiiation:
Date ofh tallation•12/9/05 per=aslbuiltcard
Were sewage odors detected when arriving at the site es or no No
(y )
- •.fx -
Y1 .. ..
1 t. ti. I
$i --- 6
_ t,ll ..
1Nt)hfli 6�;+_
1l tl
i� ;If.�,a;;1tii}ftlld:� y);ral'1'1�t I}'C' ( t,l.;.tald I �r(`• Li Ili:
I ,
Page 7 of 11
s:
' OFFICIAL IN4SP EC TI ON.; OrY
RM _
. NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C,
SYSTEM INFORMATION (continued)
Property Address:. 314 Old Mill Rocid
Osterville, MA`
Owner: John Moi cites
Date of Inspection: November 1, 2012
BUILDING SEWER(locate on site plan)
1 _
Depth below grade:
Materials of construction: cast iron 40 PVC other,(explain):.,
Distance from private water supply we or suction line:,
Conunents(on condition of joints,venting, evidence of leakage;etc.):
' E
ShPTIC!T-ANK: ✓ (locate on site plan),
Depth below graade:l�4"'hiN: M
Material of constr nuet}o L ✓ concretes ,c a metal _. fiberglass _polyethylene
_other(explain) * '
If tank is metal list age: Is age confirgied by a Certificate of Compliance(yes or no): (attkh a copy of
certificate) ;1:1 {
Dimensions: : 1500 eal.
r
Sludge�depfh"ri 11,�;, 2,, t ii;'t l r '�'�ac
Distance from top of sludge to`bottomlof_outlet_tee_orbaffle: 30"
Scuzn'thickness:.
Dismnceafrom top'of scum to toptof outlet te'e'of baffle 6"
Distance from bottom of scum to bottom of outlet tee or baffle:, 10"
How were dimensions deteniiiried: MeasuriraQ stick
at T
Comrnent's(on pumping=trecomriendatzons;uile6 and outlet tee or baffle condition;structural integrity, liquid levels
as related to'outlet invert,evidence'ofleakage,etc.)
Th teesover e`p eseim -The liquid level was even wiih the outlet invert. There did not aypear to be an))signs of leakage
l'\ .:
GREASE'zTRAPz'}'lllone'(locate'`on site.plan):sac : .
Depth below grade:~ - - -
Material of construction: `. concrete _metal . fiberglass`_"of eth Y lene" ,other
P y
(explauz)`. R I:, r.
Dimensions: 1
Scun1Nhi6kness lair.;
oito o fDistane f scun-tuom.top ofoutlet i6e or baffle;
Dsn fm bottom of sct r
to vottom of outletaee or baffle:
Dater of last pump:ing:..
Conz mcnts}(on pumping recommendations, inlet and outlet tee or baffle condition,structural`integrity,liquid levels
as'irelated to.outlet'ilvert,.evrdeiice of leakage,.etc.):
2 s
� k:;ti "l,t.?'I . �S.:.f I�.t,ir.(! i.l'-t,i'"I:ite�f,l6i';II._,. .i'.�('1'1•,
1.[L;� } ,d F,z1,lrs,i.il�
l 1 'ti La 31_ 1A{1:31 1. .
{�al•��: li i 3�.4.�§U�r u.7 rsl'.'('l t .'_'riii}j �� 11 1 (��Il � i�� _. -. .. -
1,I'l
d
Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
! SUBSURFACE WA;SEGE.D.ISPOSAL SYSTEM.INSPECTION FORM
PART C
SYSTEM-INFORMATION
Property Address: . 314 Old Mill Road
Ostei-ville MA
Owner: John Moraites z
Date of Inspection: November 1 2612
TIGHT or HOLDING TANK: Mone (tank must be pumped atr time of inspection)(locate on site plan)
Depth below grade:
Material of construction:- concrete' _metal _fiberglass polyethylene _other(explain):'
Dimensions:
Ca acit
P Y gallons,
Design Flow- gallons/day
Alarm present(yes or no):
Alarm level. Alarm in working o]der(yes or no).
Date t of lasf lumping:..
Continents(condition of alarm and float switches,etc.);
r
,. 4 11,,: LFI i 1._ta 1 q °';'I' '•d, I.' ��]s�.i'J�il`al�lra
... ::....Mt 1��4.�lA!'� .-i F.} t�' :,:.`�, �i t.� �'I:�..ls .'.•. .. .. .. -
DISTRIBUTION• BOX:. ✓ '(if present mLst`be opened) (locate on site plan)
de'ptli"ofliqu0T6vel above.oudeCinve f,11.LEyen't:,
Continents(note if box is level,!and'_distiibution to.,.outlets equal,any evidence of solids carryover,any.evidence of
leakage-into.or out of box,etc) ...'_'1!
!'i)1'a)1'4�
isaz+ .h tttt' h!
PUMP CHAMBER: None. (locate on site plan)
ps!in workingt'o]d'e)f•'(yes oriio) 1 1 ly .irl
Alamis-in.working,.order=.(yes or.no) _
Coirunents(note.condition,.of.pump chamber, condihori of pumps and appurtenances,etc:):
Lt:iin $t.iic_d]I I t'i Gli Lt
I€:tr} I VC11) i,i I (,
ov 1 L+iliifk 'ul,l'i1�.1 .-`}r]11
1�111113kl �;.�11f11�,'..:_ rlf ] Irsib• til.
1 �F��I]
'LTL 1:'INO111 d! ltl tlt ,: tlt
.. _ k
1 1�,a:d1= ,+ 1 I�f t7:7a P it•(' s }i:"it ii
�I tt.lii'1� t�a t.'u N!to:�,
,1Cj I11N t] \y? 11. I Y,lZ+t411 to(5r S Or 0)
Page 9 of I 1
f
OFFICIAL INSPECTIO'V FORM- NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE.SEWAGE;DISPOSAL,SYSTEM INSPECTION FORM
PART C
. SYSTEM7 INFORMATION (continued)
Property Address: 314 Old Mill Road."
Osterville MA
Owners John Mv}aites".,
Date of Inspection: Noveinber 1 2012
SOIL ABSORPTION SYSTEM (SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why: `.
Type
leaching pits,number:
✓ leaching chambers,number: 19 iij Itrators with stolze 14 67'r 59 38'Per as built
-.
E'' r"'leacling galleries,number
leaching trenches,number, length
leaching:tEe`ldsr,riiimber almens onsat:IC's ,
overflow,c&oq'oa;nulilliel I,t; y II .
Imlovative/alternative system Typ'e/name of tecllliolog'y:
Continents(note condition of soil, signs of,h}dlaulic failure level of ponding,damp soil condition of_vegetatoli;etc.):.
.01 1�fl:,l �... ) )
771ere did not a "ear"to be ai si is o ,aihile ron!nl lltrators.
^ - t
CESSPOOLS: None (cesspool mustbe pi iuped as part of inspection)(locate on site plan)
Number diid configuration:.
Depth- top of liquid to inlet invert:
D.dptfi oE's'ohds
, l
Depth of scum laye> � �� w
Dimensions of cesspool;
Maferials;of tons truaioll
cation of >ouiidwatei inflow
Indication g _(yes o> no)"_
Continents."(note condition of soil;signs of hydraulic failure, eve of ponding, condition of vegetation,et )
PRIK Y: IkNdnei?(locat66n site plan)
5. 3
il'Ir lib 'I -
Mate>gals bficbhl pl]ctlolu t 1 171 -:..[t `1 41.a 11!,
DunenSioils: lari. `31'al:..�llll.t �l,.l.e'�lk�),�t7�:t=lti � ' .: _
Depth of so.11ds,.J,,,.r,r 1 l)it.,a.. i-li(,I I kif�r, -
Conu_uents;(iiote cond4iQ11,of�soll;.signs of,,'hydratilic,failure level of ponding,condition of vegetatlon;.efc:):
1.:Il;i1J l•I. :1'::i 11 It .:ill 4ti 111nt1�.lii C''I'i ''S 9.1 ..1',I'�..i •,i 1..4., r..., - - -
7.
Il
ht;.�i ti` _ IIR{ _:( ' "chi ltit�i :t'I) 1 •11,`r t t -. _ .-
(I+all .31 'Seri d:114A1�}ify
-
1
-
L
1 k
�.i1"I�III,d'{.1t:d f,T-TI[�,a> 111:init :.I ,. I c ,r, :-,;I 1 I:•.. !'. - _
Page 10 of 11 ar..
OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART G
SYSTEM INFORMATION (continued)
'Property Addre
ss:
31 4� Id a Rokll d"
Osterville.MA
Owner: John Mor kites
Date of Inspection: November 1 2012
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at,least two permanent reference landmarks or
benclunarks. Locate all wells within400 feet Locate'where public water supply enters the building.'
}
{C'41
id
t t t
1®71l j.;� �..�.... {r)C l�..i. Xx)F� �• ,,. 4
1ti nJl1 ( 11 1lt{{)) k., jF FBFQ, Jia�r ;' ) I@lill4 l + IL
-
3$
A 3 oo
.. 6 -
t L
D ti
rF
44 4m .:
10
Page 11 of 11
OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
' SYSTEM INFORMATION (continued)
Property Address., 314 OId Mill Road
Osterville.MA
Owner:' Johit Moraites x
Date of Inspection: November 1, 2012 R
SITE EXAM ,
Slope ;.
Surface water
Check cellar
Shallow wells
t; 1
Estimated depth.to ground water 40+/ feet
Please indicate'(check) all methods used to determine the high ground water elevation:
1' f Obfalined from system design plans on record-If checked, date of:design plan reviewed: .
Obseiwed site(abutting property/obseiwation hole within 150 feet of SAS) .
✓ Checked'wrtha'ocal Board of Heal°th explam:F Toyograyhic atZd water contours)naps
Checked w>th local,exca'vators,installers.=, attach documentation)
Accessed USGS database-explain.
You must describe how you established the higlrground water elevation
(ill l JI ill .IH,
IJstrzQ B'arnstabh topoly. i1c ai d water contottt�s t�iaps�tlie tiiaps were sholviiiQ aypr-oiiiiiately 40 +/ to zr ottnd water at this- ,
li
site. _- -
dlihl
u r!
ti,';,.1111a1 tf�i,•L141! h,!::1 lPnIt.IL: 1t4ri�l'
t.itd;ltd:=.'
This report has been prepared only for the septic systeri`l and components described herein. This septic system has been
iiispected:and passedtasloff.;the dater,ofirnspection.",This-i. -tis not:a i'varranty or guarantee that the system will
Allctron pIpper ly iiilthe f rtu, e t Ther;e�have;bee;lno ivari anfies or.guarantees, either e_p'essed, written or implied
r;eladng to;the septr,clsy stem:I&uispec[ron'kthas report and/or rimy components of the septic.sj;stem which have not
been located.and inspected
j
i
3
9
NEW ENGLAND ENGINEERING SERVICES
INC .
January 4, 2006
David Stanton
Barnstable Board of Health
200 Main Street
Hyannis, MA 02601
Re: 314 Old Mill Road, Osterville,MA
Septic System As-Built Plan Submittal
Dear Mr. Stanton,
The following Septic As-Built plans for the above referenced property are being submitted for
approval.
Enclosed are the following:
1. (3) Copies of the Septic System As-Built Plan.
2. Form 3 Certificate of Compliance (to be completed by your office).
If the Form 3 Certificate of Compliance is not required, please disregard and discard the partially
completed form.
Please contact this office with any questions or concerns.
Sincerely,
Thomas Hector
Project Engineer
cc: Homeowner
60 BEECHWOOD DRIVE-NORTH ANDOVER, MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099
000,
i O v�IN OF B STA.B LE EC_ 4
+1v,0CATi0*
iN _ l/V e e U r� ' SEWAGE
"4'IMLAGE ✓l l—f/f ASSESSOR'S MAP & LOT Z
INSTALLER'S;NAME&i?HONE NO. �� a�Ol/ /,
SEP-11C TANK CAPAC=, /5'
LEACHING FACIL=: (type) I9 �1//f ��j`®r'S (size)/y , 5 3F /
NO.OF BEDROOMS
BUILDER OR( •,X10 rj�
a5
PERMITDATE: 2, —%e3" COMPLIANCE DATE: 1 °
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
01
4 3 76 ` �.
67-
o r �
� p
No. �U Fee
THE rOMMONW,EALTH OF MA16SACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
Z[pprication for Wgpool 6?5tem Construction Permit
Application for a Permit to Construct( , )Repair( )Upgrade(A)Abandon( ) XComplete System ❑Individual Components
Location Address or Lot No. 314 018 AA kl � Owner's Name,Address and Tel.No.
oSferv,lletMA Jctin M®ra,t�s
Assessor's Map/Parcel (��a e AR o"�
Mcc 1Yd, Lot 63 Noy+ A veP A o s a-7 q,s-ao`�`�
Installer's Name,Address,and Tel.Nora Designer's Name,Address and Tel.No.
lJ7`-1 C_/, 5 /Uew en land En�`�\heei in9 SecvIce5
G 60 &eec'Wo. �ve
o h v o 72 6, Lam- 1768
Type of Building:
Dwelling No.of Bedrooms �J Lot Size $q 9 sq.ft. Garbage Grinder(No)
Other Type of Building 1e_ 2 iden'(T�e No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design.Flow gallons per day. Calculated daily flow -e llons
Plan Date Sahu c&v I�,a0 Q 5- Number of sheets o� Revision Date rtV=0 -(�(
Title &0,,sck '),L,ri0,CP D5psal Dld AN Rod, Osf-V` e' Ph-
Size of Septic Tank ISoO &,J(n,n Type of S.A.S. L-eac.k _T'ev�Zhes
Description of Soil: 5e�n r nd Form k 1 Skc t!;
Nature of Repairs or Alterations(Answer when applicable) f�eT Pr-�if-e S V 1+e"n ahA C_t?yv�na�yt
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 Certifi-
cate of Compliance has been issued t i Bo of Ida h /
Signed _Date jV
Application Approved by rZ&_ Date a /5- G
Application Disapproved for the following reasons
Permit No. aGd S-0, j Date Issued AS
q.
No: C� 3 i Fees /2y
a� -�HE.f.:OMM_ONV�IEALTH OF MAAC:�I ETTS t, . Entered o neuter:
PUBLL . HEALTH DIVISION - TOWN BARNSTABLE, MASSACHUSETTS 1f
_. C .
Application for ;Dioponl *ps temp, Cottgtructiott Permit
Application for a Permit to Construct( , )Repair( )Upgrade(�()Abandon(( ) X Complete System ❑Individual Components
b� ,
Location Address or Lot No. 314 O Ic1 M,0 1 oa� Owner's Name,Address and Tel.No.
t. OSier-v�Ile�M/t J'chh M0ra,ie�
Assessor's Map/Pazcel ` b 8 Pi„e pi de l ow� B 1 S-a oq-4
N1a N1 Lot- 63 Nor4 A��per A 018 7 9
Installer's Name,Address,and Tel.No. �,�,, Designer's Name,Address and Tel.No.
(.v�5� 6 et nglandP�%Ve
hetf�n� 5ervic.aS
�f O eec te o
o02� t, 6- 1768
Type of Buildin : rOoP,A rV 4: Y 1>-A .�1,I
Dwelling . No.of Bedrooms Lot Size gol 9q sq.ft. Garbage Grinder(A/e)
'Other Type of Building_ t2e PA4i No. of Persons Showers( ) Cafeteria(
Other Fixtures
Design Flow gallons per day. Calculated daily flow --gallons
Plan Date TM\Uat v 111 ,ann5" Number of sheets Revision Date o3� 1
Title �c��<P� S��Si�r�race_ .iaa� /I�aSa( 5x5 W1 �)y od / ;jj Roa , 05femile M'A-
Size of Septic Tank I.SU o Asa I(rg Type of S.A.S. L Qa c k -_Tr&►n L h es
Description of Soil �_Qs h
Nature of Repairs,or,Alterations(Answer when applicabl e Akt-e S y5-Few, arA COwinod�vt-{S
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 lace the system in operation until a Certifi-
P P Y P
cate'`of Compliance has been issue by thi Board,of � lth. -
�2'/ ,
Signed_ � - -- -�
t � t
� �..� Date_ Z/�S
Application Approved by _�a� ' �L N f�`S. Date �9//S 6
Application Disapproved for the following reasons
Permit No. DO n S-U Date Issued / :70
rilC CVIYIiYiVNWGFiL1"i9 OF IYIMS:J/1vi'iVvG i i S
BARNSTABLE, MASSACHUSETTS
Certificate i of Comoliance
THIS IS TO CERR Y, that the On-site Sewage Disposal System Constructed )Repaired ( ) Upgraded( )
Abandoned( ) y !`7`�ID �/
at 3/Y Old wia 1/ I—ed cs Lulle has been constructed i accordance
with the provisionsfTitle 5 and the for Disposal System Construction Permit No. ru s^-OS 9 dated ? /S u.
Installer C!�r V-c:)�04 Designer a-
The issuance of this permit s/hall n�°.t be construed as a g uarantee that the system
Y stemwil \'yf �\et on as designed.
Date -/ �? l ' Inspector _ J �
No. 2 U S 'U S-61 Fee =
r
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Diopoof *pgtem Cow5truction Permit
Permission is hereby granted to Construct( )Repair( )Upgrade(x)Abandon( )
System located at 3 l t� o A/ �r le _
i
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of tht e t.
Date: Approved by '�� �`- J� S• _._
`j V
1 - -
02/13/2006 12:00 9786851099 NEW ENG ENG PAGE 02
SENT BY: BORTOLOTTI CONST; 50A4289399;. ,. FEB-10-06 `8:45; PAGE 2/2
Town of Barnstable
Regulatory Services
rv,ces
a Thomas F.Ceiler,Director -
Public Health Division I
Thoiaaa McKean,Director
200 Main Street,n YanQih MA 0260
Of m. 508 862,4644
Fax; 509-790.6304
JuWl FLA
Designer Ce on i
Dwe:
lgr>ter: ri 13�t.v (f C�0.uR Installer: �g
res®• emu, a r .�;p �W�i� Zl Address: ,�
(FO E 1. 1,✓coa Q rz,w.c- ,Q
x � Rti�DJuC/L �% I
( t ) (installer)
c at wes issaed a 't to install$
s 4l .Gf� v��t • basedcc a de
(ad ss) ex drawn by,
slated
0
I c 'fy that the septic system referenced above was installed sub
th dI'S st>�ntially acco to
gn, which may include minor approved changes such lateral relocstioa of the "
button box and/or septic tank
$ter ftban that th $eptic systeto referenced above was install with por ct�ges i.e.
lateral relocation of the SAS or any vertical re o�ho�of airy component
septic system)but in accordance with State do Local Re liPlan revision tin
ed as-bLdlt by designer to-follow.
OF
(tn er'8 ipiffii )
�i. BEN AMIN C
- ' OS OOD,JR{ y
r� X 8C7 (j
MARU a E P sS� NAL��
A T U
L
A ,
Q: ,eslth/9� 'cww,*gncr cwdj ca-ton Pamn
i
Commonwealth of Massachusetts
City/Town of Osterw%Ile
Certificate of Compliance
r Form 3
M I
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with
the local Board of Health to determine the form they use.
This is to Certify that the following work on an On-Site Sewage Disposal System
Important:
When filling out ® Construction of a new system
forms on the ❑ Repair or replacement of an existing system
computer, use ❑ Repair or replacement of an existing system component,
only the tab key
to move your
cursor-do not Has been done in accordance with Title 5 and the Disposal System Construction Permit(DSCP):
use the return
key.
DSCP Number DSCP Date
John Moraites
Facility Owner
314 Old Mill Road (facility location)
Street Address or Lot#
Osterville &AAA MA 02655
City/Town OFS qc State Zip Code
S
Designer Information
BENJAMIN C.
Benjamin C. Os oo , P.FSGOOD JR. New England Engineering Services, Inc.
Nam CIVIL Name of Company
N0.45891 /y/o�
Signatu 0, �FGI57E�0 ��'� Date l
Installer Information: FSS/ONALE�G\�
Name Name of Company
Signature Date
Use of this system is conditioned on compliance with the provisions set forth below:
The issuance of this certificate shall not be construed as a guarantee that the system will function as
designed.
Approving Authority ,
Signature Date
t5form3.doc•06/03 Certificate of Compliance•Page 1 of 1
b
NEW ENGLAND ENGINEERING SERVICES
INC
November 29, 2005
David Stanton
Barnstable Board of Health
200 Main Street
Hyannis,MA 02601
Re: 314 Old Mill Road,Osterville,MA
Revised septic system design plans.
Dear Mr. Stanton:
Enclosed are 5 copies of revised septic system design plans for the above referenced
property.The changes include a revised tank and building sewer location. The changes
were necessitated by the inability to service all of the basement plumbing through one
building sewer.
If you have any questions or comments regarding these revisions please don't hesitate to
contact this office.
c�
Sincerely, � C
n
Ck
/od,
BenjaminC. Osgr., P.E.
President
— r
CC: John Moraites —j M
Bortoloti Construction
60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099
Barnstable Assessing Search Results Page 1 of 2
Home: Departments:Assessors Division: Property Assessment Search Results
314
Owner:
ANDERSON, IRVING E Property Sketch Legend
Map/Parcel/Parcel Extension
142 /063/ 9i tl
Mailing AddressANDERSON, IRVING E
.:.�...:. G % r.,?...
ANDERSON, MARION F
PO BOX 139
�Yw
OSTERVILLE, MA. 02655 F>
3.
2005 Assessed Values:
Appraised Value Assessed Value
Building Value: $114,400 $114,400
Extra Features: $2,500 $2,500
Outbuildings: $0 $0
Land Value: $213,400 $213,400 Interactive Property Map: ap requires Plug in:
Totals:$330,300 $330,300 I have visited the maps before .
Show Me The Man
April 2001 photos available
Sales History:
Owner: Sale Date Book/Page: Sale Price:
ANDERSON, IRVING E 1479/784 $0
2005 REAL ESTATE Tax Information: Tax Rates: (per$1,000 of valuation)
Land Bank Tax $59.95 Town Fire District Rates Other I
$6.05 Barnstable-Residential $2.12 Land B.
Barnstable-Commercial $2.80
C.O.M.M. FD Tax(Residential) $333.60 C.O.M.M.-All Classes $1.01
Cotuit FD All Classes $1.28
Town Tax(Residential) $ 1,998.32 Hyannis-Residential $1.52
Hyannis-Commercial $2.39
W Barnstable-Residential $1.44
W Barnstable-Commercial $2.10
Total: $2,391.87 Due to rounding differences these values may vary
http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessin C._ �I�:/25/2�005"--""_)
Barnstable Assessing Search Results Page 2 of 2
4
Land and Building Information
Land Building
Lot Size(Acres) 1.01 Year Built 1971
Appraised Value $213,400 Living Area 1138
Assessed Value $213,400 Replacement Cost$ 136,162
Depreciation 16
Building Value 114,400
Construction Details
Style Ranch Interior Floors Carpet
Model Residential Interior Walls Drywall
Grade Average Heat Fuel Oil
Stories 1 Story Heat Type Hot Air
Exterior Walls Wood Shingle AC Type None
Roof Structure Gable/Hip Bedroo�s722�BeddroomsRoof Cover Asph/F GIs/Cmp Bathroo
Total Rooms 6 Rooms
Extra Building Features
Code Description Units/SQ ft Appraised Value Assessed Value
FPL1 Fireplace 1 $2,500. $2,500
Property Sketch Legend
BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished)
BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished)
CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area(Unfinished) .
FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished)
FCP Carport GRN Greenhouse UUA Unfinished Utility Attic
FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished)
FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck
FOP Open or Screened in Porch TQS Three Quarters Story(Finished)
http://www.town.bamstable.ma.us/tobO2/Depts/AdministrativeServices/Finance/Assessing... 1/25/2005
ND OlOiN46es-) Sfi'/�L.;
orV �
NEW ENGLAND ENGINEERING SERVICES
INC
January 17, 2005
David Stanton
Barnstable Board of Health
200 Main Street
Hyannis, MA 02601
Re: 314 Old Mill Road, Osterville, MA
Septic System Plan Submittal
Dear Mr. Stanton:
The following plans and enclosures for the above referenced property are being submitted for
x
approval. s
1. (2) Copies of the Septic System Design Plans.
2. (2) Copies of the Soil Suitability Assessment for Sewage Disposal.
3. Check for payment of the Town approval fee.
K
Please contact this office with any questions or concerns. ,
_g
Sincerely, i
Thomas Hector
Project Engineer
60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099
y Town ®f Barnstable P# �U
°E Department of Regulatory Services
•�' Public Health Division. Date l� o
,�ntvareet8, -
� � e� 200 Main Street,Hyannis MA 02601
s639.
plED MIS�
1 () i t ti
Date Scheduled S Time I M Fee Pd,,t .�ll0
l R
Soil Suitability Assessment foi Sewage isp®sal
ate- w_
Performed By: .�E rl tQvv\1 O 4�o 0 1r, Witnessed By: /
LOCATION&GENERAL INFORMA IONJ�ioratfes 5��
Location Address
Aaaress5a
Pint- R;1g e
. ;Z�w��,/Uor��t a er M►� o/
1 tt Engineer's Name/)VL J V1114n A Engine<r
Assessor's Map/Parcel: I Z—o l�3 &
NEW CONSTRUCTION X REPAIR Telephone# q'7 8 6 (d - 17 8
1�
Land Use—Res(d e u�Tt a( _ Slopes(%) — Surface Stones
Distances from: Open Water Body 1100 Possible Wet Area D 0 ft Drinking Water Well 2 O ft
Drainage Way gDc) ft Property line J� ft Other ft
SKETCH[:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
Qf '
Parent material(geologic) FrV1L a( OtA U-W.A Depth to Bedrock
Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face
Estimated Seasonal High Groundwater
DETERMINATION FOR SEASONAL HIGH WATIER TABLE
Method Used:
Depth Observed standing in obs.hole: — In. a •th td soil tt7o Observed• ;n, .
Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft.
Index Well# Reading Date: Index Well level moo,. Adj.betor— Adj.Groundwater Level—
E�
PERCOLATION TEST ngtp �a os .A,h„p �o��FS
Observation I „ �;pS
Hole# Time at 9
Depth of Perc h g Time at 0' 1' 7
Start Pre-soak Time @ 101. Time(9"-6") ^�
End Pre-soak
Rate MinJlnch a I�Pt t
Site Suitability Assessment: Site Passed 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:\SEPTIC�PERCFORM.DOC
1
DEEP OBSERVATION HOLE LOG
Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.)
(USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistent % ve
n
Fr:L S able,
b — /�a55iv� Fr—lk
]^ S
a a.5 — 1�assr✓e, C <t)e.
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
on istene %Grave]
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consisten 95' Gravel
DEEP OBSERVATION HOLE LOG Soil Other
# Other
Depth from Soil Horizon Soil Texture Soil Color
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
onsiste ra 1
Flood Insurance Rate Map:
Above 500 year flood boundary No— Yes-
Within 500 year boundary No_ Yes
Within 100 year flood boundary No____ Yes
Depth of Naturallv Occurrinff Pervious Material,
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system? YL --
If not,what is the depth of naturally occurring pervious mat®rial?
I
Certification
I certify that on .N 0 I el 5,L (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
the required.training,expertise and experience described in 310 CMR 15.017.
Signature Date l <7 0
Q.\SEPnC�PERCFORM.DOC
Town of Barnstable P# -
°� Department of Regulatory Services
,,, ,,, , : Public Health Division.
Date u
200 Main Street,Hyannis MA 02601
Date Scheduled V l �- 0S . Time I I I1M Fee Pd. Y>
Soil Suitability Assessment for Sewage isposal.
Performed By: . Q o �'r,• Witnessed By: 4J t>✓� W. J r' � '`�.
B" - 4, o Y
LOCATION&GENERAL INFORMA O 'Mora'i+eS S��►
Location Address 3 f U VLn� + Owner's Name =3u V! J
Address. ?"Al R`�ge �Ornc,
l
� Engineers Name�Q W
Assessor's MapPan;el: 9( d En one<r
yy' Telephone# q 7
NEW CONSTRUcnoN _L___ REPAIR
11 Surface Stones
Land Use �QS��2y�T�a� - Slopes(96)
Distances from: Open Water Body i l 0 0 ft Drinking Water Well
O ft Possible Wet Area 7 I50 ft
Dtaina a Wa g00 ft Property line Ja ft Other ft
g Y
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
C' L r>
Parent material(geologic) !u( Depth to Bedrock -
Depth to Groundwater. Standing Water in Hole: Weeping from Plt Face
al High
water
Estimated Season Ground
DETERMINATION FOR SEASONAL HIGH WATEIr TABLE
Method Used: ln. a th to soil tno /done Observed _-in.
Depth Observed standing in obs.hole in, Groundwater Adjustment tt
Depth to weeping from side of obs.hole: Adj.draandwater Level
Index Well# Reading Date: Index Well level AddCtdr;.,
PERCOLATION TEST Dr;te ,a o.s Time
Observation I 'Time at 9" 11 ..
Hole#
Depth of Perc h I 1$1 Time at 61' -0 7 .-
Start Pre-soak Time @ ��% 'ISme(9"-G") tv\i`� -------•—
Had Pre-soak 11
Rate MinAnch a mPx
Site Suitability Assessment: Site Passed
Site Failed: Additional Testing Needed(YIN)
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.
\SEPTICIPERCFORM.DOC
1
DEEP OBSERVATION HOLE LOG.
Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
(USDA) Other(Mansell) Mottling (Structure,Stones,Boulders.
Surface(in.) Con is %G e
s YIZ a a - Sabk , Fr:able
O-C,
�6 - /�abs�ve Fr•<lo�
1- 5 �o R
N a.s
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture
Soil color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders-
surface 'sten vet
DEEP OBSERVATION HOLE LOG Hole#
Soil Color Soil Other
Depth from Soil Horizon Soil Texture SMunsell) Mottling (Structu Stones,Boulders.
Surface(in.) (USDA) ( (Structure,Stones,
% 1
DEEP OBSERVATION HOLE LOG Hole#
Soil Color soil Other
Depth from Soil Horizon Soil Texture
(Munsell) Mottling (Structure,Stones,Boulders.
Surface(in.) (USDA)
Cani
Flood Insurance Rate Map: YY
Above soo year flood boundary No_ Yes
within 500 year boundary No_ Ycs
within 100 year flood boundary No Yea
-Material
Depth of Naturally Occurrins7 Pervious
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the .
area proposed for the soil absorption system? _..._...�-. -
If not,what is the depth of naturally occurring pervious material?
Certification
i
k (date)I have passed the soil evaluator examination approved by the
I certify that on
tection and that the.above analysis was performed by me consistent with
Department of Environmental Pro
the required.training,expertise and experience described in 310 CMR 15.017.
� . Date ! !7D
Signature
Q.\SEPTIGV'ERCFORM.DOC
CEi1TERVILLE-OSTERVILLE-MARSTONS MILLS
FIRE DISTRICT
1875 ROUTE 28
CEBTERVILLE, MA 02632
(508) 790-2380/FAXa(508) 790-2385
OILIHAZARDOUS MATERIAL RELEASE FORM
F.A.# 9 7 /=- <Z 7
LOCATION:
ADDRESS OF RELEASE' XC
—CZ.z
DATE OF RELEASE:!�Iu <✓ iZ
PRODUCT RELEASED:
ESTIMATED QUANTITY: r,r.P'
CORRECTF4E ACTION TAKEN BY RESPONSIBLE PARTY:
NOTIFICATIONS:
FIRE DEPARTMENT: YES( -)'"NO( DATE: 7-cl s 7 TIME
NATIONAL RESPONSE CENTER YES(d-NO( ) DATE: z.v- TIME: ra c I- i
DEFT.OF ENV IRON MENT AL PROTECTION YES(,e),NO( ) D ATE: TIME:.4,LL
OIL SPILL COORDINATOR: YES( ) NO( ) DATE: TIME
TOWN BOARD OF HEALTH: YES(,.) N ) DATE: i4_.Zs ti TIME ALL;
TOWN HARBORMASTER: YES( ) NO(, DATE: TIME:
OTHER AGENCIES:
COMMENTS: /4,,/, _, d:�r.. T h� r / fr--.11.
cd
REPORTED BY: f ' L �, l,n i cl DATE: 1, �
WHITE COPY-FIRE DEPARTMENT YELLOW COPY-D.E.P. PINK COPY-BOARD OF HEALTH
C-O-MM FORM58
"1� i
T(: : T. T; T ;,; : .T , i�,InECTCR (.;F HEALTH
RE: HCME 'TING #2 OIL LEAI'i AT 915 OLD MILL RD.OSTERVILLE
DATE: DULY 4,1997 (HOLIDAY)
FROM: EDWII RD F.BARRY,IT�I)PEC'TOR
I was called at home at 8 :50 pm on July 4,1997 by the COMM
Fire Deptibout an oil spill at 315 Old Mill Rd.Osterville.
I arrived about 15 minutes later at the home of Hr.and Mrs
Irving Anderson at 315 Old Mill Rd ,Osterville. On site was
Capt Clough and two &&her fireman. from COMM. Capt Clough informed
me of the situation. A 275 gal oil tank in the basement ,on a cement
floor had a pin hole leak in the bottom of the tank.The home owner
noted the oil odor and found the leak.He collected the leaking
oil in 5 gal containers after about fen (10) gallons had leaked
on the floor. The home owner called the fire dept and Ed .from
Nielson Oil(their oil supplier) . Ed secured the leak in the tang.
The fire dept had spread 'speedy dri" on the spilt oil.Some of the oil
had flowed towards t'ne floor d.rain.Some oil had logged in the lip
of the drain but from what I observed rione went down the drain.
Ed ,from Nelson oil said they were going to replace the oil tank.
GAS$, r
The float Lk of the tank showed about 1/8 full.I asked the home
owner to leave the /;speedy dri+on the floor tilitomorrow and theft/
pick it up and store it in 5 gal containers. The oil collected
in the containers will be recycled as will the used speedy dri.
I will contact the owner on the proper disposal of bath ;
:ST ODDS
TOWN, OF BAR STABLE
COMMONWEALTH OF MASSACHUSETTS � All
Z
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS 2' �
m d DEPARTMENT OF ENVIRONMENTAL PROTECTION
of p f"f�fCt�
�NAI Sv Ov
350 MAIN STREET
WEST YARMOUTH,MA ASSESSOR$WpNO•
508-775-2800
PARCEL NO• ".
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Map 142 Par 063
Property Address: 314 Old Mill Road
Osterville,MA. 02655
Owner's Name: Irving Anderson
Owner's Address: 314 Old Mill Road
Osterville,MA. 0265.5
Date of Inspection 6-2-04
Name of Inspector:(please print) James D. Sears
Company Name: A&B Canco
Mailing Address: 350 Main Street
West Yarmouth,MA 02673
Telephone Number: 508-775-2800
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the infonnation reported
below is true,accurate and complete as of the time of the inspection. The inspection was perfonned based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: Date:
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd
or greater,the"inspector and the system owner shall submit the report to the appropriate regional office of the DEP.
The original should be sent to the system owner and copies sent tot he buyer,if applicable,and the approving authority. =
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that time.
This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 1
Page 2 of 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 314 Old Mill Road
Osterville,MA. 02655
Owner: Irving Anderson
Date of Inspection: 6-2-04
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: N/A
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 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 breakout or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval
of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if(with approval of the Board of Health)"
broken pipe(s)are replaced
obstruction is removed
ND explain:
Title 5 Inspection Form 6/15/2000 2
Page 3 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(CONTINUED)
Property Address: 314 Old Mill Road
Osterville,MA. 02655
Owner: Irving Anderson
Date of Inspection: 6-2-04
C. Further Evaluation is Required by the Board of Health:N/A
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 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 I of public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well". Method used to determine distance
**This system passes if the well water analysis,performed at a DEP certified laboratory,for 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:
Title 5 Inspection Form 6/15/2000 3
t ,
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(CONTINUED)
Property Address: 314 Old Mill Road
Osterville,MA. 02655
Owner: Irving Anderson
Date of Inspection: 6-2-04
D. System Failure Criteria applicable to all systems:N/A
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
./ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
�— Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded
or clogged SAS or cesspool
N/A Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
Liquid depth in pit 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
N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a
surface water supply
N/A Any portion of a cesspool or privy is within a Zone 1 of a public well
N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well
N/A 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 or less than 5 ppm,provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this fonn.)
NO (Yes/No)The system fails. I have detennined 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 detennine what will be necessary to correct the failure.
E. Large Systems: N/A
To be considered a large system.the system must service a facility with a design flow of 10,000gpd 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—I WPA)or a
mapped Zone lI of a public water supply well.
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes"in Section D above the large system is 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.
Title 5 Inspection Form 6/15/2000 4
Page 5 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 314 Old Mill Road
Osterville,MA. 02655
Owner: Irving Anderson
Date of Inspection: 6-2-04
Check if the following have been done. You must indicate"yes"or"no"as to each of the following
Yes No
Pumping infonnation was provided by the owner,occupant,or Board of Health
Were any of the system components pumped out in the previous two weeks?
./ Has the system received normal flows in the previous two week period?
./ Have large volumes of water been introduced to the system recently or as part of this inspection?
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
4 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)has been determined based on:
Yes No
Existing infonnation. For example,a plan at the Board of Health.
./ Detennined 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)]
Title 5 Inspection Form 6/15/2000 5
Page 6 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 314 Old Mill Road
Osterville,MA. 02655
Owner: Irving Anderson
Date of Inspection: 6-2-04
FLOW CONDITIONS
RESIDENTIAL./
Number of Bedrooms(design): 2 Number of bedrooms(actual): 2
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms: 220
Number of current residents: 2
Does residence have a garbage grinder.(yes or no): YES
Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required]
Laundry system inspected(yes or no): YES
Seasonal use(yes or no): NO
Water meter readings,if available(last 2 years usage(gpd)):
Sump pump(yes or no) NO
Last date of occupancy: PRESENT
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203):
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of infon-nation: N/A
Was system pumped as part of the inspection(yes or no): NO
If yes,volume pumped: gallons—How was quantity pumped detennined?
Reason for pumping:
TYPE OF SYSTEM
./ Septic tank,soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no)(if yes,attach previous inspection records,if any)
Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight tank Attach copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
UNKNOWN
Were sewage odors detected when arriving at the site(yes or no): NO
Title 5 Inspection Form 6/15/2000 6
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 314 Old Mill Road
Osterville,MA. 02655
Owner: Irving Anderson
Date of Inspection: 6-2-04 "
BUILDING SEWER(locate on site plan):
Depth below grade: 10
Materials of construction: Cast iron 40 PVC other(explain)
Distance from private water supply well or suction line: s
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK(locate onsite plan):
Depth below grade: 16"
Material of construction: concrete , . metal fiberglass polyethylene
other(explain)
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate)
Dimensions: 1000 GALLON PRE CAST
Sludge depth: 4"
Distance from top of sludge to the bottom of outlet tee or baffle: 26"
Scum thickness: 1"
Distance from top of scum to top of outlet tee or baffle: 12"
Distance from bottom of scum to bottom of outlet tee or baffle: 17"
How were dimensions detennined: TAPE-PROB
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as
related to outlet invert,evidence of leakage,etc.):
MAIN TANK AT WORKING LEVEL,TANK AND COVERS 16"BELOW GRADE. NO SIGN OF OVER
LOADING OR LEAKAGE.
GREASE TRAP(located on site plan) N/A y
Depth below grade:
Material of construction: concrete _ metal fiberglass• _ polyethylene other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,,structural integrity,liquid levels as
related to outlet invert,evidence of leakage,etc.):
a
Title 5 Inspection Form 6/15/2000 7
Page 8 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued) .
Property Address: 314 Old Mill Road
Osterville,MA. 02655
Owner: Irving Anderson
Date of Inspection: 6-2-04
TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspection)(]ocate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass polyethylene other(explain)
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no)
Alarm level: Alarm in working order(yes or no):
Date of last pumping
Comments(condition of alarm and float switches;etc.):
DISTRIBUTION BOX: N/A (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.,):
PUMP CHAMBER: N/A (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
� I
Title 5 Inspection Form 6/15/2000 8
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 314 Old Mill Road
Osterville,MA. 02655
Owner: Irving Anderson
Date of Inspection: 6-2-04
SOIL ABSORPTION SYSTEM(SAS): ,/ (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number: 1
leaching chambers,number:
leaching galleries,number
leaching trenches,number,length
leaching fields,number,dimensions:
overflow cesspool,number:
innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of
vegetation,etc.)
LEACHING IS ONE 1000 GALLON PRE CAST PIT.PIT&COVER AT 2', 12"WATER IN PIT,STAIN LINE
AT 2',NO SIGN OF OVER LOADING OR SOLID CARRY OVER.
CESSPOOLS: N/A (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth—top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.):
PRIVY: N/A (locate on site plan)
Materials of Construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition.of vegetation,etc.)
Title 5 Inspection Form 6/15/2000 9
Page 1 I of 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS.
SUBSURFACE SEWAGE bISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORtvIATION(continued)
Property Address: 314 Old Mill Road
Osterville,MA. 02655
Owner: Irving Anderson,
Date of Inspection: 6-2-04
SITE EYAIVI
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to no groundwater 12 feet
Please indicate(check)all methods used to detertnine the high ground water elevation:
Obtained from system,design plans on record-If checked,date of design plan reviewed:
�- Observation site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
Checked with local excavators,installers-(attach documentation
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
TEST HOLE 12' NO WATER
TEST HOLE 4' BELOW BOTTOM OF PIT.
1,4 %�f
Title 5 Inspection Form 6i 15i2000 l l
Page I I of
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 314 Old Mill Road
Osterville,MA. 02655
Owner: Irving Anderson
Date of Inspection: 6-2-04
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to no groundwater 12 feet
Please indicate(check)all methods used to detennine the high ground water elevation: s
Obtained from system design plans on record-If checked;date of design plan reviewed:
—�_ Observation site(abutting property/observation hole within 1.50 feet of SAS)
Checked with local Board of Health-explain:
Checked with local excavators, installers-(attach documentation
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
TEST HOLE 12' NO WATER
TEST HOLE 4' BELOW BOTTOM OF PIT.
F
Title 5 Inspection Form 6/l5/2000 1.1 .
ROOF LINE OF NEW
ROOF LINE OF
ADDITION OVER tM c C ( (oda
FOYER TO MATCH EXISTING GARAGE
ROOF LINE OF / 2 'jr-DjMS-
EXISTING GARAGE r
,
(SEE ROOF PLAN ONlosillillill
DWG A-6) s
111110101000
— —PLATE
0
co
MATCH EXISTING
SIDING FLOOR
PLATE
GRADE
GRADE -
I I
I
I co
I. co
FLOOR
_ _� _ _ - _ _ _ _ - - -: - - - - - -- - -= - = - - -
LI -
- - - - - - - - - - - - - - - - - - - - - - - - - - - =REAR ELEVATION
OR TO VERIFY
ONDITIONS AND S CALE 1 /4
NS IN FIELD.
�A D RA�PVI N G
x
_ K
y
{{i
1
PRE-ENGINEER TRUSS
5/8" EXT PLY @ 24" O C W/DIAGONAL
BR
ACING HURRICANE CLIPS
R30 INSUL
' 2 2"X4" PLATE 2"x4" STUD WALL 1-0• PLATE
2"X4" STUDS @ 16" O C @16" O C
1/2" EXT PLY MASTER
R13 INSUL TYVEK
BEDROOM CLO BEDROOM
2-2"X6" SILL PTW
SILL SEAL R19 INSUL FLOOR
1/2" ANCHOR BOLTSLi
6'-0" O C CEILING
2"X10" FLOOR JOISTS 00
GRADE PLAY ROO @16" O C - , �--- GRADE
3!4" T&G PLY FL L_ 1�
#4 RDS 4" CONC FL
T&B OVER COMPACTED GRAVEL FBEDROOM71
6"X6" 1.0/10 WWM
6 MIL VAPOR RET
FLOOR
2 4"xl2" CONC FTG
2"X4" KEYWAY
34, 0;.
41-0118 1_0#' 10'-4" 7'-9" 3'-11
'
_ - 161_011 21 " 16-6��
r
6'-0►0 o
� J
MASTER 9 [BEDROOM
STAIRS
PER I BEDROOM
PER =
CONTRACTOR r
r � Q
Lo US
Lj
'4
7-r
z 14'-1011 71_01 r-s 0 81_8„ 31-6„
41
-
, N �
0 CV
C
s L0
WIC Lc
0
M JA i n SINK g I I
y.
oc =
- - - - - - - - - - - - - - - - - - - - - -
- - - - I s H
zI
Z, _ REMOVE
tQ—' -- ---- EXISTING
X w' EXT DR I
w I -------
�I - - .AND STUD �
N� OPENING
EXISTING . -� ' �I _ -"'--
� E
I .GARAGE FLOOR -- - --
LEVEL OF
NEW ADDITION
SHALL MATCH
FLOOR LEVEL OF 4,_6„ ENLARGE
I
EXISTING FOYER EXISTING 3'-0"
OPG TO 5,_0„
FOYER
EXISTING
CLOSET
EXISTING
FIRST FLOOR LIVING
ROOM
ADDITIO. N PLAN . .. L
= 1 _p
SCALE1 f
. .�, EXISTING
KITCHEN
Vl1NTR0t-TAL!�ra_...►�._,_.
--------------
r
34'-0°
A 5'-711 9'-7" 111.511
1,_5„ T-5„
199-211
r
o n
1 ' �
3' 2"
-
.__• --------------------------------- ------a ----- - ---11 --
4 PLAY
4 CONC SLAB
------ vq-- --
OVER 10" CRUSH STONE
ROOM
6" x 6" 10/10 WWM 2'-6" x 2'-6" x 12"
El
• r- '""•"'-' 6 MIL VAPOR RET CONC PAD
� W13 1/2" LALLY COL (2
A- —i�Z 10 10-911 1-1011
10
i Lrrrrrrrr•r rr rrrr .
BP
STAIRS
------..---- 1 1
----------------------------BP
UPPER --•. .•-.-- --•--- - -- •1--------•- ---•------ -- •1•ar•-----------------
CONTRACTOR uli e• (2) 3 1/2" x 9 1
0
Z io •4 VERSA LAM
O 4 3080 Fb DFco
1 J
1—
WORK
o ROOM
Q cc
10
�4
a• (2) 3112" x 9114"
r-s• VERSA LAM 3080 Fb DF JL
--------- -------------
SP Bp
..
° 12" CONC WALL TO RETAIN
EXISTING FDTN WALLty
'f
DI -
10
Z I _
'P
U) a' p,l --------
x EXISTING '1 '
GARAGE -
�D
EXISTING SLAB 1 _
FOUNDATION4*4
'
12" CONC p,
.p WALL ►•►
a' TO RETAIN ,D
• •, EXISTING WALL D
EXISTING ►'►
FOYER .D
EXISTING SLAB
p FOUNDATIONwa
► ►
s v V
s
3iy Q►d 1`'1��1 �,oa,d OsEerv�lle
EXISTING
GARAGE REMOVE DECK AND REPLACE
WITH STEPS FROM MUD ROOM i NEWREAR DOOR. FIRST
FLOOR
PLAN
.
n J�
� DECK
p
Q ap 19'-0u _ i
✓v
o
m r A
a
,
i ow
'� tV i 'lOUr�l C(r—T �O�I
I if-oil
10
n l�uM D �� �j�� p F
NEW 2'�' DR 3'-4' 9'�" 8'-2!' rp 7.cJ '^/�Ar 'f, O
000 _ Q w
cA � rE �
MUD TW246 TW2436
ROOM _ r
� ( +
8 P L WIOX4S STEEL— — — — - — S P— '-9" - J�rG c,Q fauna/`�� a tlw
BEAM ABOVE c i� to ✓
GJACU 2Z1
G
G'° KITCHEN/DININCx .,4REa
O M
EXISTING
GARAGE NOTE. EXISTING EXISTING FIREPLACE
_ MUD ROOM ALONG WITH ENTIRE S f2)1'-9"$IFLD DRS
'T— SHALL REMAIN LENGTH OF CONNECTING O i
AS IS EXCEPT WALL SHALL REMAIN. �
4'+IO"
WHERE NOTED. ALL OTHER WALLS IN MA HOUSE SINK SINK
N V Z .4 E
ARE NEW CONSTRUCTION. - if
- - Q 43
SP SP -- - --- O , - QpYA_ , � p
_ - - ---
-- ----- -
`�pp , QL
WIOX45 STEEL �`-S P � W10X45 STEEL T � 6 P = N n z
_ BEAM ABOVE --- ---- i BEAM ABOVE r' i _r W
LIVING ROOM _-- _--
r ---- - MASTER
m
_ BEDROOM
• � O
z
u :m a
Nit
TW2646 TW2646 TW2646 8.$n TWVo46,
40'-0"
A4
, A
I
I
a _
'31�{ old Xth 'RoaJ 6derw%6e'
4"X4"WOOD POSTS(S) ;
RAILING
Fr- EGiG
R
40'-O"
8'-0" 10 1
-5" 12'-1611 I
,
TLLI2436 '
' _. I I aIj .. t
WCA-
V-V �rp SINK KINK ; F .
' � °' O =� TUB�
,D U 14';C"4 >
E >
W 9 - ?o
jK
13'-011 Q 2' ' " a-- --- s+a->z Sw-R `r ram'
----------------- -------------,�0 --
tt r F
- -- ---
U _
3'-6" Z'-0" 1'-0"
' ------ oCD
1 IBEDROOM `� �3EDROOM
. i
d) u - --- 3-- _ h . _ - - o w
21 11 161-6N 1�11 I�I�It 1
i)n
1
Tw2642 Tw2642 Tw2642 TUM"2 TW2642 ,
41�11 81$/1 6'-1011 r 6'-10" I. 81�11 41 ; r
0
� z
:40'-0° n $
1
SECOND f=LOORAN
A A5
{I
O �t RogmA. 06erd���E
OUTLINE OF SECOND
,
FLOOR DECK BELOW
------ A
,
TW2642 TW2642 TW2642 TW2436 i
3'-G0"
2.$° ; n
— — — — — — — — — — — — — — — — 2'-0' I I DR QpE
SLOPE DOWN FROM �. Q W
1p
C H TO 6'-4'WALL O -
z 9�
w
r. cv N
zz O p �00
U O (K •=81NK 81NK ' Q/ "�
i
ROOM ,
-011
1,-0„
r ,
n n _ STORAGE ROOM
nIca
SLOPE DOWN FROM Q ,� -------- Q m
F 1-6,C H TO 4-0.WALL C4 ;_
—� V ' — — — — — — — — — — — — — — — — �- — —
21 '
11
Q - ------ -
' 1 Q a�Ya
n -------- O � o o F
a' ------- ru A z
LE
aOPTIONAL STORAGE 7tOPTIONAL STORAGE
,
i coo
40'-0" m
_ O
' � z
ATTIC
a �
� Q �
,
,
,
FLOOR (>
SCALE 3/Dro =1 -O
-AIL4 O *11C�Sf�rv►��e
EXISTING DECK SHALL BE
REMOVED AND REPLACED WITH
STAIRS FROM THE NEW MUD ROOM
REAR DOOR PER OWNER
- DECK
LIVING ROOM
ENTIRE LENGTH OF EXISTING WALL ALL EXISTING WALLS OF MAIN HOUSE
EXISTING GARAGE CONNECTED TO EXISTING CHIMNEY STRUCTURE SHALL BE REMOVED EXCEPT
SECTION SHALL REMAIN SHALL REMAIN WHERE NOTED
MUD ROOM
BEDROOM BEDROOM
EXISTING MUD ROOM ------
SHALL REMAIN. EXISTING CHIMNEY -------- EXISTING BASEMENT
(PLEASE SEE MODIFICATIONS ON SHALL REMAIN ------ _ STAIRS SHALL BE
DRAWING A4.) _-__-- REMOVED
Z EXISTING FLOOR SYSTEM' ------
SHALL REMAIN
7
EXISTING FIRST
FLOOR KtTGNEN
o 0
------ 0 OF. IP
ALL EXISTING FIXTURES AND
APPLIANCES SHALL BE
REMOVED Al
i
This is to certify that New England Engineering Services,
Inc. has inspected the subsurface sewage disposal
system installed at 314 Old Mill Road Osterville, MA.
The system has been constructed within allowable
engineering tolerance of 310 CMR 15.00, the approved
design plans dated 1/14/05, revised to 1 1/28/05, and
local requirements, except as noted herein.
SYSTEM TIES
INVERT ELEVATIONS
1 TO TANK 33.0'
2 TO TANK . 31.6' ° r0�
DESIGN ACTUAL 1 TO D-BOY, 38.0' p� Gj
FOUNDATION 1 97.46 97.40 2 TO D-BOX 63.5' 1�
FOUNDATION (2) 97.46 97.32
TANK IN 96.92 97.02 1 TO A 37.0' 1 TO C 99.0'
TANK IN �1�
2 96.92 97.04 2 TO A 58.0' 2 TO C 91 .0'
TANK OUT 96.67 96.82 1 TO B 43.0' 1 TO D 97.0'
D-BOX IN 96.36 96.41 2 TO B 70.0' 2 TO D 82.5'
D-BOX OUT 96.19 96.24
A 96.09 96.15
e 96.09 96.11 314 OLD MILL ROAD
INSPECTION PORTS ASSESSORS MAP 142, LOT 063
42,899 SQ. FT.
TOP OF INFILTRATORS 0.985 AC.
1 TO X 87.8' 1 TO Y 90.0'
A 96.55 96.62 2 TO X 76.0' 2 TO Y 85.5'
B 96.55 96.60
j C 96.55 96.51
O
D 96.55 96.55
C) cv
Cco
O
°
VENT
4.6T
�"y � o ' ' 23•
INSPECTION
PORTS (typ.)
TP1 '
Xc/
PT1 M'10' o,W Ay
II 1
1500 GALLON
2 '
SEPTIC TANK
ADDITION
U� ° U
27 O 19'
P.ISTP.IHUTION BOX
DECK CLEANOUT
�p
i DYER
EXISTING THREE
i
BEDROOM
R OOM HOUSE
SILL ELEV. 100.00 BENCHMARK: TOP LEFT FRONT
CORNER OF BULKHEAD FOUNDATION.
ELEV. 100.00 (assumed datum)
`:�'::`•DRIVEWAY.•..•..•..�':.•..•..•..•:�.
G
W
Cb
PROPOSED DR ,
GJ AY
I
N/F PERRY
G
225.47' w
N32006'28"E HOFMgss
BENJA WIN C.
OSGOOD,JR
CIVIL
NO.45891
OLD o
1--"*' OA_Tu
�o GIST
MILL
EH ��
LOCUS MAP NOT TO SCALE 20' 0 20' 40' 60'
FOR WAY
AS-BUILT SEPTIC SYSTEM
�v 314 OLD MILL ROAD
SITE
OSTERVILLE, MA
ASSESSORS MAP 142, LOT 063
Z
SCALE: 1"= 20' DATE: DECEMBER 30, 2005
N
Z NEW ENGLAND ENGINEERING SERVICES, INC.
60 BEECHWOOD DRIVE
NORTH ANDOVER, MA 01845
(978) 686- 1768
MAIN STREET
P�►x ':932SABN 12-30-05T
>�wrr S.G.B. s HECKED
r: & B.C.�Jr.
BACKFILL TO TOP OF CHAMBER SYSTEM PROFILE
WITH EXISTING "C" LAYER MATERIAL 105 SCALE: 1" = 20' HOR.; 1" = 2' VERT.
1 4' LOAM 113 104
COVER 4" SCH. 40 PVC
III Its I 1;R
. . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . .
CLEAN NATIVE BACKFILL 32" COVER 103
RISER TO WITHIN
LIMIT OF EXCAVATION (typ.) 6" OF FINISH GRADE
. . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . .
. . . . . . . DISTRIBUTION BOX
. . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . .
. . . • . . . • . . . . • . . . • . . RISERS TO WITHIN 6" OF FINISH GRADE
102
. . . . . . . . ..
(ALL OPENINGS) INV. IN 96.36, INV. OUT 96.19
. . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . .
59.38' OF INFILTRATOR CHAMBERS (9.5 UNITS PER ROW)
CLEANOUTS
. . . . . . 101
RESERVE RESERVE
TOP OF EXISTING-7 12" 12 VENT (see sheet 1 for vent location)
6.5 6.5- f EXISTING SILL 00 BREAKOUT ELEV. 96.55
LAYER AREA AREA ELEV. 100.00
34"— —37" 34" 37"— 34*— 37"— 34" 100 PROPOSED NEW ADDITION S FINISH GRADE
SILL ELEV. 99.26 10
—F F
99
9.00'
NEW FOUNDATION
98 INVERTS 97.46
14.67' f INSPECTION PORT
97 CONNECT PIPE
INFILTRATOR END DETAIL 96 ENDS TO VENT
SCALE: 1 2' 4* SCH. 40 PVC
95 S=0.02 INV. 96.09 BOTTOM OF TRENCH
ELEV. 95.55
94
27*— —31'
CAST IRON GATE BOX —12" OVERLAP 93
FINISH GRADE SLEEVE AT GRACE GROUND SURFACE
6"0 HAND HOLE 1500 GALLON
SEPTIC TANK
92 INV. IN 96.92
SCREW TYPE CAP CAI, T INV. OUT 96.67
OR SUP CAP 91
INSPECTION PORT 4" SCH. 40 PVC PIPE 4" SCH. 40 PVC----N,,�� POURED
PLAN VIEW (LENGTH VARIES) CONCRETE 90
4" SCH. 40 PVC
4" SCH. 40 PVC 45* ELBOW 4.'
SCH. 40 PVC
COUPLINGS 45' TEE WYE 89
FINISH GRADE ,IWATER TABLE
4" SCH. 40 PVC WITH CAP 6"0 MIN. HANDHOLE
AT GRADE 4,
TOP OF ELEV. 88.80
INFILTRATOR FLOW 88 (Tpi)
4" SCH. 40 PVC COUPLINGS
FAR 6.5" INVERT SCH. 40 PVC
INSPECTION PORT DETAIL
_NOt�-TO SCALER-
EFFECTIVE LENGTH
SIDE VIEW ' EANOUT DETAIL
INFILTRATOR DETAIL NOT TO SCALE
NOT TO SCALE
AS MANUFACTURED BY INFILTRATOR SYSTEMS, INC., OLD SAYBROOK, CT 90' SCH. 40
MODEL: STANDARD PVC ELBOWS
INFILTRATOR
CHAMBERS 90' SCH. 40
PVC ELBOWS
SCH. 4 CHARCOAL FILTER
PVC AND RODENT SCREEN
20"0 CLEANOUT COVERS
WITH RISERS TO WITHIN 6"
OF FINISH GRADE
45* SCH. 40
PVC ELBOWS
5'-8'
VENT DETAIL
NOT TO SCALE
SCH. 40 PVC TEES 2'
V-4-
V- 4" l 5' 4*0 INLET — f J(6) 4"0 OUTLET
10" 8-
_3" MIN. 4 SCH. 40 MIN. i
PVC TEEj 2"
1 TAPER I I I I F3 _T
4"0 INLET rO" MIN. 9" MIN. J PLAN VIEW SECTrION VIEW
3 6" MIN. 4"0 OUTLEr
PROPOSED SUBSURFACE
• LIQUID LEVEL 14" MAX. pk OF SEWAGE DISPOSAL SYSTEM
• 12
12* MAX.— CH. 40 6 OUTLET DISTRIBUTION BOX BENJAMIN 314 OLD MILL ROAD, OSTERVILLE, MA
PVC TEE 5'_8 SCALE: 1 2' SHEA MODEL B-6DB OR EQUAL D J
u OSGOO
GAS BAFFLE—/ • CIVIL ASSESSORS MAP 142, PARCEL 063
SE': 4'-0' NO.45 "1
4'-7' E TANK_ a '-4- 8't�l PREPARED FOR
NOTE #3 4 DISTRIBUTION BOX NOTES JOHN MORAITES
• 1. FIRST TWO FEET OF PIPE FROM D—BOX SHALL BE SET LEVEL. G1 T 58 PINE RIDGE ROAD
2. D—BOX SHALL BE SET IN 6" OF COMPACTED 3 4 NORTH ANDOVER, MA 01845
3' (se/ " CRUSHED STONE.
3. FILL BELOW D—BOX SHALL BE COMPACTED e const. note #9).
F4' 4. 0—BOX SHALL BE WATERTIGHT (see coast. note #11). SCALE: 1" = 20' JANUARY 14, 2005
5. ALL OUTLETS SHALL BE AT THE SAME ELEVATION.
REVISED
<1 6- OF COMPACTED 3/4- CRUSHED STONE 1-20-05 NEW ENGLAND ENGINEERING SERVICES, INC.
11-28-05 60 BEECHWOOD DRIVE
NORTH ANDOVER, MA 01845
1500 GALLON SEPTIC TANK (H-10 LOADING) (978) 686-1768
SCALE: 1" - 2' SHEA MODEL TK1500 OR EQUAL
DRAWN SHEET CHECKED
TANK NOTES BY T.K.H. #: 2 of 2 BY,• S.E.P. & B.C.O. Jr.
1. TANK SHALL BE WATER TIGHT AS SUPPLIED BY MANUFACTURER.
2. 9" MINIMUM COVER REQUIRED OVER TANK. FILE DESIGN
3. JOINT SEALED WITH BUTYLE RESIN BY MANUFACTURER.
#: 932-2-11-28-05 BY: B.C.O. Jr.
FINISH vrvwr-
CH* 40 PVC COUPLINGS
121 QQ
mum I=
Cr7- O.C.O.0
All#N.
DESIGN DATA
PERCOLATION RATE: <2 MIN. PER INCH
SOIL CLASS: CLASS I
DESIGN FLOW: 5 BEDROOMS x 110 GALLONS PER BEDROOM 550 GALLONS
LOADING RATE: 0.74 GAL. PER SO., FT.
SYSTEM SIZE REQUIRED: 550 GALLONS PER DAY / 0.74 - 743.24 SO. FT.
SYSTEM SIZE PROVIDED: USE STANDARD INFILTRATOR UNITS IN A LEACH TRENCH CONFIGURATION
EFFECTIVE LEACH AREA PER LINEAL FOOT OF INFILTRATOR CHAMBER = 6.53 SQUARE FEET
LINEAL FEET OF INFILTRATOR CHAMBER REQUIRED - 743.24 SO. FT./ 6.53 SO. FT. PER LIN. FT.= 113.82 LINEAL FEET
113.82 LINEAL FEET / 6.25 LIN. FT. PER CHAMBER = 18.21 CHAMBERS REQUIRED
USE 2 ROWS OF 9.5 CHAMBERS 59.38 FEET LONG EACH ROW = 118.75 TOTAL LINEAL FEET OF CHAMBER
= 775.43 EFFECTIVE SO. FT. LEACH AREA
SEPTIC TANK REQUIRED: 200% OF DAILY FLOW (550 GALLONS x 2 = 1100 GALLONS)
SEPTIC TANK PROVIDED: NEW 1500 GALLON SEPTIC TANK O Y
n�<
o�c J•Jr 2i
PERCOLATION TEST
DATE: 1/12/2005
HOLE# PT1
ELEV. 99.20
DEPTH OF PERC. 40"/18"
START PRE-SOAK 10:48
END PRE-SOAK 11:03
TIME O 12" 11:03 314 OLD MILL ROAD
TIME O 9" 11:05
TIME ® 6" 11:07 ASSESSORS MAP 142 LOT 063
nME RATE (MIN./INCH <2MMIN./INCH 42,899 SQ. FT.
PERCOLATION TESTS PERFORMED BY BENJAMIN C. OSGOOD, JR AND 0.985 AC.
WITNESSED BY DAVID STANTON, BARNSTABLE HEALTH AGENT. g8"3J
O CO
CID O
co
GENERAL NOTES
1. SYSTEM NOT DESIGNED TO ACCOMMODATE A GARBAGE GRINDER. `99� VENT `
2. SYSTEM SHALL BE MAINTAINED BY PUMPING EVERY TWO YEARS.
3. DEEP OBSERVATION HOLES`PERFORMED ON 1/12/2005 BY BENJAMIN C. OSGOOD, JR. AND WITNESSED BY g
DAVID STANTON, BARNSTABLE HEALTH AGENT. \ 8«g? 1'14 67'
4. TEST PIT LOCATION, DWELLING LOCATION, AND TOPOGRAPHIC INFORMATION TAKEN FROM AN ON THE GROUND SURVEY
PERFORMED BY NEW ENGLAND ENGINEERING SERVICES, INC. (NEES).
5. THERE ARE NO WELLS LESS THAN 150 FEET FROM THE PROPOSED SUBSURFACE DISPOSAL SYSTEM. ry(b J o
6. THERE ARE NO WETLANDS LESS THAN 100 FEET, NO TRIBUTARIES LESS THAN 325 FEET, NO RESERVOIRS LESS THAN
400 FEET, AND NO DRAINS LESS THAN 100 FEET FROM THE PROPOSED SUBSURFACE DISPOSAL SYSTEM. tK J
7. CONSTRUCTION OF RESERVE AREA AS SHOWN MAY REQUIRE RELOCATION OF SHED. NOTE: PROPOSED SILL HEIGHT SHALL o� ti i J J J
8. NEES HAS BEEN RETAINED TO FURNISH DESIGN AND CONSTRUCTION PLANS FOR THIS SUBSURFACE DISPOSAL SYSTEM, BE VERIFIED IN THE FIELD PRIOR TO \ INSPECTION
EXCLUDING CONSTRUCTION SUPERVISION. NEES CERTIFIES THAT THIS PLAN CONFORMS TO THE RULES OF TITLE 5, ►�� J J J PORTS (typ.)
EXCEPT WHERE NOTED. NO GUARANTY OR WARRANTY, EXPRESSED OR IMPLIED, IS MADE TO THE CLIENT OR ULTIMATE CONSTRUCTION. ELEVATION MUST BE g
USER WITH RESPECT TO FUTURE SYSTEM FUNCTIONING. 13�" BELOW FLOOR ELEVATION IN CEDAR TP1
9. LOT LINES SHOWN ARE FOR THE USE OF INSTALLING THE SUBSURFACE DISPOSAL SYSTEM ONLY.
10. DEED REFERENCE: BOOK 19044, PAGE 155, BARNSTABLE REGISTRY OF DEEDS. FOYER AREA OF EXISTING HOUSE 99 TREE PT1 j JA J NSF PERRY
JJ
IN, \ 99• JtLijiu J J�J M
------ J J
PROPOSED ADDITION j J J
CONSTRUCTION NOTES
PROPOSED \ 1500 GALLON -----T
1. SCOPE OF WORK. UPGRADE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM INCLUDING THE FURNISHING OF ALL LABOR, ASEPTIC TANK /
MATERIALS, EQUIPMENT, AND OTHER„'INCIDENTALS NECESSARY TO SATISFACTORILY COMPLETE THE WORK AS SHOWN ON 98 22'X34' ADDITION V
THIS PLAN IN ACCORDANCE WITH 310 CMR 15.00 STATE ENVIRONMENTAL CODE TITLE 5 AND THE MINIMUM REQUIREMENTS X� L/
FOR THE INSTALLATION OF SUBSURFACE SEWAGE DISPOSAL SYSTEMS IN THE TOWN OF OSTERVILLE. IN THE EVENT OF A y SILL ELEV. 99.26
CONFLICT, THE, MORE RESTRICTIVE PROVISION SHALL APPLY. y O O EXISTING SHED
2
2. CONTRACTOR SHALL ENGAGE DESIGN ENGINEER TO PROVIDE AS-BUILT PLAN AND CERTIFICATION THAT CONSTRUCTION 7' \ �S. / TO BE REMOVED
COMPLIES WITH THIS DESIGN PLAN.
3. REMOVE TOPSOIL AND SUBSOIL.,SPECIFICALLY THE A & B LAYERS IN TRENCH ,PEA TO AN ELEVATION OF 95.55.
' -'
SCARIFY BOTTOM AND PLACE INFILTRATORS LEVEL IN TRENCH., BACK FILL TO A LEVEL'EQUAL TO THE TOP OF
INFILTRATORS WITH "C" LAYER MATERIAL OR TITLE 5 SAND MEETING THE GRADATION REQUIREMENTS OF SECTION 15.255 CLEANOUTS - DISTRIBUTION BOX
Qw
PARAGRAPH 3. COMPLETE BACK FILL USING NATIVE MATERIAL COMPLYING WITH CONSTRUCTION NOTE JJ4. y GARAGE DECK 04 N 98"9
4. FILL USED SHALL BE CLEAN AND FREE FROM LARGE STONES, CONSTRUCTION DEBRIS, STUMPS, OR OTHER DELETERIOUS ?
MATERIALS.
5. UNDERGROUND UTILITIES SHALL BE LOCATED PRIOR TO CONSTRUCTION. LOCATIONS SHOWN ARE APPROXIMATE. '--FOYER
RELOCATION OF UTILITIES, IF,REQUIR.ED, IS PART OF THE INSTALLATION CONTRACT. ( +SS 98 46
6. DISTURBED AREAS, INCLUDING THOSE DAMAGED BY VEHICLES AND EQUIPMENT ACCESSING SITE, SHALL BE FINISH GRADED
AS SHOWN AND TOPPED WITH 4 INCHES OF TOPSOIL, RAKED FREE OF STONES, FERTILIZED, AND SEEDED. EXISTING
TOPSOIL SHALL REMAIN ON SITE. EXISTING THREE
BE
DROOM D R ,F GROUND. M 0 7. THE BRUSH, SHRUBS .AND OTHER VEGETATION SHALL BE CUT. LUSH TO THE G UND. STUMPS SHALL BE REMOVED. _ES S E 0 M
HO
USE U
SE
CLEARED� MA RI AND EXCESS 01 MATERIALS HALL BE DISPOSED OF OFF SITE.
MATERIALS D E CES SOILS S
8. MAR CORNER F H FOUNDATION. 100. sume a m
SI LL
BENCHMARK: TOP LEFT FRONT
BENCHMARK: TOP LEFT FRONT CO NE 0 BULKHEADELEV. OO (assumed datum). E
( )• LEV. 1 00.
00
CORNER OF BULKHEAD FOUNDATION.
9. FILL. UNDER THE DISTRIBUTION BOX SHALL BE PLACED IN 12" LIFTS AND MECHANICALLY COMPACTED.
ELEV. 100. assumed datum 00
10. EXISTING SEPTIC TANK AND LEACH PIT SHALL BE PUMPED, CRUSHED, AND FILLED WITH SAND. ( )
11. PIPE PENETRATIONS IN FOUNDATION, SEPTIC TANK, AND DISTRIBUTION BOX SHALL BE SEALED WITH HYDRAULIC CEMENT.
::•: DRIVEWAY:.::`• ?`. :;: ': :::.::
12. INTERIOR PLUMBING 4 MR 00.INTER O PLUMBING SHALL BE IN ACCORDANCE TO STATE CODE 2 8 C 2 0
�/
9
13. SEWAGE FLOW, INCLUDING GREY WATER DISCHARGE SHALL BE CONNECTED TO NEW SYSTEM. 40
14. PIPING U I WATERTIGHT H 40 D IN A STRAIGHT LINE AT A CONSISTENT GRADE ON A cb
W
ALL P G SHALL BE GLUED JOINT W TE GHT SC PVC LAID
FINE COMPACT BASE.
15. CONTRACTOR MUST BE TRAINED AND CERTIFIED BY THE MANUFACTURER TO INSTALL INFILTRATOR SYSTEMS.
CONTACT JAMES HEALY AT (866) 511-6066 FOR INFILTRATOR AND CERTIFICATION INFORMATION. o� 'Y
CQtot PROPOSED DftEWA TREE LINE EDGE OF LAWN
r----, LEGEND
SOIL TEST LOG
.::..:.::.::.::.::.::•::.:• LOCATION OF
.,,,.,.••.,•....••.....•.. EXISTING LEACH PIT
::,:::•:::::::::::::::::::: EXISTING GRADE - - - - - - - - - - - -
ESHGW 88.80 TP # 1 TOP OF PIT ELEV. 99.22 TEST PIT
SOIL SOIL SOIL SOIL
DEPTH HORIZON TEXTURE COLOR MOTTLING OTHER LOCATION of
' EXISTING SEPTIC TANK PERCOLATION TEST
0"-6" A L S 10YR 2/2 SABK/FR. EXISTING SPOT GRADE 99*99
6"-32" B L S 10YR 5/6 MASSIVE/FR. 20' O 20► 40+ 60,
32"-125" C M S 2.5Y 5/6 NONE MASSIVE/FR. G
OBSERVED 225. 47
W
NO STANDING WATER NO WEEPING N32°06'28"E
TEST PITS PERFORMED ON 1/12/2005 BY BENJAMIN C. OSGOOD, JR. PROPOSED SUBSURFACE
AND WITNESSED BY DAVID STANTON, BARNSTABLE HEALTH AGENT.
rre4�rBENJAIMIN
� SEWAGE DISPOSAL SYSTEM
OLD MILL ROAD � 314 OLD MILL ROAD, OSTERVILLE, MA
D C. < ASSESSORS MAP 142, PARCEL 063
LOCUS MAP NOT TO SCALE D,JR.IL PREPARED FOR
j NO.4589
FO JOHN MORAITES
RTES WAY �'�o ��GIS'T 58 PINE RIDGE ROAD
AL NORTH ANDOVER, MA 01845
N �v SCALE: 1" = 20' JANUARY 14, 2005
SITE REVISED
1-20-05 NEW ENGLAND ENGINEERING SERVICES, INC.
11-28-05 60 BEECHWOOD DRIVE
NORTH ANDOVER, MA 01845
N (978) 686-1768
03
m
DRAWN SHEET CHECKED
BY' T.K.H. #: 1 of 2 BY: S.E.P. & B.C.0. Jr.
MAIN STREET. FILE DESIGN
#: 932-1-11-28-05 BY. B.C.O. Jr.