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0129 OYSTER WAY - Health
129 Oyster Way - =--' Osterville A =.071 008 i 9 a II . ° ° a o ° n ° V . ° w 0 m 0 w 0 new addition existing z c 0 — Cc O 7 764 7R' D 7 � O IF odendeastl� I / I w O �I dennertun o L) 3 D0WOM geblerand e„ \ I // ..I Q � �5• 4•�. S 620Y ' I �6'nt - DN b�estl�a rb thW e Z - V c< BATH 11 trr .» •O L •en. � ; � � I o � � I � 6elwu rsnnlnq I _ .. �vRDDM °' � �•? D D D s = 4' u• a' MASTERBORM C) r sw-t:slmmerd sneerwdl;tn•rm J� ©{ �1 � I � W Bd Ang shank®b'a/c end s011d _ blerklrg seems W irz'6W91 1U/1 2nd Floor no scale I I4� 1 —LI — m N Cz la o � n? o �, o Ln.o^ N ^` o . DATE: 12/10/2014 F- SHEET:ALE: oted A-3 lies 3l �f�if ems, ee� i ,.I fi�2 MASTERBDRMB1�IION — — — — � T 2'-11 1/2' 1'-5 1/2" g Sl m ry —m m J u; N iv 'TI in 3'_5" 32' rr-- DEMO DEMO ,1!-4° a a'� I LAU 0RY m I 0 ( A Q I I I Q \ DINING a A — DEM N N 1'-101/2" 14' fl BATH N BATH A. CV DINING o _ BEDROOM m KITCHEN O QBEDROOM i; p , 2'-1 3/4" 20 23 , � . DEMO — m UP Bfn $ STUDY Existing kitchen wing to be razed and,replaced. ' n LIVING 1st Floor s a 8. ENTRY A 5"1 • I m,.,,,, '32' DEC-10-2013 13:06 FROM: TO:15087906304 P.2 ss. Massachusetts Department of Environmental Protection 1�189498 Bureau of Waste Prevention—Air Quality Decal Number Project Revision Notification For Asbestos Notification ANF-001 and AQ 06 Important:When filling out A. Facility Location forms on the JEFF 01LEZIQAN computer,us® only the tab key 1.Name of Facility to move your 129 OYSTER WAY cursor-d0 not use the return 2.Strool Addra" key, �ItI BARNSTABLE MA Q ' I 3.2 4.utata 5.Zip Coda «b 6,Telephone Numtter nos INSTRUCTIONS B. Project Cancelled 1- Thie form is only avallable for Check horn if this project isANas cancelled. online filing of project date revisions. 2, Enter project decal numgOr. C Project Dates ' Val aMe. pmj eci eta that 12/03/2013 12/03/2013 nmi location Is correct 1.on inal Start Date mm/ddlyy, - ell End Data(mM rWNY, ,_, for the entered 12110/2013 12M 0/2013 decal. 3,Wool,Revised Start Caste(mmtdd(yyyy) 4.latest Revised End Date(mm/ddfWW) 4. Enter your now project dates. 5, Cenify your notificadon. D. Revised Project Dates Submit data ehangos. 01/02/2014 01/03/2014 1.Revised Stan bate(mmlddlyyyy) 2.Revised End Oats Date(mm(dd/yyyy) E. Other Project Revisions F. Revision History EDEP; 11/2112013 02:21:20 PM EDEP; 11/25/2013 1 0:48:16 AM anf06pdrn-d00•rev.215104 DEC-10-2013 13:07 FROM: TC:15oe7906304 P.3 r> ., Commonwealth of Ma9sachus . Fooiewiwl Asbestos No#ificado -i=o Dec�INumttier rm �F-0�'I : .._.._.-+- . 'VO , msri.�•�- :•or.;rawM' mriplloMaVki�iYa.-.�k�M7ertn�r•_:::.ar: ... ...:•.'.. ..,., .,L_ •.:n!ry!"S:Tfw' _.. ... .:.r..n• '!'+. .. ;.:'Sr�.Yq�hl7'w: '• .. .. .. .r a.Nam of General Contractor '_=:= .'::':= b.Addresn Name (Town ""d.Zip Coda. e.Telephone Numbe area code and extension '.' f.Contractors Workers Camp.Insurer a.Policy Number + h.6x .Date(mrnMLNn 6. What is the size of this facility? a.Square Feet = n.Number of fl°ors,.N C. Asbestos Transportation and, Disposal 1. Transporter of asbestos-containing material from site to temporary storage site(if necessary): AIRSAFE • s'; Stations must I i I __ comply with the c.City/T'oMrn - d.,Zip Code e.TolEyahene Number Solid Wosta _ Dkftlon 2. Transporter of asbestos-containing waste rrtatedat from removal/temporary site to final disposal site: fteguletions 310 CMR 1g.M0 � ®.Nam of Transporter b.Address, c.cityrrown d.Zip Code a.Teiephons Number, �'`'� 3. 1 a.Refuse'Cranefer Station and Owner b.Addmw C.CI frown d.Zlp Code e.Tele hone Number 4, IMINERVA ENTERPRISES INC a.Final Disposal site Location Name b.Finet Die al Site Location Owner's Name - 9000 MINERVA ROAD WAYNES13URG c. E:tnpl Dise0al Me 4d C.cftyrrown OH _._._._ � 44688 e.State f.Zip Code g.Taleohone Number - ° D. Certification The,-1fersioned herebv stat-w under the nF WA SH _ ° penalties ,If perjury,that ncfshe has reao the a Name yp for Me.Rerroval,containrno nt or EneepstilErIz.- 433•�R 6.W and 41 u 0MR 7.73,~and that.i inkrmation 7o i I ILL J:,� AS • rottrc=tic^it true-and cot;act _ r.K.,iresentin+A —'3 •^ '*9st or hfsfier knowledge tnd�t 16f.Ei+C+�•�+�,4 %r;q r ++nfftnt,,.APP. V91M Asbestos Nbfifich_" je 3 Of o A NOV-25-2013 13:44 FROM: TO:150e7905304 P,2 4 Massachusetts Department of Environmental Protection 1011)1 9 L— Bureau of Waste Prevention Air Quality DOC-81 Number i. Project Revision Notification For Asbestos Notification ANF-001 and AQ 06 lmpprfanL Vtmgn fliUr►p out A. Facility Location forms onto the JEFF I IEUKIAN computer,use only the tab key 1.Name of Faclllty to move your 129 oYS'rER WAY cursor-do not p.13treet Address use the return koy. BAAid$- 0-C IMA 3.CLty 4.State S.Zip Code --- — w 8.T®lephpne Number ae� INSTRUCTIONS B. Project Cancelled 1. This form is only available for []Chock here if this project is/was cancelled. Who tilhig of project date revisions. 2. Enter pr C. Project Dates decal number. . the Validatprojeal that 121=013 12/03MI3 ' �o vrviea location is correct 1.Original Start Date mmld b"a¢pit I&W6 w)_� for the entered 12/02/2013 12/02/2012 dotal. 3.Latest Revlsed Start Data(mmlddlyyyy) 4.Latest Fbwiaad End pate(Mm/dd/yyyy) 4. Enter your now project dates, S. Carttryyour notification. D. Revised Project Dates Submit date ages, 12M=013 F2/10/2013 1.Revised Start Date(mmlddhAW) .Revised End Data Dats(mmidd/yyyy) E. Other Project Revisions F. Revision Hista EDEP: 11/21/2013 02:21.20 PM enfMpdm.doc•rev.2/5104 r NOV-25-2013 13:44 FROM: TO:1508790&304 P.3 i Commonwealth of Massachusetts 100189499 Asbestos Notification Form ANF-001 OeoalNumber imortaMom filing out A. Asbestos Abatement Description forms onter,u 1. a.Is.this facility fee exempt city, town,district, municipal housing authors owner-occupied computer,use tY p ' j� � 9 �+, only the tab key residence of four units or less? Yes ❑No to move your cursor-de not b.Provide blanket decal number if applicable: elanket 4eCal Number use the return key. 2. Facility Location: l JEFF BILEMAN 129 OYSTER WAY Nams.F[Fadlity b.,$traet Address BARNSTABLE 102655 c.City/rown d.State e.Zip Code f.Telephone Number INSTRUCTIONS 3. WOrk8ite t_oCabon: 1.All Sections of this SAME form must be a.Building NamelBuilding Location b Building# o.Wing d. Floor e.Room completed in order w comply with 4, is the facility occupied? ❑Yes ❑No OEF notification requiremente of 310 CMR 7.15 5. Asbestos Contractor: and the Olvislon of Occupational 1Aii SAFE INC NAICOTT STREET Safety(DOS) a.Name b,Address notilimtion NORWOOD �� 02082 7$17623390 requirements of 453 CMR 6.12 c.Cityfrown d.Zi Code e.Telephone Number AC000464 g. Contract Type: ❑Written ❑Verbal 1.Dos cenae NuFffier h.F2cility ContET.51-i"n i.Contact!arson's Title 6. JAIME E AMAYA I JAS060847 a.Name of On-Site Su leor/Foremen b.Su mvisorlForeman DOS CertificaikA Number 7 SAM COHEN _ AM060787 a.Name of Pr led Monitor b.Project Monitor 0 Garb icab no Number 8 ENVIROTEST LABS AA000128 a.Name of Asbestos Anal cal Lab i IMtnr 12/03/2013 A'%"'2013 9. a.Protect start pate mM dd�,,yl yy,Y�M b.End pate m� Migoyyy,I_ o TAM-6PM c.Work hours Mon" .Prtd ork hours - un. o 10. a.What type of project is this? o ❑Demolition ,r❑ Renovation ❑Repair []Other, please specify: a.describe 11. a.Check abatement procedures: P Glove bag Encapsulation O Enclosure Disposal only Cleanup ❑ether, specify; Q Full containment b.Describe z _ 12. Is the Job being conducted: •0 Indoors? ❑Outdoors? anf00tsp.doc•1=2 Asbestos Notification Form•Pigs 1 of 3 NOV-25-2013 13:44 FROM: TO:150e7906304 PA Commonwealth of Maseachu"tts ■ 100189422 Asbestos Notification Farm ANF-001Dem INumber A. Asbestos Abatement Description (cunt.) 13, Total amount of each type of Asbestos Containing Materials(ACM)to be removed, enclosed,or encapsulated: 250 0 a.Total ppm or duca Vineer o, t mai otner surfaces(square a) a Bailer,breaching,duct,tank d.Insulating cement surface coatings .ft Lin.� e.Corrupted or layered paper f,"rrowelprayer Caattng$ pipe insulation Lin.fl. lrn.R. g.Spray-an fireproofing 0'n 4. h.#rown board,wall board Lint.� i.Goths,woven fabrke n.R- j.Mar,plem specify: k.`nwimal,solid Core pipe insulation 1.specif� 14, Describe the decontamination system(s)to be used: 3 CHAMBER DECON 15. Describe the contalnerizadonldisposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) 6 MIL POLY BAGS 1 B. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency: a.Name at o c,We(mndd� of AR-horMion d.DEP Waiver# 0.Nome of DOS 0 del t.13013 C"Imal Mug N g.Date(mnVdd/yyyy)o Authorization hive # e 17. Do prevailing wage rates as per M.G,L. C. 149. §X 27 or 27A—F apply to this project? Yes ✓]No ° B. Facility Description N 0 1, Current or prior use of facility: RESIDENTIAL a 2. is the facility owner-occupied residential with 4 units or less? 2]Yes No 3. SAME a.Facill Owner Name b.Address 0 ®a c.Cityfrown d..Zip Code s.'re hone Number area code and extension �LL 4 a.Name of F011ty Owners On-She Manager b.Orr Its Arten ArJdrbss Z cc c-City/Town d•Zip Code e.Telephone Number(area code and extension) enI001ap,doc•1=2 Asbestos Notification Form•paw_____ NDV-25-2013 13:44 FROM: T0:150e7906304 P.5 s ` Commonwealth of Massachusetts i .,._.T 100189499 Asbestos .Notification Form ANF-001 °°ca'N"'"be` B. Facility Description (cunt.) 5' �a.Name of General Contractor b.Address c.C' !Town d.Zip Code e,'Tale hone Numbar(area code and extension f COWACtOeS Worker's Comp Insurer Poles Numbar h.Fr .Data mrnldd/ t — I I I 8. What IS the SIZe of this facility? a.square Feet b.Number of floors C. Asbestos'Transportation and Disposal 1. Transporter of asbestos-Containing material from site to temporary storage site (if necessary): AIRSAFE Note:Transfer a.Name of Transporter b Addre Statbns must comply with the c.Grtyrrown d.Zip Code e,Telephone Numbar Solid Waste Division 2. Transporter of asbestos-containing waste material from removal/temporary site to final disposal site: Regulations 310 CMR 18.00o a.Name of Tran orter b.Address c,Cityrrown d,Zip Code e.Telephone Number 3. '� a.Refuse Transfer Station and Owner I�. b.Andress c.Cit crown d,Zip Code e.Tale hone Number 4. IMINERVA ENTERPRISES INC F- a.Final Dijeosal Sfte Location Name b.Final DiWosal Site Location Owner's Name 9OW MINERVA ROAD I IWAYNESBURG Law lmapsal Sao Addreas d.Cif Mwn ON 44988 m a. State f.Zip Code g.Telephone Number O ° D. Certification N The undersigned hereby states,under the DF WALSH ° penalties of perjury,that he/she has read the a.Name b.Authorized Si nature 'd Commonwealth of Massachusetts regulations VP for the Removal,Containment or c Positionfrltla d ate Mgdgdm Encapsulation of Asbestos.453 CMR 8.00 and 1781- 762-3390 As � 310 CMR 7.15,and that the information Il... .. )... _ ..... ........_._..._._._..._........_ contained in this notifIcabon is true and Correct e.Tele none Number f,RepreGenVng to the best of his/her knowledge and belief. 161 ENDICOTT o9.Address NORWOOD 162062 z h.CityA'own. i.zip Code 4 anft]01a .doo•1=2 Asbestos Notification Form Page o•P e 3 f 3 a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 129 Oyster Way Property Address Paul&Joan Heffernan Owner owner's Name information is Osteryille MA 02655 June 7 2012 required for + every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the III computer,use 1. Inspector: l only the tab key p to move your Linda J Pinto cursor-do not Name of Inspector use the return key. A& M Land Services ' �M Company Name . _ � 61.8 Route 28 Company Address West Yarmouth MA 02673 Citylrown State -Zip u 508-827-1718 4432 �d Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails , ❑ Needs Further Evaluation by the Local Approving Authority - 0& 0 June 8, 2012 spector's Signat Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. "*"*This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-'Not for Voluntary Assessments y� 129 Oyster Way Property Address Paul &Joan Heffernan Owner Owner's Name information is required for Osterville MA 02655 June 7 2012 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D. A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 129 Oyster Way Property Address Paul &Joan Heffernan Owner Owner's Name information is required for Osterville MA 02655 June 7 2012 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ _Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 16.303(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 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 129 Oyster Way Property Address Paul &Joan Heffernan Owner Owner's Name information is required for Osterville MA 02655 June 7, 2012 every page. Cityf town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless.the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS_and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® 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 %day flow Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 129 Oyster Way Property Address Paul&Joan Heffernan Owner Owner's Name information is required for Osterville MA 02655 June 7 2012 every page. City/Town State Zip Code Date of Inspection B. Certification (cost.) Yes No ❑ ® 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.) ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system falls. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 129 Oyster Way Property Address Paul&Joan Heffernan Owner Owner's Name information is required for Osterville MA 02655 June 7, 2012 , every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ Z. 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? . S. ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 129 Oyster Way Property Address Paul&Joan Heffernan Owner Owner's Name information is required for Osterville MA . 02655 June 7 2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Main House 1500 Gallon Septic Tank, D-Box and three 500 Gal Conc chambers Guest House 1500 Gallon Septic Tank, D-Box and two 500 Gal Conc chambers Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonaluse? ® Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: 2011 29,000 Gals 2010 22,000 Gals 2009 17,000 Gals Sump pump? ❑ Yes No Last date of occupancy: Summer 2011 Date CommerciaUlndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 129 Oyster Way V' Property Address Paul&Joan Heffernan Owner Owner's Name information is required for Osterville MA 02655 June 7, 2012 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System; Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , r 129 Oyster Way Property Address Paul &Joan Heffernan Owner Owner's Name information is required for Osteryille MA 02655 June 7 2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known)and source of information: Main House Approximately 5 years old per Town records Guest House Approximately 15 Years old per owner Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 24"feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: Town Water feet Comments(on condition of joints, venting, evidence of leakage, etc.): (Tight) (Yes) (None) Septic Tank(locate on site plan): Depth below grade: 3 feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) Main: H2O 1500 Gal Septic Tank with 2.5' Riser and Cast Iron Rim and Cover Guest: H101500 Gal Septic Tank 3" Below Grade with risers If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal Tank Sludge depth: 1" r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "< 129 Oyster Way Property Address Paul&Joan Heffernan Owner Owner's Name information is required for Osterville MA 02655 June 7, 2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Main 30" Guest 30" Scum thickness Main 1/2" Guest 1/2" Distance from top of scum to top of outlet tee or baffle Main 6" Guest 6" Distance from bottom of scum to bottom of outlet tee or baffle Main 17" Guest .17" How were dimensions determined? Tape Measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The structural integrity of all of the tanks appears sound. All tanks have PVC pipes with PVC tees on the inlet and outlet ends: The liquid level is at the level of the outlet invert in all tanks and there was no sign of backup or leakage in any of the tanks. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments < 129 Oyster Way Property Address Paul&Joan Heffernan Owner Owner's Name information is required for Osterville MA 02655 June 7, 2012 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 129 Oyster Way Property Address Paul&Joan Heffernan Owner Owners Name information is required for Osterville MA 02655 June 7, 2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" 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.): The D-box for the main house appeared to be in good condition with no sign of solids carryover,and 3 outlets with no speed levelers. The top of the D-box is 3.5' b.g. with a riser. There is no sign of backup or leakage. The D-box for the guest house appeared to be in good condition with no sign of solids carryover, and 2 outlet with no speed levelers. The top of the D-box is 3' b.g. with a riser. There is no sign of backup or leakage. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order. 0 Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS)(locate on site plan,excavation not required): If SAS not located, explain why: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 129 Oyster Way Property Address Paul&Joan Heffernan Owner Owner's Flame information is required for Osterville MA 02655 June 7 2012 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: Main 3 Guest 2 ❑ 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.): Engineered Septic Plan by Down Cape Engineering Dated June 8, 2007. Main House-There are three 500 gal chambers.There is no sign of hydraulic failure in the area of the SAS. The top of the chambers is 4'deep. Guest House-There are two 500 gal chambers.There is no sign of hydraulic failure in the area of the SAS. The top of the chambers is 3'deep. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 129 Oyster Way Property Address Paul&Joan Heffernan Owner Owner's Name information is required for Osterville MA 02655 June 7, 2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 129 Oyster Way Property Address Paul &Joan Heffernan Owner Owner's Name information is required for every Osterville MA 02655 June 7 2012 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately A 'aC_ T) p C Z 3o( 'ZS 1 3 2� `f6 ZG' 6 ve 5 7- � Cry o z 0 3 3 A pSc 2 l:35 Is 20 �2.s"✓�3 � 3 s 31 f t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 129 Oyster Way Property Address Paul&Joan Heffernan Owner Owners Name information is required for Osterville MA 02655 June 7, 2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: >6.8' below bottom of SASfeet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record 2007 If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) 0 Accessed USGS database-explain: You must describe how you established the high ground water elevation: Per Septic design plan.-Bot Leach Field EI= 19.64 Bottom Perc No Water TP 1 El= 12.8 Difference at least 6.8' i Before filing this Inspection Report, please see Report Completeness Checklist on next page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 129 Oyster Way Property Address Paul&Joan Heffernan Owner Owner's Name information is required for Osterville MA 02655 June 7 2012 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D,or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i 4 n � . I' 'o p' 1 A . K M r L TOWN OF BARNSTABLE / LOCATION ey 416 V SEWAGE# l VILLAGE S 'S P&P CE INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY c ' LEACHING FACILITY:(type) (size) 2Q NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility A Feet Private Water Supply Well and Leaching Facility(If any wells exist. on site or within 200 feet of leaching facility) Ad Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 0 3 = G�' _� " +.. .. . -•.i• -r-... ... .,.. ,, ...-r'..-r''".^..� ".vim-.'".. `'-..•c-.� -n'.��..�».w.--^...i^'�.-•,r -•-_•—•r_.+...�.'�._��,�,.._.....,.- .. .._....,..,,�.*.-.•.. ?INo.aW 7'P 6 e„ Fee �d� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH.DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS -Yes Zipplication for 30is;po .Y *pgtem Congr tion Permit Application for a Permit to Construct( ) Repair(upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No.1,2 g ® J R Owner's Name,Address,and Tel.No. 11 �1- C2 Assessors Map/Parcel 1 Y a //r Installer's Name,Address,and Tel.No. i3.',4 ,,W a� �, Designer's Name,Address and Tel.No. Z6WAd 4rv-,. �_i � zn�f S-w Y- $9�6 yr��J//� �3 9`�9 �� ' Type of Building: Dwelling No.of Bedrooms Lot Size 7 /,� sq. ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures X Design Flow(min.required) / �y gpd Design flow provided 9V�( gpd Plan Date J0ev a ` ,700`7 Number of sheets Revision Date Title S 3 ��-c /8� 17 - �� % Oy,T7z-« 4 tt z at t l,,, /Hr Size of Septic Tank /Sa0 Cir Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) j,�J l� ���! ,;S /®•er. 44 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 ar ea . Signed Date < Application Approved Date Q Application Disapproved by: Date for the following reasons Permit No. ����7 � �— Date Issued L —————————— -----------_— — --- -- `,�ru.N"'" ( �+;`ra l.T.^+:`i^^«.�;.. f.. ,i,. �S-N J'::t,`.:�w-,-�+^•5+•"C.,.� - .. ..ram.-..-,-< Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1 PUBLIC HEALTH,DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for �Dt000al *?stem Construction Permit Application''for a Permit to Construct O Repair(1of pgrade O Abandon Complete System p❑Individual Components Location Address or Lot N.42 ? of VJY5 Q�. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 7177' Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. y r Ina/���r0 �s� q._39 /tea°� s ,//7 L A,, Type of Building: Dwelling No.of Bedrooms Lot Size :7 /,���"" sq. ft. Garbage Grinder (� Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) / gpd Design flow provided gP d -7- _ Plan Date T(lk�c �QG`7 Number of sheets Revision Date ( Title S 5 '/ r )Q1rrn % Vy3t!✓ l.Jfr1 t �,..,/��r 4 Size of Septic Tank /52>0 Cs L Type of S.A.S. 3 Gn 1 4 Description of Soil Nature of Repairs or Alterations(Answer when applicable).z ljle Aa_-16) '515/,—., /"'1 ��qh 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 Boa d • Health. Signed Date /�!// r 7 Application Approved by— Date6 7J?f /C) 7 - Application Disapproved by: Date for the following reasons Permit No., 1Ck5D7 a0�- Date Issued (D y THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERT FY,that the On-site Sewage Disposal)System Constructed ( ) Repaired (A/ ) Upgraded Abandoned( )by �1��b��`a C_.daJ 7` X v j at /d-7 6 57/-1 -VP d'54,11,f1r has been constructed in accordance. ' O 7-a 6 a- with the provision/s•of Title 5 and the for Disposal System Construction Permit No. `bO dated Installer 2oi lA'"A/ �wJ) Designer [ ir/✓ ,(�� L�•Ki s e ;Hr #bedrooms V Approved design flow =r ��y I gpd The issuance of//)tiis 4er it s/)Bahl notbe construed as a guarantee that the systemaillfuon ass ddesi ne�Date / /// Inspector /�J( No. Fee /<::::)a THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Mi5 poga[ *pgtem Co"truction Permit Permission is hereby granted to Construct ( ) Repair (� Up rade ( ). Abandon ( ) System located at /07� ®1,S�+v �� 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 b completed within three years of the dat�e�Of this pe it. Date 1,77 Approved`b_y_ FROM :down cape engineering inc FAX NO. :15083629880 Jun. 27 2007 01:26PIl P1 Town of Barnstable 0*KAM RegulatoryServices Thowa.s F. Geiler,Director Public Health Division Thomas McKean, Director 200 Main Street Hvannis, lNA 0160] Office,. 509-862-4644 ;ax: SUE-790-6304 Installer tC Designer Certihicatioti Form Date: 07-71e 7 Se%,age Permit# _iW 7'z6?— Assessor's Map1Parcel Designer: �o.,, C.a ne Installer: i3or` c;6 p/l� c: d� Address: ��]' Na l Address: �D 60X On 6l/�` &Prakl"�'/ 61*51 �r was issued a pernut to install a (date) (installex)1 septic system a' �a w based on a design draxm by (address) 12�1 dated (d_ er) I cerdt that the septic system referenced above was installed substarl Wlv according to the design, which may include minor approved changes such as late:al relocation of the distributior;box and/or septic.tank. I certify that the septic system referenced above was ir2stalied 'Mlh major changes (i.e. greater tll A I W lateral relooation of the SAS or any vertical relocation of any component of the septic system) but in accordance )x*ith State 8: Local Regulations. Plan revision or cerified as-built by designer to follow. DANIELA. $(in ler'5 Signature) OJALACIVIL No'46502 �Ur& a!STf%ONAL �p`ca�`� �7 \ (Desiper's Signature) (Affix Des)6EFs Stamp IE e) PLEASE PETUKN TO BARNSTABLE PUBLIC HEALTH DWISION. CERTIFICATE Off' COMPLIANCE WTLL N(2T BE I55UET) UNTIL BOTH THIS FORM AND A15-BUILT CflR.11 ARE RECEIVED BY;THEBARNSTABLE PUBLIC IiFALTH DIN SKM THANK YUI.I- Q:IiealiMcp:iclDesigna Ccrlifi=ion Form 3-26-04.doc { TOWN OF BARNSTABLE LOCATION 42% ovs44 aiati /S ycsf is.` SEWAGE # VILLAGE /2S I-A - ASSESSOR'S MAP & LOTC575 INSTALLER'S NAME&PHONE NO. /���f eo�-s> SQL s�S'y5 `Y SEPTIC TANK CAPACITY v2 SOO c // L G• . LEACHING FACILITY: (type) � /� (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet F Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet r Edge of site. and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by J r • L�I 4 I v i• O V A---© S.T•o µ . is yG• o p 0 � O No. H—ot s Fee l THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIpplication for Migo al *pgtem Cott!trurtion Permit Application for a Permit to Construct(�)Repair( )Upgrade( )Abandon( ) XComplete System El Individual Components Location Address or LQt No. /� / (�s e/' a Owner's N e,A dress and Tel.No. PIP Assessor's Map/Parcel (/ O I=- Installer's Name,Address, d Tel.N r^ C Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Ale_ Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 10.06r Type of S.A.S. 2 Description of Soil Nature of Re 'rs or Alterations(Answer when applicable) (,�.0 a I-/9 e Z Date last inspected: 21- X / Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provis' s of Title nvironment We and not to place the system in operation until a ertif cate of Compliance has be issued b f Signed Date �/ Application Approved by Date Application Disapproved for the following reaso Permit No. Date Issued No- 74V _RTO Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS . , 01pprication for Miopogar 6pgtem Construction 3permit ~Y Application for a Permit to Construct Repair )Upgrade )Abandon ) Com lete System ❑Individual Components PP x) P ( Pg ( ( � P Y P Location Address or LQt No. /� ®g c-r .ti t/ Owner's N e,A dress and Tel No. n�'+ ©s`�cr Hajurs 5 �B ( �r9v pA�u �T "7'E' 1 � Assessors Map/Parcel M x Installer's Name,Address, d Tel N .r C Designer's Name,Address and Tel.No. ✓ 'r� �olrJ S l c. i�'�f GC Type of Building: Dwelling _ No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ,� I, gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title 4 -- y Size of Septic Tank /Oe7G Type of S.A.S. Z Description of Soil Nature of Re 'rs or Alterations(Answer when applicable) r 1.2 1; r Date last inspected: Z S X I Agreement: The undersigned agrees to ensure the construction and maintenatice of the afore described on-site sewage disposal system in accordance with the provisions of Title nvironment : ode•and not to place the system in operation until a Certif cate of Compliance has bern issued by f H N Signed Date lcai, d Application Approved by Date Z Application Disapproved for the following reason i Permit No.!a ` ) ' �Snp Date Issued �i C7 -------- ——————— --------- -- ------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance- THIS IS TO CERT ,that the On-site Se age Disposal System Constructed)Repaired( ')Upgraded( ) Abandoned( )by c of a at has been constructed in acc rdance with the prov -f e 5 d the r Di al System Construction Permit No. dated Z• Cl _ p ° r Installer�d ( o�tJ S d vG ��,�' Designer The issuance of this-pp t shall not be construed as a guarantee that the system/will functio-as designed. Date Ct / Inspector - - - ----------------------------------------- No. lNU s—o o �7/` 00 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mizpooal 6potem Conotrurtton Permit Permission is hereby granted to Construct( ) epair )U grade( )Abando ( ) / System located at /a 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. i Provided:Construc ' n mqst be completed within three years of the date of this a t. r Date: 6 Z, G� Approved by 5/25/01 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM hereby certify that the engineered plan signed by me dated concerning the property located at meets all of the following criteria: This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. �• The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct preliminary tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed There are no variances requested or needed. The bottom of the proposed leaching facility will not be located less than fourteen' (14) feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete.the following: A) Top of Ground Surface Elevation (using GIS information) B) G.W. Elevation + adjustment for high G.W. _ DIFFERENCE BETWEEN-A and B SIG 4Z44441 ::- DATE: 61 NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:percexmp / V / 0 J c Ll� ��. C I � `� I ovj °� SYSTEM PRO��LE LEGEND TOP FN'DN. AT EL 26.4' NOTES C. I. ACCESS COVERS TO GRADE rror ro scALE) APPROXIMATE NGVD •- ._ ..iCCESS COVER-TO WITHIN.3". OF:FIN. GRADE. 100.0 PROPOSED SPOT ELEVATION AccEss COVER (WATERTIGHT) TO 1 DA1UM IS ,. COtl�tt 26.0 MINIMUM .75' OF COVER OVER PRECAST /` WITHIN 6" OF FIN. GRADE 2. MUNICIPAL WATER IS EXISTING 2X SLOPE.REQUIRED OVER SY';TEM. k 2"6.0� tSEE VENT NOTE.QN.PLANS. 100x0 EXISTING SPOT ELEVATION 2" DOUBLE WASHED P,,EAITONE „ RUN PIPE LEVEL OR GEOT mLE;.FABRC 3. MINIMUM PIPE PITCH TO BE 1/8 PER FOOT. 100 PROPOSED CONTOUR *EXISTING FOR FIRST 2' PROPOSED 5' MAX. 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO o H- 20 ` IFF 1-00 EXISTING CONTOUR GALLON sEPrlc ;:62,-25- 2]_ "2 TANK (H- 20 ) s s t�iP ' 22.44' n a LwUAA 21.95' 21.78' 5. PIPE JOINTS TO BE MADE WATERTIGHT. 0 M 0 0 0 l� 0 0 ALL SYSTEM COMPONENTS SHALL BE MARKED 21.64' _ p p 0 0 0 0 0 0 WITH MAGNETIC TAPE_OR COMPARABLE C P EXISTING CESSPOOL MIN. ( 2. % SLOPE) 6" CRUSHED STONE OR MECHANICAL � MEAN FOR FUTURE LOCATION. 6. CONSTRUCTION DETAILS TO BE I' /ndion N ACCORDANCE WITH West �- � �'� � 'S ' J_ COMPACTION. (15.221 � 0 � G[21) 2' E3 0 0 0 0 = 0 0 0 o MASS. ENVIRONMENTAL CODE TITLE V. r�o// 1 DEPTH of FLOW = 4' 19.64' y ( 1 % SLOPE) ( 1 % SLOPE) 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO TEE SIZES:' 3/4" TO 1 1/2" DOUBLE HASHED STONE INLET DEPTH = 1 O" BE USED-FOR LOT LINE-STAKING OR ANY OTHER PURPOSE, Seopuit River H-20 CHAMBERS Road OUTLET=DEPTH = 14" 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. - - H-20 FOUNDATION 16' SEPTIC TANK 30' D' BOX 16' LEACHING 6.84' 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED FACILITY WITHOUT INSPECTION BY BOARD OF HEALTH AND .PERMISSION OBTAINED FROM BOARD OF HEALTH. LOCUS MAP 10. CONTRACTOR SHALL BE RESPONSIBLE .FOR CALLING SCALE: 1" = 29000'f BOTTOM TH-1 EL. 12.8' DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCATION OF ALL UNDERGROUND .& OVERHEAD UTILITIES. PRIOR TO ASSESSORS MAP 71- PARCEL 8 COMMENCEMENT OF WORK. 11. EXISTING LEACHING FACILITY FOR MAIN HOUSE SHALL BE LOCUS "IS WITHIN. -FEMA FLOOD ZONE C PUMPED AND REMOVED OR PUMPED AND FILLED WITH CLEAN AS SHOWN ON COMMUNITY PANEL #250001 0018 D SAND. GUEST HOUSE SEPTIC SYSTEM TO REMAIN., DATED JULY 2, 1992 12. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE LOCUS IS IN AP OVERLAY DISTRICT - REMOVED -5' BENEATH AND ARODUNfl THE PROPOSED LEACHING FACILITY. TEST HOLE LOGS ENGINEER: DAVID FLAHERTY, R.S. WITNESS: DONNA MIORANDI, R.S. DATE: MAY 24, 2007 PERC. RATE _ < 2 MIN/INCH SYSTEM DESIGN: CLASS I SOILS P# 11759 GARBAGE DISPOSER IS NOT ALLOWED ELEV. ELEV. BENCHMARK DESIGN FLOW: 4 BEDROOMS 110 GPD = 440 GPD 0" 4 24,8' O" Q 25.4 COR BRICK PATIO USE A 440 GPD DESIGN FLOW: ELEV = 26.5' SEPTIC TANK: 440 GPD (2) = 880 12„ FILL 23.8' " FILL , Ic ` :,X TANK _ _ 'w'_ \ USE A 1500 GAL. H-20 SEPTIC TANK 12 24.4 ,f 32 F A <� ,� , o LEACHING: a . , SIDES: 2 (40 + 10) 2 (.74) = 148 GPD - LS LS " 1 OYR 4/1 10YR 4/1 _ N BOTTOM 40 x 10 (.74) = 296 GPD 16 23.5 17" �•a� f ESSPOOL \, TOTAL: 50O 'S'.. 444 GPD LS LS �._-'' USE - 3 500 GAL. LEACHING CHAMBERS ACME ORE UAL 10YR 4/6 10YR 4/6 \ u rn GUEST HOUSE (WITH 4' STONE AT ENDS, 2.6' AT SIDES AND 3.25' BETWEEN UNITS 33" 22.0 33" 22.6' \ O\ \ � `PORCH �\ r � , FLAGSTONE \ APPROVED DATE BOARD OF HEALTH PATIO \ 26 \� LO MS MS MP ST_ 144" 2.5Y 6 4 12.8' 126" 2.5Y 6/4 14.9' TH-2 j CP i _,__- _.• TH-1 \, Q0 � IRRIGATION %" NO GROUNDWATER ENCOUNTERED PAVED THROUGHOUT \ c9 LOT AREA DRIVE \ U1WN AREA wl FI I „•, o ASSOCIATED \ 49,272 SFf '\ \ .• •' •:.R ELECTRIC WIRE ,,� � � , \, EXISTING 4 BR ` j• .s• , _ �, TITLESITEPLAN \ DWELLING \ -,•-� ' TOP OF FNDN = 26.4• ` ,` ._ .•.,,. < ' '; ' \� LAMPdS o 129 OYSTER WAY ;� �.., s ALL. .�--•' , \ / � � '• C � GA DENS Nv� �-� \ ELEC UG WIRES - ` (OSTERILLE) B"%AmN,' TABLE, MA \ EXISTING \ GARAGE `k 1 PREPARED FOR w �� -----� BORTOLOTTI CONSTRUCTION/ " - F �. ��•. '�.! �_--'I 26.. SHED. , \` �� E. J. JAXTIWR BUILDERS "THE HEFE"NAN R SICEN C � Cp 327.001 PROVIDE VENT WITH CHARCOAL FILTER DATE: J U N E 8, 2'OO7 AND BUGSCREEN (FINAL PLACEMENT WITH HOMEOWNER CONSULTATION) Scale:1"= 20' 0 10 20. 30 _ 40 50- FEET off 508-362-4541 fax 508 362-98W �ZH OF MAS. 1 k OF MASSgc DANIEL �� t o� DANIELA. yG� o� q , down cape en gin eerin q, inc. OJALA OJALA N: GII/IL ENGINEERS No.465 No 09 P o o \o LAND SURVEYORS GA �Gr s T ER G rgN�s u kt ��� ! v / ONAL ��' 939 Main Street - YARMOU TI/ROR T MASS_ DATE &' J',E 8. OJALA, P.E., P.L.S. DCE ##07-078 07-078 BORTOLOTTI-JAXTIMER.DWG (DDF)