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HomeMy WebLinkAbout0222 OYSTER WAY - Health 222 OYSTER iTvAY-OSTER VII -E A 07t006 1 1; Fee n-L- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 6� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes t.S 2pplifation for Disposal *pstrm Construction Permit 00 �. Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No.�Z ��� 1n/�j Owner's Name,Address,and Tel.No.SC �� qt�l '.;a1 tee. 0�2!`J���. Assessor's MapTarcel q7lOp� ��'` R�ti�t' C-r Installer's Name,Address,and el.No. �� �•�b� (�pl Designer's Name,Address,and Tel.No. Sc, jj,*, J®�C.a- rtSc�2i �48 F`IZ ST���,r 2.e, ►3t°,G 7%� er.ah- M r rn 5 So LF--33 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(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) S LC- G( 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 Co a of to place the system in operation until a Certificate of Compliance has been issued b k Signer Date Application Approved by Date Application Disapproved by Date for the.following reasons Permit No. -43 7(n Date Issued No. -�� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in comper: _��� Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS: , 0[pplication for Misposal *pstrm Construction 3permit ? Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon(, ❑Complete System Individual Components Location Address or Lot No.221 _ 0! Tyt-4Lr WA9 Owner's Name,Address,and Tel.No. 1~,' Os„C@:(`J•.�\'(,� .,�,rw`,�'ya�� '1� W���o�'�//�,C�t�,'{� � Assessor's Map/Parcel O C R.,.c- f L -IS- Installer's Name,Address,and Tel. No..�-Pe,.,( C-.�' o fop+ Designer's Name,Address,and Tel.No. � 50y@.@• `c\ra Sc MR,^q tWD ( 1,�^ U^��.0�/ ?.o. Mlb1( V-+� 1�� MGir SAC s.C„a N.St'�-!✓. �..Q 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.(min.required) gpd Design flow provided gpd y Plan i Dhe"'-,, �. Number of sheets Revision Date jtle r Size of Septic Tank ; �y Type of S.A.S. Description of Soil Nature of airs or Alterations(Answer when applicable) t �Re P ;/ ,s� � �� :} L �� r . 1'1 o Date last inspected: a _ 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 not to place the system in operation until a Certificate of Compliance tas been issued by t 's Bo d of ealth. r. Signe - -- t � -- �Dae Application Approved by Date Application Disapproved by Date for the following reasons Permit No. �1 �[/�/ Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( Repaired( ) Upgraded( ) Abandoned( by -�o n C r n .J at Z _ � n.f- \ has been cons cted in accordance with the prov' ions of Tit1e.5'and the or Disposal System Construction Permit N `37 fnn� dated Installer tn� Designer 5.tx ; �� v .41. r,. #bedrooms Approved design flow j gpd The issuance of this permit shall not be construed as a guarantee that the system wil functi, as designed. Date ) L4 p��y Inspector li .) N (D Fee 7.5 THE COMMONWEALTH OF MASSACHUSETTS \.,,LPUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Ne- oSal stem Construction ermit � p � Permission is hereby granted to Construct( ) Repair( ) Upgrade ) Abandon( ) System located at n . and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must bellcomplete .within three years of the date of, is permit. Date } l 1 t7 c Approve TOWN OF BARNSTABLL LOCATION �2„1 Ovskt- Io:y SEWAGE# Jot)G-- 3,(z- VILLAGE ASSESSOR'S MAP&PARCEL CX)(; INSTALLERS NAME&PHONE NO. l?C - SEPTIC TANK CAPACITY' /x-0 0 t J LEACHING FACILITY:(type) �2—S 0 /f (size) NO.OF BEDROOMS OWNER f 4 4 L)k/ PERMIT DATE: COMPLIANCE DATE: Mll Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY /3 -L L) D �.�� i J F_ 0 - =- D No., � � ---' E Fee I S r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Y 01ppYicatiou for aigogar 6pgtem Cou.5tructiou permit Application for a Permit to Construct(L.-�Repair( ) Upgrade( ) Abandon( ) ©CompleteSystem ❑Individual Components Location Address or Lot No. ZZ-L Oys er Ow�ner's Name,Address,and Tel.No. .+ Assessor's Map/Parcel —00(o p'o•Go;,,,7'0811V11 SS Installe 's Name,Add ess,and Tel. o. Designer's Name,Address and Tel.No. O. OZIa� Type of Building: Dwelling No.of Bedrooms Lot Size 0,8S Ate Es€-4. Garbage Grinder 06) Other Type of Building - No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 33 1 gpd Plan Date ('a i Z.4 10(,e Number of sheets Z. Revision Date ?j 114 10(, Title Sl tiro r 2�:-Mvraozmw Size of Septic Tank 1500 Type of S.A.S. Z-560(Pr,gir, Description of Soil Pik- /,3:7 I --N-\ O-�I" w7 QMfR H-Q" A� LatiEQL lWt2y I j SA J,*-1 LQ N� (4-1-L" C_ L&JER 10V2 51Z Cerny .SA�ti� IL-Z7" i3 CAvt`CZ W%& S� LOrtrN-4 5�1u1 Z7-r ®' C (rn.,er• 7,1�`l (tiLl YM)ciZ> 5NN1 - Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boa f It . Sign 4Date �Z Application Approved by LPA41eiL7SIL2 2 Date r. Application.Disapproved by: Date for the following-reasons Permit No. Date Issued ( ' h. No. i s Fee>. y� -r.4_ "..."�3� �Y'15 0 � // Entered in computer: _ THE COMMONWEALTH OF MASSACHUSETTS ,V v PUBLIC HEALTH DIVISION'- TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZlppYiration for 0i.5po!g1 Qpp5tem (Con,5trurtton Permit Application for a Permit to Construct(-)--Re, it( ) Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. Z?--L ONsXer (, -j Owner's Name,Address,and Tel.No. 01,w 'SoSePti L-- W, Assessor's Map/Parcel 0�I -C�Co p,o,�N.:Zo8q ` �. Installe 's Name,Add ess,and Tel 0 t; Designer's Name,Add ss and Tel.No: ✓ dr Ve C���7/ V\��Vr+� t✓n�in c b u: OZ(o5 Type of Building: Dwelling No.of Bedrooms Lot Size 0.95 A(Kz,'-,) -sq ft. Garbage Grinder (Pb) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures .. 4 Design Flow(min.required) Tj3U gpd Design flow provided 3'1') gpd Plan Date (o(Z.(Q Ioc. Number of sheets 2.. Revision Date 8l)4 10(o Title sk, 'aAn ipr bsp MP�i�2�r�Pd1�S Size of Septic Tank (500 Type of S.A.S. Z-Soo(44,- 0 [�tnbesg r. IZxZS F��t_p { Description of Soil I,�j�I - �11-1 �;40 (�LAtit �f-(a�� Ar t Ayt l0�2Ll Se�,Na�l C%3N<VN ( Lmt4> 10yk 517- /_QAMV SAN�'� IL,Z��� i�; t AvC`s� fo�� S j(p �L— Z7-1?o' C 1.u.,er- Z+S`1 t 11_1 Ynco Nature of Repairs or Alterations(Answer when applicable) Date last inspected: I 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 b this Boa f -ealth. _ p Signed Date , ' Application Approved by Date C" / t / U' - Application Disapproved by: Date for the following reasons Permit No. f//� Date Issued le THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certif irate of Compliance THIS IS TO CERTI Y,that the On-site Sewage Disposal System yConstructed Repaired ( ) Upgraded( ) Abandoned( )byd /� b e at Z� n ' crc with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer � 1�� °�'10 Designer < 1. ilk, #bedrooms _ Approved design flow 3 _" gpd The issuance of this permit shall not be construed as a guarantee that the system will functio�as­alsen_ned. Date � Inspector - . _ No. ----. 36&COMMONWEALTH -------------------- J Fee — ---- SU OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE, MASSACHUSETTS wig ar * 5tem Congtrurtion Permit Permission is hereby granted to Construct (v� Repair ( ) Upgrade ( ) Abandon ( ) System located at 7--?-,? ojs5 -er 011.,, ovS c- �Aerbar-s, . r 11 and as described in the above Application for Disposal System Construction Permit.-The-applicant recognizes his/her duty to comply with Title S and the following local provisions or special condittiions� Provided: Construction must be ympleted within three years of the date of this p� t . Date / Approved�}� 1 ti Town of Barnstalble °Ft"E r°w Regulatory Services Thomas F. Geiler,Director + BARNSTABLE, • MAC Public Health Division i639• �� Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Of5ce:. 508-862-4644 Fax: .508-190-6304 Installer & Designer Certification Form Date: Sewage Permit# Z '�h:—Y&Assessor's Map\Parcel L,971—eV�. Designer: i /9�G�'� 41'�, Installer: A/ &Xw IO:S Address: . /'v 4 � � Address: Ovxfolle W4 dC5-, 'Ars10AL5; Ill//s On l L - 0 �p� �l� was issued a permit to install a l yiIvII-1 (date) (installer) septic stem at Z o ✓�- ��� O based on a design drawn b p Y � Y (address) f le::�,& /CUc-��y t��` dated �l Y/ZQI�� (designer) . I certify that the septic system referenced above was installed substantially according to the design, which may:'include minor approved changes such as lateral relocation of the distribution box and/or septic tank: Stripout (if required) was inspected and the soils were found satisfactory. !> I,certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral;relocation of the SAS or. any vertical relocation of any component of the septic system)but in accordance with State & Local Regulations. Plan revision or certified as-built-by designer to follow. Stripout (if required)was inspected and the soils were found satisfactory. F PETE.• (IhstallefX Signature) v/ d/�LLIV ;i VC 2,�9723 CIVIL C) • �E aa, i �t.n ,•,ram' ii Signature) Affix De'� `"er's S-tam Here (Designer's g ) '' ( ign P ) PLEASE.'RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL;NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- ' BUILT CARD ARE!RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 03-09-06.doc Town of Barnstable I'11 Deparinienl o1711cp lalury Services t eAantrrxotti i II�lIC HealthDivisionDa se q 200 Main Slrcct,Ilyannis MA 02601 Stu Mid" Date Scheduled Tinic (.r Ifee I'd. C Soil Suitability Assessment for Smyge Dis 7 Performed By: `I\\/4 Witnessed By\ 7w,J LOCATION& GEN E ItAL INI.ORMA 'ION ' location Address -z2z 015\T Owner's Nanne 0-jKl- t')�r\wr' Address Assessor's Map/Parcel: 07k—0 0(0 C Ot 4/0 Cnginccr's Namr. Cyn:t,1pv11v-n NCrW CONSTRUCTION REPAIR Telephone I! S Z8 33 L Land Use Lest ae,rnV A Slopes(S:) 0.5�a Su►face Stones— /U D t o + n� -}— Distances front: Open Water Body ,5 D tl Possible Wet Area 500 It Drhiking Walcr Well rj�, .it J Drainage Way Soo 4- ItPropetty Line (7J + it' Other SIC.CTCII:(Street anme,dimensions of lot,a act locations of lest holes&pem testa,locate ivellands In proxinnily to-holes) Tr l l t} Parent materiel(geologic) � Depth to Bedrock 1500 �' l Depth to Groundwater. Standing Water in Ifole:- Moe- Weeping from Pit Fnce Alm Q CslhnnlcdscnsonnlllighOroun IZ dwater _ St (EL Z4�1 ie�,T,oz. 10�a�-�o�ww�cT M•� ' D �'I'I RMINATION FOR SEASONAL IIIG11 WATEIt TABLE, Method Used: NcA4 See A\Pevt Depth Observed standing in oils.hole:• in. Depth to soil tnulllcs:- In. Depth to weeping from side of obs.hole: ill. Groundwalcr Adjustment tt. Index Well N Reading Date: Index Well level Adj.factor Adj.Groundwater Level_ PERCOLATION TEST - BAIe 2111106 Tlme t 0— Observation Ilole/ Z �'� Time MY' T N nl DepUt of Perc LIZ I,imc at 6" Stint Pre-sunk Time© t End Pre-conk Rate Min./Inch M Site Suitability Asscssmenl: Site Passed Site rniled: Additional Testing Needed(YIN) OnigittAl: Public IleAilh Division Obscrvalion ITole Dala To Bc Completed on Back----------- ***If percul:t(ioti (fist is to be conducted lvilhiu 100' of wetland,you IIIIIA first Ilutify (lie Ilnrustable Conservation Division a( Icast one(1)tivicelt prior to begilinilig. �:nl�Ar:rniwwrrncmnM i I I(OLlJ L_ `I( lI G' I.�olc tl I Ucplh liunt ,;Uil Ilwiztnl Stoil'1t;elmc Soil Cul!ir Soil — !Aker Surlhco(In.) (USDA) (Munsoll) hlullling (:iG11CIIPc,Sknlcs,l,vuldcly. - -yn (7 �Y VI I �tl Z.s�ly -— — DE,EP OBSERVATION ROLE;LOG Hole tt 7 _ Depth from Suit 1loriwll Soil Tcxlurc Sril Color Soil . (Ilhcr Surface(ill.) (USDA) (Munscll) Muffling (Shuctulr,Slums,I)uulticls. Culliislulcy °[.Gmvcl, • 30- IZo T, Z.sy (Q/y - -- DRIP OBSERVAT'•ON HOLE LOG 110le It --- Dcpllt to um Suil Irorizun Soil'l-..Ilnre Sul[Culur Soil . Olhcr Sorinc (in.) (USI :';) (Munscll) Mulfling (ShucUnc,Shines,Iluuldcul. * UIISISICIIC'�" 11 Cl b—S O �y mb-yj Z-lZ.o C_ s ,vj> _.._ZS DEEVOBSE,RVATION ROLE JAG J.iulc It Deplll FRIIIl S if lluliwo Suil Tcxlule Suil Cnlur Suil Olhcr Surface(In:)', �( (USDA) (Munscll) Muffling (Sl►uclulc,Slums,Ihnddcta, I'lood nsurnuce Rile Mao: Alw vc 500 ycnr Ouud buundaty No_ Ycs Willlin 500 ycnr bumldmy No 1� Ycs Within 100 ycnr(loud buundmy Mu ✓ Ycs Dcuth of Naturally Occurring Pervious Maler'ial Does at least fuurrleet ofnaturaily occurring pervious nlldcrial exist ill all areas obscrvcll lluonglloW the arch proposed for the soil absorption sy51c1117 y� )f nul,what is We depth of naturally occurring pervious material? CcrlificaUon I certiry that on / (dn(c)1 have passed the soil evnluulur cxnminnliun approved by the Doprirtrnonl of Gnvtruum6dnl I'rutectiun rind Ihnt the nbove nunlysis was perrunned by nto cunsvAut►t with (tic required lraiuiug,expertise rind cx1mricnco described in 310 CIAR 1.5.017. Sif.mluro auto VAOSP (1:nrnl:rnnt rn't:ItcroltM COMMONV'TE.ALTH OF'NIASSACHU SETTS X . EXECUTIVE OFFICE OF ENVIRONMEN' TAL AFFAIRS. } I EPARTMVNT�OF ENVIRONlYIENTAL RO'I'ECTTON TITLE 5 �OFFICLA,L. INSPECTION FORM--.NOT FOR VOLUNTARY.ASSESS:MENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM. PART.A CERTIFICATION Property.Address:¢�.2 .GC./ Ownerr's Name Owner's Address: QCP m .Date of Inspection: -7 Cat ram. Name of Inspector,- (Please,rintj &rkAb Company Name 7 l 71; Mailirig Address: ' 1 t1A G v Telephone Number: c 7-74 ` CERTIFICATION STATEMENT 1.certify-thatl 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 Kinction and maintenance of on:site sewage.disposal systems. I am a D.EP -approved system inspec#or pursuant to Section 15:340'of Tifle'.5•(3.10 CM'R'15:000). 1 he system: Passes _ - Conditionally Passes. Needs Further Evaluation by the.Local Approving'Authority ai s Inspector's Szgnature:. `~-- - 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 of 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 sentto the buyer, if applicable, and the approving authority. Notes and Comments ****This report onlydescribes.conditions at the time of inspection.and under-the conditions:of use at that time.,This inspection does not address"how the system will performin the future'under the same or different conditions of irse. Title.5 Inspection Form 6%15/2000 page .1 Page:2.of 1 l O 'X+'ICIAL INSPECTION FORiYT—N:OT FOR YOLIJN I' ' 2 C;ASS SS IEI`fTS. . SUBSURFACE SEWAGE'DISPO:SAL SYSTEM INSP EC'I`ION FORM.....;. . PART A. CERTIFICATION'(continued) Property Address: 2 C Yg Own:e Date o,. nspection..- d__1 Inspecti.on�Sum mary• .C`,ecl,*'A.,B',C,P orB,/AL-.WA'YScompi6te,alI ofSection.D A. jy5tem Passes: I have not found any information which.indicates.that anyofthe failure criteria described in 310 CMR 1'5.303 or in 310 CMR. 15304 exist.Any failure criteria,not evaluated are indicated below. Comnient's: 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;.Vill pass. Answer yes,no or not determined(Y;? .;NID)in the for the following statements. If"not determined"please explain. The septic;tank:is metal! over.2.0,years;ol& or:the septic tank(whether metal'or not)-is structurally unsound,eAib.its substantial infiltration or exfiltratiori 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 I;ess than 20.years old is available. ND explain.- Observation of sewage.backup or break out or high static water level in the distribution box due to broken or: obstructedpipe(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. T obstruction is-xemoved 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;xemo.ved .: ND explain: r P•aee' 3 of 11 OFFICIAL,INSPECTION FORM--NOT FOR.VOLUNTARY ASSESSMENTS SIJI3S`UI FA I SE AGE DISPOSAL SYSTEi1 INSI?ECTION FORM PART A`.: , CERT-IF!CATION,{continued) Property Address: —� 27 _ Owner: • . Date afAnspection: ('j C. Filrthar•B�valuation is equired by.the Board.of Health: Conditions exist which require fim Cher 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 ofl ea',th determines in accordance'with 310 CP„R 15,303(l"I that the system is not functioning in a manner which wili.protect:public health,safety and"the environment: Cesspool or privy is�xithin 50`feet of a'surface water Cesspool orprivy.is within 50 feet of borderinP`vebeiated`wetland'.or a salt marsh' 2: . System will fail unless the Board:of Health (and°Publ c,;Water Supplier,if any).determines that the system is:functionina in a manner that.protects the public health,.safety.and environment: _ The.system has a septic tank and.soil absorption.system (SAS)and the SASiis within']00`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 wrthima'°Zon.e l'of a-public water supply. _ The sysfem'has aseptic tanl..and.SAS and:the SAS is.wrthtri 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 determin6,distance j "This system.passes if the well water analysis;performed afaDEP certified labPratory,for coliform bacteria and volatile organic compounds indicates that the well is.free from nollutiomfrom 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 triacered.A copy of the analysis:must be attached to this:form. � 3. Other; i 3. Page 4.of. 11 O..FFICIAI;:IItiSPJEGTION FORM ..NOT" :{�.R V© .IJN ARY :ASSESS1ti�ENTS ' SUBSURFA.CE,SE'WA.GE,I)ISPGSAE.S:YSTE1N1JNSPECTI t.FORIM PART A CERTIFICATION(continued). Property.Address: Owner f Date of In pectiow. —� D.. System Failure-.Crite 5a applicable to alPsystems: You must indicate'"yes"or"no"to.each.of the:fo:llowing'for gn:inspections: V Yes N >� Backup of sevage into,facility,or system component due to overloaded or clogged SAS or...cesspool Discharge or Pondin of effluent to the surface ofthe Ground.or surface waters:due to an overloaded or, clogged-SAS or cesspool Static liquid,l'evelJn 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 i.s.less than %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. Anyportion,oF cesspool:or privy is.within.100,feet of a.surface.water supply or tributary.to:a.surface J water.supply:] _ Any.portion of a cesspool.or.privy.is wrthin.a Zone 1 of a:public well. Any portion of a cesspool of privy is within.50.feet of a:private water supply well: V Any portion of a cesspool or privyis:less than'1.00 feet but greater ihan.50=feet.from a private water supply well withno acceptable.'water.quality-analysis...[This system passes-if.the well water analysis, performed a:t:.a DEP certified laboratory,for collfor in,ba.cteria and,v.olatile'organic compounds indicates that the..well is free from pollution fro m'that.facility,and the.presence of ammonia nitrogen andinitra:te.nitrogen.is:equal.to-or less than ppm,.provided that no:other failure criteria are triggered..A.copy of;tlie analysis.must'be attached toothis form.] PV O (Yes/No.)The system fails. I have.determined that one or more of the above failure criteria exist as. described`m 3'10 CMR 15.303,therefore the system fails.•The.systein.owner should:contact the Board of Health to determine what.will be necessary to correct the:failure. ' E. Large..Systems: stems: g To be considered a'largesystem the system must serve:a facility-with a design flow of 10;000:gpd to 1.5,000 ypd. 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 4.00 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 m Section D above the large system has failed.The owner or operator of any large system considered a signif cant threat.,. Section E or failed under Section D•sha.11 upgrade the system.in accordance with 310 CMR 15.304.The system owner.,should contact.the appropriate�regional office office Department. Page 5 of 1.1 OFFICIAL I-NSPE:CTIONT F.ORM NOT`FOI2 VOLUNTARY ASSESS E.NTS SIfi Sr A E"SEWAGE DiSP:OSA:L:SYSTEM IMSPE'CTION F'ORtVZ TART R CHECKLIST Property Address:'2')' .0. 4 6 � V Owner Date of nspection: Check if the following have been done..You.must.indicate"yes"nor"no"as.to each of.the-following: Yes. Pumpina:information was.provided by the owner,.occupant, or Board of TIealth; re 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 dwellin;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 affles or,tees, material of construction, dimensions, depth of liquid,.depth of.sludaeiand.depth of scum'? _ — Was the facility owner-(and occupants if different from owner)provided with information.on the proper maintenance of subsurface sewage disposal systems? - The size and location of the Soil Absorption System (SAS) on the site has been'determined`based on: Yew. Existina information. For example, a plan at the Board of Health. Determined in the field.(ifany of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CNSR 15.302(3)(b)] Page 6 of l 1. OT` I IAL.:IN. CTIQ�(FO.R I'�tOT- fl Z:VO ;U1�i ,��PI'ASSESSIVIEIVTS SUBS URI+ACE SEWAGE DZSPOSr I; SYSTEM'INSPECTION FORM FARI`:fl SYSTEM-4NF.ORi A ION Property Address: Owner: Date o. spection: / FLOW-CONDITIONS RESIDENTIAL t/ Number ofbedr9oms .design:: [,� ( . G. ) / Number of bedrooms (actual).., DESIGN flow:based on 310:.c v1R 15.203 (for example: I O gpd x m of bedrooms):Vic Number.of current residents:. ,A/h J� " Does residence have aarbaae grinder(yes or no):. Is laundry on.a separate sewage sysfern (yes or no):wMif yes:separate' inspection required] Laundry.system inspected. e .or no): ® Seasonal..use: ('yes dr na): Water meter readings,,if a. fable(last 2 years.tisage:(gpd)):__o6 1©3 00,9 1�'�16D Sump.pump (yes or no): Z7 Last date of occupancv: �� COMMERCIAL/INDUSTRIAL.jY Type of establishment Design flow(based'qn 310 CMR'15.203): Qpd Basis of-design.flow(seats/persons/sq.£t,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 orno):- Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records ` Source-of information: Was system pumped as part of the.nspectio yes or no): U If yes, volume pumped: gallons How was quantity pumped determined? Reason.for pumping:' TYP 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) —Tight tank: _Attach.a copyof the DEP approval _.Other.(describe): proximate;geof all components, date installed(if known)and source of information: Were sewage odors:detected when'.arriuing at the.site (.yes or no):.� Page 7 of I I OFFICIAL INSPECTION FORM—NOT FOR*V'OLU:NTA.RY asSEsslnEltiTTs SUBSURFACES +W-AGF,'l8)P' SA:L SYSTE ''-INSPECT10N'-FOI2i1M: 1'AI2T:C 5YSTE INS'b' 4 TiON (continued) - Property Address: Owner: Date of Inspection: BUILDING SEWER(locate on site plan) Depth below grade: . Materials of construction: cast iron 40 PVC_other(explain): Distance-from private water supply well or suction line: .. Comments (on'condition of joints,venting,evidence of leakage, etc..)- SEPTIC TANK: (locate on site plan) Depth below_grade:_ Material of constnictiom_concrete_metal_fiberglass .Polyethylene _other(explain). If tank is metal list acre:_ .Is age:confirmed by a Certificate of Compliance(yes`or no).;_(attach..a copy of -certificate) Dimensions:. 46 h' IS Sludge depth:. . Distance from top of sl tre to bottom-o outlet tee or baffle:. j Scum thickness: ' /t Distance from top o scum:to top:of outlet tee;or baffle:. Z Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions.deterrnined: Comments (on pumping bo .recommend n baffle s, i et and outlet tee or bae condition, structural integrity, liquid levels s related to outlet invert, ev rice of leakage, etc.): AAJ �rIf A ✓�Q,Q /" fee e-�� C `°I c •; : : , . GREASE TRAPAVlocate on site plan) - Depth below;grade: Material.of constructi6m._conciete.. metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of butlet tee or baffle: Distance from bottom'of scum to bottom'of outlet tee or baft7e: , Date oflast,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.): 7 , Page 8 of 1.1 OFFICIA .•INSPECTION FORM NOT'CFO]R.NOLUNT .ASSESSMENTS. SUBSURk'AMSE'4 AGE DISPOSAL 'S 'E i1 INS P:ECTIOIo1 'ORiYI PAST C' S:YSTEM--INFORMATIOIN continued Property Address: Owner:- Date ofi nspection: TIGHT or HOLDING TANK:��y�(,�(tank must be um ed at time ofins ection. locate o .site a —r-- P .P P )( tl.s� plan), II 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: /(ifesent must.be opened)(locate on site.pla Depth of liquid level above outlet invert:. Comments (noteif box k;.Jevel and distributionto.outlets:equal;.any evidence of solids carryover, any evidence of ,,-leaka;e,intp or out of boxj.ete.): � � L��J y. P>1.1IP CHArYIBEIZ:. locate on site plan): Pumps in working.order( es•ot no): I't Alarms in working:order(yes or no):. Comments (note,condition of.pump chamber, condition of pumps and appurtenances, etc.): k Pace 9 of 11 OFFICIAL INSPECTION FORM—NOT �+'OR VOLUN'TAAY ASSESSIYiENTS SUBSURFACE iA D7:SPOSAL SYSTEM- I PECTTONFORId :.,PART C ' SYS 'EiNT INh°0'RYIATION(continued) Property Address: . Owner• LL, � _ Date o . nspection: T! - SOIL ABSORPTION S'YST M. (SAS): (locate on site plan, excavation not required) If SAS'not located explain why: T 'pe leaching;pits,number:. -leaching chambers,number: =leaching.galleries, number: leaching trenches,number, length: leaching fields,:number, dimensions: overflow cesspool; number: .innovative/alternafi.ve system- Type/name of technology: Comments (note condition of soil. signs of hydraulic failure, level of pondina, damp soil;condition of vegetation, etc y - r/ C ' / W 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.groundwat'er inflow(yes or.no): . Comments (note c'onditiur.:ofsoil, signs of-hydraulie."failure,.level ofponding, 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 ", - % ell 72 9 Page 10 of I OFFICIAL INSFECTTOiY:FORM=�iO`'T' FOR VOLUi^l'T'. Y ASSESSMENTS . SUBSURFACE SEW-AGE'DISpOSAL SYSTEM-INSPECTION FORM. PART-C. SYSTEN:ZNFORMA1:ION(continued). Property Address;. Owner Date of Inspection!:.. (� 6-7 ' o SKETCH OF SEWAGE AISPOSAI,SYSTEM Provide a sketch of the;sewage disposal system including ties to at least two pzi-manent reference laridmarks'or benchmarks. Locate all.wells within.l'00 feet.Locatz.where public water supply enters the building. If 10n 0 (C all6 )r) tow Pane.I of I l OFFICIAL INSPIJCTI0. N FORYI NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INS PECTION FORM PART•C SYSTEM INFORMATION(continued) Property Address: Goa .Owner: " Date of fnspection: � ?97-Y--- SITE EXAM Slope Surface water Check cellar Shallow wells Estimated-.depth to"ground water Meet y Please:' dicate (check):all methods used to determine the high.ground water elevation: Obtained from-system design plans on record -if checked,date of design plan'reviewed: Observed.site(abutting property/observation"hole within 1'50 feet of SAS) Checked with Focal Board of Health-explain: ��hecked with.local excavators, installers-(attach documentation) ✓Accessed USGS database-explain: You must describe how you established the high ground-water elevation: s , 11 • THE.COMMONWEALTH OF 11IASSACHIJSLT I S BARNSTABLE, MASSACHUSETTS Certificate of (Camptiante THIS IS TO.CERTIF�',that the Dn-jte Sewage Disposal System Constructed ( -�� Repaired ( ) Upgraded ( ) Abaridoned( )by ��'�` � t. at __ �,y�e_— 1 �o,•Y �c', ��- -�;����� 646eli aseen constructed in.accord ance ` t{ with the provisions of le 5 and the£ Disposal System Construction Permit No.' i - -dated rf LW GG . t' z ,Installer �t— Lt \ _ Designer bedrooms Approved'design flow gp( issuance of this permit shall not be cons ued as a guarantee that the system wi-l' functio r6gn d. r 1, 1 Inspector TOWN OF BARNSTABL)C I LOCATION i► •� , i^V,44 ��L°5 !//®// WAGE# C;x)6 VILLAG j�i/�yf,34,.-1 ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. 1i s l . SEPTIC TANK CAPACITY /S-Z70 LEACHING FACILITY: (type) -�2—J V O Z.° C. (size) NO. OF BEDROOMS J OWNER Jbsn� PERMIT DATE: 1 •�-Z.Z— 0.rJ COMPLIANCE DATE: „ Separation Dil_tance 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 e b I V U�o f - Permit Number: Date: Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location: �� Zz ® �� L N Lot o. Owner: 4A, Address: Contractor:- Address: �- / ' Notes: STEP 1 Measure depth to water table / to nearest 1/10 ft. .......... Date month/day/Year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OAppropriate index well.................................... Water-level range zone .. .. :...:..:......: ........ STEP 3 Using monthly report"Current Water Resources Conditions" determine current depth to - .D ,lJ water level for index well ............................ � 7 month/year ' STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 2B) p determine water-level adjustment ......................'.............................:....::................................ 7 STEP 5 Estimate depth to high water by subtracting the water level adjustment (STEP 4) from measured depth to water �r levelat site (STEP 1) ....................................................... ........:................................,........... Figure 13.--Reproducible computation form, 15 00 tic I c � -- }r y1. __ --_ ___ —__ - - -_ - 1, u i• r i� •. i-ric�./.irr 1,14n,—I tI /J The plans and specifications.for every on-site system shall be prepared as follows: (1) Every system shall be designed by a Massachusetts Registered Professional Engineer or a Massachusetts Registered Sanitarian provided that such Sanitarian shall not design a system designed to discharge more than 2,000 gallons per day pursuant to 310 CMR 15.203. Any other agent of the owner. may prepare plans for the repair of a system.designed to discharge not more than than 2,000 gallons per day pursuant to 310 CMR 15.203 provided they are reviewed by a Massachusetts Registered Sanitarian and approved by the approving VVV f authority; / (2) Every plan submitted for approval must-be dated and bear the stamp and signature of 4� the designer, (3) Every plan for a new system or plan for the upgrade or expansion of an existing system which requires a variance to a property line setback distance;'must.also reference a plan which bears the stamp and signature of a Massachusetts- Licensed Land Surveyor in accordance with M.C.L. c: 112, § SID; (4) Every plan for a system shall be of suitable scale(one inch=40 feet or fewer for plot plans and one inch = 20 feet or fewer for details of system components) and shall include depiction of: (a) the legal boundaries of the facility to be served; Vie-holderand-4ocation-o€4n- -easetnents appuxenant-to at which can rrpaet We system; / (c) the location of the all dwelling(s)or building(s)existing and proposed on the facility and identification of those to be served by the system* -- • e' ocation of existuig or proposed impervious areas, me u tug driveways an parking areas; (e) location and dimensions of the system (including reserve area); (f). -system design calculations,including design daily sewage flow, septic tank capacity (required and provided); soil absorption system capacity (required and•provided); and whether system is designed for garbage grinder, 7 O North arrow and existing and proposed contours; (h) . location and'log of deep'observation hole tests including the date of test, existing grade elevations marked on each test, and the names of the representative of the approving authority and soil evaluator, (i) location and results of percolation tests including the sate of test and the names of -the representative of the approving authority and soil evaluator, .} name and certification number of the Soil Evaluator of record; (k) location of every water supply,public and private, 1. within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply wells, 2. within 250 feet of the proposed system location in the case;of tubular public / water supply wells,and / 3. within 150 feet of the.proposed system.location it% the case of private water VVV supply wells; � ) location of any surface waters of the Commonwealth, rivers, bordering vegetated wetlands, salt marshes, inland or coastal banks, regulatory floodway, velocity zone, surface water supplies,tributaries to surface water supplies,certified vernal pools,private water supplies or suctiotr lines, gravel packed or tubular public water supply wells, subsurface drains, leaching catch basins,'or dry wells; and the location of any nitrogen / sensitive area identified in 310 CMR 15.215 within which portions of the proposed 1/ stern are located. m) location of water lines and other subsurface utilities on the facility; (n) observed and adjusted ground-water elevation in the vicinity of the system; o) a complete profile of the system; (p} •a note on the plan listing all variances to the provisions of 310 CMR 15.000 sought in conjunction with the plan, (q) . the location and elevation of one benchmark within 50 to 75 feet of the facility which is not siibJcct to dislocation or loss during construction on the facility; (r) when dosing is-proposed, complete design and specification of the dosing system i proposed including.but aoi limited to dosing chamber capacity (required and provided), ( � ump curves and specifications, number R dosing cycles and depth per cycle; (s) when a Recirculating Sand Filter or equivalent alternative technology is required or ro osed,a complete plan and specification for the system,including a hydraulic profile; a locus plan to show the location of the facility including the nearest existing street; u the street number and lot number, if any, of'the facility; and v) the materials of construction.and the specifications of the system. eft • ` 'R _ - _i .. ~ '' -r'."•, ; - BORTOLOTTI CONSTRUCTION,4141 .- a, �lyo�2s 199 •. l � 765 WAKEBY ROAD,MARSTONS MILLS, MA 02648 508-771-9399 508428-8926 FAX: 508- '"l.y399 � d? SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FO k9` PART A CERTIFICATION Property Address: dZia I 14 2yo _ Date of Inspection: Inspector's Nan er`s Name and Address: O� g* CERTIFICATION STATEMENT: ti I certify that I have personally inspected the sewage disposal system at th:i a address and that the informa- tion reported below is true,accurate and complete as of the time of inspec-,ion,The inspection was per- formedbas on my training and experience in the proper fmiction and icraicat.enance of on-site sewage disposal stems..The System: Passes Conditionally Passes Needs Further aluation _y. ke Local Aproviiig Authority' Y Fails _.... .... Date: Inspector's Signature: ;,._. The System Inspector shall sub t a copy of this inspection report to the Approving authority within thir- ty(30)days of completing this inspection. If the system is a shared systei l o has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the repo« to the appropriate regional office of the Department of Environmental protection. The original shorld,be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTII/ON SUMMARY: A)SYSTEM PASSES: ���////// I have not found any information which h,.dicates that the's,­,-V�.n violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria na.evaluated are indicated below. B)SYSTEM CONDITIONALLY PASSES; One or more system components need to be replaced or rep_ rE;'4. The system,upon comple- tion of the replacement or repair, passes inspection. Indicate yes,nor,or not determined(Y,N,OR ND). Describe basis of&1(t i aination in all instances. If not determined",explain why not. The septic tank is metal,cracked,structurally unsound,sho w r. ��.ostantial infiltration or exftltration,or tank failure is imminent. The system will p,ss faspection if the existing sep- tic tank is replaced with a conforming septic tank as approtxl by The Board of Health. Sewage backkup or brea;:out or high static water level obser!.u-d in the distribution box is due to broken or obstructed pipes)or due to a broken, settled o i uneven distribution box. The system will pass inspection if(with approval of-The Board i.f Health): - 1 - r SUBSURFACE SEWAGE DISPOSAL SYSTEM,INSPECTION FORM PART"A r CERTIFICATION (continued) Broken pipe(s)replaced A Obstruction is removed Distribution Box is levelled or replaced The System required pumping more than four 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 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 the public health,safety and the envi7onment. 1)SYSTEM WELL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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;1IP AJiPROPRIATE)DETERMINES THAT THE S`S)TEM IS FUNCTION- ING IN A'MANNER THAT PROTECTTHE'PUBL'IC HEALTH-AND-SAFETY AND THE ENVIRONMENTS The system has'a septic tank aiid soil abso'r`ption system and s7within 100 Feet to a surface water supply oftributary to a surface water supply. z a The system has aseptic tank and soil absorption_ system and is with a Zdne I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 Feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 Feet but 50 Feet or more from a private water supply well,unless a well center analysis for coliform bacteria and volatile orga Vcompounds indicates that the well is free from pollution from Elie fae;lity and the presence of ammonia nitrogen and`nitraid nitrogen is equal to or less than 5 ppm. D)SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR'15.303. The basis for this determination is identifie8�V low. The Board of Health should be contacted to determine what will be necessary to correct t`flkailure. Backup of sewage into facility or system component due to A',In overloaded or clogged SAS or cesspool. Discharge or ponding of efluent"to the surface of the ground'or surface waters due to an overloaded or clogged SAS or"cesspool. p Static liquid level-in the distribution box aWi b-6tidet'inveri°due to an overloaded or clog- , ged'SASor0.cesspool'" L'iquiddepth',in�cesspoof is lessthan 6"below invert or-avail.able volume is less than 1/2 day flow. Required pumping more titan 4 times in the last year NOT:due to clogged or obstructed pipe(s). Number of times pumped -2- fi SUBSURFACE SEWAGE DISPOSAL:SYSTEM tN.SPECTION FORM .. . PART A CERTIFICATION (continued) Any portion of the Soil Absorption System,cesspool or privy sip tx1ow,the high groundwater elevation. Any portion of a 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 I of a public; aF;ll. 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for colifowin bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: The following criteria apply to a large system in addition to the criteria above: The design flow of a system is 10,000 gpd or greater(Large Syst^tt,)ar.d the system is a significant threat to public health and safety and the environment because oiy:,or more of the following conditions:exist:w r s`The system is within 4.00.Feet of a surface drinking watee s 1pp9y 4 ty. _ f tributa to a surface drawkmg water,supply i 2 00 Feet o a m is within 2 ry, ... , . , <.. .�:. Thesyste ,. The system is located ir+a nitrogen sensitive area Intezun +'eIlhead Protection Area (IWPA)or a mapped done Il of a public water supply weE, The owner orr operator of an such system shall bring the systemand.facilty.into full comp liance with the Y groundwater treatment:program.requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. ,,.SUBSURFACE SEWAGE DISPOSAL SYSTEM IWSP.ECTION FORM PART B CHECKLIST Check if the following have been done: L,"'Purriving information was requested of the owner,occupant,and Board of health. None of the system components have been pumped for atleast two peeks and the system has been receiving normal flow rates during that period. Large ve[saies of water have not been introduced into the system recently or as part of this inspection: 1/As-built,plans have been obtained and examined. Note if they re not available with N/A. __Vfhe facility or dwelling was inspected for signs of sewage back,-up. . The system does not receive_non-sanitary or industrial waste fli usu. The site was inspected for signs of breakout ,. ,, , ;,;, f;systernc�omponents,excluding the Soil.Absorption.System, have been located on site. 4I'he septic tank manholes were uncovered,opened,and the interior of the•septic tank was in �, -spectedfor condition of bafIles,or tees,material of construction,dtmensions,depth of liquid, y pth of sludge,depth of scum. he size and location of the Soil Absorptio:,System on the site,,h s been determined based on existing information or approximated by,non-intrusive methods. -3- . i s 4R r.... - SUB'SURFACE°SEWAGE:DISPOSALS_YSTEM.INSPECTION FORM PART B , . . CHECKLIST(continued) t/ The facility owner(and occupants,if different from owner)were provided with Information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - - SYSTEM INFORMATION ' FLOW CONDITIONS Design Flow: lions Number of Bedrooms: Nun ber of Current Residents: Garbage Grinder: Laundry Connected To System: Seasonal Use: Water Meter Readings, if available: Last Date of Occupancy:- - rnnin�rER['rAiJINDE1STRIALe x Type of Establishment:l Design-Flow- 1"Rallons/day Grease Trap Present: (yes or no) Industrial Waste Holding Tank Present: Non-Sanitary Waste-Discharged To_The Title V System: - Water Meter Readings,If Available:. Last Date of Occupancy: OTHER: Describe) Last Date of Occupancy: GENERAL INFORMATION PUMPING 814CORDS and source of inform.tion: T y System Pumped as part of inspection:_ if yes,volume puniped: gallons Reason for pumping: TYP F SYSTEM: Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool, Privy Shared System(If yes,attach previous inspection records,,if any) Other(explain): - - ROXIMATE A of all comonents,date installed(if known)'and soiirce'of.information: - Sewage odors detected`when arriving at the site. -4 a _,SUBSURFACE SEWAGE llISPOSAL;SYST fr'`1=U13SPECTION FORM PART C GENERAL INFORMATION ;continued) SEPTIC TANK: !/ Depth below grader Material of Construction: ' concrete__..—,nnetal FRP_Other (explain) / ___ Dimisions: Sludge Depth: Scum Tlei(B�ness: Clx2. Distance from top of sludge to bottom of outlet tee or baffle: ,,'n Distance from bottom of scum to bottom of outlet tee or battle: Comments:(recommendation for pumping,condition of inlet and outlet ices or baffles,depth of liquid level i relation to outlet invert, t ctural integrity,evidence of leaka etc.) !! s,. GREASE TRAP:_ Depth Below Grade: Material of Construction'_ concret: —metal FRP_Other (explain) Dimensions: Scum Thickness: ;..__ Distance from top of scum to top of outlet tee or battle`�w .> Comments: (recommendation for,pumping,condition of inlet and outlet.tees or battles .depth of-liquid level in.relation-to.outlet.invert,-structural:integrity;evidence`of leakage:; t,.) : o TIGHT OR HOLDING TANK:�O. Depth Below Grade: Material of Construction: concrete_meq,ai_FRP_Other(explain) Dimensions: 'Capacity:_` gallons Design Flow:— gallons/day Alarm Level: Comments:_(condition of inlet,tee,condition of alarm and float switches;ctr.) DISTRIBUTION BOX:� r fi Depth of liquid level above outlet invert: Comments:(note if 1 1 and distribution is equal,evide a of solids carryover,evidenc of I age i o or out of/box,etc.) !_.. 77777 _._... `PUMP CHAMBER.LLVL4 . Pump is in working order: urlenance§(note condition of pump uiainbeC,.condition'of pumps o�sfa SUBSURFACE SEWAGE DISPOSAL'SYSTEM INSPECTIQN FORM PART C SYSTEM INFORMATION (conlinued) SOIL ABSORPTION SYSTEM(SAS): (Locate on site plan, if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: . .. . - w Leaching pits,number: Leaching chambers, number: Leaching galleries,number: Leaching trenches,number,length: Leaching fields,number,dimensions: Overflow cesspool,number: Comments: (note condition of soil,signs of hydra lic failure level pondi:a Icondition of vegetatio , etc.) — CESSPOOLS•/w - Number and configuration: Depth-top of liquidto inlet invert:_ Depth of solids layer: Depth of scum layer: Dimatisions of Cesspool: Materials of construe�v. .: Indication of gr 0 Inflow(cesspool must be pumped as -t of-Inspection) Comments: (note condition of soilk,signs of hydraulic failure, level of ponding`condition of vegetation, etc.) PRIVY:! �d Materials of construction: Dimensions: Depth of Solids: Comments: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) -6/- 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PAR T C SYSTEM INFORMATION (contiruned) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to adeast two permanent references, landmarks or bend+unarks. Locate all wells within 100 Fe t. 1 � 11) 7; i DEPTH TO GROUNDWATER: Depth to groundwater: • Z Z Feet r Method of Determination or Ap roxi tion: / �''� ✓ :�e -7- • r Fa' PY� -01 00 TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE21 ASSESSOR' & LOT DU Z/VS ,R$NAME&PHONE NO. SEPTIC TANK CAPACITY. I O LEACHING FACILITY: (type) (size) 000 aov NO. OF BEDROOMS !_ r BUILDER O OWNER PERMU DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and`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 �. 1. c �CI .. 1 ag . ASSE-SSOR'S. MAP NO. PARCEL COC &T10N SEWAGE PERMIT NO. VILLAGE' INSTA LLER'S NAME i ADDRESS S U I L D E R OR OWNER DATE PERMIT ISSUED _ DATE COMPLIANCE ISSUED q � � o -P _1 No.. Fizis .l::�R.... „ THE COMMONWEALTH OF MASSACHUSETTS POA R® OF H EALT 7D wn...........O F..... ...... s ----�......•---•------------•---- Applira#ion for Disposal Works onotrnrtion Vanfit Application is hereby made for a Permit to Construct ( or Repair ( ` an Individual Sewage Disposal System at: . _- •- -• y Loca. dress / or Lot No. Q_. .�� . ....._ : �-/. .............•----.---•--..---.- ..........-_.......-•-•---••-•--•••••----•• ........... Owner �� - ' a �S dress a ............................. �...`�.._....C!......._lr....... ✓._!1!1/.�-............ Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms___.. 5.................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building ............... No. of ersons........................__.. Showers — Cafeteria t� YP g ------------- P ( ) ( ) Q' Other fixtures .-----••--•-•-••-••---••--•••••. . W Design Flow............................................gallons per person per day. Total daily flow.........:...................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ � Test Pit No. 1.................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 1-4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ a ------------------------------------- •-----------------•---.............------ .---------•------------•----------•-------------••.--.......--------- 0 Description of Soil........................................................................................................................................................................ x W -- ---------- ... --------- ---- U Natur Re 'rs or Alterations—Answer whe ap 1i;31e._ -0�---- 5A� ..._... 6.©_ ........ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITL is 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Complianc has been is e and health. igned ----------------- .............................. -= �........._...._ Date Application Approved By..........a" I ---- ---------------•-.---.---..----- Date- Date Application Disapproved for the following reasons:..............................................................-............................................... -•-----------•-------•-------•.......................•-•-----.....---•••-•--•-•••-----........----------.._.....---••••......-••--•------•--••-•....••--•••-•-•--••---•----••-••-•-----••----••--•------- Q Date Permit No......... ..... Issued.....................'<.. Data THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I M A�C(, I DATA d� 7 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE%j _ %�• -� ............ -. ...f' ....x .........iQ(( ........................................ Appliration for Disposal Vorks,.Cbinstrurffon Vrrmit Application is hereby made for a Permit to Construct ( :'') or Repair ( 4)-an Individual Sewage Disposal System at �f ; ;`��•��„6vati.... �e.,- �/,r �, �..��,.^�1,Y �0 `...+.e� - f�+� �.d r� -�+• � �� p frt v�er'�'T) S. i !-. ................»»»....» ...... .__.........a... ......... ........... ........................». ....._..._._. _..... ......_._............_ *' t L,ca'oi - dress} r or Lot No. A. ---------------------------.7Q y.---Ow/..Ct,1.d �L................-......... .................----vY-A/lt.0 f .... �s'11��_�.................. Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms___.. .................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ------------------------- ----------------••......---. --------------•------------------- W Design Flow............................................gallons per person per day. Total daily flow..................................._........gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length......._............ Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by----------------•---•---------------..-.................................. Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water___________-_-__-----__. f% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0.,4 ................................ -•-----...------------.....--------------- ------ •....... •••--------------------- •------------------ 0 Description of Soil........................................................................................................................................................................ x U --•--•-•--•--•-----••••------•---•-----.....•-•-------------•-----------------•----------------•--••-•-------••--•-----•••-••--•-----•......-•-•--••................................................... W •••--•-----------•------••---------•---•----•------•----•• ................................................... -------- U Nature of R n irs or Alterations—Answer whgn applicable d `�'� `l f J - r a Agreement: G/ The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of 11 T LZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i jied,bj�the board of health. - Signed r ,. - :. fi / Date Application Approved By------ ` ' ! r--:r :: .............................. ------. = _W..!�_ - 7 Date Application Disapproved for the following reasons---------------•-----------------•----------•---------------------------=---•--------------------......._-_._.» ...........................•-•---•----------------...------------•---------------------.....------------.---•-•--•----•--•-•-•-•----•--•----•--•----------•••-•-•••-•••-----•-•-----•--•-•----•....-•--- Date PermitNo........ •—-- Z��- -------------------. Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD -OF HEALTH �rrtifirFatr of Toniplianrrr .r THIS als`"TO CERTIFY,.,That the:Individual Sewage-Disposal ,-System-constructed or Repaired ( ) by ��<"• 'f... ....:.:...»........: ...................... .... �....... `..................................................... I Installer / at----- .......... ;--•-f .. .Z-• ------ ---------------------------- ------ ....... • " ....... --------- --------- ..----•-------------•-- has been installed in accordance with the provisions of TIT E 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No--- .'__ ............. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..................... G ............................. Inspector.................�-I ................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD ,OF HEALTH , 1 y _.. r No..........:.............. �i��o��1..• o�ko �on��riion rrnii# Permission is hereby granted------.......` ............ = -f "°`....._.. » to Construct ( ) or Repair ( ) an Individual Sewage Disposal System / at No a ° .. ::....................................................... •---. p:. .,_G.............• $ -, j ..... Street ----•--•--.............. as shown on the application for Disposal Works Construction Permit I9Vo.' .............. .... Dated............................... DATE................ -;L,— ............ ....................... VVV Board of Healtfi--------••------------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS Z ,�o � L .` FFFI FM Illy, - ------- — ---- ------- ---- -------------- ---- —��o".<. DRAWN BY: M.K. 2 RFAR ELEVATION NEw O ---- F- -: - All } I _ Q W F— W N DUST.DECK - L op NEW SCREENED PORCn f>tsr.DfLK LU t Z O -Ouxiu o'. o.y- z EW N, R, K.'D5 GAME RM", ____. �. *�// g �rx- u n (, * Q Y..1 • - U � II � KI- TCHEN - z I LIVING RM. BATH NEW A �..� x.w caaa ir. • f. §z§;' - V ED FIR5T FLOOR PIAN �_ I •,y,� T M.f" 5. ASSESSORS REF . m j Map 071, Parcel 006 ' ' • `� \ I i0 moo '. � �,. � . l \ \\ Y Lot 1015 �Y,k � ! rr Tlms�>xd o� • �!r rPt ' p N/F rind �t 8 odY ' FEMA Zone Line ` m Joseph P ",45 1 � OVERLAY DISTRICT:�, As Shown on FIRM Gt1 ,>r Panel / z50001 Dole D E 1v �0<10� \ AP — Aquifer Protection. District Rev bly 2, 1992 yp79'33�00" �,t IRK CFI w� As Shown on Pion Entitled o�syJs., • 18 IF rn _„gip , 70 2 N Ptl" �i! P a� r 213.20� �} A "Revised Groundwater Protection J a '„ a US r ITOo Overlay Districts" April, 1993 ! ' °• CO ce/D :t5, setb� _- Fnd - 1 FLOOD - tr nc ® "' � ones & C ` ; o ZONE. _ r3 —_..► ..,.. � Units _.........� 1" ..n -k o• i u 1 Q _......................w , E1ec Community Panel No, o pp •� s F�' Lce :t.. / f v Meter N #250001 0018 D 11 Parcel Area `� ° July 2r 1992 Fnd _. 4, 1 40,490±SF CO Cr a o Way .2s.o< `22 1 � " LOCATION MAP: ! Dec septic System Exist 2 1/2 Paced \\Dr'+aewoy tl Scale: 1" = 20001f (tiy Card 7U8) sty W/9 \ED Drive .. j'. / Wellin PR P ive �� k.. 0 M 2) N - - ► i �8 s SEPnG T 2.of N ZONE: a m SM I ....... � EE i F (S REE \ i N } —1 1 / a PROPOR T \ rn } •. Area (min,) 87.120 (RPOD) 1 GOIF 10 xto') \ 4. wg �," Frontage (min) 20' ( \ S6 LCB. P Width (min) 125 Frd�N Setboc s: Front 30' . N i mai� r Side 15ri ' ol` ExtstinQ..- -� O 10 Dom NOTES: Rear 15' ! Z `r 1Ri+.. Gora9e OVE O MIN. 11 Apron Let.�aRR O E REM to' �. 1.) The structures shown were located on the ground nc MtN ,O \ by conventional survey methods on (or between) ca: Z 161AUG106 and 17/AUG/06. Pool •PROPOSE UE,a N �- 75 2.) The property information shown hereon was 00 GWAG X24') a TH_t ��- Zo•:'R�St cB/tiH compiled from available record information. ( u�rn• Fna 3.) The contours shown are from Town — of Barnstable G.I.S. - \ / TBM , - E�o DB N H w Top `B/D LFne. \ "!I- -1 < 5, St o 40"W 52• 246,59' A!t ® Wo er Gate (round) SOLLIVAN C819H Concrete Bound NO.29733 a 6 r , CIVIL -0 GU y _ p Lot tat c\ 4-tw O` ® -O- Utility Pole. N/F 1wst 4 w r r Land �J , .. .. ".Unde g ound •Utility Llne gon'Stobt 151431 . ; ;; -anw Overhead WreS. 30 :; x„45. 6 4�FEET �� ✓ a - -. _ ., / ',,:+, r � Y X+-"w.`y,.•�.!^P"a+9!".•y<3 - k: �a Y::� 1 _ �,1+•.- - - , s , ,.• h ... e ', e-,l ../r. �.... ...it... .. -Y.e A" •..>,,.,... .:: .e�r. . M .'P..: _ . a.Y.,., t�_�cat I o n.:..Ghon 9 e.s Based:Qn.�•Su..rv �. :Ofie ,OS 29 ' . ./. .:. ... , : ... ., _.4. 4 • n, 5s �. -.. ..;... ..r.,' is , a... :t ,. :r 16. M,ww> .. ,, rd... ,..,.. o..:-..rw,,<v+,r. .:t._. a... b .-s +.''�.. +ef •�d •uaA• „r. .!4G+. .:-, :. ..exm nw<,K kw.,V,�{..,,:,w�.,<,.r-,.ar.ra.,++,t{+.>. y:..>?.r,.:.,�,,..•�: l.,• :::..t._,.•.��•.-w.,w�.was+Su,-��i4'+-w.y4mtff.*e;.�s.,«�•.1sAvt..,��f,,.�',.a�>FRewston_ Ad,d;,a.Se tica�&,.,.Field Clie Exlstln ,>�:Gara do ©8..14.Q6 _ '.=s S :� w- ..�-.•� -�c •� .. k a. . ..-:..,xierr+.«�w.,,., -:.w�,. mow.,. � ;. .. ;: ..... .y.. .. .. . , ,�...r, .. �: .. s-,T,.,._ � .i� - .rt'M+_.w mr' s:..a. ..^:T•v,.5 .iyi�+r ,X s'"Rs sz «.^e»,s -,.s<<•.=s;..,;.:»rti�•' ,.,,. r. ,„��, �, ,r'r.. , :... �, .. :. ..<_. `.- w: ,� ., ,-,r '. _�.,. . .w -" -Pre aced For, t Y -,. '.*-.. ..., .4:i� ->;r,'w.'»M.r ry. r. . . .� m. -�JCa e-.:=•'. F _i ,�.•�: 4 >. .. ,;.. >� } ate n : . ., S a i<. . :<. _ ., >n ,.•., S. .. M. :.. : �,. .,..' ,. ., Jra �.,.eV' S { .. :F r ..4 Y, .a 1.,e. ♦'. 4 M... v.. :e.< , .. ... •.". i. • N.•rn-.,:4 .. �v �. +:4n ., .",ti,r...w 1 - ... ", .' • 4 dP .. „ ...:, ... ..,,.... ... fF., :,3,. ..dv.. �' A �.: r .. # ..:.. ,,.d ..: w .k .: _, .: .* ,. _'- '.::.. a . .. y:k�.�� '� v i.....k, F v is F.. 11 .an En ineerin h ,Vr Inc. ed. ro ements � . ,. . „ g.,.. ,, R g ,.� _ . . , . . � �� ;a i, Joseh:. a / ' w r u P T . . YSir- nq, .,. a .. . . .. ._.. �S .,. . r_ .:, . -.. - R r: a. : ..��._ � . .,. �. ,. ..� .Y, �. " r 7 P F i > 4 orker Rood `'" r z.. .. . N/0 Osterwll ,02655 6/J ...: . e., 02655 „. � �....w :�.<•:�K e� ,:� ��.,; r Os ferville AAA. 02655 Wa ., '.. .. - .. ,. .FIT .. Y �w, .,.. ,... .. .... .� x .I . b„ ,yx ..+. ... ...t y,. e. '•w. .,. »5 .., _ Yf ,. .., �, .,. "'.'l t. '4 :, . 7• ... '� . ,... r,:, . „ sr:, ,,. SOE 428 3344.: 11 t . ., .. ,P,< Sa8 420;-3.9. SE18 4:20-�935,fcrx ,sc �#•,Pro'ec .__. , , '+ u. ( ) , Sa8 4,28 J 5,..fox. a,, ., f J ,�,:• � B _ O ter..H .: . .,.� ,. �, cape5urvi9rop � _ - .w am le , arbors . �. �. stab .� ass z_. __ �. a , �,�,,. .°�� . . ._ .�< - .,,...rr.......,.._ ,a..d., w+...k,..,... .W.`�y....a:zfwr,a,: �:-,•.w e...s,az.-., ., ..ter.,,...fax,; .. •,x, ':3:ii=.. a7;a.�vw�«G«� A::a... - .,,CFI-,,.- :vN•,"•^i. .. .. .., ...... .', -ea .: .. :. t., .. . ..' ....... -.. �. a _: s'*ft+-,.e'"n!�yaw� � w>.;u-•. •r•..-•• •m:,. - .a ., ,.. .. 5 S ram. .. •, .a.. :.. F. ., .. ,t„ ,.s^'r a ..c `r.a. _.1�,. .�.. h- .. .,;..« h, ....� .,. _:4 d _�' } �""'� •�. t- ,...,.> r,.,u..,,_. „]..F., ,+,,. ,..:,, Prr.n.- . l u .n :. �... ',,,. ... �,.... -.,. � r _.,�.,,,.w.m. :._..�. .:.:�.M,a.x....,,._....., a-,- :.r ..:�` -u, 7,. �, ^L• 1 ,..amrrw:s.•a, ......,.....,,........,.,,:......:,:..ce..w.o.mrm,...,,,-..........,..«........n�ammmm�,�,..,,.,.,�:....,.,.�..�,.....,..w..__....,e __._....:.,'�.. _r N'i nz,y,z. M wr.:'R..a. ..,, "�M...= � �. :._ ,acnfrsn.n�nwnn.-aw...,m....,.,.,:xm,.enrac,.-..,e..,.,._.t i�...�a... ums•>s�or>et•.w..-.�.,:.,.:...,., ... f v.f ,.5 � � ..p„ r, w .�.. � i V , ... .,a , Z�K� Ke' NF` 4 7- L 114- -A 0' :j "J 4 77-7-r- V N' I WE I 4� ANDMR 39*- 1500 GaRm M Top M e 3' Double1 112" Septic TanLFACHM waaAed 'N Flv�i CHAMBER As Bedft.'rs.&Be .. .... 71 -IV ABU "IrsibLzUb (See Notes 8&9) CROSS SECTION OF CHAMBER DEVELOPED 14i6ftLE OF PROPOSED SEPTIC SYSTEM EL 23 NOT TO SCALE NOT TO SCALE SEPTIC NOTES DESIGN DATA PERC TEST: 11,371 1.Location of Utilities Shown on This Plan Are Approx At Least 72 Hours Single Family-I Bedrooms Prior to Any Excavation For This Project the Contractor SW Make With NO Garbage Grinder PERFORMED BY:JOHN ODEA,E.I.T.- SULLIVAN ENGINEERING the Required Notification to Dig Safe(1-888-344-7233� 3 Bedroom Mimmum Design WITNESSED BY:DONALD DESMARAIS,R.S.-TOWN OF BARNSTABLE 2.The Contractor is Required to Secure Appropriate Permits From Town Daily Flow=110 x 3=330 GPD AUGUST 1.2006 Agencies For Construction Defined by This Plan Septic Tank:330 GPD x 2W%=660 GPD 3.The Water Line Shall be Constructed in Coordination With TEST HOLE-1 -2 EL.mo -3 EL.20.0 -4 EL.20.0 rth EL.20.0 TEST HOLE TEST HOLETEST HOLE" ',J Barnstable Water.and Shall be in Accordance With 248 CMR 1.00-7.00 use 1500 Gallon Septic Tank 0 LAYER 0 LAYER 0 LAYER 0 LAYER PARTLY DECOMPOSED PARTLY DECOLE40SED PARTLY DECOMPOSED PARTLY DECOMPOSED &310 CMR 15.00.The Water Line Shall be Sleeved Where Required LEACHING AREA Install Risen to Within 61 6fFinished Grade(4 Required). 4' LEAVES&TWIGS 19.7 3' LEAVES&TWIGS 19.8 5. LEAVES&TWIGS 19.6 r LEAVES&TWIGS 19.8 t 5.All Structures Buried Four Feet or Mom or Subject 330 GPD 0.74=446 SF Required A LAYER 10YR 411 A LAYER 10YR4/1 A LAYER 10YR.4/1 A LAYER IOYR4/1 to Vehicular Traffic to be H-20 Loading.It is the EgIgineces Sidewall=2(12'+25')7=148 SF DARK GRAY DARK GRAY DARK GRAY DARK GRAY Recommendation that H-20 Always be Used. Bottom Area=(12,x 251)=300 SF SANDY LOAM 19.5 6' SANDY LOAM 19.5 71 SANDY LOAM 19.4 SANDY LOAM 19.6 448 SF Total Providex! E LAYER 10 YR 5/2 E LAYER 10YR92 E LAYER 10 YR 5J2 E LAYER 10 YR 5/2 61.Septic System to be Installed in Accordance With 310 CMR 15,00 ai GRAYISH BROWN GRAYISH BROWN GRAYISH BROWN GRAYISH BROWN 248 CMR 1.00-7.00 Latest Revision and theTown of Barnstable 12' LOAMY SAND 19.0 10. LOAMY SAND 19.2 12' LOAMY SAND 19.0 91 LOAMY SAND 19.3 Board of Health Regulations. LEACHING CHAMBER DESIGN B LAYER 10YR.5/6 B LAYER 10YR 516 7.All Piping to be Sch.,40 PVC. B LAYER 10YR5/6 B LAYER IOYR 5/6 8.Inlet Tees Shall Extend a Minimum of 10- All Pipes to be Schedule 40. Use YELLOWISH BROWN YELLOWISH BROWN YELLOWISH BROWN YELLOWISH BROWN 2-500 Gal.Leaching Chambers in 27" LOAMY SAND 17.8 LOAMY SAND 17.5 32" LOAMY SAND LOAMY SAND Below the Flow Line C LAYER 15Y 64 173 26' 178 9.An Outlet Tee Shall Extend 14'Below the Flow Line. I Z x 25'Washed Stone Fields as Shown. CLAYER2.5Y6/4 C LAYER 2,5Y 614 C LAYER Z5Y 6(4 LIGHT YELLOWISH BROWN LIGHT YELLOWISH BROWN LIGHT YELLOWISH BROWN LIGHT YELLOWISH BROWN NM.SAND MED.SAND, NEED.SAND MED.SAND 2;-- _PERC TUff- 7 T05 42' PERC TEST 7_63 25 GALLONS IN 8 MIN. 25 GALLONS IN 8 1,914. 10.0 10.0 '12 10.0 - • LESS THAN 2 MN INCH 10.0 120*. LESS THAN 2 MN.INCH NO GROUNDWATER ENCOUNTERED NO GROUNDWATER ENCOUNTERED NO GROUNDWATER ENCOUNTERED NO GROUNDWATER ENCOUNTERED OF SSW I .297 CIVIL. ocotion Changes Based On Surveyed PlanO8/29/06 Sheet # Title: Prepared By.. Revision Add Septic & Field Check Existing Garage Locatior 08/14/06 Site Plan Prepared For: Scale: Sullivan' En Inc. CapeSury As Noted gineering, Joseph L. Daly 54 Proposed Improvements PO Box 659 7 Parker Road Date: At P.0. Box 2084 2. . M Oyster Way Osterville, MA 02655 Osterville MA 02.655 Osterville. MA 02655 261,IUN106 Barnstable (Oyster Harbors) MaSS (508)428-3344 (506)428 1­3115 fax (508)420-3994 (5W420-J995 fox SEI Project: c0pftvrV4tCpecodnet \7, ASSESSORS 'REF r ;� Map 071, Parcel 006 ti .� `\ 1 1`. ,, Pit �$q. ® • B 06 OVERLAY DISTRICT. y } Tiff;_t �170Q ! u°'� � f `[� AP — Aquifer Protection District a.` ~� C�` Q°,'' ' i ` 'I 4► ' J N) '�As Shown on Pion Entitled Jtster t u�`„ r \Revised Groundwater Protection oisy Overlay Districts — April, 1993 ;' � FLOOD ZONE: 4` €, Dz o" �' ` . . 3 \� O Zones B & C to o. 'r C ` C` • 4 u _ ..',.. o Community Panel No, � ?�•s° ,� o� �� `�,;��J 2'�. #250001 0078 D ' July 2. 1992 twat p-- .�- ons j EXISTING A DWELLING Na LOCATION MAP: r / Scale: 1 = 2000 t . /. ZONE: 32 �o RF-1 ra . Area (min.) 87,120 (RPOD) ! / 0 " ". PROPOSED Frontogge (min) 20' SEPTIC SYSTEM Width (I in) 125' ` T F ' Setbackks: H SEE SHEET 2 0 2 PROPOSED TH— Fron t 30' i I GARAGE Side 15' EXISTING GARAGE O o Rear I5' TO BE DEMOLIS ` EXISTING ' Pool ` TH-z NOTES: TH 1 'P_ 1.) This plan was generated using information No from the Town of Barnstable G.I.S. field referenced by Land Court Bounds. l � 2.) No construction should occur until the property lines, and required setbacks hove 1 ` been established by a surveyor licensed in A OF the State of Massachusetts. t / p _ _ ------ SULLIM � 2973 _ -- 0 15 90 45 60 FEET r' 61VIL Revision Add Septic & Field Check Existing.. Garage.Locotio 08/lA/,06 Sheet Title: Prepared B Prepared For. Sca►e: ` # Site Plan P Y P Proposed/mpr6vements Sullivan Engineering, Inc. Joseph L. Daly Date, 1 -30' 1 At PO Box 659 P.O. Box 2084 2 � Oyster Way OsterviNe, MA 02655 Oster-ville, MA 02655 261JUN/06 BaMStable (Oyster Harbors �/w��o�+ (5oe)a28-3344 Esa111 s ris fox SEI Project: _. � 15/CGi�?a7 ?Su;/PFAtwlrorn i F.G 6I..2Qa P.G Fl.2&0 �pmiib(y.4e S.Nma 4 eyp•1 3' tafu. 9.hfm Compacted Fig Firm Fabric AND/OR r ":k B•-12• Pm St- 1 5011 Gallon Tao EL 17.8 3' }7 -Me W.ched Septic Tank D-Bmt 2 LEACHING Flow Egwliaers _ CHAMBER �� as }} �.'J ��i Leachir8 1 y"� Chamber IL t 1 I 1 Bed�rg.'I"s,6.BEHds 4'-lo• 1st as Per Title 5 If It.-and Rmow A Replace tn An unoi W,soa.vr"5'of ly as 10,W..-shb (See Notes 6&9) The Omer p.imeer of the system V 2W Mi.- CROSS SECTION OF CHAMBER DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM a 2.5 NOT TO SCALE Appaos.G�dst NOT i0 SCALE P.TOA caomdw Map SEPTIC NOTES DESIGN DATA PERC TEST: 11,371 1.Location of Utilities Shown on This Plan Are Approx,At Least 72 Hours Single Family-1 Bedrooms PERFORMED BY:JOHN O'DEA,E.I.T.- SULLIVAN ENGINEERING Prior to Any Excavation For This Project the Contractor Shall Make With NO Garbage Grinder WITNESSED BY:DONALD DESMARAIS,R S.-TOWN OF BARNSTABLE the Required Notification to Dig Safe(1-888-344-72331 3 Bedroom Minimum Design AUGUST 1,2006 2.The Contractor is Required to Secure Appropriate Permits From Town Daily Flow=110 x 3=330 GPD Agencies For Construction Defined by This Plan Septic Tank:330 GPD x 200%=W GPD TEST HOLE- 1 TEST HOLE-2 TEST HOLE-3 TEST HOLE-4 3.The Water Line Shall be Constructed in Coordination With Use 1500 Gallon Septic Tank EL.20.0 EI.20.0 EL.20.0 EL.20.0 Barnstable Water,and Shall be in Accordance With 248 CMR 1.00-7.00 O LAYER O LAYER O LAYER O LAYER &310 CMR 15.00.The Water Line Shall be Sleeved Where Required. LEACHING.AREA PARTLY DECOMPOSED PARTLY DECOMPOSED PARTLY DECOMPOSED PARTLY DECOMPOSED 4.Install Risers to Within 6'of Finished Grade(4 Required 4" LEAVES&TWIGS 19,7 3• LEAVES&TWIGS 19.g 5• LEAVES&TWIGS 1g,6 LEAVES&TWIGS 19.8 5.All Structures Buried Four Feet or More or Subject 330 GPD/0.74=446 SF Required A LAYER 1 OYR 411 A LAYER IOYR 411 A LAYER 1 OYR 411 A LAYER I OYR 4/1 to Vehicular Traffic to be.H-20 Loading.It is the Engineer's Sidewall=2(12'+25')Z=148 SF DARK GRAY DARK GRAY DARK GRAY DARK GRAY Recommendation that H-2O Always be Used. Bottom Area=(12'x 25')=300 SF 6" SANDY LOAM 19-5 6• SANDY LOAM 19.5 7' SANDY LOAM 19A 5' SANDY LOAM 19.6 448 SF Total Provided MR E LAYER 10 YR 5/2 fi LAYER 10 YYR5r2 E LAYER 10 YR 55/2E LAYER 10 YR 5.2 6.Septic System to be installed in Accordance With 310 C 15.00& GRAYISH BROWN GRAYISH BROWN GRAYISH BROWN GRAYISH BROWN 248 CMR 1.00-7.00 Latest Revision and the Town of Barnstable 12" LOAMY SAND 19.0 10, LOAMY SAND 19.2 12' LOAMY SAND 19.0 Sr LOAMY SAND 19.3 Board of Health Regulations. LEACHING CHAMBER DESIGN B LAYER l OYR 5/6 B LAYER I OYR 516 B LAYER I OYR 516 B LAYER 10YR 5/6 7.All Piping to be Sch-40 PVC. All Pipes to be Schedule 40. Use YELLOWISH BROWN YELLOWISH BROWN YELLOWISH BROWN YELLOWISH BROWN S.Inlet Tees Shall Extend a Minimum of Kr 2-500 Gal.Leaching Chambers in 2T LOAMY SAND 17.8 30" LOAMY SAND 17.5 32• LOAMY SAND 17.3 26' LOAMY SAND 17.8 Below the Flow Line, I Z x 25'Washed Stone Fields as Shown. C LAYER 2.5Y 614 C LAYER 2.5Y 6/4 C LAYER 2.5Y 6/4 C LAYER 2.5 Y 6/4 9.An Outlet Tee Shall Extend 14'Below the Flow Line. LIGHT YELLOWISH BROWN LIGHT YELLOWISH BROWN LIGHT YELLOWISH BROWN LIGHT YELLOWISH BROWN MED.SAN MED.SAND MED.SAND MED.SAND 2' PERC TEST 16.5 2' PERC TEST 5 25 GALLONS IN''8 MIN. 25 GALLONS IN 8 MIN. 1 10.0 1 LESS THAN 2 MIN.INCH 10.0 120" 10.0 120" LESS THAN 2 MIN.INCH 10.0 ^^cc NO GROUNDWATER ENCOUNTERED NO GROUNDWATER ENCOUNTERED NO GROUNDWATER ENCOUNITERED NO GROUNDWATER ENCOLR,7ERED OF - P�TER Sm W yr 3 1 Revision ,Add Septic & Field Check,Existing Garage. Locotio 08/14/06 SR'eet Title: Prepared B . "Prt ored For: Scale: # Site Plan p Y p As Noted: Proposed Improvements Sullivan Engineering, Inc. Joseph L. Daly Dote:. .2 At PO Box 559 P.O. Box 2084 261JUN106 222 Oyster Way osterville, MA 02655 Osterville, MA 02655 1 (508)428-3344 (508)428-3115 fox Project: Barnstable- (oyster. Harbors) MASS _ Psu11PE60d.com .„, ..e-.�'e sazr�. .n. ;,..� ..,.,•.t..._....«.».. w<. :. „,.....,,....pr ...,r.u*.c: ..,-k,.w,..m,�.v. •«-: -... .,�..-..M ....,.............,.--.,",.:_.. _�.•,....a.a,....v. .,K,,...:...w a .. .. �+ s<'�^.5"+ ,e^_.:3" cti'. "^Y" -.,: x rati+� � .. .. „gin* .. _.. ., ,t .. ... . :.^, »�.w«•.v.«. .:-. ,.,�.rr. ., ... I g " o EYc #y ELT I ;06ae 3G I al 1 I S ; II 24V.— L y - 0 " f. I ' e I .00.. N:I / I � III i � F � •I I' T!2 ct�x'(�»y�-Ira;. I Y f _ 1 11 j t I i c 3H 1�1c LFs• —_ N. s; 141i I I 0 i cam I ' ><6 I tt? I ::,_ 1 ...,p. '." I.__� ..•q� O'Y�}'�Fia.41/+ c.,�10 ., i n i ....1 i a _ '� �'�. - - . I ;S I _: "... �. ,. ,� _ ,..:,, • , �- of =�1 _. .._".. .. -44 • i SCALE-- PPROYED BY .s -. .. .. _ ORA WINCa'NUMBER. -75 C.: � ..���.._..._.._..--_. F ,/,ice - — - �-- - �• \ ,. r i — =rya. _ — t .. ._ fsi 3 CO LEE liw�` L61ICk1f�ATE .', I jmr; I.I -- , a,-._ 71 - I At -.— i f nn f - ---- ! _ j 77 — I j I I <� OF \ 3 ¢ 71. i OF ' T _ �?Sr�QSrE •��� . . qPP BV + y ORq N BY E } 't : gRAWI, NVNJB FMR �L IL 4 yc co z-,e 6 17 7 ld � I CLo�T ;7 � 0 Lo l �, m' I Ji- LA ........... ........... Lit N9 fT 19 %7 oil Mt Q c—Q-13 Y.7-V 6===T7= T7V DIRECTIONS: ZONE. . a From Hyannis — Follow Main Street to the West RF-1 End Rotary and take third exit onto Scudder Area (min.) 43,560 SF 1t� �7 • Ave. Turn right onto Smith St. at the stop Frontage (min) 20' ' ef, `• ' ` sign. Continue on to Croigville Beach Road and Width min 1 left " .. le onto South Main Street. Continue over the t ( 25 . Setbacks: . , bridge to Osterville onto Main turn Left at West Front 30 �rri "� Bay Rd. follow and turn left on to Bridge St. Side 15' continue to Gate at Oyster Harbors stay straight on Oyster Way #222 is on the right. Rear 15 1 ,c �'' `� •o. ASSESSORS REF.. • c Map 071, Parcel 006 _ o (, L 0 CATION MAP: OVERLAY DISTRICT: 1"=z,000±' AP — Aquifer Protection District FLOOD ZONE: Zones VE Elev. 12, X (0.27. Annual Chance) & X (Min. Flood Hazard) Community Panel No, #250001 C0756 J July 16, 2014 N/F e I Priscilla M. Hostetter CB/DH \ Fnd r \ N79' 33' 00'E IPROPOSED POOL FENCE 13.20' LCB Fnd - cb Lot 102 m Z c, Lot 1RR Lot Area 15' Setback 40, O±SF V AC Units Q C 7T7TJT7-r- N m vW .Q C 0 N k z c o u Q Deck Elec // #222 Existing Meter m a / .c / 2.5 Sty. w/f o o �.. Existing S.A.S. / Dwelling U h at g per B.O.H. As CD Built Cord. f m o x Q ^ 0 0 C) zz- v t PROPOSED •� !' m �6 UPPER '� 2 PATID o b Stone Driveway Q: � m (CD 3 p - MCL om, W M N Existing Conc. Pool Apron ULUZ oLU Q z r+1 Existing Pool 4� 47.7' t PROP. l 15' X PROP. LCB Lot 1RR z _ 20 20' X 20' PROP. Existing Garage / Fnd Fnd CABANA Port ng S.A.S. LCB Lot 1RRR PATIO POOL 24' X 20' & Golf Cart ` % PROP. 38' X 18� P OL ON f yM ,ryt Existiper B.O.H. As t SLAB4V P3h Built Card. m okr PROP. POOL PATIO 0 O ® I h� PROP. POOL PATIO 0 �j -� p TBM E1=20.6' NGVQ r` Topo� 27.5'PROP. Setback" 23.3' U��`"O of CB/DH � PUTTING Ir, l �C3�c r GREEN CB/D ; PROPOSED POOL FENCE Fnd L=2.59, R=517.75 tr ?rp 4� - N/F LEGEND: Barnstable Land Trust CDT Cedar Tree �- HT Holly Tree DT Deciduous Tree CT Coniferous Tree c-� Utility Pole —E— Electric -G- Gas CapeSury lD• Wet►ond Flag 7 Parker Road Light Post Osterville MA 02655 o ce/DH OHW— Overhead Wires (508) 420-3994 (508) 420-3995 fax copesurvdkopecod.net -------25--- Elevation Contour T1 TLE: PREPARED FOR: PREPARED BY. Site Plan Engineering & � Proposed Improvements Scott J. & K o t h l e e n A . At Harrington uivaiiconsuiti0n Inc. 222 oyster Way g ..�, 2 7 Will o wm ere cr. (508)428.3344• P.O. Box 659 . 711 Main Street,Osterville, MA 02655 a BarnStabl e (Oyster Horb ors) MASS Riverside, CT 06875 seciQsullivanengin.com • www.sullivanongin.com 20 0 10 20 40 60 Draft: ASL Draft: DATE: SCALE: n Review: CTR Review: JOD September 28, 2020 1 =20 Proj. # 2006031 Proj:. Docey/Harrington