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Home My WebLink About0178 PARKER ROAD - Health 17 I Parker Road Osterville P A = 116 039 o. Y a a n , ° 0 a a p� , u „ ° o a b r ^ , ^ ^ TOWN OF BARNSTABLE L6CATION 77 Pat ker SEWAGE# 4261-7®3 41 VILLAGE ( � i�. ASSESSOR'S MAP&PA CEI; �'" �7 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1 5 LEACHING FACILITY: (type) X (size) io!x g �;: , NO.OF BEDROOMS T OWNER- kQQP _ >Y PERMIT DATE: � COMPLIANCE DATE: 1 7 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 r site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands e 'stw"'ithin 300 feet of leaching facility) Feet FURNISHED BY v � � � o � � �� : � t �. � � .. a i ^�� , c�b T � � A „ � _� � ��, �. �5 No: a t � Fee l �`� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZlppCiration for Misposal.6pstern Construction VPrntit Application for a Permit to Construct(Repair( ) Upgrade(' ) Abandon Complete System ❑Individual Components Location Address or Lot No. T e Own e 's Name,Address d Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No.:1 Design')Name,Ad ess,and Tel.No. d1fiA !`, Type of Building: Dwelling No.of Bedrooms Lot Size j g/ �?2 sq.ft. Garbage Grinder( ) Other Type of Building .fie F. 2eS No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided �O 5 gpd Plan Date 1c.112 3/17 Number of sheets Revision Date Title Size of Septic Tank J Z �5'0p 6q l(oyq� Type of S.A.S. 3`Soo �, e tv* rF Description of Soil T+t'I 3 I r'. ! - 15 �/- !D(t htl�i �7nc I5�'�C� �• 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 Enviro al Code and not ace the system in operation until a Certificate of .l 'Compliance has been issued by this Board o a th. Si ed Date Application Approved by ` Date Lo^ a 'Y Application Disapproved by I Date for the following reasons Permit No. 2cp Date Issued i }[ IL Y No. got 7` , , " Fee r ''THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: j Yes PUBLIC HEALTH DIVI I N -r- W S O _. OWN OF BARNSTABLE MASSACHUSETTS �pYication for ]D sposal 6pstem Construction Permit Application for.'a Permit to Construct(1olo'--Repa' \)\ Upgrade( ) Abandon(L<-n C mo plete System ❑Individual Components ( Location'Address or Lot No. 1/11 YQ � � � Owner's Name,Address, �and�Tel.No. , V Assessor's Map/Parcel !� �j 3��,�` ��rL��►^' Installer's Name,.Address,and Tel.No.�667, />Cl7 Designr•'s Name,Address,and Tel.No. c""' S[��(1 �/Gl M ,�hJ'i/1��(`,'n�' -F Co h S!✓�f t�,'�S, f� A$A< YLi6nic ..S400 .Zhu. Type of Building: Dwelling No.of Bedrooms J Lot Size 1 3 2 sq.ft. Garbage Grinder( ) Other Type of Building S-,F, /C't S. F No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) . 130 gpd Design flow provided ' C> 5 gpd Plan Date Number of sheets Revision Date F f Title S: e `f/�9 h 6-4, wip' -Z M ro L,t/b!-'ir 4S Size of Septic Tank Gti//orpt Type of S.A.S. ��+D l t:6,g,y -f rG, S�+ •Q Description of Soil T/J"3 ^ I l-.W, /- 15 �G P� l(J �1. �a/�r �►r7a� /S j� P � 132 Nature of Repairs or Alterations(Answer when applicable) Date last inspected:Agreement: The 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 t,V457 the system in operation ti t it a Certificate of t ,I--- ,Compliance has been issued by this Board o ea t th. Signed 1 Date Application Approved by �� tJ W Date t Application Disapproved by - Date for the following reasons Permit No. ( , % Date Issued '(�1-7 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 `1"�•I -.-�. . at (.rr� ,f - - has been constructed in accordance f r G11- with the provisions of Title 5 and t_he f_or Disposal System Construction Permit No. A17 ��'/ dated I Installer e Designer SC)llitltlh En(je,,P-Pr;,,c f (•�,ar(✓/6'hc E #bedrooms & rd t o©n� Approved design flow -. gpd The issuance of this permit shall not be construed as a guarantee that the system will�as designed. Date J i / Inspectors. 1, No Fee /70 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disnosal 6pstem Construction Permit t Permission is hereby granted to Construct( Repair( ) Upgrade( ) Abandon( ) System located at U .�+a r/4, e fr 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:Constructio must mpleted within three years of the date of this permit. —.- Date 10 � � Approved by Town of Barnstable Inspectional Services Public Health Division aNtrtsraet.e. MASI Thomas McKean, Director o 39. ° 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Sewage Permit# ZQJ]-_3bq Assessor's Map\Parcel��_� Designer:S Si1� h�Installer: S G ca,_va4l Address: I[i Mao S7 Address: M-PJ_111c , Mo zvfD C On was issued a permit to install a date (installer) septic system at based on a design drawn by (addre s)' 5 �U Y I 111 Ated �3 1 (ddsi ner ( g ) �Ice ify 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. Strip out (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. Strip out (if required) was inspected and the soils were found satisfactory. Pbt I certify that the system referenced above was constructed in 9 the to rms of the IAA approval letters (if applicable) JOHN v CIVIL No.48168 ( nstaller's Signature) (Designer's Signature) (Affix Designer's Stamp Here) 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. UtoAdeptAHEALTHISEWER connecASEPTICOesigner Certification Form Rev&14-13.130C r Commonwealth of Massachusetts -dV W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 178 Parker Road Property Address Kathleen Gralton `y Owner Owner's Name information is / c required for every IDS--- t/ Ma 02655 11-4-16 page. City/Town State Zip Code Date of Inspection W .A Inspection results must be submitted on this form. Inspection forms may not be altered in anyo way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information S/ on the computer, use only the tab 1. Inspector: key to move your cursor-do not Matthew Gilfoy use the return Name of Inspector key. B&B Excavation r� Company Name 374 Route 130 Company Address m Sandwich Ma 02563 City/Town State Zip Code (508)477-0653 S113640 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 11-4-16 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent 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. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 kord V6 f Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 178 Parker Road Property Address Kathleen Gralton Owner Owner's Name information is required for every Osterville Ma 02655 11-4-16 page. City/Town 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: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System was in working order at time of inspection. 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): l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 178 Parker Road Property Address Kathleen Gralton Owner Owner's Name information is required for every Osterville Ma 02655 11-4-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 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 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ° 178 Parker Road Property Address Kathleen Gralton Owner Owner's Name information is required for every Osterville Ma 02655 11-4-16 page. City/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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 178 Parker Road Property Address Kathleen Gralton Owner Owner's Name information is required for every Osterville Ma 02655 11-4-16 page. CityrFown State Zip Code Date of Inspection B. Certification (cont.) 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 fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large 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 II 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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 178 Parker Road Property Address Kathleen Gralton Owner Owner's Name information is required for every Osterville Ma 02655 11-4-16 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 ❑ ® 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? ❑ ® 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): 3 Number of bedrooms (Actual) _2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 348GPD t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 178 Parker Road M Property Address Kathleen Grafton Owner Owner's Name information is required for every Osterville Ma 02655 11-4-16 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d See below 9 ( Y 9 (gP ))� Detail: 2015- 144,000gallons 2014-96,000gallons Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: NA 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: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w. 178 Parker Road Property Address Kathleen Gralton Owner Owner's Name information is required for every Osterville Ma 02655 11-4-16 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: Owner- Last pump date unknown 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): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 178 Parker Road Property Address Kathleen Gralton Owner Owner's Name information is required for every Osterville Ma 02655 11-4-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: System installed 2013 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 2'2" Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 12 Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions:, 1500gallons Sludge depth: 3„ t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments "M 178 Parker Road Property Address Kathleen Gralton Owner Owner's Name information is required for every Osterville Ma 02655 11-4-16 page. Cityrrown 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 33" Scum thickness 0 11 Distance from top of scum to top of outlet tee or baffle NS Distance from bottom of scum to bottom of outlet tee or baffle NS How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank was in working order at time of inspection with liquid level equal to outlet invert. Tank is not in need of pumping at this time but should be pumped every two years for maintenance. Grease Trap (locate on site plan): Depth below grade: NA 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 l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 178 Parker Road Property Address Kathleen Gralton Owner Owner's Name information is required for every Osterville Ma 02655 11-4-16 page. City/Town 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: NA 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 178 Parker Road Property Address Kathleen Gralton Owner Owner's Name information is required for every Osterville Ma 02655 11-4-16 page. CityfTown 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 11 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.): D-box was in good working order with no high staining and no carry over present. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): NA * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 178 Parker Road Property Address Kathleen Gralton _ Owner Owner's Name information is required for every Osterville Ma 02655 11-4-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: (2) 500 gallon ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching was in working order at time of inspection. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts L Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 178 Parker Road Property Address Kathleen Gralton Owner Owner's Name information is required for every Cisterville Ma 02655 11-4-16 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: NA Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): J t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 178 Parker Road Property Address Kathleen Gralton Owner Owner's Name information is required for every Osterville Ma 02655 11-4-16 page. City/Town 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 FRONT DRIVEWAYIFAM ,22' A4M 42 3- +�1.2 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 178 Parker Road M Property Address Kathleen Gralton Owner Owner's Name information is required for every Osterville Ma 02655 11-4-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: No GW 120" feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 9-23-13 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: t ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high groundwater elevation: Plan on file with BOH. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 178 Parker Road Property Address Kathleen Gralton Owner Owner's Name information is required for every Osterville Ma 02655 11-4-16 page. Cityfrown 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Town of Barnstable .�j"�rOwti Regulatory Services Richard V. Scali, Interim Director nnRtvszna[.E, : -Public Health Division 039 Thomas McKean,Director 200 Main Street,.Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date:, 10,1(-2ot Sewage Permit# Z6k3=3gt. Assessor'sMapTarcel 116 030t, Designer: CfiA �efV&e£& Installer: Ccc Address: dAe,;Av�..�� Address: 15 3 C. On Q'3a"'��3 v�c9e.(�-V 1/•Zy,� was issue d:a permit to install a (date) (installer septic system at I7$ Phrklur based on a design drawn by (address) G' yy dated. Z Zv'3 (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. Strip out (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. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was construct ompliance with the terms of the IAA approval letters (if applicable) OFMAR g DI c� ( s. ler's igna o CIVIL ti No.45937 - 9 � Q AyUti F�fST - (Designer's Signature) (Affix Stamp Here) 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:1Septic\Designer Certification Form Rev 8-14-1.3.doc i TOWN OF BARNSTABLE LOCATION I?8 tea 2 K e- 2a 4A a S 1 ca v;1 I e' SEWAGE# 2 0-13 -3F 1 VILLAGE Ay- ASSESSOR'S MAP&PARCEL rlla INSTALLER'S NAME&PHONE NO. (' ;;: L�{t+ ,',�� 0. +-izi Ez I-? SEPTIC TANK CAPACITY t J G LEACHING FACILITY:(type) (—'Z) Gov!E, AL (size) 2 5;,(B,.S NO.OF BEDROOMS '3 OWNER 9 V PERMIT DATE: -3 a - 3 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility X)y i-1 20(F-F ('I- 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 �Nip" �e C-A K'e gn'so, 01 -Tr 0 , ` i/ -j A ► _ IN 3 31 -36 TOWN OF BARNSTABLE OCATION 1-7 P42t,tr S r—C,Rvi11,e SEWAGE# 2 3F I VILLAGE ASSESSOR'S MAP&PARCEL t1 CCa INSTALLER'S NAME&PHONE NO 0l LlZ-1 1g 1-7 SEPTIC TANK CAPACITY 1 J o G LEACHING FACILITY:(type) fAL 14--Zo (size) 2 5 o NO.OF BEDROOMS OWNER 9 W PERMIT DATE: - d - 13 COMPLIANCE DATE: 10 A I t _2Q,3 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 1J0 i4 2-,cjk' t 2 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 �J � A'� '�r, I_L(— r 604 1 .0 Al A ,2L-j- N ly � 3•_33 (� �/� �T No. _ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Ytca�tion for t� ont t�� p� ens Con5tructton Vernttt Application for a Permit to Construct O Repair I�( Upgrade Abandon O ❑ Complete System ❑Individual Components Location Address or Lot No. 1 17 p'� Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 11440,39 q I GO e r W&�io®®b AM Installer's Name,Address,and Tel.No. 5-og- 477`8.877 Designer's Name,Address and Tel.No. 5,68-5 1.0 (0100 C W lust r')E e!t_,1Z-Xfi4u 3' LLC OA -TeWI CCS sr 5�1�° 015� w ctzu�t �T' c 't21� A Type of Building: Dwelling No.of Bedrooms Lot Size 191'31 a+ sq.ft. Garbage Grinder ( ) Other Type of Building kM fp�.LL, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date —.10J�j Number of sheets Revision Date Title _f� Pft�a ROAD Size of Septic Tank ` O® Czz4e eoa] Type of S.A.S. 6 C) Description of Soil Nature of Repairs or Alterations(Answer when applicable) _;e1e_) 15'0& &44J►CWV .15�_tPOTuG." {reUL TZ p 6LQ 0 _604 (00 5 00 6')4-u-®di OP dwvec pSu62 u�JXS IFJ 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 this Board of Health. Sig p Date Application Approved by Date :2 Application Disapproved by: Date for the following reasons Permit No. Date Issued r No.. Ij a;' s'_x,� Fee ' Entered in com uter: THE �COMMO:NIVEAUTH OF.MASSACHUSETT'S p Yes PUBLIC HEALTH DIVISION TOWN°.OF�BARNSTABLE MASSACHUSETTS > � Ytcatton for-Wt ogal �& 5tem, Comt tructtort _ �� p Permit Application for a Permit to Construct O 'Repair i Upgrade' Aband"on O ❑ Complete System'-❑Individual Components Y Location Address or Lot No. 17 2 PAD V Q R'0 Owner's Name,Address,and Tel.No. .. 1`."` o STtRVtC.c�' Pl4 V G. "Tt�pP l t�Gt�"�.t1 s T.. Assessor'sMap/ParcelQQD h[A ,- CCcc Ip Installer's Name,Address,and Tel.No. JC'08-- 477 "0071 Designer's Name,Address and Tel.No. 5'0a -(0100 C A,0 eWt t�E l Tt�2p �Ste' Lt c CA ft4dPd-9Q A o& 5-eW1 3 c �c r✓,c sz s00-eC 115o w c44&,-rr.)vr sr tU&-J7)W MA Type of Building: Dwelling No.of Bedrooms Lot Size 19131X�-, sq.ft. Garbage Grinder Other Type of Building QC3 I>� jx'�L�_ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) y_ gpd Design flow provided .3 41 .1 gpd Plan Date 9-, Number of sheets ( Revision Date Title —119, p7�� Size of Septic Tank 11500 C7 4-1-O'Up Type of S.A.S. S y0 604.L.Cw eluwklre(ad • Description of Soil _�) EM F 's Nature of Repairs or Alterations(Answer when applicable) Vtw 15f0 &4t.L-09-/ -<W0 'k �CtiV D-6-rlhL 0 - yV 6-4 tit C>dj aw Ew& 4Jl V 4' Date last inspected: 'r 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 br this Board of Health. / Sig ed ,,//�� ,, o Date /"� (� --- Application Approved by J[,r r- �� 'late y . Application Disapproved by: Date for the following reasons lei Permit No. Date Issued 1211 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS .` (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( 11) Upgraded ( ) Abandoned( )by 0ATEW1 D6 1 �ej C1, �.LC at I g PAME. L P OM 057SW 44 L' has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated ,.�� Installer G� l�� .P��$ t'.(�. Designer C 5)GC1 �J�LDW,(LtZ V(@W(C> t #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date /d' Inspector %<�{ ————————————— ———————————— ———————————— I No. n�/.�� Fee ti 0�- - THE COMMONWEALTH.OF MASSACHUSETTS PUBLIC HEALTH DIVISION;BARNSTABLE, MASSACHUSETTS 0i5poal,*p.5temn Con6truction Permit 1 Permission is hereby granted to Construct ( ) Repair ( x) Upgrade ( ) Abandon ( ) System located at r'"� {P/4TZV4&R- P-004D Os-[EP VI C.(Ai�:, 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 conditions0,;� Provided: Constructio m st be 6mpleted within three years of the date of thiDate A roved b ✓ Approved y l 1 • . �lime Town of Barnstable P# 63 Departinent of Regulatory Services Public Health Division O Date 130 200 Main Street,Hyannis MA 02601 Date Scheduled Time Fee Pd._ ®I `r pt vi ►s � oil Suitability Assessment fog Sewa e is os �H�a.►,,P,� p Performed By:_ /;£ Witnessed By: CATION& GENERAL INFORMATION Location Address /7� Owner's Name I- a. Address Cj!,( G� 5 Assessor's Map/Parcel: (� ' n 39 1U� /P-.�(-,e Engineer's Name �'✓I�rr'{Z- �`�� NEW CONS UCTION REPAIR Telephone# 77 y—2 Q— ?� Land Use: ! lil�iC Slopes(` ) Surface Stones IVy Distances from: Open Water Body. tt possible Wet Area Zvv t ' ft Drinking Water Well ft r' Drainage Way. /V� ft Property Llne ZU R Other = a I t era FETCH:(Street name,dimensions of lot exact locations of test hales&perc tests,locate wetlands I:n proximity to holes) l! CD TPA e-7WY • � »:per Parent material(geologic) (4 t Depth to Bedrock N✓� Depth to Groundwater. Standing Water in Hole: t/V okr Weeping from Pit Rice Estimated Seasonal High Groundwater _� �32 D TERMINATION FOR SEASONAL 1HG!WATER TABLE Method Used: o o Depth Observed standing in obs.hole: 1n, Depth to soil mottles: In, Dcpth to weeping from side of obs,hole: in, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level-�_ Adj.factor,, _ Adj.Groundwater level PERCOLATION TEST Date Time,._. Observation Hole# Timo at 4" Depth of Perc (6,r-r-M) Time at 6" Start Pre-soak Time @ I D'OV Time(V-0) End Pre-soak ' / D 17, Rate Min.flnch G Z PS Site Suitability Assessment: Site Passed _ Sitg Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back---------- ***I£percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1) week prior to beginning. Q:\SEP.TIC1PFRCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Sdil Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. onsistenny,%'G ivel) /0 y2 Y2 ?'Y /©Ye g it Ye y DEEP OBSERVATION HOLE LOG Hole# 2 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. on We % , e aye SAND /oY 'v S�ti� vYQ `1 DEEP OBSERVATION HOLE LOG Hole# 3 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, Gravel) 6,V' r" / /0Y2,712 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil 7 Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Cositn r��sir � 5 Al0 /DY2' Z CS471JD Z D 3 Gi 5�� r0 2 Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No Yes ' Within 100 year flood boundary No.T._. Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring perviou material exist in all areas observed throughout the area proposed for the soil absorption system? ^ If not,what is the depth of naturally occurring pervious material? Certification I certify that on 6 Z (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise nd experience described in�10 CMR 15.017. • Signature Date—�=•�— • Q:\S,EPTICIPERCPORM.DOC -\ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION f ;4AP PARCEL z_�._..._.�, TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: -1 ` Owner's Name: Owner's Address: Date of Inspection: 64 Name of Inspector:( lease print) v �} Company Name: (J"I Mailing Address: ou Telephone Number: — CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the 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 Needs Further Evaluation by the Local Approving Authority Fail Inspector's Signature: Date: 1.Dk)_q 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. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address flow the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: s T Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Pass: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: r-J c ors oD QA e.c System Conditionally Passes: ne or more system components as described in the"Conditional Pass"section need to be replaced or repaired. a system,upon completion of the replacement or repair,as approved by the Board of Health,will pas . Answer yes,no or no etermined(Y,N,ND)in the for the following statements.If"not determi "please explain. The septic tank is metal over 20 years old*or the septic tank(whether metal or )is structurally unsound,exhibits substantial infiltra ' n or exfiltration or tank failure is imminent. Syste will pass inspection if the existing tank is replaced with a complyi septic tank as approved by the Board of H th. *A metal septic tank will pass inspection if is structurally sound,not leaking an ' a Certificate of Compliance indicating that the tank is less than 20 years of ' available. ND explain: Observation of sewage backup or break out or high s 'c ater level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distri i box. System will pass inspection if(with- approval of Board of Health): broken pipe(s)are eplaced obstruction is r oved distribution ox is leveled or replaced ND explain: The system required pumpin ore than 4 times a year due to broken or obstructed e(s).The system will pass inspection if(with approval o e Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 ^g r4sc.7 Ul 11 �J OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY.ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: t Owner: Date of Inspection: Mt-4 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 fail*n to protect public health, safety or the environment. 1. Syste will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that e system i of functioning in a manner which will protect public health,safety and the environme Cesspoo r privy is within 50 feet of a surface water Cesspool o rivy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Boa of Health(and Public Water Supplier,if ny)determines that the system is functioning in a manner tha rotects the public health,safety an nvironment: h _ The system has a septic tank and so absorption system(SAS)an he SAS is within 100 feet of a surface water supply or tributary to a surfac water supply. _ The system has aseptic tank and SAS and t SAS is with' a Zone 1 of a public water supply: _ The system has a septic tank and SAS and the SA is ithin 50 feet of a private water supply well. r _ The system has a septic tank and SAS and the S is s than 100 feet but 50 feet or more from a private water supply well".Method used to dete me distan i "This system passes if the well water analys' ,performed at a DE certified laboratory, for coliform bacteria and volatile organic compounds i icates that the well is free om pollution from that facility and the presence of ammonia nitrogen and n' ate nitrogen is equal to or less an 5 ppm,provided that no other failure criteria are triggered.A copy the analysis must be attached to this orm. 3. Other: 3. �, 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: M c t Owner: r Date of Inspection: t O / (a U N D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _ J 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 Jclogged 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 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. -7 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. 7 Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this forma (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. Large Systems: To be nsidered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indica ither"yes"or"no"to each of the following. (The following critert ly to large systems in addition to the criteria above) yes no _ the system is within 400 feet o face drinking water supply _ _ the system is within 200 feet of a tributary to ace water supply the system is located in a nitrogen sensitive ar terim ead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any ton in Section E the system is considered a signi i threat,or answered "yes"in Section D above the 1 system has failed.The owner or operator of any large system idered a significant threat under S ton E or failed under Section D shall upgrade the system in accordance wit 0 CMR 15.304.The system er should contact the appropriate regional office of the Department. 4 Page 5 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address JL er \ , r Owner: Date of Inspection: C (, Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Ygs No Pumping information was provided by the owner,occupant,or Board of Health _ Were any of the system components pumped out in the previous two weeks? _ Has the system received normal flows in the previous two week period? _ 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? J _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition oft/he baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? �./ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yet no J _ Existing information.For example,a plan at the Board of Health. _ -j— Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] 5 Page 6ofII OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART C- SYSTE_1M INFORMATION Property Address: f ]�Cl Owner: S J <-1 Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): I-- Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):'Z Z 0 Number of current residents: S Does residence have a garbage grinder(yes or no):Y\ Is laundry on a separate sewage system(yes or no):-11Q [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no):AD ,1 Water meter readings,if available(last 2 years usage(gpd)): �JJA Sump pump(yes or no):r1c� Last date of occupancy:OMMERCIAL/INDUSTRIAL Typ f establishment: Design based on 310 CMR 15.203): gpd Basis of design seats/persons/sqft,etc.): Grease trap present(yes _ Industrial waste holding tank pre es or no):_ Non-sanitary waste discharged to the Tit a em(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records 1 � Source of information: RAP- se- Was system pumped as part of the inspection(yes or no):_*e5 If yes,volume pumped: 1( gallons--How was quantity pumped determ e ? -v f' Reason for pumping: r"rA 1'14 P►'lria CC- r�C C)M N'1 P�'f ► t� TY E 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 copy of the DEP approval Other(describe): a Approximate age of all components,date installed(if known)and source of information: ten V-- 11 - Were sewage odors detected when arriving at the site(yes or no): I1 CJ 6 Page 7 of l I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued). Property Address: M51 pud:.�C- Owner: V4 te V' Date of Inspection: Co.a.. Lo y BUILDING SEWER(locate on site plan) Depth below grade: `L _ ILI Materials of construction: cast iron 140 PVC_other(explain): Distance from private water supply well or suction line: -Fo w,11 Comments(oil cond' ion of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_(locate on site plan) Depth below grade: q —�� Material of construction: concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or r►o):_(attach a copy of certificate) I r Dimensions: Sludge depth_ 17 ' Distance from top of iludpq to bottom of outlet tee or baffle: Scum thickness: 3 ^ Ll q Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet to orb ffle: Co r cam,{' How were dimensions determined: 2 rw e e. Comments(on pumping recommendations, Net and outlet tee or baffle condition,structural integrity, liquid levels' as related to outlet invert,evidence of leakage,etc.) " e /S S -,GREASE TRAP:_(locate on site plan) Depth be ade:_ Material of cons n:_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 aflle: Date of last pumping: Comments(on pumping reco ations,inlet and outlet tee or baffle condition,s al integrity, liquid levels as related to outlet' ,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 0- Owner: v A-co(_ Date of Inspection• T or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below gra e: Material of construction: oncrete metal fiberglass col ene other(explain): Dimensions: Capacity: gallons Design Flow: gall y Alarm present(yes or no): Alarm level: A in working order(yes or no): Date of last pump' Comments(c ition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or o t of box,etc.): is ktZ_L5 o cc,C!2�d-ovee - PCHAMBER: (locate on site plan) Pumps in working order(yes or no : -- — Alarms in working order(yes or no): Comments(note condition of pump chamber,conditio 8 ' Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: c,(kC-c t�I kc Owner. S v t--t+t" Date of Inspection: N o� j G 14 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,,excavation not required) If SAS not located explain why: Tye leaching pits,number: ('S U O ct�. leaching chambers,number: U 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.): a, e w ►'%ors o S` C)f SSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan)' Number configuration: Depth—top o 'quid to inlet invert: Depth of solids la Depth of scum layer: Dimensions of cesspool• Materials of construction: Indication of groundwater inflow(yes o Comments(note condition of soil,signs of h ulic failure,level of pond' ,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition soil,Zsigns of hydraulic failure,level of ponding,condition of vegetation,e . 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART C SYSTEM INFORMATION(continued) Property Address: J, 1 Owner: 'a 04 k- Date of Inspection: HE I o SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. rar`� O O0 O 10 r e` Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: S v Date of Inspection: 1.t2 i r4 _ SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: (Y\k-A- 2 Yo must describe ow you established theVQd ground water vation: J V O� 16 �^ tQ �6N 11 S Ic COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION M� J V TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A , CERTIFICATION Property Address: i Owner's Name: Owner's Address: — &O, RECEIVED tg Date of Inspection: Nov 2 0 or• ( rm 2001 Name of Inspectplea a t) 7 — '+- .. �- Company Name TOWN TOWN OF BARNSTABLE Mailing Address: ' HEALTH DEPT. Telephone Number: s50R--7'7/ -!9, 9V CERTIFICATION STATEMENT ]certify that 1 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 ection 15.340 of Title 5(310 CMR`15.000). The system: Passes Conditionally Passes Nee As Further Evaluation by the Local Approving Authority il ate: Inspectors Signature: D 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. Notes and Comments ****This report only.describes conditions at.the time of inspectiop-and under the;conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different. conditions of.use. Title 5 Inspection Form 6/15/20.00 page 1 Page-2 of 11 s,- OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS t SUBSURFACE SEWAGE DISPOSAL SYSTEM-INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection:T(/►�c(1/{�}y�,� � �- �}�j� Inspection Summary: Check A,B,C;D or E/ALWAYS complete all of Section D A. S stem Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteri&not evaluated are indicated below. Comments: 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,Will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain" The septic tank is nietal and over 20 years old* or the..septic tank(whether metal or not is structurally unsound, exhibits substantial infiltration or exfiltration or.tank failure is imminent:System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: .. Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is.]ev'eled or replaced. , ND explain: The system required pumping.more than4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page of 11. OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY. ASSESSMENTS. SUBSURF ACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner:ITl� � !'I�, �9./3'Yt.� � Date of Inspection: C. Further Evaluation is Required by the Board.of Health: . Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect,public health,'safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any).determines that the system is functioning in a manner that protects.the public health,safety and.environtnent: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 10.0 feet of 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 deter►iiine distance' **This system passes if the well water analysis,performed at a'DEP certified,laboratory, for coliforni bacteria and volatile organic compounds indicates that the well.is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen.is equal to or less than 5 ppm,provided thatno other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: r 3 Page 4 of 11 OFFICIAL.INSPECTION:FORM—NOT FOR.VOLUNTARY,ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART, A CERTIFICATION(continued) Property Address: ��° Owner: Date of Inspection: , i 00� D. System Failure Criteria applicable:to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes 11kischarge: ackup of sewage into facility or m syste component due to.overloaded or clogged SAS or cesspool _ or ponding of effluent to the surface of the ground.or surface waters due to an overloaded or /clogged SAS on 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 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 I00 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 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 106 feet but greater than 50 feet from a private water supply well with no.acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen.and nitrate nitrogen is equal to or less than 5 ppm,provided that no;other failure criteria are triggered. A°copy of the analysis must be attached to this form.] �/o (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15:303,therefore the system.fails. The system owner should contact the Board of Health to determine what will,,be necessary to corred the failure. E. Large Systems: To be considered a large system the system must serve a facilitywith a'design flow of10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply — _ the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in,Section E the system is considered a significant 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM`INSPECTION FORM PART B CHECKLIST. Property Address: i Owner: ' ` ! Date of Inspection: o / Check if the following have been done. You must indicate"yes"or"tio'•'as to each of the following: Yes No _ Pumping.information was provided by the owner,occupant,or.Board of Health V"'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 systein 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 _V11 _ 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? _I_ Was the facility owner(and occupants if different from owner)provided with information on.the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _ Existing information. For example, a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance. is unacceptable) [310 CMR 15.302(3)(b)] I 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR,VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM JNFORMATION Property Address: Owner: " 14 Date of Inspection: ZZ FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): . Number of bedrooms(actual): DESIGN flow based on 310.CMR 15.203(for xample: 11.0 gpd x#of bedrooms): ® Number of current residents:`' , caw- Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system (yes orho) of yes separate inspection required] Laundry system inspected es or no� Seasonal use: (yes or no):. ye . Water meter readings, if azable(last 2 years usage(gpd)): Sump pump(yes or noj;, - m Last date.of occupancy: sa, e_u"ae�4 Otatee A& Ld� COMMERCIAL/INDUSTRIAI�_,� Type of establishment: . Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc. ): Grease trap present(yes or no): Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: .. , Was system pumped as part of the i specti ,(yes or no): If yes,volume pumped: gallons--How was quantity pumped determined? Reason'for pumping: TYPE OF SYSTEM eptic 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 copy'ofthe DEP approval Other(describe): Ap oximate age f all components date mst4) Pled(if own)and source of information: Were sewage odors detected when arriving at the site(yes or no)—:-12m— 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C n SYSTEM INFORMATION(continued) , " Property Address: /0 Owner: Date of Inspection: v BUILDING_SEWER(locate on site plan) U,/&O— 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: C4 Z Material of construction: concrete_metal_fiberglass__polyethylene _other(explain). If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no):._(attach a copy of certificate) � Dimensions: ?y.:q"y � Sludge depth: Distance from top o sludge to bottom of outlet tee.or baffle: Scum thickness: ri Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee_ or baffle: 7 How were dimensions determine' : �o Comments(on pumping recomme ations, tnlet and outlet tee or baffle condition,structural integrity, liquid levels s related to outlet invert evidence of leakage,etc. : e _ 0 GREASE TRAP�Wocate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum.thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid.levels as related to outlet invert, evidence of leakage,etc.): 7 Page18 of 1] OFFICIAL`INSPECTION.FORM—NOT FOR:YOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C . SYSTEM INFORMATION(continued) Property Address: / /&de;�p . ,� A Owner:'" �e, Date of Inspection: J TIGHT or HOLDING TAN k: tank must be.pumped at-time of inspection)(locate on.site plan) l: 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:�/ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:U=/6 r'j" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of J akage into or out of box,etc.): zv� � � � �� QAZ PUMP CHAMBER(locate on site.plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): 8 Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner34�d�-� Date of Inspection: QQ SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type eaching pits,dumber: leaching chambers,number: leaching galleries,number: leaching trenches, number, length: leaching fields,number, dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, R i/ qz CESSPOOL&&(cesspool must be pumped as part,of inspect ion)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): a; Comments(note condition of soil, signs of hydraulic failure;level of ponding, condition of vegetation,etc.): PRIVY ("locate on site plan) Materials of co'nstruction:. Dimensions: Depth of solids: Continents(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTI.ON FORM=NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner ' ! i. Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. Cr l� 5 r ]0 Page I l of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 19ff ? Owner: , Date of Inspection: Ito SITE EXAM Slope Surface water Check cellar Shallow wells .-. Estimated depth to ground water 1 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with,local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you.established the high ground water elevation: i�J� , II I Permit Number: Date: ` Completed by: =` +' HIGH GROUND WATER LEVEL COMPUTATION Site Location: 175 1 ,/J �7 Lot No. Owner: �t'f/'� /� (/fir L° Address: j79T Contractor: yr®/ G3'�® � %�G �v = `u Notes: STEP 1 Measure depth to water table to nearest 1/10 I ...................:................ / ............................................ .Date month/day/Year i STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: O APPropriate index well:...................................... ��/4/Z i OWater-level range zone ........................:...............:..........:.L r STEP 3 Using monthly report "Current i Water Resources Conditions" determine current depth to %Dl�'� water level for index well ........................... — 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 23) m� determine water-level adjustment .............................:............................................................ STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water level at site (STEP 1) ............. figure 13.—Peproducibie computation:iorm.. 15. "af /00 IJ Mea TOWN OF BARNSTABLE L(A:ATION� �,� �? _gdSEWAGE # VILLAGE.__ ��e`� A.SSESSOR'S .MAP & LOT INSTALLER'S NAME & PHONE NO. Ca l L- I � Q( _ SEPTIC TANK. CAPACITY��V yet -14 &EACHING FAC:ILITY:(Cype) I t2 00 (size) qq NO..OF BEDROOMS vC PRIVATE WELL OR PUBLIC WATER._ BUILDER OR OWNER _ - DACE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No � r r j No.._� ......� Fps.... .. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 0wLL..............._0F. crrn,>LG/C.....------------•-----------••------•--.....--•------ Applirta#ion for Bispvii al Works Tomtrnr#iun Prrntit Application is hereby made for a Permit to Construct (X,) or Repair ( ) an Individual Sewage Disposal syrt ® c> ......_... Location-Addres� or Lot No. _. 17Y1 --------------•----........_....._._..._ ........ I..------••----.......------........_ Owner Address Installer Address UType of Building Size Lot..... .....Sq. feet �. Dwelling—No. of Bedrooms.____.'w.-c:a_...........................Expansion Attic (k1o) Garbage Grinder (4) a.4 Other—T e of Building No. of ersons____________________________ Showers — ) YP g ----•---•-•------•------ P ( ) Cafeteria dOther fixtures .......................................................................................................................... Design Flow..................................... per person per day. Total daily flow.............................. gallons. 9 Septic Tank—Liquid capacity_!_(?_U4gallons Length.9�-.�°_-_ Width_4'--lam.`__. Diameter________________ Depths'�r! Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft: Seepage Pit No....onw----____-- Diameter.._.1 ............. Depth below inlet____............ Total leaching area... ____sq. ft. z Other Distribution box (X,) Dosing tank ( ) aPercolation Test Results Performed ............ Date__/f..z1-_8: .............. ,.a Test Pit No. 1.___a........minutes per inch Depth of Test Pit.... Depth to ground water--------...--_-----.. Test Pit No. 2_____ _.....minutes per inch Depth of Test Pit..... 4 4!'____ Depth to ground water________ _____________ a -1 tiAd..--------- 0 Description of Soil.T€t?_.--O-30' 7-P aiJ_l_Ss kz ?►.1.`_r ________________ V `'ji`-1QZ" T�xscccnr„ .:c:,zs__lyct^.s -ixAr4xc�__cl. /. il}.._cicl'g�aCt �122._-._i_�1!ij--------------------•-------------------------- ------------------- ••----------•--•--•-•....................•--•----•-•--._.._.._......-----•-•---•--.._--•-- .................................................... V Nature of Repairs or Alterations—Answer when applicable..._.............................................•....._____..._.._...____._..._.____.__.__.._.. ----------------------------•-------------------.-.--------------------------------....-•-•--------------....---------------------------------•----------------------------------------•••-•--••-•-•_.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with T!'1Y-� the provisions of fJ.rl T � 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be ssued y oar f health. Signed---•--• •- _...- •-- ................. Date Application Approved By--•• •••--. r .. -Ap---- -----•-•----•---•------ � Date Application Disapproved for the following reasons- -------------------••-------•----•-------•--------------•-------------------------------•--•---•....--•----- -•----•----------------------•---•-••------•-•--••-----------.......------•---._..._._..--••-•------...--•-•--•----••-......--•---•-•--••--•-•-•...-- ------------ --------- --------------------- Date Permit No-------9.0—.700............... Issued...... . ........._v._L! No....f> (1,....,!- FimE r.. f.�'"�---...... .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . .. .............OF. ��r�+. .r ................. Applira#iun for Disposal Varks Taustrurtiun Wrmit Application is hereby made for a Permit to Construct ('C,) or Repair ( ) an Individual Sewage Disposal Syit�-.�t--- . � T C� l'�-C�V'l----- --------------------------------•---------- Loocation--Ay ddres -'7 or Lot No. Owner Address W ........... .................•--................_......._... --•--- ::.kL;.:_i1.__5.._.................._..�.... .._............. Installer Address QType of Building Size Lot....LE,2 .&.� ...Sq. feet Dwelling—No. of Bedrooms...._- .us x;z............................Expansion Attic (1Q.0) Garbage Grinder (✓ ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) 0.1 Other fixtures .-----------•-----------------------------------------............................................................................................... W Design Flow................................... 2, _.gallons per person per day. Total daily flow.............................. ca....gallons. WSeptic Tank—Liquid capacity-W.CA gallons Length!._- ...... Diameter._.--:- x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No._,.�e^__-_._... Diameter....1.9�.......... Depth below inlet.._46............. Total leaching area...:.&�6....sq. ft. Z Other Distribution box (X. ) Dosing tank ( ) a Percolation Test Results Performed by. ke: .-1;�3.9. s�� ...: >x;, .ta y ............. Date_11._.�'1_=. ' ................. Ir Test Pit No. 1....aZ........minutes per inch Depth of Test Pit.... 6)........ Depth to ground water- ................... GL, Test Pit No. 2...... .......minutes per inch Depth of Test Pit...;!-.4e9j...... Depth to ground water_:: ....... ................................................ O Description of Soil-•-'•`--s?----C?_>3Q .1�---w�.!lCeo x i................................................ V uFi.. _4.G a:._.. r.:..� -caa.::: .-.��?�cs_e. _ ..{-lssa {,..�!' D�.t�.._L J-q'C 7--•------------------- --- .........................--••-••--•--•••.........-••--•-•-•••... V Nature of Repairs or Alterations—Answer when applicable......................._.._..__.._____..........__.___.__.__.___._.._.................._ --------------•--------------........---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI T 1E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bege7ssuedky boar of health. Signed _.: . J/ ... .. .. ------ - i � 1- -- sy7 y.� Date Application Approved By.. f___;.. `_ ...................................r Date Application Disapproved for the following reasons; .............................................................................................................. .............................................. .......... -•........•-•-•-•---.._.........•-----....••-'--------------------.........................• ;...---- Date ......------ / Permit No....... --.......,!__..........----------------- Issued----- 1,............--" ................... Date THE COMMONWEALTH OF MASSACHUSETTS / BOARD OFrHEA)..T�Ft, .................... 0 F.B A 71 .......r............... flit wrtifirtttr of Tompliaure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (. or Repaired ( ) by at._.... .. ..t�1-...- '�- •jill�" _��.f.....-1.� --•------------- -•--•----......--•---•-•---•----..... f - has been installed in accordance with the provisions of TILT 5 of 3:he State Sanitary Code as described in the application for Disposal Works Construction Permit No r -'� �. dated ...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS 1 P OARP-, O H iALTH� YY ' .OF.. . ..,. ....... .:... ..................... . _. NO.. - FEE... Disposal Murky Tunu#r ion rrmi# Permissionys hereby granted.............................................................................................................................................. to Construct (V or Rep it (�; n divi >� S . T e Disp System 0 at No............. ... Street � � / / as shown on the application for Disposal `forks Construction Permit No � �. 4Dated......P....:..... 7 ..._.�-'.. . ................................ �..J......................... .............................. Board of Health DATE --•.................t----._-. '" .? FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS f � � Sir - S� �-t%a.60 . . . . . . ..,.. _. . IS��"kc�. P �l5 OS,D.L PtT use loop / � IpZ•'_ ..:':" _�, '�._.`:. :.- _ ._,._ � n2. SF �c 2.S • �•--1 ca' �.P.D, all' , ' TgT ,&L -0ESIG►,1 — D. o TaTA t- Pt-72coLeTioO czeTE : t"Ik.ItT 2/Yttu' otz 1.�. :•: :.F •Y ,�•pPe lam© tw. ►uv�4S -Box15) GAL. tuV, tW t. PIT IF ENCOUNTERED, ALL UNSUITABLE SOIL 11� u/I TII SHALL 'T A WIDE HE LEACHING ZONE AROUND I , t �fJ �Z �a/a•I lL AND SHALL BE REPLACED WITH CLEAN WQW[D SAND AND GRAVEL IN'ACOORDANCE WITH { . . . . . . . x STo..t� .=�� TITLE V. CE�'TlF1ED pLbT' P•L';A,};,1 LoUSTloN .; qlt. ; E Lr �? J o S c t��.�- }-• �o II� �j Ti�.TIr Z�(0�`,� Prz 0 p) 1 cGtZTtt=�( T�4A7 TP 5Wo.U►J fit:A 1 QP--1= r'E!:1ca ' CorT0�1 .;_. aub SCTL'�AC�C SZGQUI�E/�tc:u'CS o� TNT P�l��.i 1:.,"= Aqt) is Wc>7- : r f 241 YF, LoGATED wtrt41w Tug Pl-UOp VL-Aitit Zoo+✓.A. C. RC.6t5'CERal- L.5,1,1t, ;utvt=Yoz<. THI5 t7LA►-1 I-e, UoT P,la•SCID UV.J A," 05'YE� /1C.1G a, �tr(.S•S�,r°: i"ST'LZUMaQ'r 6umV CY 4--T�4E CFF5Er5 59oULP t40T 8E USED T'a EST'ABUG" Lo T LI►.lES APPLICATION FOR PERUULAT.Ly,, 'rear nlvu { LOCATION Parker Road : NO. 7l D VILLAGE Osterville DATE11/14/88 I IAPPLICANT John B. 'Cotton, Jr. FEE S75 nn •ADDRESS 15 West Bay Road, Ost, TELEPHONE NO. (Non-refundab ! 1 ENGINEER Baxter & Nye. Inc. . Prtcr S1111ivan_TELEPHONE 110. 428-913 i DATE SCHEDULED �J- a (-rh /�7 A m i (Applicant's signature) i. ASSESSOIl'SD1�F' 6�LUT NOc.. . . .. . ... .. . . . . . . . . . . . . . . . . . . . .... . ....... . ...... . . . MAP 116 PCL 39 SOIL LOG SUB-DIVISION NAME DATE Mc,,) z i 199 3e TIME I O AM s it EXPANSION AREA: YES_i-NO S1ko(W2 1srn ENGINEER.') ' TOWN {IATER_�PRIVATE WELL Tc�c� `��rnl t BOARD OF HEA i Brvcc l�Il`/dllisdni- EXCAVATOR SKETCH: (Street name,etc. ,dimensions of lot; exact location of test holes and t II percolation tests, locate wetlands in proximity to test holes.)-, NOTES: JFENCOUNTE1iE37 "I -UNSUITABLE SOIL. SHALL BE REMOVED WITHIN A/O WIDE ZONE AROUND THE LEACHING FACILITY AND SHALL BE REPLACED WITH CLEAN SAND AND GRAVEL IN.ACCORDANCE WITH TITLE Y. IV ) 30216�1a !+a i '� a• tee i G r��l!'•'r^ C I i PERCOLATION RATE:_ .2 mir�rc4 TEST HOLE N0: ELEVATION: TEST HOLE NO: Z ELEVATION: L.I1 T.psoil �' sa broil 1 l �Sol c I � I o 2 z4 2 Svl.sa.l f 3 3 3o�. 44 tiVrlcslow� Sa t�P f; 6 6 7 7}Yl c J v nL Sa,QQ 7V�r 89° �.c.vc.�^t>,nuovs layer�f g 9 - - — ,i; t! 10 10 lrluiw,n s�.,,.t¢Q; i 11 11 i 12 (.Sfo Gla/c. 12 �/✓o G/r<!c.J 13 144 13 1 14 14 115 15 16 16 j. SUITABLE FOR SUB-S.URFACE SEWAGE: . LEACHING FIELD LEACHING PITSy_ LEACHING `1'REN.CHE_ F UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: NOTE: ENGINEERING PLANS, MUST SHOW NU7d13ER ASSIGNED .ON PERC TEST APPLICATIO17 ORIGINAL: COMPLETED IN ENTIRETY13Y P, E. TO BOARD OF HEALTH COPY: RETAINED BY APPLICANT f , I f,! GENERAL NOTES _r` 1.ALL EXTERIOR WALLS SHALL '-I BE 2X6 @ 16"O.C.UNLESS OTHERWISE NOTED. _ 2.ALL INTERIOR WALLS SHALL BE 2X4 @ 16"O.C.UNLESS OTHERWISE NOTED. 3.CONTRACTOR SHALL VERIFY FNDN WALL HT, r-k ALL WINDOW ROUGH OPENINGS CHANGE------ ---------- --- -- ---------- PRIOR TO ORDERING WINDOWS. ' 4.CONTRACTOR SHALL VERIFY ' 1 .:', r------------------- --------------------- --- ------------------ ALL DIMENSIONS PRIOR TO 10•THICK x]'-10• ASSUMES RESPONSIBILITY FOR 36•DIA.raR reD i 1 —lo•THICK x B`-4'H.FNLXI B 1 :? i 't ' ' T n CONSTRUCTION. CONTRACTOR GALVANIZ3D ST EL M I I WALL ON CONTINUOUS POCKET CONCRETE WALL I I AREAWAY-G VEL c I ^': I 24'xIO'CONCRETE ON CONTINU0E1" I I BED, (TYP) I I FOOTING Y DINING ROOM T 24•x10•CONCRETE 1 ':. ' ANY MISSING OR INCORRECT I I RAISED FLOOR. BASEMENT = FOOTING(TTP,) I ' 4'Cam,SLAB ON 10 MIL --- --- DIMENSIONS NOT BROUGHTTO D i VAPOR RETARDER i i <` i D THE ATTENTION OF THE I DESIGNER. I I I I 1 ' I I I I I I I REVISIONS I (3)1-94YI-W LVL 1 I I I I I DROPPED BELOW DINING -.. TS 'x4 x.25.-r R_M,_F_L. 1-71 T S 44'x2'4 A A COLUMN WSTD. - 6 9T0,BASE PLATE t 2-V'D09 ANCHOR BOLTS TYP,TTP FNDN WLL HT. CHANGE ------ � �'..: _ _---_______________JIIIII •�::. IIIIII '^1 _ , - I I TS 4'x4'x.25'COLUMN ON 4B4W02'DEEP 9'B CONK.FOOTING NO. REVISION DATE I I I I 9('9TD,649E PLATE t D. I 2-1%'DIA.ANCHOR I I BOLTS - (3)I-Y'xll-T6' 1 I�J I ®COPYRIGHT I I LVL DROPPED I I NORTH SIDE HEREBY EXPRESSLY RSERVES ITS _ COMMON LAW COPYRIGHT. 9 I I THESE PLANS ARE NOT TO BE REPRODUCED, ' I I 3-15'DIA.CONC. 1 I CHANGED OR COPIED IN ANY FORM OR r I I I FILLED STEEL LALLY I I _� MANNER WHATSOEVER WITHOUT FIRST ' I COLUMN ON 1 -: I LINE OF 2ND OBTAINING THE EXPRESS WRITTEN I : I BUILD OUT FNDN WALL 4 I I 49Y4B41ro.fAhK. 1 I FLOOR BEDRM. I : I TO SUPPORT EXTERIOR 1 I FOOTING TYP) I I PROJECTION PERMISSION AND CONSENT OF NORTHSIDE I I FACER STONE mot^ I I VENEER FALSE i ( I I ABOVE CHIMNEY ABOVE -- --- 1 '�,. I / V DESIGN ASSOCIATES BUILDER: BASEMENT - 10•THICJC T -10 1 1 CONCRETEWALL ON I I PATIO I 4'CCTIC.SLAB ON to MIL CONTINUOUS 24'x10' I I PERMEABLE L I i VAPOR RETARDER __ ___ CONCRETE FOOTING ' ' PAVERS ON . (TYP,) NG I BEDDI COURSE E l i I I E :'` I E I I I I I .' I I I I I ' .�� 1 O•THICK r tr-IO' -- --- I ;: I ' CONCRETE WALL ON (3)I-a'xll-%' 1 ',-. I A.6 DESIGNER: LVL DROPPED ( NORTHSIDE I CCamCRETE FOOT NG 1 :: I DESIGN ti '-" rL ASSOCIATES - ----'- i --- --- T54'x4'x.25'COLUMN I p DISTINCTIVE RESIDENTIAL&COMMERCIAL DESIGN 9TD.BASE PLATE - I 1 t 2-V'DIA,ANCHOR I �V j ^� 141 MAIN STREET'YARMOUTHPORT•MA 0267S 1 I I BOLTS TYP. 12'DIA.SONDTUBE (503)362-2230 (500)362-9802 x 1 1 I / 1 / W/BIGFOOT ` I 4 PATIO ^- FOOTING(BF26FOR ) NORTHSIDEDESIGN.COM • I i TS 444'x15'Ca.UM I 1��WALL'�' PAVERS ONE SUPPORT nomhsidel@com .n 1 f I __ ___ CHANGE _ BEDDING COURSE (TMP') . 96•STD.BASE PLATE I I—___ I I <2-q'DIA.ANCHOR 1 — (L T BOLTS TYP. I I————— zz"] _2T STRUCTURAL ENGINEER: 0 . FOCCET .......... ......�.,- PIP . __ ____________ ____________________ - ---------------- -------------' - ------ -- ---- - LL 10'THICK FNDN WALL. DESIGN C I I DROPPED HEIGHT• ANCHOR BOLTS I I TS 4'x4'x.25'cowM I 10'THICK x 4'-B'(MIN.) I I 4. •36'O.C.MIN,T I 1 76.9TD.BASE PLATE CONCRETE FNDN WALL ON I 1 BRICK FLOORING A0p✓E. EMBEDMENT I - I t 2-V'DIA.ANCHOR I CONTINUOUS 20•x10' I I I I 2)H W F (REF,EST FLOOR PLAN) L I I FLUSH HDR. CONTRACTOR TO CONFIRM WASHE x Y'PLATE I '�'.. I BOLTS TTT'. I CONCRETE FOOTING. I Y STAIR HASHER(TYP.) I I I I DROP PER SELECTION OF I I I I STAMP: I ;t -- -- BRICK AND SETTING I I I I I I I LVL DROPPED r - , I ' - MATERIALS. I I 76'ANCHOR BOLTS Y 36' I " I 11 ' ' ' GARAGE SLAB I I I HDV�3Y3'xY'•PLATE�h1A5HER I I O 4 I ); 1 4•CONC.SLAB ON 10 MIL I (TYP.) I I A.7 r I :.� I bxb P.T POST ON. I "y4 ]"'�4 I EAM VAPOR RETARDER I aJ 24424412'D. I I --- 1 I I I POCKET BACKFILL WITH CLEAN I I I I I FOOTING FOR I I STAIR LANDING I I ' I I I I I COMPACTED FILL I I I I I I I o 7 PROJECT: (2)h12 FLUSH1——————— — 'IIII ;'�:-•:'.'1I1 I I HDR,6 STAIR OP'G1 I' I -- --- J 'Ic--_---- --_--- DEEP CONTRACTION KOO P (3) JOINT CUT WITH EARLYUP3R.Y 1' I PROVIDE I LAYER 5/B'TYPE RESIDENC E 7.%'9'T. LVL DROPPED (TTF, ''FIREOEGWBETIRE ENTRY SAW 1 ': 1 GARAGE!CEILING I I I __ ___ I I 3-)$'DIA,CDC.FILLED BASEMENT § 1 1 1 1 178 PARKER ROAD I I I I STEEL LALLY COLUMN ON 4'CONC.SLAB ON 10 MIL I .: I PITCH SLAB X'PER FONT I I FOOTING (D.CONC. VAPOR RETARDER D OSTERVILLE,MA. I I (2)I-�411-:B' ___J _ FOOTING(TTP.) A.6 LVL DROPPED I 4 I I BEAM POCKET I 10'THICK r Sr-Id I i TITLE CONCRETE WALL ON --_ __-� TS 4x44.25'COLUM 1 DROP TOP OF FNDN , 1 '•: CONTINUOUS 24410' 96'STD,BASE PLATE I "-' WALL 12'!GARAGE, I ` I 1 +'�, CONCRETE FLUTING t 2-%'DIA.ANCHOR __ _________________________________ _J ICI 4'x4'x,25'(ALUM DOOR OPENING FOUNDATION (TTP.) ,n BOLTS TYP. '.': I� I 96'STD.BASE PLATE I %• I _ ....:.y:.-;:.,":.:':i'i.:;: ;;':`,:i:,,':, 1: .::": ::;• :'::;,'::' :`.::.,,.:.::.::'.:.'.::;.:,':;( ';..:.. .'_:C::.,;;; 1 4 2_%.DEA ANCHOR I :';. I ,., FCNANGE LL HT. I 1 BOLTS TYF. I I PLAN r .:... :. _ .. • �___________________ ______ _________________J I I ;•, I _ __ - BRICK PORCH SLAB �— SCALE NOT TO SCALE ___-_ _ II IO"fNICK x 4'-0'MIN. I I.nri-e: /�./,/.;,./',//.; /./,/� ;�/ ' ___________ '. ;,::,':::.... ..:..::..:':•; ____ CONTR�410 LCONCRETE 0 o FOOTING v 24'APRON _ APRON 1 L _ _ -_ _ 13'-0' r_3 ..:. .. :'r ...- .y6 _6 '_6 '-6 2'-6 WINDOW BAT :' .:' .....� I : FOUNDATION PLAN -- --- - - -- ----- -- -- J PROJECT#: SHEET BRICK STEP -6 25'{ 17-02 A.0 A DATE: OF A.6 09/26/17 16 1M8�01/1:N000 PM 56 ©�� GENERAL NOTES 1.ALL EXTERIOR WALLS SHALL BE 2X6 @ 16"O.C.UNLESS OTHERWISE NOTED. 2.ALL INTERIOR WALLS SHALL BE 2X4 @ 16"O.C.UNLESS OTHERWISE NOTED. 2 3.CONTRACTOR SHALL VERIFY ALL WINDOW ROUGH OPENINGS PRIOR TO ORDERING WINDOWS. 4.CONTRACTOR SHALL VERIFY T, ALL DIMENSIONS PRIOR TO p p ' A 8 � • CONSTRUCTION. CONTRACTOR DINING ROOM STUDY A.B ASSUMES RESPONSIBILITY FOR (WOOD) (WOOD) ANY MISSING OR INCORRECT DIMENSIONS NOT BROUGHT TO THE ATTENTION OF THE DESIGNER. DROPPED REVISIONS STEEL BEAM ABOVE -----------——————————— 2670 ROLLING STEP UP '-p ......! 30]0 BUILD OUT WALL TO 7....J i.....I.1....... PROVIDE b'W. I DROPPED DROPPED ON. t FALSE CHIMNEY W/ STEEL BEAM CEILINGVSTEEL 3R. STONE VENEER TO I ABOVE BN ABOVE ..... I- 3'-d MIN.ABOVE :.....I...., FA I..t.. J RIDGE AND ^I 9TTIMETRICAL OVER I I IS-D.BOOKS RIDGE. VENEER,CAP AND I I DETAILING T.B.D. I I WAS. 1 3D•w COVERED rj NO. REVISION DATE LIORIZONTAL VENT GAS FP I ISLAND SINK PORCH LINE OF ❑ ......[(PEW'IEAB4E,.... 2ND MODEL PER CLIENT, ___________' —_— ""'i FLOOR ®COPYRIGHT BUILDER TO CONFIRM I 2q•y ;^PAVER) i� BUMFOUT NORTHSIDE HEREBY EXPRESSLY RSERVES ITS VENT LLOCATI PER FP 124' DW .`:::..fl.............1,,,!i..._ ..,,_. ABOVE COMMON LAW COPYRIGHT. REQUIREMENTS/CLIENT ETION CLIENT _ I� ''"""" THESEPLANSARE NOTTOBE REPRODUCED, __________ CHANGED OR COPIED IN ANY FOR R a PREFERENCE li 3SINK _ ! MANNER WHATSOEVER WITHOUT F AST I I a ��...� OBTAI NING THE EXPRESS WRITTEN �. ------ , SENT F NORTHSIDE!II =::::'""'""' PER 4------- emu: ! DESIGN ASSOCIATESO GREAT ROOM 1..............I"L...... (waoD) BUILDER: I..........._i. AE.B i I II 1 1 RECY (P_ATIOr;:: ------ E � E ITRA5N - I RAVFR9I.�...... I ' 1 :................. . KITCHEN PRO ......._.._I 1....i i....,.._:.) ...... E DROPPED RANGEDESIGNER: STEEL BEAM I NORTHSIDE ABOVE ^ ....... PAD OUTTO PTRT REF. REP. 'IF..........1_:....i:......... !, ... .. WALL TO ASSOCIATES RECEIVE BEAM ;! ...;..................:._.. .. TrI' ... .. F. DROPPED ... ... 1... .. ... I t IffII IIf DESIGN uh :BE-ARNC BEILING/STEEL . I�^l I'— �l ', I I "� ^� COMMERCIAL DESIGN '. 20]0 I BEAM ABOVE DISTINCTIVE RESIDENTAL&COM ER IAl GNPATIO� �( HFAB - 141 MAIN STREET'YARMOUTH PORT`MA 02675 IPAV€RS) .... (50R1362-2230 (5081362-9802 d I J NORTHSIDEDESIGN.COM N CASED OPG i FULL-LITE ................::...... ..L.L:..2s]o:, :'._�RI K R I� I STEEL LEB EAM STRUCTURALeENGINEERt: L I VENEER) TAYLOR DN 13R,i].96' I DROPPED __ _ I VANITY I I OPEN R'T.(TYP.) I SIL TEEL BEAM 40]0 PR-- I I CLOSET 0 I I DESIGN LLC 7ELIVING ROOM I (wooD) GARAGE C UP bR ULIN. WASH, (CONQRETE SLAB) STAMP: L(5RICK SET LAUNDRVj DRY, EER) jr MCR) FOYER s= UTILITY (BRICK VENEER) SINK ❑0 PROJECT: FRONT ROOM - r---- ——————— 1 KOO P A6 II RESIDENCE 'El BAR I 30]o i i I I I I I I DROPPED o HALL 3R. I 178 PARKER ROAD STEEL BEAM I - I I OSTERVILLE,MA. ABOVE B'DROPPED CLG, BOWFRONT ..: :....._.........:...._...:..............:.. _ I TITLE CABINET -.o.,:_....._:..�...._L.�.:......_:..:..1::::.:�:::::.: ti.:....,...,-.._,..:.._.-.-":::'::T__1':..::'.::.::!::,::[::::::,::::::::::::t:::I::;: HT.•BAT ._ 9080 GARAGE 9p90 GARAGE 1ST FLOOR o ' COVEREDFRONT Y 1 224'COW. PORCH PLAN APRON SCALE:NOT TO SCALE PROJECT#: SHEET '-I A.6 17-02 DATE: OF 09/26/17 16 tonR�4�]�.44RPN • I GENERAL NOTES 1. ALL EXTERIOR WALLS SHALL BE 2X6 @ 16"O.C.UNLESS -6 - OTHERWISE NOTED. 2.ALL INTERIOR WALLS SHALL a 6 BE 2X4 @ 16"O.C.UNLESS za 4 ti OTHERWISE NOTED. ____ ------------- 3.CONTRACTOR SHALLVERIFY , - ALL WINDOW ROUGH OPENINGS " .."" :-"": PRIOR TO ORDERING WINDOWS. - ..... ...._ ..... ................................_..................-........ . ............................................................_...............__'_......_....... .. ��""� 4.CONTRACTOR SHALL VERIFY ............._..............................................__................__....... ALL DIMENSIONS PRIOR TO DINING O j - � fooF BE�I� 4 ' CONSTRUCTION. CONTRACTOR ASSUMES RESPONSIBILITY FOR ANY MISSING OR INCORRECT ROOF DECK, _ g - DIMENSIONS NOT BROUGHT TO THE ATTENTION OF THE I 1 -.- ( DESIGNER. II........._...._--_........._...—_..........__................- REVISIONS I I I I - I .................__..............._.__.................___..................._........_..._.... ,_I� _ ...........----...._...------.....------ ._._.._.................:.._..._._....._._.._ ......... EN �e _1 BENCH DROPPED EIEAFI STEP M.6' OCTAGONAL LIN. ABOVE� (KTAGONAL[uPOLn w . \ 5'SHORT DIAPIETER,2M q WINDOWS HERS °t W.LC. I ��'^ el CUPOLA PLAN #1 I_—————— 4 SCALE: Ye"=1'-O" II NO. REVISION DATE II I -� CATH RAAL (ID COPYRIGHT 4 12688 MASTER I CEILING _ NOR HSIDE HEREBY EXPRESSLY RSERVES ITS COMMON LAW COPYRIGHT. BEDROOM I I THESE PLANS ARE NOT TO BE REPRODUCED, _ED CHANGED OR COPIED IN ANY FORM OR HEADER - 3 ABOVE _ x -O'WALL MANNER WHATSOEVER WITHOUT FIRST OBTAINING THE E%PRESS WRITTEN ART PERMISSION AND CONSENT OF NORTHSIDE WAL DESIGN ASSOCIATES BUILDER: It s I;' E W.I.C. LAUNDRY#2 y iliii A.8 HIS #2 v Ili A '-II'�/-2'-1 B + DR WASH COUNTER $ A.6 --------------- ® uN. j BALCONY - .. DESIGNER: I NORTHSIDE 66b r-6 DESIGN HALLASSO Iill ::I FLAT CIIi. I i j j O. , IATES _]. I ! IMNCTIVE AL DESIGN . .: 161 MAIN STREET...__�. .._ 06 '1ANMOUTMPORT'I. MA 026]6 2r>sa II BALL NY BEDROOM NO.Z 1606136 NON MSIOEDE6IGN.a 4 N,2-2210 62-9NO2 : ............................... _......_........................._..._.._.._......_.__._ ........:.:.:_:::::::... _ ... ...... .......... ..........._..........._.......... orthsidel@co t [ 286I I --_1__ - . ILL. ------� a- Ilrl ql� '-ty2' B 1 1212 I I 12:12 - STRUCTURAL ENGINEER: ---- TAYLOR SNOW ER ON ITR I ROOF T. I I BEDW W DESIGN LLC �. T. x6'-Ib xG'-ID'N I � I j � \\ GYM/REC ROOM - BATH HALL r———J L——— VAULTED TO ID.-O. I x I STAMP: 4 NO. hWTe Fur CLG. I LOFT I-——--—— I A.7 - W-2 I / — \ VAULTED WHERE CLG.HT.CHANGE NOTED TO 8'-I0' FLAT CLG. e e DROPPED BEAYI ABOVE OPEN TO L LIN. I I CUPOLA SAUNA I ABOVE PROJECT BEDROOM NO.3 FLAT CI 2ry� VAULTED TO B'-Ib W.I.C.. ———— _____ _ OO P 868 I I LG. N I I � - I� BATH II -- -- — ---- II z2— K B NO. �xl; r--- r- x6'-Ib11 , -- oE�PBB1Tl RESIDENCE A.6 \\�" xc'a� x6'-0'�� =1 r� WALL I � i 178 PARKER ROAD WALL WALL "� "� Z9 I OSTERVILLE,MA. ROOF BELOW 45'-0'KNEE WALL WALL - - � BATH NO.4 I _ 1 n 1212 VAULTED TO 10'-0' 12:12 ROOF ' L B -----—BELow <— FLAT CLG. .—, BELOW i TITLE . .12 -'� -- --- ---- _----- PEDESTAL ; 2 N D FLOOR -T I ----- ------ , B1NK -----J PLAN I I FRONT PORCH ROOF b D SCALE:NOT TO SCALE 2T-6 26'-I 25'-6 PROJECT#: SHEET ]a r A 17-02 A.2 A.6 OF DATE: 09/26/17 16 10/1 0171: 48 VN Proposed FpEie3 oo SEPTIC NOTES F.G. EL. 31.5* - *Final Foundation GradingTo Be See Note 6 t (yP) 1.Location of Utilities Shown on This Plan Are Approx.At Least 72 Hours � � MT-�� • '�'i�� Coordinated With;Landsca e Plan F.G. EL. 0. ZONE: r: Prior to Any Excavation For This Project the Contractor Shall Make t + •, � � the Required Notifications to Dig Safe(1-888-344-7233)and contact RC Flow Equilizers Sullivan Engineering&Consulting Loc.(508428-3344). Area (min.) 87,120 SF (RPOD) EL. 29.5 As Required ( , v . •,. , . ar 2.The Contractor is Required to Secure Appropriate Permits From Town Frontage (min) 20' Installer To EL 29.00 1500 Gallon Agencies For Construction Defined by This Plan. Widthm(min) 100' Confirm Prior s+ � �" •� �� ' + '< To Any Work Septic Tank EL. 28.84 To EL. 28.20 Supply Setbacks: p 3. Wherever Sewer Lines Must Cross Water Su 1 Lines Both Lines Shall H-20 Required 28.16 H-20 Front 20' D-Box EL. 28.0 Be Constructed of Class 150 Pressure Pipe and Shall be Water Tested to + { (See Note 5) „t Side 10' � H-20 Assure Watertightness. In General, Water Lines Shall be Constructed in 27.20 -a 9 Rear 10' Leaching Coordination With COMM Water,and Shall be in Accordance To Be Installed On /� ti Chamber ' pia ee o� Bot. L. 5.20 With 248 CMR 1.00-7.00&310 CMR 15.00. " Bedding,"T"s, 4.A Minimum of9"of Cover is Required for All Components. ` FLOOD ZONE: Ins ection Port, If Encainteted:RBrkve 8c Re IaC2 P p 5.All Structures Buried Three Feet or More or Subject & Baffels kll U/Suitab{e Sbils Wthirt 5 of: Zones X(Min. Flood Hazard) rt1 � , r sd as Per Title 5 The Dut'er P�rlmetEr of.7he System:: to Vehicular Traffic to beH-20Loading.Itis the Engineers p q Recommendation that H-20 Always be Used. Community Panel No ¢ #250001 0757 J 4 EL. 19.5 6.Install Watertight Risers and Covers to Within 6 of Finished Grade No Groundwater Over Septic Tank inlet Outlet,D-Box,and Leaching Chamber. July 16, 2014 Per Test Hole 3&4 DEVELOPED PROFILE OF SYSTEM All covers are to be maximum18"for concrete or24"Cast Iran. 7.Septic System to be Installed in Accordance With 310 CMR 15.00& Location on Map: NOT TO SCALE 248 CMR 1.00-7.00 Latest Revision and the Town ofBamstable 1"=2,000±' Board ofHealth Regulations. 8.All Piping to be Sch.40 PVC. 9.D-Box Shall Have a Minimum Inside Dimension of 12,and a Minimum ASSESSORS REF: Sumpof6". H-20 O Ma 116 Parcels 039 PERC TEST: 13,632 1500 Gallon P 10.The Separation Distance Between the Septic Tank Inlets and Septic tank PERFORMED BY:MARK DEBB P.E.-ENGINEERING SERVICES,INC. Outlets Shall be No Less than the Liquid Depth.Inlet Tees Shall Extend WITNESSED BY:DAVID STANTON,R.S.-TOWN OF BARNSTABLE a Minimum of 10"Below the Flow Line.Outlet Tees Shall Extend 14" OVERLAY DISTRICT. MAY 8,2012 Below the Flow Line,and Shall be Equipped With a Gas Baffle. H-P0 AP - Aquifer Protection District SITE PASSED O D-Box TEST HOLE I EL.30.5 TEST HOLE 2 EL.31.0 TEST HOLE 3 EL.30.5 TEST HOLE 4 EL.30.5 A LAYER IOYR 3l2 A LAYER IOYK3J2 2.0' L 4ERI D.AiZI..... ..tS.... VN VERYD.ARX:0RAYISItBRt7 N FILL FILL 8 LU 29.8 8 t11D f)A11 30.3 9' 29.8 9 29.8 H-20 O $I AA EI2 ZOY 5/$ B t1#ER IQI`12 5/8 ALAYER I0YR 3/2. . ALtIYER 10YR 3/Z 500 Gallon 1 Y L)f36V15I ItQWN YlLl4WISH 1tQWN ;. VEKY7))ARKGRAYTST3BRC3W1� :: VERYDARK�cR. ....BRQI N ': 2 8' .. ;.:`.. 28.2 I S' % GQfkJktY$Atd). 29.3 1 S LO A141X:SAIVD.... 29.3 Chambers 34 Lt)AMY.SAND' . 27.7 34' LO.AMY:SAND Cl LAYER IOYR 714 Cl LAYER 10YR 714 B LAYER IOYR 5I8. B LAYER IOYR�($ 4,0 Crushed Stone VERYPALEBROWN VERYPALEBROWN YBLL'C?WISI1BltC?WN , iBLLUWIS1113k1?WN .. .. MEDIUMSAND 104" MED 22.3 38' LO§MY SANb. . . 27.3 40 LOAMY SAND 27.2 58" PERC TEST 25.7 C2 LAYER 10YR 7/4 Cl LAYER 10YR 7/4 Cl LAYER 10YR 7/4 29.5' 25 GALLONS IN<15 MIN. VERYPALEBROWN VERY PALE BROWN VERYPALEBROWN 104" PERC RATE<2 MIN/IN TAR=0.74 21.8 ]loll FINE SAND 21.8 132" MEDIUM SAND 19.5 132" MEDIUM SAND 19.5 SAS DETAIL C2 LAYER IOYR 714 C3 LAYER 10YR 518 VERY PALE BROWN YELLOWISH BROWN 110" FINE SAND 21.3 120" MEDII/MSAND 21.0 NOT TO SCALE C3 LAYER IOYR 518 NO GROUNDWATER ENCOUNTERED YELLOWISH BROWN DESIGN DATA 120" MEDIUM SAND 20.5 Utilit Fence on our Single Family NO GROUNDWATER ENCOUNTERED Pole n/f property to be Proposed -3 Bedroom @ 110 GPD Anne Meads Tr. Removed Stone Wall Shed No Garbage'Grinder cb/dh Total Daily Flow=330 GPD N88' 44' 52"E Use a 1500 Gal Septic Tank fn no i 170.4 Mal 3 1; LEACHING AREA __.. 330 GPD/0 74(LTAR) 446 SF Required Fence on our - e un'e G / 10' Setback_ -�r -A - property to be q Removed Sidewall=202.83'+29.5')2'=169.3 SF G-�-- Lawn Tree to be 4 Bottom Area=(12.83'x 29.5)=378.5 SF E "t mo d i -' Total Provided=547.8 SF(405.4 GPD) Septic LocQtion E 32 As per Tie Card ( Proposed oposed ermit#20N3-381 Crushed Stone LEACHING CHAMBER DESIGN ^+ D iveway To_e Removed j Drainage with ?.L W -1 Proposed j Perforated Pipe All Pipes to be Schedule 40. Use p TH_2,i First Floor Proposed Connected to 3-500 Gal.Leaching Chambers in a Elev. 34' FO U f 1 d Q t l orl i Drainage Pit 12.83'x 29.5'Washed Stone Field as Shown. Of Finish Grade iCF '-7 �� i , t i. _ z til s lT i 50.7 _ Demo/Rebuild: 3' Max. FE ll��ll� (� �( o t Lan n i ; o n� Proposed Lot Coverage 20% I or 9" Min Compacted Fill o ) I� �{ Less than 4' 18,382x0.2=3,676.4sf Allowed P Filter I Bump Fabric Z O 2 t1 w8f 'i o 3,621sf Proposed Per Architect And/Or ® n1-3 DIling See Calc by Northside Design 2" 1/8" - 1/2 o ropbsed 11 20 1 p Be 4 q 1 3 bedroom Lawn I re o be n/f Floor Area Ratio 0.30 �. Pea Stone emove� t p • >5 Removed Louise M. & dean A. 18,382x0.3=5514.6sf Allowed 3, g Se t c S tem ? L H-20 3/4" - 1 1/2" x "� I Leahy Trs 5 461sf Proposed Per{I 2' LEACHING Double washed o Architect Lot Area ' �., pa Stone I ti Includes first & second floor CHAMBER 18,372 SF Proposed ation Chamber garage Iand not ara e or basement. 1 P�pposed Per Reclord Pldn with 4' of Stone Typ. Driveway I 4' 10» r Pro Slab Eledv3 •�J { - y A Pro Nosed o � � 4 1 Shed Driv way `10' Setback IJGI CROSS SECTION OF CHAMBER - - q i ' 11.5' p ss NOT TO SCALE ____ F , �{ fnd a' i. ' h 1 n/f c 38"W a Geoffrey A. Keslie A. P a a S84' 05' Proposed b �� Ballotti Crushed Stone b x Drainage with 4. -69 '10 Perforated .o o Connected to a iF Will cb/dh CB/DH Plot Plan Drainage Pit erg ;n I`tom: Pole" Ind n f Ssoo�RG :aG d Bench Mark / ' � Miles J & Kathleen H. Scale : , =2� Elev. 30.9' Powloski Trs TITLE: PREPARED BY.- PREPARED FOR NOTES: Site Plan _ 1.) The property line information shown was _ Proposed Improvements Engineering & Bryan J. KOop compiled from available record information. AtUivaii 100 Pier 4 2.) The topographic information was obtained from an y Consulting, Inc. Unit 716 on the ground survey performed on or between w Parker Road December 8, 2016 an December 9, 2016. (508)428.3344 • P.O. Box 659 • 7 Parker Road,Osterville, MA Boston MA 02210 3.) The datum used is an assumed datum based on �y Barnstable Osterville Mass. seci@sullivanengin.com • www.sullivanengin.com Town of Barnstable GIS Map. 4) Septic Components are to be field confirmed. Draft: CTR Field: WHK/JOD/CTR 20 0 10 20 40 80 �-•l DATE. October 23, 2017 SCALE: 1„ - 20' Review: CTR Comp.: CTR Project: 360050 Project: Koop [�_ r Y ` F>, ;' 2, ::€ r e ,'X} m s .�s. t' , •'` .,'. )as'' .: F r s.� _, ,r ; - 4a 1. =,,TOP OF FOUNDATIO '., a '::, ,, ,, :... 'EST PIT TEST PtT TEST PIT _ �" - �:,, .,TEST PIT 1 T 2 3 4 E -81.634 ,:,., � i ,.; ; : a � , u , LRD EL 79 9 GRD. EL. 80.1 GRD. EL 80.1GRD EL. 79.7 G M , : r a 4...d,:. , :..., ` <, :`r .,, .. .'. ,.v. ,....Sv ,a {n � ; } CONCRETE COVERS TO WITHIN 6 ., ,, _. :.' . ,.'. x . . ..,. , <E., �. T. HIGH GW 69.9 EST. HIGH GW 69.1 EST. HIGH GW 70.1 ,,.. T EST. HIGH GW 69.7 ES ':Tea$` ;5y f l:r '. -:.r, ff^ - '�'.x.x s s ..-.: .... - .5-:,1' S.. .*,� -t,x a.. , Jr <i a *..,& Y 'S� ,>.'c, -e OF FINISH GRADE ,,.. , . .; i :. w,Nk. » » » H z ,S r , `�-y,,,.,. '.,""`9x 1., :: �k sa` 1 z .., ;,°r`Y . - +�x,�.s _,^ <:., .,. a .:.., ::aa.<,:,. .,> .<. Ry yi ' silo 3>`& ,�a"r ., t�i a ad _ i �'R'a: ,v��t9"' 5 :L?.?> 4 :A s ;;_, a a FIRST PIPE LENGTH TO BE SET air? E. ,z y 1 5 �i i.F:k�',f�pi h .•r,a IRS I E L x.. ��r,�, v'%K,,✓. Dn , ,<, ...e.... M:;:. 5 i �.-, i "a, ,9)' ➢tF `ri�r' �. A FILL FILL ; ,. � :, ., ,,,: .. •: , .,.A INDICATES ASSUMED LEVEL FOR A MIN. 2 s �A Pt , e. Tt, 10YR 3 2 10YR 3 2 _ GW BO ,:.. ri „ .: ,:' A A11 - S. LOAM HOLE. NO GW �., '� S. LOAM a « }, .'�t� ; 10YR 3 2 10YR 3 2 .\ / /\ / / ,' �; OBSER a11,1 8 8 SAND // . F - �� € r ;.�, 5 L. SAND L \ .\ /� / <. b: > /� ', 3 • � 15 15 4 PVC ; ,.' :.." k Y n .kr f 7 1. ,i, V C�,. yf B A A INDICATES i 4 PVC`® » r "> -- , 2% • a ! 4 5..,,.,PVC „ .» r ,.M >> -�* 10YR 5 8 ,.. r ,..1 . ,. r :, 10YR 5 8 10YR 3 2 10YR 3 2 PERC EST a s: pi f v "x;,:.- ,. z t ,,<...xi " ''.r ,.x3sr.z„ lie :ay} "�1:.+ .,,%u r �: <' . , ' ,a; x:r" .. .. .z Y ... .. r ';4w" v ag,,, £.:> f.'.c: a_ i;e s p L. SAND L. SAND L. SAND - „ I >,t .^ , „s . L. SAND .r INV 77.80 , .. ,. � I w. ., . t= oaoo ® ot= ot� 9< f T , ,. f k �' t ,7: F ' s. .•. . INV 77.03 0 :: H H a t= I= L. f ..:'- ..,r,,:. ,,k.,. .-... , x @ ~y t, �, a ..z i x• s I ?s•..: 8 H 34 38 40 � . 34 t� ooctt= o00 _. : �. H „ _ ., ,t,., ., r - r:..,. , -v,. -r ,., .,.>:., ,:,t... ? :,. v....,: , r .,e.,, ..a.. { ,>:,^, ° „... fi:....x +..sa,'xr A`di »k.f x A" V 77.55 PROPOSED _ ' r = <� 48 IN iNV 76.87 l� O C� ] O ® � O O O ;> �y r „ _ ;. m C1 C1 4- H t ,,.. F+, + , z s. D BOX l €, k CIOC] CtQOOO � l� .,. a. t ;, Y 7 4 M 10 R 10YR 7 4 U,.. s ° „ rr if f, INDICATED : M. SAND „ _ r M. SAND ... UNSUITABLE c, INV 77.20 LEACHING CHAMBERS, ; s' , .°; :J „,, '.... __1 , �. R „ , s., „, �Y.;, .,, x �.,^i 3 s r .`c,„t - '.,,.,t ' - a...,r.. 3g'. T l' r » P OPOSE 1 500 GALLON SEPTIC TANK s ° C MATERIAL R D a 58 C 1 1 � q .I " .«». '"s',s �,., '� x ,.`w 5.,' r t x .:lir a 8 nd` e ,11< = T.?. a u" , ...».a ^, .., _ r. .,. ,r j. .k x „ ,g', ,a .a,.%;+-, ,a,'i .w H H INV 77.30 ., �;> :.� ,, a: ,. '. , 4;:: , z; 1 ti 10YR 7 4 10YR 7 4 n ' , 104 / / BOT. ELEV-74.87 , . ":: �, .,_; , 104 3 EL 71.03 A D M. SAND 5 0 MIN g : t,,., i .%f, ,k ' i zr., , ;tY _ :n „r: < x.<',H-< c.S - l ' i`n ,a, z;'€ i :',:,,:. 10YR 7/4 / I /§ .1111, ,af.,, f 4 ? .w i `^, i.,�.,5 ,, y. : ffi ��K Y afiY ,}i>{ ., d & €'<l` F. SAND F. SAND ` 0.. ;I € �, L, ti 4 C3 C3 STE P R O FI E � ,� , 3MCI SY M L , s "' v t 10YR 5 8 10YR 5 8 .' / / z l < M. SAND M. SAND NOT TO SCALE ' , ,.5 h a, ';i 'It ::1,1�a «d, aft ^ri °gr`,i'' :,v,. tam'=:a€ �,a .r y,: » n » H B > �« s s "l.:r; .s �ti s 4 ° # e f t � ! k ': 12 0 120 132 132 %}-, k N u° t � = € :, » , .:i , l g L, r r,>s z$ r ,q..v� o f 'i' ,. 5 , ..' > .. ,,f i ac ..:° ,a.. .., „ . ,,".... ,::'>.. ,,._., , = : ,Y '::. i�C F'^.:..: , ,...: 34a dr ;..b.i,... 'xR LOW. s a ,,,, ;.. : L,r, ,. DESIGN F SIZE OF LEACHING FACILITY REQUIRED x' - ,0 w '=„ , a �a ,. 8 , r.�}x„ 5 .I-— i,::..- ,:;..,.<:. _.^.:,: w. a :'>:.k i ,x ,,,'*a ,.'. s ;:,x ,:; a'r .,a>:;',' RIN DATE. 5 8 12 DATE, 5 8 12 ,._ . _ . ., ENGINEERING DATE. 5 8 12 / / F , DATE. 5 8 12 / / / / _ s _.,y d � .> ..,. ,__ _ . _' » � � , :A, ALL PER DAY PER BEDROOM 330 G.P.D. TITLE V DESIGN FLOWa w ,.,")r, ® 110 GALLONS E 3 BEDROO M DWELLING D IG PERC. RATE. 2 MIN. INCH _ ... „_ , K IB N ,. . „ ,, P.E. ARK DIBB P.E. MARK DIBB. P.E. TEST BY. MAR D B, P.E.P E. / ., , _ < . `"_ Y, MARK DIBB, E TEST BY. TEST BY. a TEST B ,. a� DESIGN FLOW 330 G.P:D: I ,.. .x...,... ... -... ,...,. ....,. ...,. ,.., .. 3 ,F r ,.,., kF> ,,, ,.,....,.,. TOTAL L�_. ,, , � n_ . _ SERVICES, L C . € M RATE. 0.7 G.P.D. S.F. _ r i DA STANTON R.S. DAVE STANTON R.S. LONG TER APPL 4 STANTONR.S. DAVE STANTON R.S. Y. VE WITNESS BY. / ,�' „ > �. u r , r WITNESS BY. DAVE WITNESS BY. WITNESS B v:: , ., .. .,, _ . . , ,,. ,. �, � ,�� ;. h2 ;` >{:,,an P�,: ,.,.,;: .e ? Y 7, -'''.ilY 'r ,.3..,. y ''p' b .. 't ..�$S ._.aL k . .. 9 :,.:.., , .>.. _.>,:,."f : - i z x "" .,s..::,. , .) ...xr s» :3 Sr. :, ..1:- ':,,i, MPI 2 MPI PERC. RATE 2 MPI 330 G.P.D. 0.74 G.P.D. S.F. 446 S.F. _ PERC. RATE 2 MPI PERC. RATE 2 PERC. RATE / / «;w4 ,, ., i:. r _ .a`„ k is ;:;?_ .�- r, s, ,p:" ,. , .,,;.. S CLASS I SOIL CLASS I � y r _ ,11- , n ,, SOIL CLASS I SOIL CLASS OIL �: l .k " ::£ ,. r ;,:,, REQUIRED SEPTIC TANK . . ^, ,.�.. i , >, L , r. ,. ,., „:,,, ,. , N ,,,. , , .. . . ., 4 G.P. S FT. 0.74 G.P.D. S .,, ., , 0.74 G.P.D. S Ff. L.T.A.R. 0 7 D Q L.T.A.R. Q. FT. G.P.D./SQ. FT. .A.R. Q L T / /0.74L T / SIZE OF LEACHING FACILITY PROVIDED "m :> .: ,." .- : 1150 W.CHESTNUT ST r,..- ..b s. �,.» <. N , 2 Ol MINIMUM OF 1 500 GALLONS FOR NEW CONSTRUCTION F € <, ,. x , fl ,. ,, t , , . BROCKTON MA 0 3 200% DESIGN FLOW OR MIN , Via, ,�:.,..., t, ,'s -. _.,:, _�'» .> .,. .:.,<,., "u x .,..,, nv s ;, e, s _ ., J. 50 GALLONS. %_BOTTOM AREA. 25 X 12.8 320 ., , , a, ., �., . „ �w,,. ;: ) PROPOSED SEPTIC TANK 1, 0 r 1 ;aft - a T , IF " TEL.508-510-6100 I �- = , a, xa., SIDE AREA: 25 X2 x2 + 12.8 X2 x2 151.2 SOIL TEST PIT DATA ( ) � x t 8- 10-6101 TOTAL AREA PROVIDED - 471.2 S.F. _ ,' s< . FAX 50 5 a 7°g 3 'a� 'Y r, -:re ,4 ,5d? e *, t11 ,, f a C >d ar �C; u. Z"zaf 1-1 ..,��1 .- �`.� v,€ ::-g r »r z> 4 a i 'Y' :::3 NOT TO SCALE DESIGN CRITERIA r 11�1111.111111 'ata ? .>` Ef k x,Ei,9a i $i'r-ps s- c W,l ��N aaIN 25.0' ��►� ��.'`� gCir F4.0''''�"'�8.5'--►1-�•--8.5' 4.0' ' �_ '` te.RP.fi�K D. G �, ',' 0 C,I'•11L fl (1) INSPECTION PORT O O O O Study ,spy i;V f"`Q'I(` '12'•On x 0.1-1ff t?I..-I,�T' oaf 1 ' 0 12.8'4.8 O O P T^6» 12 16- -4'-OH storage O P P P O O �I 4.� , i 1 �_-__`� Z, .aa i 1 1 Second Floor Plan ROFESSIONAL ENGINEER DATE i r 8°;l Master Bath ` Coiling Height=T-0 (3) INLET : ai•� 7r.e'+xa••ja' (2) 500 GALLON LEACHING GALLEYS KNOCKOUTS FOR 4" POLYSEALS ' - . 3/4" TO 1-1/2" DOUBLE �j WASHED STONE (NO FINES) 6'-6" - - - LOCUS INFORMATION, Master Bedroom 19'-3'x 15'-0" F� 15'-2"x I&-w //\ �\/\ - Ce01ng H.IQhl=.13'-e" oeCl< W �/\ �\ //\ .\/� // \� (3) OUTLET CURRENT OWNER: 94 GAY STREET NOMINEE TRUST, 414'x12'-4" tP_l 3' MAX COVER \ \ / KNocKOUTs PAUL R. TOPPING, TRUSTEE 3" PEASTONE LAYER FOR 4" POLYSEALS ►� H / - I ITITLE REFERENCE: DEED BOOK 20563, PAGE 319 �b�l ' "P C rW PLAN REFERENCE: PLAN BOOK 455, PAGE 32 Kitchen sunroom wm W 11'-7!X aHv 12'-Zn:x 11'-9" h`r q PLAN VIEW Bedroom 6'-10" q 0 O 0 ® 15'-Q"x IT-5" „ ® Garage c) Z U ceiUny He�hl=13'•6" 21=t'i°%12'•4° o O P P P 11 P P ASSESSORS MAP: 116 C� - 0 `- VNIn x't2,• v ® O = = O PARCEL: 039 . _ 2l'-U/Dining2- " I� I� 36" RISER TO WITHIN . 5_e a.8. Foyer CeufngHeigm=tso^ Ix o�.l C7 L� O O "�� n ZONING DISTRICT. RC 7'-Q"x8'-a° I""--I 0 0 0 o P 24 c�a 6 OF FINISHED W 0 = 0 = ® o GRADE SETBACKS: FRONT 20' Goael 0 0 0 ® W SIDE 1O' Q W � W O P O O C' ,�/14 .\\\/, REAR 1 O' , \ ts-+ /� .\ i\ // v 12" MIN 21" DIA. COVERS MINIMUM LOT SIZE: 87,120 S.F. RPOD •� 00 W � 4.0' 4.8' 4.0'--►� �. [� � RISER COVER r4" c RISER - EXISTING TOTAL LOT AREA: 18,372t S.F. f L00 R P LAN CA 04 LEACHING CHAMBER D ETAI L INLET .•..•., .' .71... ' . ?': OUTLET NITROGEN SENSITIVE W NOT TO SCALE KNOCKOUT •, KNOCKOUT ZONE: NOT A ZONE II � � FEMA FLOOD 3» ZONE DISTRICT. V DATED 7/2/1992 #168 GENERAL NOTES: o" INLET 14" PANEL #250001 0016 D PARKER ROAD �MAP 11s 1. THIS PLAN IS FOR DESIGN AND CONSTRUCTION OF THE SEWAGE DISPOSAL FACILITY ONLY. _ _ 5'-8" ---- - • _---"- TEE '-"------'-____-' --'--"'-"-----___-•- OVERLAY DISTRICT: ESTUARINE DISTRICT PARCEL 038 BENCHMARK 2. ALL CONSTRUCTION METHODS AND MATERIALS SHALL CONFORM TO MASSACHUSETTS 'D.E.P. TITLE 5 AND 4'-0" NAIL IN 24- OAK LOCAL BOARD OF HEALTH REGULATIONS. 4'-6" LIQUID 4'-3" " ELEVATION 82.88 . L EL OVERLAY. DISTRICT:. AP BARNSTABLE EXISTING ASSUMED. 3. ALL PIPES LOCATED UNDER PAVEMENT OR TRAVELED WAY SHALL BE SCHEDULE 40 OR EQUAL. I �� SHED 3" I CONCRETE BOUND p 2' CONCRETE BOUND 4. THERE ARE NO KNOWN PRIVATE WELLS LOCATED WITHIN 150 FT. OF THE PROPOSED LEACHING FACILITY NOR 3" I I FOUND & HELD FOUND do HELD ANY KNOWN WELLS PROPOSED WITHIN 150' OF ANY KNOWN LEACHING FACILITY. ,a. 44'52"E '�' - - 13 • .• t :• • . . •.. -•• '• 2 DATE 9 23 20 5. WITHIN LIMIT OF EXCAVATION REMOVE ALL TOPSOIL, SUBSOIL AND OTHER IMPERVIOUS MATERIAL. TAPER I I 1 8 11 PROJ11 ECT 1 NU P P P P o o P P o o P P o PROTECT NUMBER:PARKERRD 6. REPLACE ALL EXCAVATED MATERIAL WITH CLEAN GRANULAR SAND, FREE FROM ORGANIC MATERIAL AND \ e s . ,� s / 12.8x25 LEACHI 10.5 -- - - - - M DWG FILENAME:PARKER-SEPTIC.DWG DELETERIOUS SUBSTANCES. MIXTURES AND LAYERS OF DIFFERENT CLASSES OF SOIL SHALL NOT BE USED. THE i, / N. /\ /�� \//' / i\ I / BED (PRIMARY) TP 1 EXISTING C ° 1t BOTTOM ON LEVEL STABLE BASE I MARY) I fr \ REVISIONS: FILL SHALL NOT CONTAIN ANY MATERIAL LARGER THAN TWO INCHES. A SIEVE ANALYSIS , USING A #4 SIEVE 6" MIN. 3/4" TO r - - __ _.,.SEPTIC i � --_ NO. DATE DESC. SHALL BE Pl,"RFORMED'ON A REPRESENTATIVE SAMPLE OF FILL UP TO 45% BY WEIGHT OF THE FILL SAMPLE 1 1/2" STONE + I I (1g88) C BOX IN 77 MAY BE RETAINED ON THE #4 SIEVE. SIEVE ANALYSES ALSO SHALL BE PERFORMED ON THE FRACTION OF THE � CROSS SECTION VIEW � I N I I =77.30OUT=77'10 N k' # # FILL SAMPLE PASSING THE #4 SIEVE, SUCH ANALYSES MUST DEMONSTRATE THAT THE NATERIAL MEETS EACH NOTES: I � a ' TP'#2 ! l , INV=77.55 OF THE FOLLOWING SPECIFICATIONS: 1. SEPTIC TANK SHALL BE REINFORCED CONCRETE. 11 2 SEPTIC TANK TO WITHSTAND H-10 LOADING I �• ' I \ '� � 100% MUST PASS #4 SIEVE (4.75 mm EFFECTIVE PARTICLE SIZE) 3. ALL PIPE CONNECTIONS AND CONCRETE CONSTRUCTION SHALL I ;U I Z " =� ' TOF-81.63 83.7 . Rom., BE WATERTIGHT. I -0 /V I INV-77.80 10%-100% MUST PASS #50 SIEVE (0.30 mm EFFECTIVE PARTICLE SIZE) 4. FILL ALL UNUSED KNOCKOUTS WITH MORTAR. Cr T 5. INLET AND OUTLET TEES TO BE CAST IRON, SCHEDULE 40 I r- I I I ? - \ ��L 0%-20% MUST PASS #100 SIEVE (0.15mm EFFECTIVE PARTICLE SIZE) PVC, OR CAST-IN-PLACE CONCRETE. I n M I Ct,, I �� #178 ( l 6. TEES TO BE CENTERED UNDER MANHOLE COVER. I A I ``' .YTP#3 P KER RQ PREPARED FOR: 0%-5% MUST PASS #200 SIEVE (0.075 mm EFFECTIVE PARTICLE SIZE) I � I #178 ASS ORS 116 % I I I II4�_ EXISTING P CEL 0 SHALL BE : I P#4 RANCH 18 372f SIF. I to 7. EXISTING UTILITIES WHERE SHO to WN IN THE DRAWINGS ARE APPROXIMATE. THE CONTRACTOR1 .50o GALLON _ I to � I " RESPONSIBLE FOR PROPERLY LOCATING AND COORDINATING THE PROPOSED CONSTRUCTION ACTIVITY WITH _ 94 GAY STREET NOMINEE TRUST �,( m ('�� 41 $'" PAUL R.TOPPING,TRUSTEE DIG-SAFE AND THE APPLICABLE UTILITY COMPANY AND MAINTAINING THE EXISTING UTILITY SYSTEM IN SERVICE. SEPTIC TAN�♦ DETAIL I V I ! #55 94 GAY STREET DIG-SAFE SHALL BE NOTIFIED PER THE STATE OF MASSACHUSETTS STATUTE CHAPTER R2, SECTION 409 AT TEL I I 20 DECK I 1-888-344-7233. THE ENGINEER DOES NOT GUARANTEE THEIR ACCURACY OR THAT ALL UTILITIES AND i / t FIRST AVE. WESTWOOD,MA SUBSURFACE STRUCTURES ARE SHOWN. LOCATIONS AND ELEVATIONS OF UNDERGROUND UTILITIES TAKEN FROM I I 9\� ASSESSORS MAP 116 RECORD PLANS. THE CONTRACTOR SHALL VERIFY SIZE, LOCATION AND INVERTS OF UTILITIES AND STRUCTURES PARCEL 047 AS REQUIRED PRIOR TO THE START OF CONSTRUCTION. I I G �• ��f�/,�1,� o I I E.MET si ' \ 8. THIS SYSTEM IS NOT DESIGNED FOR THE USE OF A GARBAGE GRINDER. I .WA . I 11x27 LEACHING I � ='i B.WAY NCL � �`'' �•�\ 0.6' *, I � . ( \1, � . - . . 9. EXISTING INVERTS ARE TO B E CHECKED BY THE CONTRACTOR PRIOR TO CONSTRUCTION. BED (RESERVE) TO BE NOTIFIED OF ANY FIELD CHANGES THAT MAY BE REQUIRED. °' NOTES: I I - - - _ - - -- EXISTING 10. THE ENGINEER IS 1. DISTRIBUTION BOX TO VO;THSTAND H-10 LOADING I I I GARAGE I \ 2. PROVIDE INLET TEE OR BAFFLE WHERE SLOPE OF PIPE SHED 20 EXCEEDS 0.08 FT/FT OR IN PUMPED SYSTEM. I I EXISTING I 00 GENERAL NOTES : O O O I I - - .� DRNEWAY ��, I ` 8 3. FIRST TWO FEET OF PIPE OUT OF DISTRIBUTION BOX TO BE 5" 3" LAID LEVEL. I \� I , IRON PIPE . 4. ALL PIPE CONNECTIONS AND CONCRETE CONSTRUCTION SHALL I � I, .� FOUND OFF NONE REQUESTED .4 .,e •• BE WATERTIGHT. .W 174,57v 5. FILL ALL UNUSED KNOCKOUTS WITH MORTAR. I \ - - J'' SS405'38 SCALE: 4 /� I I ' #113 111=20' VARIANCE REQUEST I 1 � /, . » » BOTTOM ON LEVEL BASE I ( ; u' FIRST AVE. 6 MIN. 3/4 TO I I CONCRETE BOUND #190 ASSESSORS MAP 116 VERTICAL DATUM: ASSUMED 1 1/2" STONE FOUND & HELD PARKER ROAD PARCEL 042 ASSESSORS MAP 116 PARCEL 040 BENCH MARK SET: TOP OF FOUNDATION = 81.63 DISTRIBUTION BOX SEPTIC DESIGN PLAN DATUM SHEET C 1 OF C 1