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HomeMy WebLinkAbout0105 POND STREET - Health 10� Pand Street Osterville A= 118-031 - Y i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M ^M 105 Pond Street - Property Address r+. Tiffany Markoski ' Owner O wner's Name information is Osterville Ma 02655 4-20-17 required for every � page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information S/may jday� on the computer, I' use only the tab j 1. Inspector: key to move your Y cursor-do not Matthew Gilfoy use the return Name of Inspector key. B&B Excavation r� Company Name 374 Route 130 Company Address ' r 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 4-20-17 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Pond Street Property Address Tiffany Markoski Owner Owner's Name information is required for every Osteryille Ma 02655 4-20-17 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. Dwelling does have a garbage grinder and system is not designed for it. It is recommended that the grinder be removed to prolong life of SAS. 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): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts �4 W Title 5 Official Inspection Form Subsurface Sewage,Disposal System Form - Not for Voluntary Assessments 105 Pond Street Property Address Tiffany Markoski Owner Owner's Name information is required for every Osterville Ma 02655 4-20-17 page. CitylTown 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 ,M 105 Pond Street Property Address Tiffany Markoski Owner Owner's Name information is required for every Osterville Ma 02655 4-20-17 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 '/2 day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts 4 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Pond Street 'M Property Address Tiffany Markoski Owner Owner's Name information is required for every Osterville Ma 02655 4-20-17 page. Cityrrown 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 105 Pond Street Property Address Tiffany Markoski Owner Owner's Name information is required for every Osterville Ma 02655 4-20-17 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) _3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 355gpd t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 I�, Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 105 Pond Street Property Address Tiffany Markoski Owner Owner's Name information is required for every Osterville Ma 02655 4-20-17 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 5 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 See below 9 ( Y 9 (gpd))� Detail: 2016-69,000gallons 2015-74,000gallons 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: l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 L Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 105 Pond Street Property Address Tiffany Markoski Owner Owner's Name information is required for every Osterville Ma 02655 4-20-17 page. City/Town 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: Not pumped since new tank was installed 3 years ago 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 r ❑ 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 v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 105 Pond Street Property Address Tiffany Markoski Owner Owner's Name information is required for every Osterville Ma 02655 4-20-17 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: SAS installed 2010 and new tank was installed in 2014 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 2 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): Depth below grade: 1 2 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: 6 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 .' 105 Pond Street Property Address Tiffany Markoski Owner Owner's Name information is required for every Osterville Ma 02655 4-20-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 30" Scum thickness 4 Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 13" 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 in need of pumping at this time and should be pumped every two years for maintenance. (more often if grinder is used) 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 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 105 Pond Street Property Address Tiffany Markoski Owner Owner's Name information is required for every Osteryille Ma 02655 4-20-17 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 105 Pond Street Property Address Tiffany Markoski Owner Owner's Name information is required for every Osterville Ma 02655 4-20-17 page. CityFrown 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 working order at time of inspection. No evidence of back up was 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•3/13 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 ;.� 105 Pond Street Property Address Tiffany Markoski Owner Owner's Name information is required for every Osterville Ma 02655 4-20-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: (20)ARCinfiltrators ❑ 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 with no sign of back up present. 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 105 Pond Street Property Address Tiffany Markoski Owner Owner's Name information is required for every Osterville Ma 02655 4-20-17 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.): 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 105 Pond Street Property Address Tiffany Markoski Owner Owner's Name information is required for every Osterville Ma 02655 4-20-17 page. CityTrown 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 DEAF( t3RCH A, B Al....39'6" AZ 55' A3w 59' 94 81y:0'�J1yj3}�]]" ��1IB1I�{3 ��.ir({y({jt. 3 VENT t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° 105 Pond Street M Property Address Tiffany Markoski Owner Owner's Name information is required for every Osterville Ma 02655 4-20-17 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: >10' 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: 7-1-10Date ❑ 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: 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 105 Pond Street Property Address Tiffany Markoski Owner Owner's Name information is required for every Osterville Ma 02655 4-20-17 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION /0.5- 10091W S7_ SEWAGE# / —0 VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. - (' f H SEPTIC TANK CAPACITY LEACHING FACILITY.(type) (size) NO.OF BEDROOMS & OWNER r �3 PERMIT DATE: COMPLIANCE DATE: Separation DistancABetw en the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on` site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY O � O i � Q r [ - S W 1 `} r No. V 1 '4 j Fee o THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ftphtatlon for Misposal Opstem ConstrUttlon 3pErmit Application for a Permit to Construct( ) Repair�o Upgrade( ) Abandon( ) ❑Complete System . ❑Individual Components Location Address or Lot No. f o S eovtd r'1-rrf_eT -/` Owner's Name,Address,and Tel.No.�V,i A Z ow') 7r,) Assessor's Map/Parcel 118 031 m A s Installer's Name,Address,and Tel.No. C fe,ji J.4 Ck ren->� Designer's Name,Address,and Tel.No. enf;n 3 07� z tcj Type of Building: GG Dwelling No.of Bedrooms Lot Size ��O W - sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) . Other Fixtures I Design Flow(min.required) 33, gpd Design flow provided gpd Plan Date q—1 2 Z l O Number of sheets Z Revision Date ,Title 105 Nln3 S r Size of Septic Tank f 56C Type of S.A.S. Description of Soil IP(✓k Nature of Repairs or Alterations(Answer when applicable �) e^'' )w S fly hZ t-n Date last inspected: (� Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed f Date 17-6>--�Z Application Approved by Date 7' Application Disapproved by Date for the following reasons Permit No. s 16-3. Date Issued -� `� n.�,,,. w.� .�-,,: . _, ,,• -.. � '.:"w,,�,...-.,.,m,,... �ur..- K.,.�.rVt�*S� ..._: ,.....-ar�+'�sr+t'=-,..^r . ..•,.�:.�=r-w.A r R::x_ti, m„_• wi p o OF ✓ V No. ! ..�/ +•� .d^.�i`.z�„� �. Fee t THE COMMONWEALTH OF MASSACHUSETTS 'Entered in computer. $r,._„ � Yes PUBLIC HEALTH DIVISION - TOWN-OF BARNSTABLE;AAS ACHUSETTS RpPlitation for -Tksposal *pstem (Construction Permit Application for a Permit to Construct( ) Repair?)- Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. pn $rre� Owner's Name Address,and Tel No' ' :Tuba 1Zv'$i•9 "17.��5 Assessor's Map/Parcel. l 1$ Installer's Name,Address,and Tel.No. <2 Ape-),c -, Eh r�°'^9�� Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms _ Lot Size 30,8M - sq.ft. Garbage Grinder( ) Other Type of Building f No.of Persons Showers( Cafeteria( ) Other Fixtures Design Flow(min.required) 33'p gpd Design flow provided gpd Plan Date A—t 2 O 1 O Number of sheets `11 Revision Date Title S( r Size of Septic Tank I Type of Description of Soil ,p t 1 _ Nature of Repairs or Alterations(Answer when applicable) W e--' t . -tip Date last inspected: (L) ° Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed s1z Date 7-6" Z �� Application Approved by; Date 7— � O Application Disapproved by Date c for the following reasons il 4. ` Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certifitatr of 4ompliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired K) Upgraded( ) l Abandoned( )by C �'t.�o, �2�w i 1 e> at STfC,.I' has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction.Permit No. 0 dated � :fir' Installer C+r�(l.-) t-4.4 -{��/� Designer nA-o (L, W #bedrooms Approved design flout U and The issuance offt7hi perinit shall not be construed as a guarantee that the system wi funn,ti!n as designed. Date / v Inspector � - No. aV0 � .Fee (IDl? c THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal &pstem Construction Vrrmit Permission is hereby granted to Construct( ) Repair(� Upgrade( ) Abandon( ) System located at to S 1/'C,rt (4 e_�` $ 1 Cl ' and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date —7 j Approved by cl r/ . Towel of:Barnstable P# • C� 7 d Department of Regulatory Services e�tweres� Public Health Division Date /o MAIR& 165q �s� - 200 Main Street,Hyannis MA 02601 ' Date Scheduled Time. 10 Fee Pd. Soil Suitability f Sewage Disposal Assessment Sewa e ' osal Performed By: �Q 1� f" �' L� G Witnessed By; S LOi.CATION, & GENERAL INFORMATION Location Address /U f nv� / s Owner's Name iQuy�� US�21v,�Ile Address L . Assessor's Map/Parcel: I D y Q�f / Engineer's Name NEW CONSTRUCTION 0 REPAIR ✓ Telephone# Land Use 51 Cu vLh`.a j Slopes(%), 5 }l—' Surface Stones Ni/I Distances from: .Open Water Body .2��� ft Possible Wet Area � g 7 t S� ft �ft Drinking Water Well Drainage Way 2� ft Property Line �� ft. Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) ------------- 30 r i 1 r ' s -z . 1prJ1,J p Parent material(geologic) t_J Jf-tivcts Ll Depth to Bedrock Depth tq Groundwater: Standing Water in Hole:_ /A Weeping front Pit Fuca AJL,/L- Estimated Seasonal High Groundwater /� t DETF*,MNATION OR SEASON'AL:SIGH WATT tt TABU Method Used: Depth Observed standing in obs.hole: in. Depth to loll mottles; _ _. In, Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj,Groundwater level I�E'RCOI:,ATION.TEST Duce.. n: 7Citne:_ Observation I Hole# 1 Time at 9" Depth of Perc L-1 l0145 Time at 6" Start Pre-soak Time @ S Time(9"•6") rut YX End Pre-soak Rate Min./Inch. Site Suitability Assessment: Site Passed _ Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland;you must first notify the Barnstable.Conservation_Division at least one(1) week prior to beginning. Q:\SEPTIC\PERCFORM.DOC DEEP'OMERVATION HOLE LOG Depth from Soil Horizon Soil Texture „ — Soil Color Surface(in.) Soil Other (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistent %Gravel $-30 S la `� �57� DEEP OBSEItVATION.if .LOG H61e# Z Depth from Soil Horizon Soil Texture Soil Color Soil Surface(in.) Other (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel a 8 L S o -3 Z- (2 I,S k 32-13� C_ C , _/3 DEEP.'OPSERVATION HOLRLOG Hole## Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) Soil (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel DEEP'O$SERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, Gravel) Flood Insurance Rate Man: Above 500 year flood boundary No,V ` Yes Within 500 year boundary No, Yes Within 100 year flood boundary No^ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on �C(dat'e)I have passed the soil evaluator examination approved by the, Department of Environmental Protection and that the above analysis was performed b me consistent with P Y the required tra' ertise and experience described in 310 CMR 15.017. . Signature Date b 1k ( G i�SEPTIC�PERCF R .Q O M DOC , �I No. ^' d �/" Fee J BOARD OF HEALTH TOWN OF BARNSTABLE 2pprication jFor Yell Con5tructton 3permit Application is hereby made for a permit to Construct V), Alter( ), or Repair( ) an individual well at: o 5PonLK�&R& ( �\\e- M1 D31 Location-Address Assessors Map and Parcel lob hoc)& shgL-� I n&" �t Owner Address Installer-Driller Address Type of Building Dwelling Other-Type of Building No. of Persons Type of Well _!I I Sml-�p N c Capacity 1519 0v" Purpose of Well Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Complia ce has been issued by the Board of Health. Signed 2 r Date ?. /Application Approved Byvbhy ate Application Disapproved for the following reasons: Date Permit No. Issued Date --------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed( ), Altered( ), or Repaired( ) by Installer at has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector s F+e No. tN o L w a Fee BOARD OF HEALTH TOWN OF BARNSTABLE ZIppricatfon _for Veft Construction Permit Application is hereby made for a permit to Construct(J), Alter( ), or Repair( ) an individual well at: 105 Q*OAS Q- 1 1 I I n3 Location-Address Assessors Map and Parcel i��a�v�w Mo.c� oSk� lob © C)265� i�,, \A' Owner Address 7�kk 5.3 Installer-Driller Address Type of Building Dwelling Other-Type of Building No. of Persons Type of Well 4".S Capacity OV), Purpose of Well Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Iv` ,� -jc_ y Z l ,J I Date Application Approved By ate ' Application Disapproved for the following reasons: Date Permit No. G I�� Od 1 Issued alb Date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed( ), Altered( ), or Repaired( ) by Installer at has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector BOARD OF HEALTH TOWN OF BARNSTABLE Vern Con5truction Permit ((_ No. ti/� o L - 00cl Fee Permission is hereby granted to 'NOV M �Y�L, � Installer to Construct(✓), Alter( ), or Repair( an individual well at: No. 105 {1 �, Street II ' o, t� as shown on the application for a Well Construction Permit No. UJd G I L -OU / Dated -/ - Date / J! j l Approved By r J TOWN OF BARNSTABLE LOCATION i ?0IN� .$+ SEWAGE# 2-010 20' VILLAGE ASSESSOR'S MAP&PARCEL //p* - o 3 l INSTALLER'S NAME&PHONE NO. � SEPTIC TANK CAPACITY 1 57o u \k LEACHING FACILITY:(type) 7-0 Are 3 G 1 co (size) //- Z NO.OF BEDROOMS pp 3 OWNER :jA\. tJo'eve PERMIT DATE: 7LJ Z®Lc COMPLIANCE DATE: -7 1 Z61. l Separation Distance Between the: 611L) 0 a Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility /'�� Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 00 feet of leaching facility) Feet FURNISHED BY eggP&W)G& CV/0"P`7J'e5 L(,L Z 'ub b1J 4 s biz � Za Qs 9 s zS, _S 9 C.'S£ £� P1 �,Zz z9 No. 20 — Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS es 01pplication for Bisposar 6pstem Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No. jQ j nh S Owner's Name,Address,and Tel.No. ej- STi f{arvy �SfelLV�l�i Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. s hfre^� a2q& 00 4-s-5 6�_1 Type of Bu ing: ' Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building HbLk_S-e'_ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided O gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. 2y Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and no o place the system in operation until a Certificate of Compliance has been issued by this Board of Health. , F Si e Date u Application Approved by VVLA Date , 1 Application Disapproved by V Date for the following reasons Permit No. �V 0 Date Issued ur �. IVa No. 3 tk q Fee 1 / 1 THE COMMONWEALTH'OF MASSACHUSETTS Entered in computer: ✓ s r PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pplitation for jBisposal *pstrm Construction Permit ! r Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No. /Qj _ �� S Owner's Name,Address,and Tel.No. e- b 5 j-f{uNy C,rl"9 Assessor's Map/Parcel (� Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Bu' ing: Dwelling No.of Bedrooms 3 Lot Size Z sq.ft. Garbage Grinder..( ) v Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 gpd Design flow provided 3-�O gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank I SAO Type of S.A.S. Description of Soil / - f"" Nature of Repairs or Alterations(Answer when applicable) ►/1 yT^ � �oo Date last inspected: Agreement The'undersigned agrees to ensure the construction and maintenance f the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and no to place the system in operation until a Certificate of Compliance has been issued by this Board ofHealth. Si e / ' Date Application Approved by Date n± ' / Application Disapproved by Date for the following reasons Permit No. Date Issued p� L ---------- --------------------1----------------------------------------------------------------------------------- ---------------- THE COMMONWEALTH OF MASSACHUSETTS �� �j F�, .�� _ BARNSTABLE,MASSACHUSETTS CPrttfltatr of CDt pliantP THIS IS TO CERTIFY,that the On-sit e Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( )by 40 PsC`7l S ' s k to at �t'7 l0 nn Gt S r- has been constructed in accordance yA with the pr Aji ns of T' le 5 and the for Disposal System Construction Permit No. 011da ed C, J Installer Designer �,l.� � q �,5 #bedrooms , Approved design fl 1% 3�0 gpd The issuance of this perm It shall not be construed as a guarantee that the system will fun,ti on as de igned.�( Date Inspector s`4� 1CJ t � � ---------------=1------=-- -------=---------------------------------------------------------------------------------- ------- Cl ---------- No. 2� I `V ( /J Fee U THE COMMONWEALTH OF MASSACHUSETTS ' PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS $. I8tl08aY bp8t I`YC CDItStCUttlDttErIYCIt Permission is hereby granted to Construct( ) Repair(" ) Upgrade( ) Abandon( ) System located at 105 V7 n ad 91 a�&Qq tflf , 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 /m�us)be comp]'ted within three years of the date of this permit. r`.1 Date o L/ Approved by Commonwealth .& Massachusetts . _ Title, 5 Official Inspec ion Form. - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Pond Street Property Address:. .. Thomas&:Meredith Reen Owner Owner's Name information is Osterville -MA 02655 12/31/12 required for every page." City/Town State Zip Code. -" Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at.the end of the form. Important:Whens. filling out#owns A. General Information on the computer; use only the tab 1. Inspector: - 1 key to move your IU/ll - cursor-do not... Ricky Wright.. Use the rertu key. rn: Name of Inspector B & B Excavation;Inc. r� Company Name 14 Teaberry Lane Company Address. Forestdale MA':. 02644 City/Town State Zip Code 508-477-0653 S14595 Telephone Number License.Number - B. Certification certify that I have personally inspected the sewage disposal system at this address and thatAhe information reported below is true, accurate and complete as of the time of the:i=nancqf9f on: The inspection was performed based on my training and experience,in the proper function and on lte 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 Furt" her Evaluation by the Local.Approving:Authority. _. ..... .....: 12/31/12 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 10,00.0 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. : ::: ' V l/U{ T t5ins•11/10 - Title 5 Official n fcion orm:Subsurface Sewaga Disposal System Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 105 Pond Street Property Address Thomas&Meredith Reen Owner Owner's Name information is required for every Osteryille MA 02655 12/31/12 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: 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M SVBy'�r 105 Pond Street Property Address Thomas & Meredith Reen Owner Owner's Name information is Osterville MA 02655 12/31/12 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): obstruction is removed Y N ND❑ ❑ ❑ ❑ (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 105 Pond Street Property Address Thomas & Meredith Reen Owner Owner's Name information is required for every Osterville MA 02655 12/31/12 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 El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6"below invert or available volume is less than Y day flow t5ins•11/10 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 105 Pond Street Property Address Thomas & Meredith Reen Owner Owner's Name information is required for every Osterville MA 02655 12/31/12 page. City/Town 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. (Sins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth :of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 105 Pond Street Property Address:. Thomas&Meredith keen Owner: Owner's Name information is Osterville MA 02655 12/31/12 required for every, page. City/Town State Zip Code. Date oflnspection C. Checklist Check if:the followi ng.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 Boardof Health ❑ El 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): ... ... ... ... .. ... 10 El 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.. El ® 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 GMR 15.203_(for example: 110 gpd x#of bedrooms): ." 330 l5ins•11/10::: 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 ,M 105 Pond Street Property Address Thomas & Meredith Reen Owner Owner's Name information is Osterville MA 02655 12/31/12 required for every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence de ce have a grinder? garbage g ❑ ..Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage n/a 9 ( Y 9 (gpd))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: November 2012 Date Commercial/Industrial Flow Conditions: Type of EstablIishment: 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 i Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ,. 105 Pond Street Property Address Thomas & Meredith Reen Owner Owner's Name information is required for every Osterville MA 02655 12/31/12 page. City/Town State Zip Code Date of Inspection D. System Information (cont:) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ - Other(describe): t5ins-11/10 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 105 Pond Street Property Address Thomas & Meredith Reen Owner Owner's Name information is required for every Cisterville MA 02655 12/31/12 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: 2010 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >20feet Comments(on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in working order. No sign of leakage or blockage. Septic Tank(locate on site plan): Depth below grade: 2 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: 1500 gal Sludge depth: no sludge t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 105 Pond Street Property Address Thomas & Meredith Reen Owner Owner's Name information is Osterville MA 02655 12/31/12 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle, no sludge Scum thickness no scum Distance from top of scum to top of outlet tee or baffle no scum Distance from bottom of scum to bottom of outlet tee or baffle no scum How were dimensions determined? scour stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appears to be structurally sound. No sign of back-up. Grease Trap (locate on site plan):, Depth below grade:. feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date l5ins•11/10 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 ,M 105 Pond Street 5 Property Address Thomas & Meredith Reen Owner Owner's Name information is required for every Cisterville MA 02655 12/31/12 page. CityTTown State Zip Code bate 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.): t Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: F Material of construction: ❑ concrete 1_1 metal ❑fiberglass ❑ polyethylene ❑ other(explain): , Dimensions: ° a 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•11/10 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 M 105 Pond Street Property Address Thomas & Meredith Reen Owner Owner's Name information is required for every Osterville MA 02655 12/31/12 i page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At time of inspection d-box appears to be in good condition. i 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.): r Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page J 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 105 Pond Street Property Address Thomas & Meredith Reen Owner Owner's Name information is required for every Osterville MA 02655 12/31/12 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: (20)Arc 36's ❑ 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.): At time of inspection leaching appears to be in working condition. No sign of hydraulic failure Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 105 Pond Street Property Address Thomas & Meredith Reen Owner Owner's Name information is required for every Osterville MA 02655 12/31/12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 105 Pond Street Property Address Thomas & Meredith Reen Owner Owner's Name information.is required for every Osterville MA 02655 1`2/31112 page. Cityfrown 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 theboxes below hand-sketch in the area below drawing attached separately EA — M14 .. .. 'S 131 B2= 22' = 35 � r35 i 6z'3 C4 �D L tt 5 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 105 Pond Street Property Address Thomas & Meredith Reen Owner Owner's Name information is required for every Osterville MA 02655 12/31/12 page. Cityrrown 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: >138" 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. 7/1/10 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) i ❑ 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: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts ` Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 105 Pond Street Property Address Thomas & Meredith Reen Owner Owner's Name information is required for every Osterville MA 02655 12/31/12 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file ` r ' 1 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 t5ins•11/10 P 9 P Y 9 Town of Barnstable Geographic Information System June 15,2010 d Y� t ff`-.'..,,,..,+ 7 d 118125001 x39 45 i118#63020 O • a_ j '27.19 X 41.05 ...,. ..._y,. , J' `118019�Y�� + p 118125 03 r #2 118037 J ! l }} 118025 ! f y 118125002 -� E*- X 1 *33 #42 4 k - IL 1 23.06. — t I ' P L>' + ! '- 118030002 r ; X 39.24 i { + y ` � I f i #99 ,y ' q -� r X 38.91 1#398 �i� . 0 �1 /f X 22+..17 r •f 118026 34 • 118030001 6e j, •/O P f 1#8615 , I U .n to `q23.21 #97 1 i {`y, '• 'd S Imo~ - „ lot, 118017 #25 18027 118034 ##22 05 _ 118033 I ,r' #145 �; ♦ �. -..; , + �f,� 45 ` 118117 #137 - .- 20.58 \l 118016#16Gp 4 38 36 r [ f S 118029 + ti �++ ,+ t ;1 , 118028 87 35.82 t #77 + y X 30.52 01 1T81 �.. Y- 9136 1#574 i`r1 X 26.48 --- _ __"`ti- `` W201 / E r .'� 118099 f 0327 X 25.21 11 81 040 01 t ti " ftr r ✓"f f '��Q 118103 #aD t , ��F�f �ps•_�t .�.� 1. �� /f 1 / ! •!� .Spo+' 0 �4 S Feet DISCLAIMERS:This map is for planning purposes only. It Is not adequate for legal Map:118 Parcel:031 - p Selected Parcel boundary determination or regulatory Interpretation. Enlargements beyond a scale of Owner:RUBIN,JULIA TR Total Assessed Value:$252600 1"=100'may not meet established map accuracy standards. The parcel lines on.this map W E are only graphlc representations of Assessor's tax parcels.They are not true property Co-Owner:JULIA RUBIN TRUST Acreage:0.72 acres Abutters boundaries Ind do not represent accurate relationships to physical features on the map Location:105 POND STREET such as building locations. Buffer f ' Massachusetts Department of Environmental Protection 1 ~r Bureau of Resource Protection Well Completion Reports Well Driller Please specify work performed: Address at welllocation: -- New Well Street Number:•. Street Name: •- (::105 D QT Please specify well type: I ui ding Lot#: Assessor's Irrigation 41 118' Assessor's Lot#: ZIP Code: Number Of Wells: 031 02655 City/Town: Well Location BARNSTABLE In public right-of-way: GPS C'>Yes fJ No North: West: 41.63547 70.38673 " SubdivisiorVProperty/Description: Mailing Address: r click here if same as well location addres Property Owner: Street Number: Street Name: SWAN 105 POND ST City/Town:. State: Engineering Firm: ABINGTON ImASSACHUSETTS' I ZIP Code: 02655 Board of health permit obtained: r Yes f'Not Required Permit Number: Date Issued: W2014 009 r/2'2014 -� r r Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) Well Driller - General Well Form DRILLING METHOD Overburden Bedrock uger Choose Bedrock— WELL LOG OVERBURDEN LITHOLOGY From To(ft) Code Color Comment Drop in drill Extra fast or slow Loss or addition of (ft) stem drill rate fluid 0 20 Medium Sand Brown ��— (3 YES GO NO r Fast r Slow r Loss r Addition �� �� �� __..ddition 20 35 Medium Sand Brown � YES r NO r Fast r Slow � Loss �A 35 45 Fine Sand Brown r YES NO G* Fast G Slow r Loss r A� ddition WELL LOG BEDROCK LITHOLOGY From Drop in drill Extra fast or'slow Loss or addition of Visible Extra To(ft) Code Comment t; Rust Large (ft) stem drill rate fluid Staining Chips Choose Code r YES r NO 0 Fast r Slow Of Loss r Addition 10:Yi] Ye ADDITIONAL WELL INFORMATION Developed Yes No Disinfected :Yes Ci No Total Well Depth 45 Depth to Bedrock Fracture Surface Seal Type None ` Enhancement Yes 01 No CASING IrJ Is Casing above ground. I From To Type Thickness Diameter Driveshoe 0 37 jPolyvinyl Chloride Schedule 40 4 0 Ye SCREEN r No Scree From To Type "Slot Size Diameter 37 45 Stainless Steel Well Point 0.010 4 WATER-BEARING ZONES' r DRY WEL From To Yield(gpm) 22 45 12 PERMANENT PUMP(IF AVAILABLE) 2 Wire Constant Speed Pump Description Submersible Horsepower 3/ Pump Intake Depth(ft) 43 Nominal Pump Capacity(gpm) 10 } i Massachusetts Department of Environmental Protection ~`P Bureau of Resource Protection—Well Driller Program i Well Completion Reports(General) r. ANNULAR SEAL/FILTER PACK Water From To Material 1 Weight Material 2 Weight Batches Method Of Placement (gal) Choose Material IChoose Material --Choose One-- WELL TEST DATA Time Pumping Time To Date Method =Yield (gpm) 'Pumped Level (ft Recover Recovery (ft (HH:MM) BGS) (HH:MM) BGS) 4/8/2014 lonstant Rate Pump 12 1:30 39 0:01 22 WATER LEVEL Date Measured Static Depth BGS (ft) Flowing Rate(gpm) 418/2014 22 12 • g .. .. III COMMENTS i WELL DRILLERS STATEMENT This well was drilled or altered under.my direct supervision,according_to the applicable rules and regulations,and this report is complete and accurate to the best of my knowledge. PATRICK Supervising Driller DESMON Driller DESMOND Registration# 877 Monitoring[M] Signature PATRICK, DESMOND WELL Firm Date Job Complete DRILLING INC. Rig Permit# � 024 5/13/2014 .• NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion. OF A 4A Y Page, , :of 1. =�r�stat�e !�oun�y•I�#eatt� �,ab©ra#o III-NO(39\y O01 5 lored,for.. ftpoff Dated: 4/1012014. Ddid L3esmbnc :V1/Q[I Di?Il7ling 4rdr No G1:4T9Z72 P'-O,:Bix: 783 Or WA. !NIA'026 L tigcater► �D > 14 Dose,"ft r V.Osr DrinkiFl VVater - 9 � l Sample Locgtioml tt)&Pond St� Collected; 04/0,872014 Cepeted ibr ;Cudomer Received: Q4!(ff3/2014 Jt .M BEMMgUNITS RL lift.., MQD#! A Vie: Mig N�rafil3�as NWC en_ 66_ _ mgli:, 0 10: `10 EPA.3QO;Q LAP 4/8/-2014 . '' Q mg/L, 0.04.0 d", EPA`d.l LAP' 4/9I201.4 MaAganese 0 0'l5 mall - o.00s; EPA Zoo 7 -IAP 4/W-014 PK 0 2 RA 25C PIA A,,S 5 4. 4500 DCB 4020,1:4 S ) " 91< mg%L. 2:5; EPA 200.7 LAP 41912014 T I bilf0ml: Al seYtt: P/A 0 0. s1N OW RG' 4/WO1.4 ConduDtam urriobslan> 2 0 $M 25 0E DCB' . 4/8�2014 YAlater3at�p/e�e�s=lfie:r�aandllm►'t�.tat'dt� wafeJ of aJl fide.ebove'test�alhP,aters;.. . • dPtflndthe*labc►ratreertifted`parasisberJist ' ARPl01F6tl B�►:; (Lab- Dtre� f�One,Aedad; .R4 @ip Rept�rtktg;Lhnit fVICL=NfaXimum Ppn.tamir►a►it:levet= S i or Gio rt Huse, P 8ox 4 , .0arnsft- iote, MA 4210 ::.Ph:-oov' ,605, ti CB N 82'53'40" W 9 �\ 144.21' �j N 1 X 88.4 _) ter re en i A. , Q, 1 jwt7. 1 60,9 0 s. Pond E LOCUS Q LOCUS MAP m 1 .68 iOj % e NOT TO SCALE i lot--EXISTING CONTOUR 16°9 ,33% APN(LOT 118-031 -&H .-LOAMY SAND EXISTING T GRADE � t 30,800 S.F.t —G—EXISTING GAS SERVICE b. —W—PROPOSED WATER LINE \`. TEST PIT t � 97, 1 f 20' cn \� BENCHMARK f 93:92 U69 01 i 20 9 3 , l.EGMD 1 1 06 j. I 1 2� E 1. 09 - 92.90 9217 i 1 '1 PROPOSED SEPTIC TANK 14' 1k 2� VENT \��� \ \\ 2 E97 \ \ N TP\ 1 \ � '35 EXISTING CESSPOOL '9 �\ '1- 2( /� E TO 8E PUMPED & FILLED A\\ \�`.�\ \\\ � 971�9 .�" (SEE, ALSO, NOTESAND AND D13)D \ 1 Go N , a w 0 0 0 2 Ems!'95, ' 2 Ben chm ark J10 to _c te) Nn — CEO+. o�5� 1 _ OUTSIDE TOP COR: OF STOOP ' N -- oo� P , +�7, , EL.-98.45 (Assumed datum), o 36�D 96.68 96,68 I \ �0Lp \ I �' +• \ \ ,EXISTING 8:45 �� Z W 0? HOUSE(#105) �'�,: T.0.F.=98.5fi LA I _ _ 2 FENCE I -—-—- -----x 99,03 �� o BH 'FENCE LINE C�S 97.09 X 98,09 N cS- 97.52rn 98.21 i G iu ' ' 1 3 ;\ 7. V-I 7 PICKET FEN J v i 98,21 ' � 0f k4sS PETER T. y�� ;EX/STING EE 9. .32 �,� M CIVIL N HOUSE(#105) X 98 4 3 �'` w o. 35109 , T.O.F•=9&5ti_ fGIS1 � 9 .61 X .91 ,xc S.A.S.LAYOUT " OWNER OF RECORD PLAN REFERENCES: 3 = RUBIN, JULIA TR LAND COURT PLAN 9755 B JULIA RUBIN TRUST LAND. COURT PLAN .9755 d F 9 ,87 36 SURF DRIVE' LAND COURT PLAN 9755 N PLAN REVISION: 7/9/10 MASHPEE, MA 02649 PLAN BK 560 — PG .23 SHEET 2 — DEPTH TO GROUNDWATER J ipi0 1 X 100 3 100.56 X 01,17 4 PROPOSED ' SEPTIC -SYSTEM UPGRADE PLAN. 1 1 94 4 PA l/ED I 75t APRON LCB •101,95 foo1231 PAl/E 105 POND STREET; OSTERVILLE MA 1 , % X 100,6 0 00.57 X l0 .8 �y6, X 1 52 Prepared for: Ca ewide Enterprises, . PROM P.O. Box 763, "Centerville, MA 02632 --- GS / 99.71 100.00' 100,2.0 P P R 99,55 99,12 _--'� Engineering by:. SCALE DRAWN JOB. NO. P oioo.z3 Engineering Works, Inc: i68-10 99,26 ovement 1 =20 P.T.M. ` edge 99.00 of STREE • 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED. SHEET NO. 98.22 POD (508) 477-5313 7/1/10 P:T.M. 1 of 2 NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL:90.33 FOR A DISTANCE OF 15' AROUND THE SEPTIC TANK PROPOSED D-BOX PERIMETER OF THE S.A.S. INSTALL RISERS & COVERS OVER INLET INSTALL WATERTIGHT RISER' & AND SET TO 6" OF FINISH GRADE. COVER SET TO 6" OF GRADE PROPOSED S.A.S. PROVIDE ACCESS TO GRADE OVER. OUTLET COVER INSTALL INSPECTION PORT.OVER END UNIT T.O.F. CHARCOAL F.G. EL=97.5f F.G. EL.=95:Ot F.G. EL: 94.3t F.G. EL 94.3(MAX.) VENT EXISTING MAINTAIN 2% GRADE MIN. OVER S.A.S. S=1%1(MIN.) L 10' L 9'(MAX.) IN PORT TION 4"SCH40 PVC S=1% (MIN.) S=1% (MIN.) 4"SCH40 PVC 4"SCH40 PVC 6 10.38" TO 14" INVERT INV.=92.75 48" uoulo INV.=89.87 ;- LEVEL ADD INV.=91.87 PROPOSED INV.=91.70 5•ROWS OF 4 UNITS AT 5.0'/UNIT'= 20.0' GAS BAFFLE INV.=92.50 D-BOX SOIL ABSORPTION SYSTEM (PROFILE) (5 OUTLETS) PROPOSED SEPTIC TANK TIE IN TO EXISTING SEWER AT, OR ABOVE, INV. EL.=93.25 ESTABLISH VEGETATIVE COVER BACKFILL WITH CLEAN NATIVE OR PERC SAND TO TOP OF CHAMBERS NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE BREAKOUT=TOP INVERTS, PRIOR TO INSTALLATION: TOP ELEV.=90.33 2) SEPTIC TANK AND D-BOX SHALL BE SET LEVEL AND INV. ELEV.=89.87 TRUE TO GRADE ON A MECHANICALLY COMPACTED SIX BOTTOM ELEV.'89.00 INCH CRUSHED STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 2.83' 3 INSTALL INLET & OUTLET TEES AS.REQUIRED.- 5'-MIN. SEPARATION 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE TO HIGH GROUNDWATER EFFECTIVE WIDTH=14.2' AS MANUFACTURED BY TUF-TITS, ZABEL OR EQUAL. EXISTING SUITABLE NO GROUNDWATER, EL=84.3 MATERIAL USE 5 ROWS OF 4-ADS Arc 36HC UNITS WITH NO SEPARATION BETWEEN EACH ROW & NO STONE * TYPICAL SECTION SEPTIC SYSTEM PROFILE EST: DEPTH TO G.W.=23' BELOW GRADE (EL.=74) (BARNSTABLE G.I.S. DATA) ' r _ N.T.S. - GENERAL NOTES: 1. ALL CHANGES TO THIS PLAN MUST BE'APPROVED BY THE LOCAL SOIL LOG BOARD OF HEALTH AND THE DESIGN ENGINEER. " 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS DATE: JUNE . 18, 2010 (REF#12,978) OF THE .STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE SOIL EVALUATOR: PETER McENTEE (SE#1542) LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: WITNESS: DAVID STANTON R.S. -310 CMR 15.405(1)(b): HEALTH AGENT 1) A i' variance to the 3' maximum cover requirement, for 4' of ELEV. TP' 1 DEPTH ELEV. TP-2- DEPTH max. cover. S.A.S. shall be vented and rated H-20. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 97.2 A 0 95.8 A 0 TO_INSPECTION:-AND-_APP-ROYAL-BY THE BOARD-OF-HEALTH-AND-THE- - - - ---LOAMY'SAND "-LOAMY SAND DESIGN ENGINEER. 96 5 10YR 4/2 97 t. 10YR 4/2 .8„ 8". .4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING B B FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN :LOAMY SAND LOAMY SAND ENGINEER BEFORE CONSTRUCTION CONTINUES. 1OYR 5/6 10YR 5/6 -" " 93.1 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 94.7 C 30 30" C 32" 42 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF PERC THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS` DURING CONSTRUCTION. 54" 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. COARSE SAND COARSE SAND 8. THERE ARE NO WELLS WITHIN 100' OF THE PROPOSED S.A.S. ` 10YR 5/4 10YR 5/4 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS >20% GRAVEL >20% GRAVEL AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY 85.7 .138" 84.3 _ 138" THE LOCATION OF ALL- UNDERGROUND UTILITIES, PRIOR TO BEGINNING PERC. RATE c2 MIN/IN. ("C" HORIZON) CONSTRUCTION. NO GROUNDWATER ENCOUNTERED 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS NOTE: SOILS SHALL BE VERIFIED AT S.A.S. IN THE AREA BENEATH AND FOR 5' ON ALL SIDES. OF THE"S.A.S. AND LOCATION PRIOR,TO INSTALLATION. REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE ' INSPECTED BY HEALTH•DEPARTMENT PRIOR TO BACKFILL 63.25" 13. THIS PLAN IS TO BE USED FOR'SEPTIC SYSTEM PURPOSES ONLY AND ' IS,NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. 16" 14. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED EXISTING SEPTIC SYSTEM COMPONENTS NOT SHOWN ON THIS PLAN. 34.5" DESIGN CRITERIA TOP VIEW NUMBER OF BEDROOMS: 2 BEDROOMS (DESIGN FOR 3 BEDROOMS) SOIL TEXTURAL CLASS: CLASS I 60" END CAP END CAP DESIGN PERCOLATION RATE: - <2 MIN/IN FRONT VIEW SIDE VIEW DAILY FLOW: 330 G.P.D' END CAP REAR/TOP VIEW DESIGN FLOW: 330 G.P.D. NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT SIDE VIEW GARBAGE GRINDER: NO - TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY - DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. - - LEACHING AREA REQUIRED: (330) 445.9- S.F. .74 HIILL ARD, OH 0 430215 PROPOSED SEPTIC, TANK: 1500 GALLON CAPACITY Arc 36HC DETAIL GLL�I Xr�\ AWMCED DFMWIGE SYSTEMS.INC. UNITS MUST BE STAMPED H-20 .PROPOSED D-BOX:: 1 INLET; 5 OUTLET (MINIMUM), H=10 RATED- PROPOSED SEPTIC. SYSTEM UPGRADE PLAN- USE s Rows of 4-ADS Arc 36Hc: uNITs`wiTH No 105 POND STREET, OSTERVILLE, MA - SEPARATION BETWEEN EACH ROW & NO. STONE Prepared for: Capewide Enterprises, P.O. Box 763, Centerville, MA 02632 BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.80 SF/LF OF UNIT) Engineering by: SCALE DRAWN JOB. NO. (Are 36HC Units) 20 UNITS x 5.0 LF x 4.80 SF/LF = 480.0 SF Engineering Works, Inc. NTS P.T.M. 168-10 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74(480.-0 S.F.) 355.2 G.P.D. (508) 477-5313 7/1/10 P.T.M. 2 Of 2 m N J 144.2 1' cz U Q w to w (\ Q O U J w LOT AREA: Q 30,872 .9 5. F. 44'. EXISTING LEACHING SYSTEM (3 5DRM5) INSTALLED 07-2010 PERMIT#2010-203 - - ' qs T -------------------- I I I I I � RELOCATED i i 'i �l INIM :110 NMI 1 500 GAL. SEPTIC TANK i O Fv ------------ ro EXISTING ; PROPOSED DWELLING (3) BDRM. TO BE RAZED i DWELLING I , , ' 1U I LDI NG LOCATION PLAN ---� i FO R 105 POND 5T., 05TERVILLE, MA PREPARED FOR THOMA5 KEEN * MEREDITH HALEY SCALE: DATE: DRAWN BY: = 20' O9- 1 3-20 13 TMW JOB NUMBER:' REVISION: 5HEET NUMBER:13-026 CPP- I I , K=2000.00' WELLER * ASSOCIATES A=G I .G4' , 13.30 1 G45 I'ALMOUTH.RD., SUITE 1`9 P.O. BOX 4 17 CENTERVILLE, MA 02G32 TELEPHONE: (508) 328-4G92 POND 5TREET EMAIL: tr•I5WCller@gmad.com REGISTERED LAND SURVEYORS 4 ENVIRONMENTAL CONSULTANTS Traverse PC i �LJG to N , m w 0 �00� Q m In L, -lye m o O J w -z T AREA: � PRb�os�.� a IJ6�p .. f - - X15TING LEACHING SYSTEM (3 BDRM5) �Ewc E. IN5TALLED 07-201 0 PERMIT #201 0-203 I I I --------------- I I . I I � • I j I RELOCATED i 1 1500 GAL SEPTIC TANK i I / , 7,, 0, -- __- - - - - - � , EXISTING PROPOSED ' i � DWELLING , (3) BDRM: } TO BE RAZED i DWELLING �' STEVEN v y RUMB r i i No.357 1 sl I / ' DUILDING LOCATION FLAN FOR ! / ' 105 POND 5T. , OSTERWILE, MA 1 - - PREPARED FOR - - ' THOMA5 - BEEN MEREDITH HALEY 1 - � SCALE: DATE: DRAWN DY: % I = 20' 09 I3-2013 TMW 1 - 1OB NUM(MR: 13-026 F:Ev�S1ON: �nr.r.r r,umim-:F:� CPP- I 1 I i ! 'R=2000:00' WELLER * A550CIATE5 1 , •I A=6 1 .64' 13.36 I G45 FALMOUTH RD., SUITE F9 P.O.bOX 4 17 CENTERVILLE, MA 02G32 TELEPHONE: (508) 328-4G92 POND 5T RE ET EMAIL: trr5weller@cymail.com REGI5TERED LAND 5URVIfYOR5 4 ENVIRONMENTAL CON5ULTANT5 y Traversc PC /1 r S lf-_C N C' C (� rn r cu � D - D r`v N - O J Cam J -- n o � �, y ^' O 1�l 'yy�' T ^ I l x m HOSTETTER HOMES' Rl i r MARKOSKI, 105 POND STREET N 770 Main Street x Osterville, MA 026551 o SOUTH ELEVATION Main:508-428-2828q Fax:508-428-1974 3111-AR.Cl•.6C --- xg>>=� pNy A C O Z a a WALL URROR O 0 4 V . b� O O , 0 9 O O O (A O u R K N a g 39'.23'RY-ulE 39'.23'HY-UIE Ny (x) N rn L., rn z - CJ U o c v T R MARKOSKI, 105 POND STREET HOSTETTER HOMES { 770 Main Street !� Osterville, MA 02655 BASEMENT PLAN Main:508-428-2828 Fax:508-428-1974 J fSZAw KLar C235 f 00 i Q O O 4 ❑O s N 1.1 _ N �2 O ❑ I • ` - N x. y 000 oQ ARCH ABOVE- x= ❑ ^. ;$ q� 2 V 0 v� 0 x ly x A o o _ ARCH ABOVE - - 0 c 9 O x Z O � . N 3'-6 3'-6 El irl1647 AW41 c ' : N> - .. C) O N -n �' O cry o > � , . v A)t9 .41 r° Go l v: ���••�.�yy! � � C`�S� _C /f a'•,`2.+ G N m A HOSTETTER HOMES 7 MARKOSKI, 105 POND STREET N r oefwe W[� 770 Main Street x Osterville, MA 02655 FIRST FLOOR PLAN Main:508-428-2828 Fax:508-428-1974 W � oo I N � W N T1F2642 TW2642 •rl aooc oc O O In mrol W > y . OFFICE LAUNDRY ROOM I4'-6"f 11'-3" 9'-I"■11•-3• O (� O ROOF DECK - 470 S.F. i! l -- UNFINISHED- 377 S.F. - 20'-J"K 23'-a• - - 16'-7'K 22'-10" . OM 51T0Np ROOM IT n•-3"x D STORAGE 12•-7"K 5'-11• 1 FWC6061 I �. .. - �— - AW251 AW251 AW751 BUILT IN MASTER 19.-6"K I1'-6• HALLWAY :DOWN HIE c z _ o wC7CL M1 tn 001 - � zF. BEDROOM t MASTER BA111 16'-7" K lo'-I1• - rs. O c/) U o W 5ECON0 FLOOR f,s N___ .. c/) 1947 5.F. BEDROOM z 16'-7' : 10-11" CL SEP 2 5 013cq TW2642 M642 TW26.2. '��.IOHAMED H. HUSSEIN P.E. INSULTING ENG I NEFR P,ARRETT AVENUE �il\.TH PROVIDENCE, Rl i IU.NE/FAX (44t) 353-5sss s`�`.E: 1/8" — I'-0" Bail: mohamed1939@cox.net DRAW"ev CBH DATE: 9/20/13